respiratory disorders

Question 1

types of URTI?

Answer 1

• common cold
• pharyngitis and tonsillitis (sore throat)
• acute otitis media
• sinusitis

Question 2

common causes of tonsillitis?

Answer 2

• group A B-haemolytic streptococci

- EBV

Question 3

a) treatment of group A strep tonsillitis?

b) why?

Answer 3

a) 10 days of penicillin

b) to prevent rheumatic fever

Question 4

features of tonsillitis?

Answer 4

• red, swollen tonsils
• may be white exudate
• headache
• apathy
• abdominal pain
• cervical lymphadenopathy

Question 5

peak age for otitis media?

Answer 5

6-12 months

Question 6

why are children prone to otitis media?

Answer 6

their eustachian tube is short, and horizontal

Question 7

presentation of otitis media?

Answer 7

• pain in ear
• fever
• bright red bulging tympanic membrane

Question 8

pathogens that cause otitis media?

Answer 8

• RSV
• rhinovirus
• H. influenzae
• Moraxella catarrhalis

Question 9

serious complications of otitis media?

Answer 9

• mastoiditis

- meningitis

Question 10

management of otitis media?

Answer 10

• paracetamol or ibuprofen for pain relief
• otherwise just wait
• amoxicillin helps with severe pain

Question 11

presentation of otitis media with effusion

Answer 11

• asymptomatic, or slightly reduced hearing
• eardrum looks dull and retracted
• visible fluid in it

Question 12

peak incidence of otitis media with effusion?

Answer 12

2.5-5 years old

Question 13

management of otitis media with effusion?

Answer 13

• nothing at all

- if hearing loss, grommets

Question 14

main complication of otitis media with effusion?

Answer 14

conductive hearing loss

Question 15

indications for tonsillectomy?

Answer 15

• recurrent tonsillitis
• NOT large tonsils alone
• peritonsillar abscess
• obstructive sleep apnoea

Question 16

commonest cause of acute upper airway obstruction?

Answer 16

CROUP!!!!

Question 17

rarer causes of acute upper airway obstruction?

Answer 17

• epiglottitis
• bacterial tracheitis
• inhalation of smoke
• trauma to throat
• laryngeal foreign body

Question 18

signs of upper airway obstruction?

Answer 18

• stridor (inspiration)
• hoarse voice
• barking cough
• dyspnoea (varies)

Question 19

management of upper airway obstruction?

Answer 19

• do NOT examine throat
• look for signs of hypoxia
• if there is resp failure, get urgent tracheal intubation

Question 20

commonest cause of croup?

Answer 20

parainfluenza virus?

Question 21

age for presentation of croup?

Answer 21

6 months - 6 years old

Question 22

peak age for croup?

Answer 22

2nd year of life

Question 23

which season is croup most common in?

Answer 23

autumn

Question 24

features of croup?

Answer 24

• barking cough
• harsh stridor
• hoarse voice
• prodrome of fever + coryza
• symptoms worse at night
• symptoms disappear at rest if mild croup

Question 25

management of croup?

Answer 25

- inhaled warm, moist air | - oral steroids

Question 26

presentation of bacterial tracheitis?

Answer 26

- high fever - toxic appearance - rapidly progressive obstruction - stridor, cough, resp distress

Question 27

causative organism in bacterial tracheitis?

Answer 27

staph aureus

Question 28

management of bacterial tracheitis?

Answer 28

- do ABCDE - IV ceftriaxone and cloxacillin for 5 days - then oral co-amoxiclav for 7-10 days

Question 29

causative organism in acute epiglottitis?

Answer 29

- H. influenzae b | - incidence really low now due to vaccination against Hib

Question 30

features of epiglottitis?

Answer 30

- high fever (>38.5C) in toxic-looking child - painful throat, struggling to swallow (drooling) - soft inspiratory stridor - reluctant to speak - no cough

Question 31

management of acute epiglottitis?

Answer 31

- treat it ASAP - every minute counts - intubation under GA - if this not possible, then tracheostomy - IV cefuroxime - rifampicin for all close contacts

Question 32

presentation of whooping cough?

Answer 32

1 week coryza, followed by: - paroxysmal cough, worse at night - may vom from coughing - older children whoop - infants have apnoea - red / blue in face during paroxysm - epistaxis - subconjunctival haemorrhage

Question 33

age for whooping cough?

Answer 33

<4 months, they have not been immunised yet

Question 34

management of whooping cough?

Answer 34

- highly infectious, so child should be isolated | - erythromycin prophylaxis for unimmunised close contacts

Question 35

how is whooping cough diagnosed

Answer 35

- culture of bordetella pertussis on per-nasal swab | - lymphocytosis on blood film

Question 36

age of presentation for bronchiolitis?

Answer 36

1-9 months, rare after 1 year old

Question 37

causative organism in bronchiolitis?

Answer 37

respiratory syncytial virus (RSV)

Question 38

features of bronchiolitis?

Answer 38

1 week coryza, followed by: - sharp, dry cough - increasing SOB - tachypnoea - tachycardia - recession - prominent sternum (hyperinflated chest) - difficulty feeding - cyanosis / pallor - expiratory and inspiratory wheeze

Question 39

investigations in bronchiolitis?

Answer 39

- PCR of nasopharyngeal secretions - CXR (unusual) shows hyperinflated lungs - O2 sats (keep monitoring)

Question 40

management of bronchiolitis?

Answer 40

- supportive - humidified O2 in nasal cannula - ventilation and fluids both as needed