Respiratory Lecture

Question 1

Chronic cough vs acute in children

Answer 1

• Acute - <3 weeks
• Chronic - >8 weeks
• Prolonged acute/subacute cough between

Question 2

Recurrent cough

Answer 2

• 2 or more cough episodes
• Apart from those associated with colds
• That each last 7-14 days

Question 3

When to consider CXR in child?

Answer 3

• Suspicion of lower respiratory infection
• Persistent/non resolving cough
• Haemoptysis or features of chronic disorders

Question 4

Most common cause of CAP

Answer 4

• Viral - respiratory syncytial virus most common
• Bacteria - streptococcus pneumoniae

Question 5

Investigations for ?pneumonia in child

Answer 5

• Not usually done
• Usually managed without
• If severe, or doubt then can do CXR
• Can take microbiological samples eg sputum culture

Question 6

Management of pneumonia in children

Answer 6

• Non severe - oral amoxicillin for 5 days (clarithromycin in allergy)
• Severe - IV amoxicillin

Question 7

Complicated pneumonia - definition

Answer 7

• Parapneumonic effusion - pleural fluid collection
• Empyema - pus in pleural space, infected effusion

Question 8

Management of complicated pneumonia

Answer 8

• Antibiotics - long course eg 7-10 days
• Chest drain and intrapleural fibrinolytic agents (urokinase)
• VATS

Question 9

How to ask re failure to thrive - physical evidence?

Answer 9

Ask to see red book

Question 10

Characteristics of cough and likely diagnosis

Answer 10

Question 11

Important causes of chronic wet cough

Answer 11

• Persistent bacterial bronchitis
• Rhinitis and PND
• GORD
• Bronchiectasis - CF, PCD
• Immune problems - recurrent/unusual
• Recurrent aspiration - NM weakness, bulbar palsy

Question 12

Investigations with chronic wet cough

Answer 12

Bloods:
* Immune screen
* Allergy markers
* LFT if old enough

Imaging:
* CXR

Question 13

Advanced/2nd line inv for chronic wet cough

Answer 13

• Sweat test
• Bronchoscopy
• pH impedance study

FINISH

Question 14

Causes of bronchiectasis

Answer 14

• CF
• Post infectious
• Immunodeficiency
• Ciliary dyskinesia
• Aspiration

Question 15

Diagnosing bronchiectasis

Answer 15

High resolution CT

Question 16

Management of bronchiectasis

Answer 16

• Prophylactic abx
• Physiotherapy
• Aggressive management of LRTI
• Nutrition
• Regular monitoring of lung function

Question 17

Diagnosing CF

Answer 17

• Screening - heel prick IRT
• Sweat chloride over 60mmol/L
• Genotyping for CFTR gene

Question 19

Features of PCD

Answer 19

• Chronic wet cough
• Sinutisits/rhinitis/persistent nasal dishcarge
• Situs invertus
• Congenital heart lesions, asplenia, hydrocephalus, renal disease

Question 20

Diagnosis PCD

Answer 20

Ciliary studies via nasal brushing or bronchosocpy

Question 21

Tracheobronchomalacia

Answer 21

• Floppy airway - collapse
• Can be congenital, external compression or acquired

Question 22

Management of tracheobronchomalacia

Answer 22

• Nothing
• Prophylactic abx
• CPAP
• Surgery

Question 23

Sleep disordered breathing types - disrupted resp pattern and ventilation during sleep

Answer 23

• Obstructive - upper airway obstruct, adenoids large or genetic eg Pierre Robin syndrome (large tongue), trisomy 21
• Central - brainstem lesions, neuro/genetic disorders
• Hypoventilation - NM weakness, mechanical eg scolliosis
• Complex/mixed

Question 24

Sleep disordered breathing investigations

Answer 24

• Polysomnography - GOLD, resp effort, nasal flow, EEG
• Cardiorespiratory polygraphy study - same as PSG without

Question 25

Sleep disordered breathing management

Answer 25

* Depends on cause * Adenotonsillectomy

Question 26

Define long term ventilation

Answer 26

Any child who requires 3 months of ventilation assistance at home

Question 27

CPAP is for...

Answer 27

Obstructive causes first

Question 28

NIV complciations

Answer 28

* Pressure sore * Dry nose, mouth or conjunctiva * Rhintiis * Increased flatulence - swallow air

Question 29

Risks of invasive ventilation

Answer 29

* Loss of humidification system -