Year 4 Respiratory

Question 1

three types of inhalers

Answer 1

1. pressurised metered dose inhaler (pMDIs)
2. breath actuated inhalers (BAIs)
3. drug powdered inhalers (DPIs)

Question 2

can you use pMDIs with a spacer?

Answer 2

yes

Question 3

how many breathes in pMDIs with a spacer?

Answer 3

10 for young children

5 for older children

Question 4

how to use a pMDI without a spacer?

Answer 4

press canister once until lungs feel full then hold your breath for 10 seconds or for as long as is comfortable

Question 5

how many pMDI puffs can be taken?

Answer 5

10

one a minute

Question 6

examples of spacers

Answer 6

volumatic

aerochamber

Question 7

what does it mean if the spacer squeaks?

Answer 7

need to slow inhalation

Question 8

yellow aerochamber age group?

Answer 8

pre-school

Question 9

blue aerochamber age group?

Answer 9

school

Question 10

DPIs usage

Answer 10

breathe hard and fast

dose counter on the side

Question 11

rinse mouth with inhaler if it contains what?

Answer 11

steroids

Question 12

what causes croup?

Answer 12

parainfluenza

Question 13

diagnosis of croup

Answer 13

characteristic stridor + barking cough

do not examine as stress can lead to acute closure of the airway

Question 14

management of croup

Answer 14

nebulised adrenaline + dex + oxygen

Question 15

what is laryngomalacia?

Answer 15

floppy larynx in babies <6 months (supraglottic/above vocal cords)
presents with noisy breathing

Question 16

what causes bronchiolitis?

Answer 16

RSV

Question 17

what age-group gets bronchiolitis?

Answer 17

<1 year

Question 18

what is prophylaxis in bronchiolitis and who gets it?

Answer 18

palivizumab is a biologic (IgG for RSV) that is given as monthly prophylaxis during RSV season (autumn and spring) for at-risk infants (chronic lung disease, congenital heart disease)

Question 19

what are complications of bronchiolitis?

Answer 19

chronic wheeze
bronchiolitis obliterans (adenovirus)

Question 20

what is the likely cause of pneumonia in a neonate?

Answer 20

GBS, listeria or e. coli due to mother’s GU

Question 21

sweat test diagnostic result for CF?

Answer 21

Cl- >60mmol/l

Question 22

features of moderate acute asthma

Answer 22

peak flow >50%

normal speech

Question 23

features of severe acute asthma

Answer 23

peak flow <50%
saturations <92%
unable to complete sentences in one breath
signs of respiratory distress
resp rate >40 in 1-5 and >30 in >5
HR >140 in 1-5 and >125 in >5

Question 24

features of life-threatening acute asthma

Answer 24

peak flow <33%
saturations <92%
exhaustion and poor respiratory effort
hypotension
silent chest
cyanosis
altered consciousness or confusion

Question 25

when to consider monitoring K+ in acute asthma?

Answer 25

when on high doses of salbutamol as K+ can be absorbed into cells

Question 26

treatment ladder for asthma in children

Answer 26

SABA (move up if using 3 or more doses a week) very low ICS (or LTRA <5) very low ICS + LABA or LTRA (if <5 LTRA + ICS) consider increasing ICS dose

Question 27

what causes epiglottitis?

Answer 27

H. influenza B

Question 28

management of epiglottitis

Answer 28

IV antibiotics (ceftriaxone + dex) ENT/ anaesthetics tracheostomy

Question 29

what is viral-induced wheeze?

Answer 29

wheeze following coryza

Question 30

management of viral-induced wheeze

Answer 30

beta agonists and ipratropium | limited role for steroids

Question 31

how long should you be off school with whooping cough?

Answer 31

48 hours once antibiotics are commenced

Question 32

what is primary ciliary dyskinesia (Kartaganer's)

Answer 32

AR condition affecting the cilia

Question 33

triad in Kartaganer's

Answer 33

1. paranasal sinusitis 2. bronchiectasis 3. situs inversus (organs switched)

Question 34

diagnosis of Kartagner's

Answer 34

take samples of ciliated epithelium via nasal brushing or bronchoscopy

Question 35

management of Kartagner's

Answer 35

daily physio high calorie diet antibiotics