respiratory

Question 1

what are some LRTIs

Answer 1

tracheitis 
pneumonia
bronchitis
empyaema
bronchiolitis

Question 2

what are features of LRTIs

Answer 2

• 48 hrs, fever (>38.5C), SOB, cough, grunting
• wheeze (bacterial unlikely)
• reduced or bronchial breath sounds

Question 3

what are common infective agents

Answer 3

bacterial

• streptococcal pneumoniae
• haemophillus influenzae
• moxarella catarrhalis
• mycoplasma pneumoniae
• chlamydia pneumoniae

viral

• RSV
• parainfluenza
• influenza A & B
• adenovirus

Question 4

what are the principles of management for LRTI?

Answer 4

• make a diagnosis
• assess the patient (oxygenation, hydration, nutrition)
• treat or wait for resolve

Question 5

describe tracheitis

Answer 5

uncommon
croup (which does not get better)
fever, sick child
staph or strep invasion
tx: augmentin

Question 6

describe bronchitis

Answer 6

common
loose, rattly cough, post tussive glut, chest free of wheeze/creps
haemophillus, pneumococcus
self limiting

Question 7

describe bacterial bronchitis

Answer 7

nasal stuffiness. tachypnoea, poor feeding, crackles +/- wheeze
disturbed mucociliary clearance
RSV/adenovirus
secondary bacterial infection/overgrowth

Question 8

describe pneumonia

Answer 8

signs are focal
crepitations
high fever
tx: if symptoms are mild then no management, oral amoxycillin, macrolide

Question 9

describe empyaema

Answer 9

complication of pneumonia
extension of infection into pleural space
chest pain, unwell
tx: antibiotics, drainage

Question 10

describe bronchiolitis

Answer 10

< 12 months
3 days before reach peak
fever rarely >38 degrees

Question 11

describe pertussis

Answer 11

coughing fits
vomiting and colour change
vaccination reduces risk and severity

Question 12

what are some URTIs

Answer 12

rhinitis
tonsilitis
laryngitis
epiglottitis
otitis media
pharyngitis
croup

Question 13

what are features of URTIs

Answer 13

• common, fever

- child ill (bacterial, child well (viral)

Question 14

describe rhinitis

Answer 14

• very common (5 - 10/year)
• winter months
• self limiting
• prodrom to: pneumonia, bronchiolitis, meningitis, septicaemia

Question 15

describe otitis media

Answer 15

• common
• spontaneous rupture of drum
• primary viral infection
• secondary infection with pneumococcus/h. influenzae
• self-limiting (antibiotics don’t help)

Question 16

describe sore throat (tonsilitis/pharyngitis)

Answer 16

• common
• viral or bacterial - throat swab
• either nothing or give 10 days penicillin
• don’t give amoxycillin

Question 17

describe croup

Answer 17

• common
• parainfluenza
• child is well
• coryza, stridor, hoarse voice, barking cough
• oral dexamethasone

Question 18

describe epiglottitis

Answer 18

• rare
• h. influenzae type B
• toxic, stridor, drooling
• tx: intubation and IV antibiotics

Question 19

describe asthma

Answer 19

• chronic
• wheeze, cough, SOB
• multiple triggers
• variable/reversible

Question 20

what causes asthma

Answer 20

• genes
• allergen
• smoking

Question 21

what is the epidemiology of asthma

Answer 21

• 1 million UK children
• 110, 000 in Scotland
• 5% UK children on inhaled steroids

Question 22

what diagnostic tests are useful in asthma

Answer 22

there is no diagnostic asthma test

• peak flow
• spirometry
• allergy tests
• exhaled nitric oxide
• examination (stethoscope)

Question 23

describe SOB in asthma

Answer 23

• significant respiratory difficulty (<30% lung function)
• airway obstruction
• sooking in of ribs

Question 24

describe cough in asthma

Answer 24

• dry
• nocturnal
• exertional

Question 25

what is the association between asthma and atopy?

Answer 25

- parent Hx of asthma | - personal history of eczema, hayfever or food allergies

Question 26

how is asthma treatment trialled?

Answer 26

2 month trial of ICS with steroid holiday after

Question 27

what is the ideal presentation for asthma diagnosis?

Answer 27

- wheeze with and without URTI - SOB at rest - parental asthma - responds to treatment

Question 28

what is the differential diagnosis for asthma with onset <5 years?

Answer 28

- congenital - CF - PCD - bronchitis - foreign body

Question 29

what is the differential diagnosis for asthma with onset >5 years?

Answer 29

- dysfunctional breathing - vocal cord dysfunction - habitual cough - pertussis