respiratory

Question 1

asthma signs and symptoms

Answer 1

polyphonic wheeze
coughing
SoB
diurnal rhythm

Question 2

asthma DD

Answer 2

foreign body
croup
pneumonia
TB

Question 3

asthma investigations

Answer 3

spiro - FEV1:FVC < 70%

CXR

Question 4

asthma managment 5 step process

Answer 4

1 - inhaled short acting B2 agonist as required (salbutamol)
2 - add inhaled corticosteroid (beclamethasone)
3 - try inhaled long acting B2 agonist (salmeterol)
4 - increase steroid dose and try leukotriene receptor antagonist (montelukast)
5 - add oral prednisolone

Question 5

acute asthma managment

Answer 5

O2 if needed
nebulised salbutamol (with ipratropium bromide)
hydrocortisone IV
magnesium sulfate IV
aminophylline IV (with ondasetron as causes vomitting)

Question 6

viral induced wheeze common cause

Answer 6

respiratory syncytial virus (RSV)

Question 7

recurrent and persistent wheeze caused by

Answer 7

IgE

Question 8

reasons of failure to respond to treatment

Answer 8

Adherence (Compliance)
medication technique
Bad disease
Choice of drugs/devices

Question 9

POSSIBLE RISKS OF LONG TERM Inhaled corticosteroids

Answer 9

slows short/medium term growth (doesnt effect adult height)

adrenal crisis

Question 10

pneumonia aetiology new born

Answer 10

group B streptococcus (maternal) - Streptococcus agalactiae

Question 11

pneumonia aetiology infants and young

Answer 11

streptococcus pneumoniae
haemophilus influenza B
RSV

Question 12

pneumonia aetiology atypical

Answer 12

mycoplasma pneumoniae

use macrolide - Erythromycin

Question 13

pneumonia aetiology considerations

Answer 13

viruses commoner in younger children, bacteria in older

consider mycobacterium tuberculosis in all ages

Question 14

pneumonia signs

Answer 14

cough
fever
poor feeding
respiratory distress (tachyponea, cyanosis, grunting)
older children may get end respiratory crackles / bronchial breathing

Question 15

pneumonia managment

Answer 15

O2 if signs of resp distress - admit
oral amoxicillin (1st line) - IV for newborns

Question 16

bacterial pneumonia diagnosis

Answer 16

<3years
fever >38.5
chest recessions
RR >50

Question 17

pneumonia investigations

Answer 17

CXR - opacity throughout lobe or lung

Question 18

croup (laryngotracheobronchitis) cause

Answer 18

95% viral
parainfluenza virus (1,2,3)
respiratory syncytical virus

Question 19

croup (laryngotracheobronchitis) epidemiology

Answer 19

autum, <6 years

Question 20

croup (laryngotracheobronchitis) signs

Answer 20

onset over a few days
barking cough
harsh stridor
voice hoarseness
worse at night

Question 21

croup (laryngotracheobronchitis) management

Answer 21

mild - dexamethasone / prednisolone
cyanosed - ABC +/- O2
nebulised adrenaline if severe

Question 22

bacterial tracheitis what is it

Answer 22

consider if croup does not improve with treatment
tracheal bacterial infection
thick mucopurulent exudate and tracheal mucosal sloughing not cleared by coughing

Question 23

bacterial tracheitis cause

Answer 23

staph. aureus

Question 24

bacterial tracheitis management

Answer 24

IV third-generation cephalosporin (eg, cefotaxime, ceftriaxone) and a penicillinase-resistant penicillin (eg, oxacillin, nafcillin)

Question 25

bronchiolitis cause

Answer 25

RSV (80%) | also parainfluenza, adenovirus

Question 26

bronchiolitis presentation

Answer 26

``` coryza dry cough wheezing inspiratory crackles tachypnoea ```

Question 27

bronchiolitis RF

Answer 27

congenital heart defects make more severe

Question 28

bronchiolitis management

Answer 28

O2 if SATS <92% prophylaxis - ribavirin (for immunocompromised / heart defect) Palivizumab - for immunocompromised, CCF

Question 29

epiglottitis cause

Answer 29

haemophilus influenza B (99% reduction since vaccine)

Question 30

epiglottitis presentation

Answer 30

``` DO NOT EXAMINE acute toxic fever >39 continuous soft inspiratory stridor drooling minimal / absent cough ```

Question 31

epiglottitis management

Answer 31

cefotaxime IV

Question 32

cystic fibrosis cause

Answer 32

CFTR mutation on chromosome 7 decreases chloride excretion into lumen with increased reabsorption of sodium into epithelial cells less water excreted = less viscousity

Question 33

CF presentation

Answer 33

recurrent respiratory infections meconium ileus failure to thrive raised sodium sweat level

Question 34

CF complications

Answer 34

90% chronically infected by pseudomonas aeruginosa | commonly infected by staph.aureus

Question 35

CF management

Answer 35

physio pancreatic enzyme replacement therapy inhaled corticosteroids / B2 agonists

Question 36

common cold (coryza) causes

Answer 36

rhinovirus RSV coronavirus

Question 37

pharyngitis causes

Answer 37

``` usually viral: rhinovirus RSV coronavirus adenovirus ``` bacterial: group A b haemolytic strep

Question 38

FeverPAIN score (/5) - higher score more likely to be bacterial URTI

Answer 38

Fever (during previous 24 hours) Purulence (pus on tonsils) Attend rapidly (within 3 days after onset of symptoms) Severely Inflamed tonsils No cough or coryza (inflammation of mucus membranes in the nose)

Question 39

centor criteria

Answer 39

Tonsillar exudate Tender anterior cervical lymphadenopathy or lymphadenitis History of fever (over 38°C) Absence of cough 3+ = likely bacterial

Question 40

sinusitis viral or bacterial

Answer 40

viral - symptoms <10days | bacterial - symptoms worse after 5 days or >10days

Question 41

Chronic lung disease of prematurity

Answer 41

``` breathing machine injures babys lung Officially needing oxygen at 36 weeks corrected age Reduced lung volume Reduced alveolar surface area Diffusion defect ```

Question 42

Apnoea of prematurity treatments

Answer 42

stimulation | caffeine

Question 43

Periorbital cellulitis

Answer 43

Medical emergency Staphylococcus aureus, Streptococcus pneumoniae URTI followed by painful swollen eye Proptosis - abnormal protrusion or displacement of an eye Red colour vision: sign of optic nerve compromise IV Abx Incision and drainage of abscess – open or endoscopic

Question 44

respiratory distress syndrome cause

Answer 44

deficiency in alveolar surfactant | prematurity major risk factor

Question 45

respiratory distress syndrome prevention

Answer 45

maternal corticosteroids (beclamethasone / dexamthasone) to promote fetal lung maturation

Question 46

respiratory distress syndrome management

Answer 46

O2 | exogenous surfactant

Question 47

bronchopulmonary dysplasia cause

Answer 47

complication of ventilation used for respiratory distress syndrome lungs damaged by mechanical ventilation and long term O2 use

Question 48

bronchopulmonary dysplasia presentation and sequale

Answer 48

persistant hypoxia | feeding problems. cerebral palsy

Question 49

sinusitis cause

Answer 49

step. pneumoniae h. influenza moraxella catarrhallis

Question 50

meconium aspiration syndrome

Answer 50

meconium stained amniotic fluid and respiratory distress

Question 51

asthma management if under 5

Answer 51

1 - try SABA 2 - add low dose ICS 3 - add leukotriene receptor antagonist (montelukast) 4 - if still unresolved stop LTRA and refer to specialist