Respiratory month

Question 1 of 6

1. Question

A 12 month old boy attends the emergency department overnight. He woke up at 03.00am with difficult breathing. He has had a cough and runny nose for 1 day. On assessment, he is saturating at 99% in air, respiratory rate is 36 breaths/minute, and temperature is 37.6 degrees. You hear an inspiratory breathing noise. This seems to get louder when he cries. He looks well, and drinks some milk while you see him. His parents report his cough sounds different to normal. Which would be the best management?

Give oral dexamethasone
Give nebulised salbutamol
Give paracetamol and review
Give atropine and 10 puffs of salbutamol

Question 2 of 6

2. Question

A two year old girl attends ED with ongoing fevers and difficulty breathing. She was seen in ED four days previously and started on Amoxicillin for a lower respiratory tract infection. She has ongoing fevers up to 39.5 degrees, and difficulty breathing. On assessment, she is saturating at 94% in air, respiratory rate is 50 breaths/minute, Heart rate is 145 beats/minute. She has tracheal tug and subcostal recession. Auscultation is very difficult as she screams whenever examined. What would be the next best step?

Do a chest x-ray
Start on oral antibiotics
Admit for observations

Question 3 of 6

3. Question

What % of acute respiratory infections in children worldwide does Respiratory syncytial virus (RSV) account for? What % does RSV account for in infants younger than 1 years at peak viral season?

60% & 80%
44% & 10%
15% & 80%
60% & 75%

Question 4 of 6

4. Question

Why would a child have a tracheostomy?

Facilitation of long-term ventilation
Preterm infant
Multifactorial upper airway obstruction
Discrete site of anatomical upper airway obstruction – subglottic stenosis
Facilitation of long-term ventilation
craniofacial abdnormality
multifactorial upper airway obstruction
Discrete site of anatomical upper airway obstruction – subglottic stenosis
Facilitation of long-term ventilation
Multifactorial upper airway obstruction
Upper airway obstruction – subglottic stenosis
Facilitation of long-term ventilation
Abdnormality
multifactorial upper airway obstruction
Superglottic stenosis

Question 5 of 6

5. Question

7 month old attends a&e in due to poor feeding. Parents report child refusing bottle feeds and reduced wet nappies. Parents mention he sneezes a lot, has a very dry cough which keeps him up at night, and he seems more lethargic than normal. When you assess him, you notice he is using his accessory muscles, and upon auscultation you note there is a prolonged expiratory phase, mild wheeze and coarse crackles scattered throughout. Observations are mildly abdnormal with saturations of 92%, tachypnoeic at 50, and tachycardia of 145. What are your next steps?

Consider bronchiolitis as your diagnosis
Nasal suction
Trial feed
Repeat observations post suction
If o2 lowering consider nasal cannula and/or NG
chest xray
Consider Gas if child worsening
Do a chest xray
Give Salbutamol inhalers to treat wheeze
Consider optiflow and gas
Escalate to PCCU

Question 6 of 6

6. Question

Which statement is false regarding airway remodelling?

A. There is an increase in goblet cells and mucus production
B. Thickened smooth muscle cells, with hyperplasia and hypertrophy
C. Decreased collagen deposition in airways
D. Increased vascularity in the airway wall
E. all of the above

Decreased collagen deposition in airways
Increased vascularity in the airway wall
all of the above
There is an increase in goblet cells and mucus production