😀 EASY

Have a crack at three paediatric patients with respiratory concerns.  Good luck! 

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child resp 1

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Question 1

Stem 1 of 6

A 7 year old child is brought to his GP with a history - a week prior - of mild runny nose and dry cough. His mother has come due to a recent (three day) start of severe coughing fits. She describes the fits as “getting worse and worse before he is fighting for breath”. You do not witness an episode.
What is the best-matched cause of the most likely diagnosis?
A
Bordetella pertussis
B
Chlamydia trichomoniasis
C
Neisseria gonorrhoea
D
Streptococcus pneumoniae
E
Treponema pallidum
Question 1 Explanation: 
BT is a gram negative cause of whooping cough - aka the upper respiratory tract infection that causes an inspiratory “whoop” during paroxysmal coughing fits (the whoop appears distal to a crescendo of increasingly urgent dry coughs).
Question 2

Stem 2 of 6

Who is eligible for a vaccine against this diagnosis?
A
All Adult females
B
All Adult males
C
Children
D
Pregnant females
E
There is no vaccine currently
Question 2 Explanation: 
The pertussis vaccine is available for pregnant women and children. The primary course of pertussis occurs at eight, twelve and sixteen weeks with a reinforcement dose at three years. A neonate is any baby up until the first month of life, so does not qualify.
Question 3

Stem 3 of 6

Which approaches can be used for diagnosis?
A
Nasopharyngeal swab to culture
B
Nasopharyngeal swab for PCR
C
Serological testing
D
Full blood count
E
Urea and creatinine
Question 3 Explanation: 
It is advised that a NP swab to culture is performed with PCR as an adjunct. Whilst the culture is 100% sensitive, a negative result does not rule out the diagnosis. Thus best practice suggests both should be performed concurrently. Serological testing would be performed later in the disease, with FBC and UEC for differentials and to monitor the patient progress
Question 4

Stem 4 of 6

Which class of antibiotics should be prescribed for this patient first-line?
A
Aminoglycoside
B
Beta lactam
C
Fluoroquinolone
D
Macrolide
E
Nitroimidazole
Question 5

Stem 5 of 6

The patient is a 7 year old male weighing 28kg and is 1.3 metres tall. Calculate the patient’s BMI.
A
14
B
15
C
16
D
17
E
18
Question 5 Explanation: 
BMI = weight (kg)/ height (M^2) ergo = 28/(1.3*1.3) = 16.7 ergo 17BMI
Question 6

Stem 6 of 6

Based on the above criteria, what is the correct dosing regimen for the patient?
A
300 mg once daily for 3 days.
B
300 mg once daily for 5 days.
C
300 mg twice daily for 3 days.
D
300 mg twice daily for 5 days.
E
500mg once daily for 2 days.
Question 6 Explanation: 
For Child 6 months–17 years (body-weight 26–35 kg) 300 mg once daily for 3 days (Azithromycin - BNF-C, 2021)
Question 7

Stem 1 of 6

A 12 year-old male presents to ED with a stridor secondary to a week of a sore throat. He is sitting in the tripod position and has a high objective fever. He is visibly drooling.
What is the classic cause of this presentation?
A
Haemophilus influenza A
B
Haemophilus influenza B
C
Haemophilus influenza C
D
Staphylococcus aureus
E
Streptococcus pyogenes
Question 8

Stem 2 of 6

What is the best matched differential?
A
Acute bronchitis
B
Acute epiglottitis
C
Community acquired pneumonia
D
Peritonsillar abscess
E
Retropharyngeal abscess
Question 9

Stem 3 of 6

The “thumbprint” sign is characteristic of this condition. In which modality can this be visualised?
A
Abdominopelvic CT
B
Anteroposterior radiograph cervical
C
Head ultrasound
D
Lateral radiograph cervical
E
Skull CT
Question 9 Explanation: 
A lateral X-ray of the neck can show shadowing of the soft tissue int the teacheal region. But if the patient is in extremis, obviously this should be a clinical diagnosis.
Question 10

Stem 4 of 6

The patient remains on the hospital trolley in triage. What is the next-best step?
A
Call paediatrics, anaesthetics and intubate
B
Call paediatrics, anaesthetics and monitor airway
C
Call paediatrics, anaesthetics and perform tracheostomy
D
Call paediatrics, anaesthetics and transfer to ICU
E
Administer IV ceftriaxone and dexamethasone
Question 10 Explanation: 
Although most patients do not require endotracheal intubation, immediate response from paediatrics and anaesthetics should be sought, the patient should not have the condition provoked (ie minimise stressors, do not palpate region) and an intubation kit should be prepped and available next to the patient should the condition undergo hyperacute deterioration.
Question 11

Stem 5 of 6

The patient requires which combination of adjunct therapy once the airway is stabilised? Select two of the list below.
A
Antibiotic and antiviral
B
Antibiotic and steroid
C
Antibiotic combo therapy
D
Antiviral and steroid
E
Dual steroid therapy
Question 11 Explanation: 
Once anaesthetics/paediatrics are happy with the airway, the patient requires steroid (dexamethasone) and antibiotic (eg IV ceftriaxone) therapy - the former to reduce epiglottic inflammation, the latter to treat the cause (usually HiB)
Question 12

Stem 6 of 6

Which antibiotic is the most appropriate first-line antibiotic of choice?
A
Ampicillin
B
Ceftriaxone
C
Flucloxacillin
D
Gentamicin
E
Vancomycin
Question 12 Explanation: 
Cephalosporins have excellent activity against HiB (BNF, “Cephalosporin” 2021).
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