Paediatric breathlessness.

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What classic breathing sound is heard here? "Courtesy on Dr Donovan Dwyer".

Bronchiolitis.

Expiratory wheeze in asthma.

Inspiratory stridor in croup.

Grunt and increased respiratory rate in pneumonia.

No classic barking cough but inspiratory stridor at rest. Typical of severe croup.

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Watch the video and choose which condition these 2 infants have.

Bronchiolitis caused by RSV.

Vrial tracheobronchitis.

Viral induced wheeze.

Bacterial pneumonia.

2 Classic presentations of RSV bronchiolitis (From the RSV Patient Network).

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Which of the following is TRUE about aspiration of peanuts?

Occurs most often in 4 to 6yr olds.

The most common place it lodges is the left main bronchus.

Fortunately a well trained paediatric radiologist can see it on CXR.

Needs identification and removal by bronchoscopy.

It most often lodges in the right main bronchus and most commonly occurs in 1 to 3yr olds.

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A 4yr old girl presents with drooling, a muffled voice and appears toxic. She is sitting forward and very anxious.What is the most appropriate management principle?

Examine her throat with a tongue depressor ASAP.

Lie her supine for a proper examination.

Give 6 puffs of salbutamol via a spacer.

Anticipate requiring airway managment in OT and keep the child calm.

It sounds like bacterial tracheiitis or a retropharyngeal abscess. Historically it would have been epiglottitis. Ideally the airway would be calmly secured in the operating theatre with a "gas induction".

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Which of the following was NOT a traditional cure for chest infections in children?

Using "mustard plasters" applied to the infants chest to draw "corruption" from the lungs.

Feeding "salt of tartar" and cochineal sweeted then diluted with water to infants with whooping cough.

Brown ale, wheat and oats poulice applied to the chest of infants.

Animal fat chest rubs mixed with camphor.

The mustard plasters could not stay on longer than 20minutes otherwise they would blister the skin.

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A 3yr old with acute severe asthma has received repeated salbutamol and ipratropium via a spacer along with IV steroids. After 30min he remains tachypnoeic with decreased air entry and significant work or breathing. Which adjunct has the strongest role in acute severe refractory asthma?

Nebulised budesonide.

Nebulised adrenaline.

IV Magnesium sulphate.

IV Frusemide.

It has few side effects and may make a difference.

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A 14 month old girl presents with bronchiolitis. She has been on high flow nasal oxygen and "working hard". What does the following VBG show?

That she needs an IV fluid bolus of 10ml/kg to improve the acidosis.

That she requires ventolin via spacer to help "open the airways".

That you should increase the high flow nasal prongs to 2l/kg/min.

That she is tiring and may soon require mechanical ventilation.

Despite "working hard" her PaC02 is elevated. This is likely to get worse as she tires resulting in the possible requirement for assisted ventilation. A trial of CPAP could be considered---closely monitored with regular VBGs and the set up to intubate if required.

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This child had severe pneumonia requiring intubation. He worsened afterwards. What caused this?

The ETT went into the esophagus rather than the trachea.

ETT went down the right main bronchus causing collapse of the left lung.

The pneumonia became "fulminant".

Failure to put an NG tube down caused respiratory compromise.

The ETT was pulled back and the 02 sats recovered with the reinflation of the left lung.

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A nut has been aspirated by this infant. What is illustrated on the CXR?

Hyperinflation of the left lung because of a "ball valve" obstruction.

Complete obstruction of the left main bronchus.

Prolonged obstruction causing right side pneumonia.

An inflammatory reaction in the right lung because of the "peanut allergen".

The right lung looks more radiodense because of the increased blood flow being shunted away from the left lung.

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What is the origin of the word "croup"?

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From the Latin word for narrow--- "croupae".

From the old Scottish word "crawp" which mimicked the sound of frogs and crows.

Named after the sound of rapid inspiration--it is onomatapoeic.

A shortening of the word "croupier" becuse the cough in croup sounds like the cough the croupier uses to gain attention at the beginning of a game.

Must admit though---the frogs I know don't sound much like croup.

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