Introductory questions

This quiz has 3 multiple-choice questions. Feedback has been included. Scoring is at the bottom of the page. To answer the following questions, select the best answer, then select 'Check answer'.

Question 01

For which of the following reasons are young children and infants more predisposed to the development of respiratory failure than adults? Choose one of the answer options below, made up of items from the following list:

  • A. Smaller diameter airways
  • B. Relatively reduced immunity
  • C. Increased susceptibility to ventilation – perfusion mismatch
  • D. Increased foetal haemoglobin
  • E. Inefficient respiratory muscles

 
C, D, E
A, B, C
B, C, D, E
A, B, C, D
A, B, C, D, E
Check answer

Explanation

All of the above: A, B, C, D, E

Smaller diameter airways lead to increased airway resistance. A relatively minor reduction in airway diameter will lead to a four-fold increase in airway resistance.

The relatively compliant chest wall provides less support for maintenance of lung volume.

Fewer alveoli contribute to the potential for V-Q mismatch.

The increased proportion of foetal haemoglobin until around six months means oxygen is less readily given to the tissues.

Question 02

A 3 year old boy presents after choking on peanuts. He was wheezy for a few minutes but is now asymptomatic. Which one of the following is INCORRECT?

Unilateral wheeze is consistent with inhaled foreign body
Bronchoscopy should be performed
The foreign body is likely to be seen on chest x-ray
Check answer

Explanation

The foreign body is likely to be seen on chest x-ray. The history is highly suggestive of inhaled foreign body. Bronchoscopy should be performed irrespective of examination and x-ray findings. Unilateral wheeze adds weight to the diagnosis. Foreign body should be suspected in any case where there are localised respiratory signs or radiological abnormalities that do not resolve.

Organic material may stimulate an especially severe inflammatory reaction. Inhaled foreign bodies are usually radiolucent and cannot be seen on x-ray.

Question 03

An 8 year old child presents with a vomit, stridor, difficulty breathing and poor perfusion after eating a chocolate bar given to him by a friend. His heart rate is 160 bpm with a weak, thready pulse. His respiratory rate is 40 per minute, oxygen saturations 95% in room air and blood pressure is 80/50mmHg. He is pale and sweaty and is struggling to keep his eyes open when you ask him questions.

Which one of the following is the most appropriate next step?
Immediate chest x-ray to rule out foreign body
Immediate administration of oxygen
Immediate intramuscular adrenaline
Try to calm him down and then re-assess his vital signs
Immediate penicillin therapy
Check answer

Explanation

This history is suggestive of anaphylaxis. Anaphylaxis is an immediate hypersensitivity reaction, usually mediated by IgE.

In any situation where there is a likely systemic reaction, the drug of choice is adrenaline 0.01ml/kg 1:1000 IM.

This may need to be repeated. 100% oxygen should be applied and IV access obtained. 20mlkg normal saline may be required for hypotension, as well as hydrocortisone 4mg/kg IV. Intubation and ventilation may be required. Please note that answer option B - ‘Immediate administration of oxygen’ is correct, but is not the first step.

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