Bronchiolitis

Question 1

What is the most common cause for acute paediatric hospital admissions?

1 - cardiology
2 - respiratory
3 - musculoskeletal
4 - gastroenterology

Answer 1

2 - respiratory

Respiratory infections account for 50% of GP appointments as well, with asthma being the most common chronic childhood illness in the UK.

Question 2

Bronchiolitis is an acute viral infection of the lower respiratory tract that occurs primarily in the very young. In 2019/20 what was the number of hospital admissions for bronchiolitis?

1 - 15,000
2 - 23,450
3 - 47,506
4 - 105,250

Answer 2

3 - 47,506

Bronchiolitis is the most common lower respiratory infection in the first year of life in the UK

Roughly 3% of all hospital admissions

Question 3

Bronchiolitis is an acute viral infection of the lower respiratory tract that occurs primarily in the very young. What age does bronchiolitis typically affect?

1 - <12 months
2 - <2 years
3 - <4 years
4 - <6 years

Answer 3

2 - <2 years

Peaks between 3-6 months

Question 4

What time of the year does the number of cases of Bronchiolitis peak?

1 - Jan - May
2 - August - Dec
3 - Oct - March
4 - Dec - April

Answer 4

3 - Oct - March

Question 5

Which of the following is NOT part of the lower respiratory tract?

1 - trachea
2 - larynx
3 - bronchi
4 - bronchioles
5 - alveoli
6 - lungs

Answer 5

2 - larynx

Question 6

The lower respiratory tract is composed of all of the features below. Which of the following becomes inflamed in Bronchiolitis?

1 - trachea
2 - bronchi
3 - bronchioles
4 - alveoli
5 - lungs

Answer 6

3 - bronchioles
- smallest airways of the lungs

Question 7

Which virus accounts for up to 80% of Bronchiolitis cases?

1 - human metapneumovirus (hMPV)
2 - adenovirus
3 - rhinovirus
4 - parainfluenza and influenza viruses
5 - respiratory syncytial virus

Answer 7

5 - respiratory syncytial virus

The others together account for the other 20% of cases

Question 8

Are steroids key to reducing inflammation in the standard management of bronchiolitis?

Answer 8

• no
• linked to mucus plugs rather than inflammation

Different pathophysiology to asthma

Question 9

What is the most common cause of pyrexia of unknown origin in children?

1 - malignancy
2 - infection
3 - autoimmune
4 - trauma

Answer 9

2 - infection

Question 10

The following are the most common risk factors for Bronchiolitis, but which is the most important risk factor?

1 - premature birth
2 - young age
3 - attending busy areas (nursery)
4 - older siblings in schooling/nursery
5 - chronic lung disease (cystic fibrosis)
6 - congenital heart disease
7 - immunocompromised

Answer 10

2 - young age

Question 11

Bronchiolitis is an acute viral infection of the lower respiratory tract affecting children <2 years old, with respiratory syncytial virus accounting for 80% of cases. What age is at the highest

1 - <3 months
2 - <9 months
3 - <12 months
4 - <24 months

Answer 11

1 - <3 months

Question 12

How do patients typically contract Bronchiolitis and the respiratory syncytial virus accounting for 80% of cases?

1 - kissing infected person
2 - skin to skin contact
3 - touching infected surface (few hours)
4 - inhaling air droplets

Answer 12

4 - inhaling air droplets

Most common, but all others can also cause infection as well

Question 13

The respiratory syncytial virus is an enveloped virus with a linear negative-sense strand of RNA, which means it needs to converted into a complementary sense strand by RNA polymerase in order to be translated once inside the epithelial cells. Once enough cells become infected this can turn multiple cells into a multi-nucleated cell called what?

1 - langerhans cells
2 - astrocytes
3 - syncytia
4 - granuloma

Answer 13

3 - syncytia

Can lead to apoptosis of some cells aswell

Question 14

Once the epithelial of the bronchioles become infected, this infection attracts immune cells to the site of tissue damage. Specifically which immune cell is attracted?

1 - B cells
2 - neutrophils
3 - basophils
4 - natural killer cells

Answer 14

4 - natural killer cells
- attempt to kill virus infected cells

Question 15

Once the epithelial cells of the bronchioles are infected, all of the following occurs, EXCEPT which one?

1 - immune cells release chemokines
2 - increased mucus production
3 - increased vascular permeability
4 - decreased blood flow to affected area
5 - increased fluid and inflammation narrow the airways

Answer 15

4 - decreased blood flow to affected area
- blood vessels in the area vasodilate

Question 16

Do adults or children have narrower airways?

Answer 16

• children

This is why they can be even more affected by bronchiolitis

Question 17

In addition to inflammation and narrowing of the bronchioles, what else can happen to the airways?

1 - airways bleed and cause blood clots, leading to blockage of the airways
2 - dead cells and mucus slide down airways and form mucus plugs leading to atelectasis and overinflation of lungs
3 - damaged airways leads to fibroblast recruitments and interstitial lung disease
4 - all of the above

Answer 17

2 - dead cells and mucus slide down airways and form mucus plugs leading to atelectasis and overinflation of lungs

Mucus plugs act as one way valves, air enters but cannot leave
Atelectasis = partial lung collapse

Question 18

In Bronchiolitis, typically caused by respiratory syncytial virus, dead cells and mucus slide down airways and form mucus plugs leading to atelectasis and overinflation of lungs. Which of the following can this lead to?

1 - systematic hypoxia (low O2 getting to tissue)
2 - hypoxemia (low O2 in blood)
3 - hypocapnia (low CO2 in blood)
4 - hyperoxia (high O2 in blood)

Answer 18

2 - hypoxemia (low O2 in blood)

Due to air trapping, O2 cannot diffuse into blood and CO2 cannot be removed

Question 19

Which of the following in Bronchiolitis, typically caused by respiratory syncytial virus do patients NOT present with?

1 - coryzal symptoms (including mild fever)
2 - mucus dry cough
3 - increasing breathlessness/SOB/hypoxemia
4 - wheezing, fine inspiratory crackles (not always present)
5 - feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

Answer 19

2 - mucus cough
- typically a dry cough

Initial symptoms are similar to the common cold

Question 20

All of the following can occur in infants <2 with Bronchiolitis, typically caused by respiratory syncytial virus. But which of the following is most important to address in the childs developing brain?

1 - coryzal symptoms (including mild fever)
2 - mucus dry cough
3 - increasing breathlessness/SOB/hypoxemia
4 - wheezing, fine inspiratory crackles (not always present)
5 - feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

Answer 20

3 - increasing breathlessness/SOB/hypoxemia

Leads to:
- increased HR
- increased RR
- exhaustion of the infant and hospital admission
- central apnea (stopping breathing altogether)

Question 21

Which of the following children may be at greater risk if they become infected with Bronchiolitis, typically caused by respiratory syncytial virus?

1 - non-breast fed infants
2 - premature infants
3 - neuromuscular disorders (difficulty breathing)
4 - all of the above

Answer 21

4 - all of the above

Question 22

How is Bronchiolitis typically diagnosed?

1 - viral antibodies present on nasopharynx swabs
2 - PCR for respiratory syncytial virus (RSV)
3 - clinical diagnosis
4 - chest X-ray
5 - blood gas

Answer 22

3 - clinical diagnosis
- based on current outbreaks for RSV
- patients age and symptoms

All others can also be useful

Blood gas can help identify those who have severe illness

Question 23

Is there a proven antiviral that can be given for respiratory syncytial virus (RSV) that causes bronchiolitis?

Answer 23

• no

Question 24

All of the following would be indicators that a child with bronchiolitis needs to be admitted for closer monitoring and support, EXCEPT which one?

1 - RR>60 b/min
2 - SPO2 <98% in air
3 - Severe respiratory distress
4 - Cyanosis
5 - Apnoeic episodes
6 - Reduced feeding <50%–75% of normal volume or clinical dehydration

Answer 24

2 - SPO2 <98% in air

Typically if it drops below 92%

Apnea can be defined as the cessation of respiratory effort lasting more than 20 seconds

Question 25

As there is no known anti-viral that can be given for Is there a proven antiviral that can be given for respiratory syncytial virus (RSV) that causes bronchiolitis, which of the following are used to manage patients?

1 - oxygen supplementation
2 - fluids to reduce risk of dehydration
3 - palivizumab antibody
4 - suctions if high level of mucus secretions
5 - nasogastric feeding
6 - all of the above

Answer 25

6 - all of the above

Oxygen supplementation may be humidified

Palivizumab
- monthly injections of a pre-made antibody against RSV. Only used in high risk patients

Question 26

NICE recommends calling 999 in all of the following, EXCEPT which one in an infant with a suspected respiratory syncytial virus (RSV) causing bronchiolitis?

1 - apnoea (stopping breathing - observed or reported)
2 - child looks seriously unwell to a healthcare professional
3 - severe respiratory distress (grunting, marked chest recession, or a respiratory rate of over 70)
4 - central cyanosis
5 - sibling has RSV infection
6 - persistent O2 sats <92% on breathing air

Answer 26

5 - sibling has RSV infection

Question 27

Which of this baby’s features with bronchiolitis necessitates immediate referral to a hospital?

1 - Grunting
2 - Her oxygen saturation
3 - Her respiratory rate
4 - Nasal flaring
5 - Widespread fine crackles

Answer 27

1 - Grunting