Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

inflammatory obstruction of the bronchioles (small airways)

Question 2

What is the most common cause of bronchiolitis?

Answer 2

Respiratory syncytial virus (RSV)

Question 3

In which season is bronchiolitis most common?

Answer 3

Winter

Question 4

What patient age group does bronchiolitis affect?

Answer 4

infants (mainly children under 1)

Question 5

Why is it viruses affect infants’ bronchioles more so than adult bronchioles?

Answer 5

the airways of infants are very small to begin with and when there is even the smallest amount of inflammation and mucus, it has a significant effect on the infant’s ability to circulate air to the alveoli and back out

Question 6

Give two sounds created by airway obstruction in brochiolitis:

Answer 6

1) wheeze
2) crackles on auscultation

Question 7

Give 8 clinical presentations associated with bronchiolitis:

Answer 7

1) coryzal symptoms
2) signs of respiratory distress
3) dyspnoea
4) tachypnoea
5) poor feeding
6) mild fever (under 39 degrees C)
7) apnoea
8) wheeze and crackles on auscultation

Question 8

What are coryzal symptoms?

Answer 8

Acute, inflammatory contagious symptoms associated with upper respiratory tract infections

Question 9

Give 4 examples of coryzal symptoms:

Answer 9

1) runny nose
2) sneezing
3) mucous in throat
4) watery eyes

Question 10

Give 7 signs of paediatric respiratory distress:

Answer 10

1) raised respiratory rate
2) tracheal tugging
3) abdominal airway noises
4) use of accessory muscles
5) cyanosis
6) nasal flaring
7) head bobbing

Question 11

Name 3 accessory muscles that may be used in paediatric respiratory distress:

Answer 11

1) sternocleidomastoid
2) abdominal muscles
3) intercostal muscles

Question 12

Give 3 abnormal airway noises that may be associated with paediatric respiratory distress:

Answer 12

1) wheeze
2) grunting
3) stridor

Question 13

What is wheeze?

Answer 13

whistling sound typically heard on expiration caused by narrowed airways

Question 14

What is grunting?

Answer 14

An “uh” sound during exhalation which reflects the child’s attempt to keep alveoli open caused by exhaling with the blottis partially closed to increase positive end-expiratory pressure

Question 15

What is stridor?

Answer 15

high pitched inspiratory noise caused by obstruction of the upper airway

Question 16

Describe the progression of bronchiolitis: (4)

Answer 16

1) it begins as an URTI with coryzal symptoms
2) half getting better spontaneously while the other half develop chest symptoms over the first 1-2 days
3) symptoms are generally worse on days 3-4
4) symptoms usually last 7 days

Question 17

True or false: children who have had bronchiolitis as infants are more likely to have viral induced wheeze during childhood

Answer 17

True

Question 18

Give 8 reasons for bronchiolitis admission:

Answer 18

1) aged under 3 months
2) any pre-existing conditions such as prematurity, Downs syndrome or CF
3) 50-75% or less of their normal intake of milk
4) clinical dehydration
5) respiratory rate above 70
6) oxygen saturations below 92%
7) moderate to severe respiratory distress such as recessions or head bobbing
8) apnoea

Question 19

Give the 4 types of supportive treatments offered for bronchiolitis management:

Answer 19

1) ensuring adequate nutritional intake
2) saline nasal drops and nasal suction
3) supplementary oxygen
4) ventilatory support (if required)

Question 20

Why should overfeeding be avoided in paediatric respiratory distress?

Answer 20

a full stomach restricts breathing movements

Question 21

Where is capillary blood glucose taken from in an infant?

Answer 21

big toe

Question 22

What antiviral is given in severe cases of bronchiolitis?

Answer 22

Ribavirin

Question 23

what is a Paramyxovirus?

Answer 23

Negative strand RNA virus

Question 24

What type of virus is RSV?

Answer 24

Paramyxovirus

Question 25

How is RSV transmitted?

Answer 25

respiratory droplets

Question 26

How is RSV infection diagnosed? (2)

Answer 26

1) genome detection
2) immunofluorescence of nasopharyngeal aspirates

Question 27

Give two ways that passive immunity can be given to high risk infants for RSV:

Answer 27

monthly administration of either
1) hyperimmune globulin against RSV
2) Palivizumbal (monoclonal antibody against RSV)

Question 28

What babies are offered monthly globulins/ Palivizumbal?

Answer 28

high risk e.g. premature and those with congenital heart disease