BRONCHIOLITIS

Question 1

Bronchiolitis is most commonly due to which virus? It affects most babies by which age?

Answer 1

Respiratory syncytial virus

2 yrs

Question 2

What 2 findings might you see on a chest x-ray of someone with bronchiolitis?

Answer 2

• Hyperinflation
• Patchy collapse or consolidation

Question 3

What do you expect the prodrome of bronchiolitis to be? What are three common symptoms seen in this condition?

Answer 3

History of coryza followed by dry cough and worsening breathlessness

♦ Wheeze, feeding difficulty, apnoea

Question 4

What is this sign?

Answer 4

Subcostal recession → clinical sign of respiratory distress, occurs as increasingly negative intrathoracic pressures cause indrawing of part of chest

Question 5

Which 2 skin signs indicate respiratory distress?

Answer 5

• Cyanosis
• Pallor

Question 6

Which part of the breathing would you expect to be prolonged in bronchiolitis?

Answer 6

Prolonged expiration

Question 7

What are the three key investigations of bronchiolitis?

Answer 7

• Pulse oximetry
• CXR
• Nasopharyngeal swab: immunofluorescent antibody testing for respiratory syncitial virus binding

Question 8

What is the treatment for bronchiolitis?

Answer 8

• Oxygen to achieve saturation >92%
• Bronchodilators for wheeze. Best evidence for nebulised adrenaline
• If tachypnoea limit oral feeds and use NGT
• Use IV fluids if oral fluids not tolerated or significantly increased work of breathing
• Mechanical ventilation for severe respiratory distress or apnoea

Question 9

How can RSV be prevented in at risk infants?

Answer 9

Palivizumab is a monoclonal antibody to RSV and can be used as prophylaxis particularly during winter months

Question 10

Important preventable complication in bronchiolitis

Answer 10

Dehydration