Bronchiolitis & Pneumonia

Question 1

What is Bronchiolitis?

Answer 1

It is a disease of the small bronchioles with increased mucous production and bronchospasm.

Question 2

What is the primary pathogen in causing Bronchiolitis?

Answer 2

Respiratory Syncytial Virus (RSV)

Question 3

What are other viruses that can cause Bronfhciolitis?

Answer 3

Human Metapneumovirus
Parainfluenza virus
Influenza Virus
Adenoviruses
Rhinoviruses
Coronaviruses
Mycoplasma pneumoniae ( infrequently)

Question 4

How is Viral bronchiolitis spread?

Answer 4

It is spread by contact with infected respiratory secretions.

Question 5

True or False? Bronchiolitis occurs almost exclusively after the first two years of age.

Answer 5

FALSE!! It occurs DURING the first two years of age

Question 6

What is the incubation period for Bronchiolitis caused by RSV?

Answer 6

4-6 days

Question 7

What are the clinical manifestations of Bronchiolitis?

Answer 7

Cough
Rhinorrhea
Noisy, Raspy breathing
Audible Wheezing
Low - Grade fever
Irritability
Apnea ( cane the first sign of infection)
Prolongation of expiratory phase of breathing
Nasal flaring
Intercostal retractions
Suprasternal retractions
Air trapping with hyperextension of lungs

Question 8

What are some findings indicating Bronchiolitis on examination ?

Answer 8

Percussion - Hyperresonance of chest
Auscultation- Wheezing, Crackles
Grunting and Cyanosis

Question 9

What findings will you find indicating Bronchiolitis on Chest Radiography?

Answer 9

Lung hyperinflation
Increased Lung Lucency
Flattened or Depressed diaphragms

Question 10

How can one differentiate Bronchiolitis from Asthma?

Answer 10

• Age ( Bronchiolitis occurs primarily in the first two years of life while Asthma is diagnosed after age 5.
• Presence of Fever ( Bronhciolitis is normally accompanied by fever while Astham typically is unaccompanied by fever UNLESS a RTI is the trigger for the exacerbation of the Asthma)

Question 11

What are the different causes for Wheezing?

Answer 11

• Upper and Lower RTI
• Airway foreign body
• Congenital Airway obstructive lesion
• Cystic fibrosis
• Exacerbation of COPD
• Viral or Bacterial Pneumoniae
• Cardiac Failure
• GERD

Question 12

What is the Treatment for Bronchiolitis?

Answer 12

Oxygenation ( via cnasal cannula)
Bronchodilators
Corticosteroids
Chest Physiotherapy
Hypertonic Saline

Question 13

Which drug can be given monthly to prevent the onset of RSV bronchiolitis?

Answer 13

Monthly injections of Palivizumab

Question 14

What is themes common pathogen that causes Lobar pneumonia?

Answer 14

Streptococcus Pneumoniae

Question 15

What are other pathogens that can cause Pneumonia in children less than 5 years of age?

Answer 15

RSV
Parainfluenza virus
Human Metapneumovirus
Adenovirus

Question 16

What are the common pathological agents that cause Atypical pneumonia?

Answer 16

Mycoplasma Pneumoniae
Clamydophilia pneumoniae

Question 17

Fill in the blanks. “ Pneumonia in patent with Cystic fibrosis is caused by _____________ in infancy and _____________ in older patients.”

Answer 17

S. Aureus in Infancy
Psuedemona Aerguinosa & Burkholdiera Cepacia in Older patients.

Question 18

What are some risk factors for Pneumonia?

Answer 18

• Exposure to infected persons
• Gastrointestinal Reflux
• Neurologic Impairment ( Aspiration)
• Immunocompromised State
• Anatomic abnormalities
• Residence in residential care facilities
• Hospitalizations ( ICU)

Question 19

How can one differentiate viral or bacterial pneumonia?

Answer 19

• Viral pneumonia is associated with cough, wheezing, or stridor- FEVER is less prominent . Mucal congestion and upper airway inflammation suggests a Viral infection.
• Bacterial pneumonia is typically associated with HIGHER FEVER, cough , chills, dyspnea, auscultatory findings of lung consolidation.
• Viral pneumonia will have a normal or mildly elevated WBC count with a predominance of Lymphocytes
• Bacterial pneumonia will have a WBC count of > 15,000 - 20,000/mm3 with a predominance of Neutrophils .

Question 20

Fill in the blanks.” Atypical pneumonia in young infants is characterised by _________ ,__________ & ___________.”

Answer 20

Tachypnea
Cough
Crackles on Auscultation

Question 21

Mild eosinophilia in infants can be indicated of Pneumonia caused by which pathogen?

Answer 21

Chlamydia Trachomatis

Question 22

What are the pathological agents that cause pneumonia in the immunocompromised patients?

Answer 22

Gram - negative bacteria
Mycobacteria( M.Avium complex)
Fungi( Aspergillosis)
Viruses ( Cytomegalovirus - CMV)
Pneumocystis jirovecii

Question 23

Which test is helpful in diagnosing pneumonia caused by Legionella pneumophila ( Legionnaires disease) ?

Answer 23

Urinary Antigen Test

Question 24

What is the most likely pathogen causing Afebrile pneumonia in a 2-18 weeks year old infant and what is the treatment?

Answer 24

Chlamydia trachomatis
Macrolide is the treatment

Question 25

What are the pathological agents causing Pneumonia in a neonate ( 0-3 weeks)?

Answer 25

Group B Streptococcus
E.Coli
Other gram-negative bacilli
Strep pneumoniae
H. Influenza

Question 26

What are the pathological agents causing Pneumonia in a Infant ( 3wks -3 months)?

Answer 26

RSV
Parainfluenza virus
Influenza virus
Adenovirus
S.Pneumoniae
H.Influenzae
Chlamydia Trachomatis ( AFEBRILE patient)

Question 27

What are the pathological agents causing Pneumonia in a Toddler( 4months -4 years)?

Answer 27

RSV
Parainfluenza virus
Influenza virus
Adenovirus
S.Pneumoniae
H.Influenzae
Mycoplasma Pneumoniae
Group A strep

Question 28

What are the pathological agents causing Pneumonia in a Toddler( 5 years & older)?

Answer 28

M. Pneumoniae
S.Pneumoniae
H.Influenzae
Influenza virus
Adenovirus
Legionella Pneumophilia