Bronchiolitis & Pulmonary TB Flashcards
what is bronchiolitis?
Acute viral LRTI associated with inflammation of the bronchioles
Which age group is most likely to her bronchiolitis?
2-12months
What is the most common virus to cause bronchiolitis?
Respiratory syncytial virus (RSV)
what are the clinical features of bronchiolitis
Coryza low grade fever cough difficulty breathing apnoeic episodes?
Which children are most likely to get apnoeic episodes in bronchiolitis?
infants
What is coryza?
rhinitis, inflammation of the mucus membrane of the nose
What will be found on examination in bronchiolitis?
low grade fever tachypnea hypoxaemia inspiratory crackles expiratory wheeze palpable liver
Why would an infant with bronchiolitis develop a palpable liver on examination?
because there can be hyperinflation of the lunch, the diaphragm pushes down in the liver, making it palpable, but does not increase its size
What investigations can be done on a baby with bronchioloitis?
CXR - though usually not indicated if it is clinically apparent that bronchiolitis is the cause
Nasopharyngeal aspirate - to test for pathogen. Only done in children who are kept in hispital
What would be found on a CXR of a baby with bronchiolitis?
Non-specific, hyperinflation, patchy infiltration, focal atelectasis
on a CXR what is atelectasis?
partial collapse or incomplete infiltration
What are the risk factors for severe bronchiolitis?
infants
what are the indications for hospitalisation in an infant with bronchiolitis?
risk factors present
sat 60 with recesstion and poor feeding
What is the management of bronchiolitis?
oxygen fluids apneoa monitoring isolation nasal continuous postive pressures
What are the complications of bronchiolitis?
otitis media
secondary bacterial infection
What can be done for prevention in infants with significant risk factors to bronchiolitis?
Can be given Palivizumab which is a monoclonal antibody to RSV
What is the difference between TB infection and TB disease?
TB infection there is a primary complex which causes a local rection in the lung perenchyma
TB disease is early hatmatogenous dissemination leading to millary TB meningeal TB and extra pulmonary disease (30%)
How do symptoms present in TB disease at different ages?
school age - silent usually
Infants - poor feeding, failure to thrive, cough tachypneoa
Adolescent - fever, weight loss, night sweats, productive cough
How is TB Diagnosed?
Positive tuberculin skin test (mantoux)
CXR changes - hilar lymphadenopathy
Histology or culture for definitive diagnosis, ealry morning gastro aspirate in infants
How is a Mantoux test carried out?
Injected with tuberculin. Left for 48 hours, area of swelling (induration) measured, >10mm is positive. Area of swelling threshold is reduced in high risk or immunosupressed patients.
What is the treatment of TB?
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
