Bronchiolitis, RSV, Croup, & Pertussis

Question 1

acute inflammation and damage to small airways characterized by upper respiratory symptoms followed by lower respiratory symptoms

Answer 1

bronchiolitis

Question 2

what is the most common cause of bronchiolitis?

Answer 2

RSV

Question 3

what bacterial organism can cause bronchiolitis, on occasion?

Answer 3

mycoplasma pneumonia

Question 4

what is the problem in RSV?

Answer 4

sloughed epithelium and mucus production = obstructs airway = air trapping

Question 5

what is the incubation period of RSV/bronchiolitis?

Answer 5

4-6 days

Question 6

if not treated appropriately, what can rsv/bronchiolitis lead to?

Answer 6

viral pneumonia

Question 7

a patient presents with fever, fatigue with increased sleeping, rhinorrhea, sore throat, tachypnea, increased work of breathing, cough, wheezing and crackles. what are they likely experiencing?

Answer 7

RSV

Question 8

what point of care diagnostic should be done for RSV?

Answer 8

nasopharynx swab for virus

Question 9

what would RSV look like in a chest xray?

Answer 9

hyper-expansion
peri-bronchial thickening

Question 10

what is the treatment/education for non-severe RSV? (5)

Answer 10

nasal suction
hydration
avoid OTC decongestants
peak on days 3-5
resolve over 2-3 weeks

Question 11

what is the treatment for severe RSV? (4)

Answer 11

nasal suction
hydration
high flow nasal cannula
CPAP

Question 12

what should we try 1 time in severe RSV?

Answer 12

SABA - albuterol

Question 13

what should be given if RSV patient responds well to SABA (albuterol)

Answer 13

corticosteroids

Question 14

what medication should be given in RSV patients that are immunocompromised?

Answer 14

ribavirin

Question 15

what general discharge criteria must the patient meet for RSV?

Answer 15

stable for over 12 hours

Question 16

what respiratory rate discharge criteria must the patient meet for RSV?

Answer 16

< 6 mo = < 60 b/min
6-11 mo = < 55 b/min
12 mo and over = < 45 b/min

Question 17

also known as laryngotracheobronchitis that leads to narrowing of the subglottic airway

Answer 17

Croup

Question 18

what is the cause of Croup?

Answer 18

parainfluenza virus

Question 19

a patient presents with nasal discharge, congestion, fever, hoarse voice, barking cough, and inspiratory stridor. what are they experiencing?

Answer 19

Croup

Question 20

what would Croup look like in a neck xray?

Answer 20

steeple sign

Question 21

Croup treatment if patient has occasional barking cough, no stridor at rest, mild or no retractions

Answer 21

single dose of PO dexamethasone

Question 22

Croup treatment if patient has frequent barky cough, stridor at rest, mild to moderate retractions, no distress or agitation

Answer 22

single dose of PO dexamethasone
nebulized epinephrine

Question 23

Croup treatment if patient has frequent barking cough, stridor at rest, marked retractions, significant distress and agitation

Answer 23

single dose of PO/IM/IV dexamethasone
repeated nebulized epinephrine
hospital admission

Question 24

Croup treatment if patient has a depressed level of consciousness, stridor at rest, severe retractions, poor air entry, and cyanosis

Answer 24

single dose IM/IV dexamethasone
repeated nebulized epinephrine
ICU admission
+/- intubation

Question 25

what is the cause of pertussis/whooping cough?

Answer 25

bordetella pertussis

Question 26

what is the incubation period for pertussis?

Answer 26

7-17 days

Question 27

what is characteristic of the cough in pertussis/whooping cough?

Answer 27

cough over 2 weeks
+ vomitting
post-tussive whoop

Question 28

a patient presents with lacrimation, sneezing, anorexia, hacking night cough, consecutive coughs + high-pitched inspiration. what are they experiencing?

Answer 28

pertussis/whooping cough

Question 29

what 3 diagnostics can help diagnose pertussis?

Answer 29

nasopharyngeal culture
PCR
CBC

Question 30

what would be seen in a CBC for pertussis?

Answer 30

increased lymphocytes + WBCs

Question 31

what 3 medications can be used for the treatment of pertussis?

Answer 31

azithromycin
erythromycin
clarithromycin

Question 32

what medication, besides a macrolide, can be used to treat pertussis?

Answer 32

trim-sulfa DS