Bronchioloitis + stuffy nose + CrouP

Question 1

Causes of bronchiolitis?

Answer 1

RSV - MC

Other causes include adenovirus parainfluenxa rihinovirus

Question 2

Who does bronchiolitis affect ?

Answer 2

<2 year old (although usually <1 years old)

Winter period

More vulnerable infants include: Preterm, chronic lung disease, cardiac disorders, early age of onset, tabacco exposure.

Question 3

How does bronchiolitis affect the airways?AA

Answer 3

characterised by epithelial cell destruction, cellular oedema, and airway obstruction by inflammatory debris and mucus

Question 4

Signs and symptoms of bronchiolitis

Answer 4

Cough

Preceeded by coryxal sympotms (blocked runny nose)

Fever

Tachypnoea/increased work of breathing

Question 5

We look at a few different featre when looking at increased work of breathing in babies/infants

What are they?

Answer 5

Subcostal recession, tracheal tug, nasal flaring, abdominal breathing, use of accessroy muscles, grunting, head bobbing

Question 6

What to look for in examination

Answer 6

end of bed assessment

Increased work of breathing/distress

Crackeles/wheeze on the chest

struggling to feed

Snotty, congested sinuses

any rashes

Hydration

Cap refill

Question 7

Tx for bronchiolitis?

Answer 7

1) Supplementary O2 as needed
2) NG tube/IV fluids
3) Saline neb/nasal de congestant
4) In severe cases/no improvement- optiflow/CPAP/ Senior support

Question 8

TRUE or FALSE

Antibiotics/salbutamol neb work on bronchiolitis

Answer 8

FALSE they dont work

Question 9

At what day is bronchiolitis worse?

Answer 9

day 3-5

Question 10

What is anteror rhinoscopy?

Answer 10

pulling the tip of the nose and looking inside

Question 11

What can you give if there is a newborn with nasal obstruction

Answer 11

obligate nasal breathers/ NaCl drops

Question 12

What could be causing a unlateral nasal obstruction?

Answer 12

Foreign body, choanal atresia, adenoid, deflected septum

Question 13

What could be causing a bilateral nasal obstruction

Answer 13

Adenoids/ allergy

Question 14

Differential diagnosis for a stuffy nose

Answer 14

Congenital: CF/Chanal atresia/ Masses- myelocoele/meningocoele/lymphoma

Acquired: Infection- URTI/Adenoids/sinusitis, foreign body/ nasal polyps/ mucocoele

Question 15

A unilateral nasal discharge in achile is consideres to be ?/??

Answer 15

a foreign body until proven otherwise

Question 16

What is an urgent foreign body that needs to be removed urgently

Answer 16

Batteries because these can leak out and result in septal perforation and a cosmetic deformity

Question 17

What is croup usually caused by

Answer 17

parainfluenza

Question 18

Croup results in….

Answer 18

upper airway obstruction- leading to stridor and respiratory distress

Question 19

What age group does croup usually affect?

Answer 19

children between the ages of 6 months and 3 years

Question 20

Signs and symptoms of Croup

Answer 20

1-2 day history of preceding coryzal symptoms

sudden onsent of a barking cough

stridor (inspiratory) and voice hoarseness

Respiratory distress (eg intercostal recession)

lethargy

Mild to moderate fever

Symptoms often worse at nigh

chest sounds are usually normal (unless a secondary bacterial infection is present)

Question 21

Differential DIagnosis for Croup

Answer 21

Epiglottis

Foreign Body inhalation

Question 22

What is epiglottis caused by

Answer 22

Haemophylis influenxa type B

Question 23

is epiglottis common or rare

Answer 23

Rare

Question 24

Symptoms and signs of Epiglottis

Answer 24

Cant swallow secretions- drooling child

Tripod postion

high fever

Non barking cough

Question 25

Explain the classificaiton of croup?

Answer 25

Question 26

What is the scoring system used in croup

Answer 26

Westley clinical scoring systen

Question 27

Explain the westley clinical scoring system

Answer 27

Question 28

Which patients with croup need admission?

Answer 28

-All children with moderate, severe or impendig respiratory failure must be admitted

consider hospital admission in children with a RR of over 60 breaths per minute or who have a toxic appearance

Consider hospital admission for children with a background of chronic lung disease or co morbidities

ANy child under 3 months old with temp >38

Question 29

What management for Croup in primary care

Answer 29

prescribe a single dose of oral dexamethasone (0.15mg/kg) to be taken immediately

encourage the use of paracetamo; and ibuprofen

encourage oral fluid intake

advise parents to check on their child through the nigh

Symptoms should resolve within 48 hrs- review if not resolved

Safety net advice

Question 30

What management for Croup in secondary care

Answer 30