Broncholitis

Question 1

What is bronchiolitis?

Answer 1

A: An acute inflammatory injury of the bronchioles, usually caused by a viral infection.

Question 2

In which age group is bronchiolitis most severe?

Answer 2

A: Young infants, though it can affect all ages.

Question 3

Which virus is most commonly associated with bronchiolitis?

Answer 3

A: Respiratory Syncytial Virus (RSV).

Question 4

How is bronchiolitis transmitted?

Answer 4

A: Through direct contact with nasal secretions, airborne droplets, and contaminated surfaces.

Question 5

What season is bronchiolitis most common?

Answer 5

A: November to early April.

Question 6

Can reinfection with RSV occur in the same season?

Answer 6

A: Yes, with the same or a different strain.

Question 7

Which two strains of RSV are there, and which is more severe?
A:

Answer 7

Strains A and B; RSV A is more severe.

Question 8

What are the first symptoms of bronchiolitis?

Answer 8

A: Irritability, difficulty feeding, nasal congestion, and low-grade fever.

Question 9

When do symptoms of lower respiratory infection appear in bronchiolitis?

Answer 9

A: 2-3 days after upper respiratory symptoms.

Question 10

What severe symptom might younger children present with in bronchiolitis?

Answer 10

A: Apnea (cessation of breathing for 20 seconds or more).

Question 11

What physical exam findings are common in bronchiolitis?

Answer 11

A: Wheezing, crackles, rhonchi, hyperinflation, and respiratory distress signs.

Question 12

Q: Is chest radiography necessary for diagnosing bronchiolitis?
A:

Answer 12

No, it is only used in atypical cases.

Question 13

Why might chest radiography lead to unnecessary antibiotic use in bronchiolitis?

Answer 13

A: Because findings can resemble pneumonia.

Question 14

Are laboratory tests helpful in diagnosing bronchiolitis?

Answer 14

A: No, they do not aid in diagnosis.

Question 15

When might a urine culture be valuable in a bronchiolitis patient?
A:

Answer 15

For febrile infants under 3 months.

Question 16

When might a urine culture be valuable in a bronchiolitis patient?
A:

Answer 16

For febrile infants under 3 months.

Question 17

What are the main components of bronchiolitis management?

Answer 17

A: Oxygen supplementation, saline drops, nasal suctioning, hydration, and antipyretics.

Question 18

Are bronchodilators recommended for all bronchiolitis patients?

Answer 18

A: No, only if they show clinical improvement after initial use.

Question 19

Should epinephrine be used in bronchiolitis treatment?

Answer 19

A: No, it is not recommended.

Question 20

Why are antibiotics generally not recommended in bronchiolitis?

Answer 20

A: Because it is a viral infection.

Question 21

When is hypertonic saline used in bronchiolitis?

Answer 21

A: For hospitalized infants only.

Question 22

What are the criteria for hospital admission in bronchiolitis?

Answer 22

A: Hypoxia, apnea, inability to maintain oral hydration, prematurity, and more.

Question 23

What hygiene measure is critical in preventing RSV spread?

Answer 23

A: Hand washing.

Question 24

What is Palivizumab?

Answer 24

A: A monoclonal antibody given monthly during RSV season for prevention.

Question 25

When should Palivizumab administration be stopped?

Answer 25

A: If the patient contracts bronchiolitis while on the treatment.

Question 26

What is the prognosis of bronchiolitis?

Answer 26

A: It is self-limiting, with most children recovering without sequelae.

Question 27

How long can the cough last after bronchiolitis?

Answer 27

A: Median of 12 to 15 days.

Question 28

What long-term risk is associated with RSV bronchiolitis?

Answer 28

A: Increased likelihood of asthma and lower lung function by age 6.

Question 29

What percentage of children experience wheezing in the first year of life?

Answer 29

A: Approximately 50%.

Question 30

What is episodic wheeze?

Answer 30

A: Wheezing within a discrete period, often associated with a viral cold.

Question 31

Define “multitrigger wheeze.”

Answer 31

A: Wheezing that occurs with and apart from an acute viral episode.

Question 32

What is transient early wheeze? 33.

Answer 32

A: Wheeze starting early in life, peaking around the second year, and subsiding after the third.

Question 33

What are risk factors for transient early wheeze?

Answer 33

A: Maternal smoking, low birth weight, low socioeconomic status, daycare attendance, siblings.

Question 34

What is persistent wheeze?

Answer 34

A: Wheezing with onset at 6 months or later that persists.

Question 35

What two subtypes exist for persistent wheezing?

Answer 35

A: Nonatopic persistent wheezing and IgE-associated atopic/persistent wheezing.

Question 36

How is airflow resistance related to airway radius in children?

Answer 36

A: Inversely related to the fourth power of the radius.

Question 37

Are antibiotics generally recommended for recurrent wheeze?

Answer 37

A: No, as respiratory infections are usually viral.

Question 38

What is the role of inhaled steroids in recurrent wheeze?

Answer 38

A: Effective in persistent and late-onset wheezing with careful monitoring.

Question 39

What medication class does Montelukast belong to?

Answer 39

A: Antileukotriene.

Question 40

How might antibiotic use in infancy impact respiratory health later?

Answer 40

A: It may increase asthma risk by altering gut flora.

Question 41

What clinical feature distinguishes severe bronchiolitis?

Answer 41

A: Hypoxia (O2 saturation below 90%).

Question 42

What does RSV stand for?

Answer 42

A: Respiratory Syncytial Virus.

Question 43

Which patients are eligible for Palivizumab for RSV prevention?

Answer 43

A: Infants born before 29 weeks, those with chronic lung disease, and those with CHD.

Question 44

Q: What is considered a fever threshold for imaging in bronchiolitis?

Answer 44

A: Temperature above 39°C despite antipyretics.

Question 45

Q: What is considered a fever threshold for imaging in bronchiolitis?

Answer 45

A: Temperature above 39°C despite antipyretics.

Question 46

What complication is 6% of infants with bronchiolitis at risk for? A:

Answer 46

Concurrent urinary tract infection.

Question 47

What complication is 6% of infants with bronchiolitis at risk for? A: Concurrent urinary tract infection.

Question 48

What type of respiratory pattern might infants with bronchiolitis exhibit?

Answer 48

A: Tachypnea, nasal flaring, and intercostal retractions.

Question 49

Inn what cases is capillary CO2 measurement used in bronchiolitis?

Answer 49

A: In children with high respiratory effort despite oxygen. 50.

Question 50

What environmental measure is essential in reducing bronchiolitis spread?

Answer 50

A: Disinfecting surfaces due to RSV survival up to 6 hours.

Question 51

What diagnostic measure is not useful for bronchiolitis management?

Answer 51

A: Viral culture or PCR for common viruses.

Question 52

What is a characteristic finding on lung exam in bronchiolitis?

Answer 52

A: Bilateral wheezing.

Question 53

When is chest radiography indicated in bronchiolitis?

Answer 53

A: For atypical cases or when respiratory distress persists.

Question 54

Why might bronchiolitis increase asthma risk in the future?

Answer 54

A: Due to lung damage and airway hyperreactivity from RSV.

Question 55

What does “RS distress” refer to in bronchiolitis?

Answer 55

A: Respiratory distress, including symptoms like tachypnea and cyanosis.

Question 56

Which infants may require closer monitoring for bronchiolitis?

Answer 56

A: Those with a high respiratory rate (>70/min

Question 57

What is the typical age range in which tachypnea is defined as a respiratory rate over 40?

Answer 57

A: In children aged 1-5 years.

Question 58

Q: What is the most persistent symptom of bronchiolitis, and how long does it typically last?

Answer 58

A: Cough, lasting a median of 12 to 15 days.

Question 59

What risk factors are associated with late-onset wheeze?

Answer 59

A: Allergy and exposure to smoking.

Question 60

What subgroup of persistent wheeze is often associated with viral triggers?

Answer 60

A: Nonatopic persistent wheezing phenotype, frequently triggered by viral illness.

Question 61

What are common environmental factors that affect wheezy conditions in children?

Answer 61

A: Exposure to allergens, smoke, and viral infections.

Question 62

What are the two main subgroups of persistent wheeze based on etiology?

Answer 62

A: Nonatopic viral-induced wheeze and IgE-associated atopic wheeze.

Question 63

How are episodic and multitrigger wheeze differentiated?

Answer 63

A: Episodic wheeze occurs only with viral infections, while multitrigger wheeze occurs with and without infections.

Question 64

What proportion of children experience recurrent wheezing by preschool age?

Answer 64

A: About one-third of children.

Question 65

What is the role of the Asthma Predictive Index in managing recurrent wheezing?

Answer 65

A: It helps physicians assess the likelihood of asthma in children with recurrent wheeze.

Question 66

67. Q: What symptom may occur in younger children with bronchiolitis, sometimes as the only presenting sign?

Answer 66

A: Apnea, particularly in children under 6 weeks of age.

Question 67

What clinical signs might indicate respiratory distress in bronchiolitis?

Answer 67

A: Tachypnea, nasal flaring, intercostal retractions, use of accessory muscles, cyanosis, and grunting.

Question 68

Why is a viral panel sometimes performed in bronchiolitis cases?

Answer 68

A: Mainly for research purposes or as part of a neonatal sepsis workup.

Question 69

How often should Palivizumab be administered during RSV season?

Answer 69

A: Monthly, for a maximum of 5 doses.

Question 70

What specific group of children is at higher risk of recurrent wheezing after recovering from RSV bronchiolitis?

Answer 70

A: Children with a history of RSV-positive bronchiolitis.

Question 71

What is the significance of a respiratory rate greater than 70/min in infants with bronchiolitis?

Answer 71

A: It is associated with a more severe form of the illness and may indicate the need for hospitalization.

Question 72

What is one potential long-term effect in children who have been hospitalized for RSV bronchiolitis?

Answer 72

A: They are three times more likely to be diagnosed with asthma and have lower lung function at age 6.

Question 73

How can bronchiolitis affect the ventilation-perfusion ratio in the lungs?

Answer 73

A: Inflammation, edema, and mucus cause bronchiolar obstruction, leading to mismatched ventilation-perfusion.

Question 74

What are some recommended indications for a chest radiograph in bronchiolitis?

Answer 74

A: Persistent focal crackles, high fever above 39°C, and respiratory failure requiring critical care.