Broncholitis Flashcards
What is bronchiolitis?
A: An acute inflammatory injury of the bronchioles, usually caused by a viral infection.
In which age group is bronchiolitis most severe?
A: Young infants, though it can affect all ages.
Which virus is most commonly associated with bronchiolitis?
A: Respiratory Syncytial Virus (RSV).
How is bronchiolitis transmitted?
A: Through direct contact with nasal secretions, airborne droplets, and contaminated surfaces.
What season is bronchiolitis most common?
A: November to early April.
Can reinfection with RSV occur in the same season?
A: Yes, with the same or a different strain.
Which two strains of RSV are there, and which is more severe?
A:
Strains A and B; RSV A is more severe.
What are the first symptoms of bronchiolitis?
A: Irritability, difficulty feeding, nasal congestion, and low-grade fever.
When do symptoms of lower respiratory infection appear in bronchiolitis?
A: 2-3 days after upper respiratory symptoms.
What severe symptom might younger children present with in bronchiolitis?
A: Apnea (cessation of breathing for 20 seconds or more).
What physical exam findings are common in bronchiolitis?
A: Wheezing, crackles, rhonchi, hyperinflation, and respiratory distress signs.
Q: Is chest radiography necessary for diagnosing bronchiolitis?
A:
No, it is only used in atypical cases.
Why might chest radiography lead to unnecessary antibiotic use in bronchiolitis?
A: Because findings can resemble pneumonia.
Are laboratory tests helpful in diagnosing bronchiolitis?
A: No, they do not aid in diagnosis.
When might a urine culture be valuable in a bronchiolitis patient?
A:
For febrile infants under 3 months.
When might a urine culture be valuable in a bronchiolitis patient?
A:
For febrile infants under 3 months.
What are the main components of bronchiolitis management?
A: Oxygen supplementation, saline drops, nasal suctioning, hydration, and antipyretics.
Are bronchodilators recommended for all bronchiolitis patients?
A: No, only if they show clinical improvement after initial use.
Should epinephrine be used in bronchiolitis treatment?
A: No, it is not recommended.
Why are antibiotics generally not recommended in bronchiolitis?
A: Because it is a viral infection.
When is hypertonic saline used in bronchiolitis?
A: For hospitalized infants only.
What are the criteria for hospital admission in bronchiolitis?
A: Hypoxia, apnea, inability to maintain oral hydration, prematurity, and more.
What hygiene measure is critical in preventing RSV spread?
A: Hand washing.
What is Palivizumab?
A: A monoclonal antibody given monthly during RSV season for prevention.
When should Palivizumab administration be stopped?
A: If the patient contracts bronchiolitis while on the treatment.
What is the prognosis of bronchiolitis?
A: It is self-limiting, with most children recovering without sequelae.
How long can the cough last after bronchiolitis?
A: Median of 12 to 15 days.
What long-term risk is associated with RSV bronchiolitis?
A: Increased likelihood of asthma and lower lung function by age 6.
What percentage of children experience wheezing in the first year of life?
A: Approximately 50%.
What is episodic wheeze?
A: Wheezing within a discrete period, often associated with a viral cold.
Define “multitrigger wheeze.”
A: Wheezing that occurs with and apart from an acute viral episode.
What is transient early wheeze?
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A: Wheeze starting early in life, peaking around the second year, and subsiding after the third.
What are risk factors for transient early wheeze?
A: Maternal smoking, low birth weight, low socioeconomic status, daycare attendance, siblings.
What is persistent wheeze?
A: Wheezing with onset at 6 months or later that persists.
What two subtypes exist for persistent wheezing?
A: Nonatopic persistent wheezing and IgE-associated atopic/persistent wheezing.
How is airflow resistance related to airway radius in children?
A: Inversely related to the fourth power of the radius.
Are antibiotics generally recommended for recurrent wheeze?
A: No, as respiratory infections are usually viral.
What is the role of inhaled steroids in recurrent wheeze?
A: Effective in persistent and late-onset wheezing with careful monitoring.
What medication class does Montelukast belong to?
A: Antileukotriene.
How might antibiotic use in infancy impact respiratory health later?
A: It may increase asthma risk by altering gut flora.
What clinical feature distinguishes severe bronchiolitis?
A: Hypoxia (O2 saturation below 90%).
What does RSV stand for?
A: Respiratory Syncytial Virus.
Which patients are eligible for Palivizumab for RSV prevention?
A: Infants born before 29 weeks, those with chronic lung disease, and those with CHD.
Q: What is considered a fever threshold for imaging in bronchiolitis?
A: Temperature above 39°C despite antipyretics.
Q: What is considered a fever threshold for imaging in bronchiolitis?
A: Temperature above 39°C despite antipyretics.
What complication is 6% of infants with bronchiolitis at risk for?
A:
Concurrent urinary tract infection.
What complication is 6% of infants with bronchiolitis at risk for?
A: Concurrent urinary tract infection.
What type of respiratory pattern might infants with bronchiolitis exhibit?
A: Tachypnea, nasal flaring, and intercostal retractions.
Inn what cases is capillary CO2 measurement used in bronchiolitis?
A: In children with high respiratory effort despite oxygen.
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What environmental measure is essential in reducing bronchiolitis spread?
A: Disinfecting surfaces due to RSV survival up to 6 hours.
What diagnostic measure is not useful for bronchiolitis management?
A: Viral culture or PCR for common viruses.
What is a characteristic finding on lung exam in bronchiolitis?
A: Bilateral wheezing.
When is chest radiography indicated in bronchiolitis?
A: For atypical cases or when respiratory distress persists.
Why might bronchiolitis increase asthma risk in the future?
A: Due to lung damage and airway hyperreactivity from RSV.
What does “RS distress” refer to in bronchiolitis?
A: Respiratory distress, including symptoms like tachypnea and cyanosis.
Which infants may require closer monitoring for bronchiolitis?
A: Those with a high respiratory rate (>70/min
What is the typical age range in which tachypnea is defined as a respiratory rate over 40?
A: In children aged 1-5 years.
Q: What is the most persistent symptom of bronchiolitis, and how long does it typically last?
A: Cough, lasting a median of 12 to 15 days.
What risk factors are associated with late-onset wheeze?
A: Allergy and exposure to smoking.
What subgroup of persistent wheeze is often associated with viral triggers?
A: Nonatopic persistent wheezing phenotype, frequently triggered by viral illness.
What are common environmental factors that affect wheezy conditions in children?
A: Exposure to allergens, smoke, and viral infections.
What are the two main subgroups of persistent wheeze based on etiology?
A: Nonatopic viral-induced wheeze and IgE-associated atopic wheeze.
How are episodic and multitrigger wheeze differentiated?
A: Episodic wheeze occurs only with viral infections, while multitrigger wheeze occurs with and without infections.
What proportion of children experience recurrent wheezing by preschool age?
A: About one-third of children.
What is the role of the Asthma Predictive Index in managing recurrent wheezing?
A: It helps physicians assess the likelihood of asthma in children with recurrent wheeze.
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Q: What symptom may occur in younger children with bronchiolitis, sometimes as the only presenting sign?
A: Apnea, particularly in children under 6 weeks of age.
What clinical signs might indicate respiratory distress in bronchiolitis?
A: Tachypnea, nasal flaring, intercostal retractions, use of accessory muscles, cyanosis, and grunting.
Why is a viral panel sometimes performed in bronchiolitis cases?
A: Mainly for research purposes or as part of a neonatal sepsis workup.
How often should Palivizumab be administered during RSV season?
A: Monthly, for a maximum of 5 doses.
What specific group of children is at higher risk of recurrent wheezing after recovering from RSV bronchiolitis?
A: Children with a history of RSV-positive bronchiolitis.
What is the significance of a respiratory rate greater than 70/min in infants with bronchiolitis?
A: It is associated with a more severe form of the illness and may indicate the need for hospitalization.
What is one potential long-term effect in children who have been hospitalized for RSV bronchiolitis?
A: They are three times more likely to be diagnosed with asthma and have lower lung function at age 6.
How can bronchiolitis affect the ventilation-perfusion ratio in the lungs?
A: Inflammation, edema, and mucus cause bronchiolar obstruction, leading to mismatched ventilation-perfusion.
What are some recommended indications for a chest radiograph in bronchiolitis?
A: Persistent focal crackles, high fever above 39°C, and respiratory failure requiring critical care.
