Respiratory & Sleep Medicine\ Airway Infections

Question 1

What is bronchiolitis?

Answer 1

An airway disease (usually viral lower respiratory tract infection) characterized by acute inflammation, edema, and necrosis of the bronchiolar walls; hypersecretion of mucus; and bronchospasm

Question 2

In what patient population is bronchiolitis most common?

Answer 2

Infants

Question 3

What is the most common etiology of bronchiolitis? Respiratory syncytial virus (RSV)

Answer 3

Respiratory syncytial virus (RSV)

Question 4

Does infection with RSV confer immunity?

Answer 4

No. Reinfection can occur.

Question 5

What is the name of the vaccine used to help prevent RSV infection (routinely given to infants with a history of chronic lung or heart disease or prematurity)?

Answer 5

Palivizumab

Question 6

How is a diagnosis of bronchiolitis made?

Answer 6

• It is a clinical diagnosis.
  
  • An upper respiratory infection developing into a lower respiratory infection
  • with signs of respiratory distress including
    
    • wheezing
    • tachypnea
    • increased work of breathing (nasal flaring, grunting, retractions).

Question 7

What is ribavirin?

Answer 7

An antiviral used to treat severe bronchiolitis (or those at risk for severe disease)

Question 8

What is acute bronchitis?

Answer 8

Transient inflammation of the bronchi (medium and large airways)

Question 9

What are the causes of acute bronchitis?

Answer 9

• Viruses (most often)
• bacterial
• inhalation of foreign material (toxic fumes, etc)

Question 10

What age group is most commonly affected by acute bronchitis?

Answer 10

Children less than 5 years old

Question 11

What are the signs and symptoms of acute bronchitis due to infection?

Answer 11

• Fever
• cough and sputum production
• shortness of breath
• wheezing
• chest pain and/or
• malaise

Question 12

How long does acute bronchitis usually last?

Answer 12

20-30 days

Question 13

What is the treatment of acute bronchitis?

Answer 13

• Rest and plenty of fluids
• acetaminophen or other pain relievers
• cough drops
• expectorant cough medication (eg, guaifenesin)
• cough suppressants for nonproductive cough (eg, dextromethorphan)
• bronchodilators
• antibiotics (only when bacterial cause suspected or if patient has chronic lung disease)

Question 14

The American Academy of Pediatrics strongly recommends that cough and cold medications not be given to children younger than what age because of life-threatening side effects?

Answer 14

2 years

Question 15

Evidence shows that cough and cold medicines are not effective in children younger than what age?

Answer 15

6 years old

Question 16

What can caregivers give children to reduce coughing?

Answer 16

• A small amount of honey may be given to children over 1 year old.
• Throat lozenges or cough drops may be given to children over 4 years old.

Question 17

What is croup?

Answer 17

Common infection that causes acute inflammation of trachea and larynx

Question 18

What is the most common cause?

Answer 18

Parainfluenza virus

Question 19

What symptoms are seen with croup?

Answer 19

• Hoarseness
• barking cough

Question 20

In what age group does croup occur?

Answer 20

• Children 6 months to 12 years
• most commonly in children 1-3 years of age

Question 21

What is the radiographic finding known as the “steeple sign?”

Answer 21

Anteroposterior (AP) view of the neck shows narrowing trachea.

Question 22

What is the treatment of Croup?

Answer 22

• Steroids
• nebulizer treatments
• cool humidified air
• racemic epinephrine

Question 23

What is the infectious agent of pertussis (whooping cough)?

Answer 23

Bordetella pertussis

Question 24

What are the classic symptoms?

Answer 24

• Whooping cough spells (paroxysms)
• followed by posttussive emesis

Question 25

What are the three stages of disease?

Answer 25

1. Catarrhal stage (mild upper respiratory infection symptoms) 2. Paroxysmal (whooping cough) 3. Convalescent (mild cough continues)

Question 26

How long may Pertussis(whooping cough) last?

Answer 26

12 weeks

Question 27

Do antibiotics abort tpertussis(whooping cough)?

Answer 27

Only in the catarrhal phase

Question 28

What is the main purpose of antibiotics in whooping cough?

Answer 28

To decrease spread to others

Question 29

What is the treatment of choice in whooping cough(Pertussis)?

Answer 29

* Erythromycin for 14 days for patient and close contacts

Question 30

What is the concerning possible complication of erythromycin in infants?

Answer 30

Hypertrophic pyloric stenosis

Question 31

What are alternatives to erythromycin (in the treatment of pertussis(whooping cough)?

Answer 31

* other macrolides e.g. Azithromycin