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BRONCHIOLITIS Flashcards

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1
Q

What is bronchiolitis?

A

An acute respiratory infection causing inflammatory obstruction of the bronchioles, primarily affecting children under 2 years.

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2
Q

What is the main etiology of bronchiolitis?

A

Mostly viral; bacterial infections are secondary.

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3
Q

Which viral agents commonly cause bronchiolitis?

A

• Respiratory Syncytial Virus (RSV) – 50–75% of cases • Parainfluenza virus type 3 • Human Metapneumovirus • Adenovirus • Rhinovirus • Coronavirus • Influenza virus • Human Bocavirus

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4
Q

Which bacterial agents are secondary invaders in bronchiolitis?

A

• Staphylococcus aureus • Klebsiella pneumoniae • Mycoplasma pneumoniae • Chlamydia pneumoniae

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5
Q

What are the main risk factors for bronchiolitis?

A

• Age < 2 years (peak 2–10 months) • Male sex • Not exclusively breastfed • Exposure in day care or crowded environments • Wet season/rainy or cold months • Exposure to cigarette smoke

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6
Q

How does bronchiolitis develop at the cellular level (pathophysiology)?

A

• Virus infects distal bronchi and bronchioles → inflammation → release of cytokines (IL-8, MIP-1α, interferons, leukotrienes) • Cellular + humoral immune activation → epithelial necrosis, submucosal edema, mucus hypersecretion • Reduced airway lumen → increased airway resistance → air trapping → hyperinflation → potential atelectasis • Gas exchange impairment → early hypoxemia, later hypercapnia

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7
Q

How is bronchiolitis transmitted?

A

• Inhalation of infected respiratory droplets • Inoculation via contaminated hands into nostrils or conjunctiva

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8
Q

What are the key differences between bronchiolitis and bronchopneumonia?

A

Feature Bronchiolitis Bronchopneumonia
Age <2 years <5 years
Etiology Mostly viral Mostly bacterial
Fever Usually low grade Often high grade
Ill appearance Mild to moderate More acutely ill
Crepitations Fine Coarse
Rhonchi Sometimes Only in severe cases
Feeding Poor feeding Not typical
History Exposure to adult URTI Insidious onset

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9
Q

What are the typical clinical features of bronchiolitis?

A

• Paroxysmal or episodic cough • Breathlessness / tachypnea • Poor feeding / refusal to feed • Wheezing (musical sound) • Chest retractions, grunting • Cyanosis • Fever (usually low grade) • Hyperresonant percussion • Fine crackles on auscultation • Palpable, non-tender liver due to diaphragmatic descent • Apnea in young infants may be first sign

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10
Q

What investigations are indicated in bronchiolitis?

A

• Full blood count (usually normal) • Chest X-ray: peri-bronchiolar thickening, hyperinflation, atelectasis • Pulse oximetry: monitor hypoxemia • Arterial blood gas (if severe) • Blood culture (if secondary bacterial infection suspected) • Viral culture or antigen testing (rarely done)

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11
Q

What is the mainstay of bronchiolitis treatment?

A

Supportive care: • Humidified oxygen if SPO₂ < 90% • Adequate fluids/calories (IV or NG feeding) • Nasal/oral suctioning • Nebulized hypertonic saline • Tepid sponging/antipyretics for fever

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12
Q

When are antibiotics indicated in bronchiolitis?

A

Only for secondary bacterial infection. Commonly used: erythromycin.

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13
Q

Are bronchodilators useful in bronchiolitis?

A

Trial may be given, especially for first-time wheezers; beta-agonists (salbutamol), epinephrine, or anticholinergics (ipratropium) may help. Not routinely indicated.

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14
Q

Are corticosteroids indicated in bronchiolitis?

A

No—use of corticosteroids is contraindicated. Some studies combine nebulized epinephrine + dexamethasone with limited success, but not standard therapy.

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15
Q

What are potential complications of bronchiolitis?

A

• Apnea (especially in infants < 2 months) • Severe dehydration • Respiratory failure • Acute otitis media • Heart failure (rare, usually in underlying cardiac disease)

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16
Q

What is the differential diagnosis of bronchiolitis?

A

• Bronchial asthma: recurrent wheeze, eosinophilia, family history, triggers like pollen/dust, corticosteroids indicated • Bronchopneumonia: high fever, coarse crepitations, no rhonchi unless severe • Congestive heart failure: due to underlying heart disease (e.g., VSD) • Pertussis: post-tussive vomiting, paroxysmal cough, wheeze • Foreign body aspiration

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17
Q

What prophylactic measures can prevent bronchiolitis?

A
  1. Passive immunoprophylaxis: palivizumab (RSV monoclonal antibody) 2. Prevent child-to-child transmission in daycare or crowded settings
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18
Q

What is the prognosis of bronchiolitis?

A

• Generally good if treatment is started early • Most critical period: first 48–72 hours • Poor prognosis if: prematurity, congenital heart disease, chronic lung disease, PaO₂ ≤ 60 mmHg or PaCO₂ ≥ 40 mmHg

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19
Q

What is GOBIFFFFEETH in pediatrics preventive strategy?

A

• G: Growth monitoring • O: Oral rehydration therapy • B: Breastfeeding • I: Immunisation • F: Female education • F: Family spacing • F: Food supplementation • F: Fertility control • E: Environmental sanitation • E: Expanded programme on immunisation • E: Early treatment of disease • T: Treatment of infection • H: Health education

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20
Q

A 12-month-old boy presents with 3-day cough, fever, noisy breathing worse at night, attends daycare, weighs 10 kg, RR 68, intercostal recession, rhonchi. Most likely diagnosis?

A

Bronchiolitis (typical viral infection, age < 2 years, daycare exposure, paroxysmal cough, tachypnea, rhonchi).

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21
Q

Concerning bronchiolitis: Which of the following is true? • a) Cause of paroxysmal cough in children • b) Predominantly viral • c) Percussion note is dull • d) Bronchospasm present • e) Nebulized dexamethasone is beneficial

A

a) True, b) True, c) False (hyperresonant), d) Sometimes (due to wheezing, not classic bronchospasm), e) False (not standard therapy)

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22
Q

Which therapies are considered in bronchiolitis management?

A

Bronchodilator therapy, intranasal oxygen, IV fluids, nasal suctioning. Not chromoglycate sodium (ineffective).

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23
Q

Which agent offers passive prophylaxis against bronchiolitis?

A

Palivizumab (RSV monoclonal antibody).

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24
Q

How do you differentiate bronchiolitis vs first episode of asthma?

A

• Bronchiolitis: <2 years, viral, first-time wheeze, self-limiting, resolves with supportive care • Asthma: recurrent attacks, eosinophilia, family history, corticosteroids indicated

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25
A 6-month-old infant presents with apnea and mild cough. What must you do first?
Assess airway, breathing, circulation; monitor oxygen saturation; consider admission—apnea in young infants can be the first sign of bronchiolitis.
26
What is bronchiolitis?
An acute respiratory disease resulting from inflammatory injury of the bronchioles, occurring mostly in children under 2 years, predominantly viral in origin.
27
What is the main causative agent of bronchiolitis?
Respiratory Syncytial Virus (RSV), accounting for 50–75% of cases.
28
Other viral causes of bronchiolitis include?
• Parainfluenza viruses, especially type 3 • Adenoviruses • Rhinovirus • Human Metapneumovirus • Human Bocavirus
29
Are bacteria a primary cause of bronchiolitis?
No. There is no evidence that bacteria cause bronchiolitis, though bacterial pneumonia may be confused with it clinically.
30
Epidemiologic risk factors for bronchiolitis?
• Age < 2 years (most common) • Male gender (2:1 ratio) • Not exclusively breastfed • Rainy season or cold harmattan months • Exposure to cigarette smoke • Daycare attendance • Crowded living conditions
31
Describe the pathophysiology of bronchiolitis at the airway level.
• Viral infection → mucous secretion, necrosis of respiratory epithelium, edema of bronchiolar mucosa • Lumen narrowing → increased airway resistance • Complete obstruction → atelectasis; incomplete → air trapping and hyperinflation
32
What happens to gas exchange in bronchiolitis?
Impaired alveolar gas exchange causes ventilation-perfusion mismatch → hypoxemia early, hypercapnia later in the disease.
33
Typical clinical features of bronchiolitis?
• Exposure to older contact with mild respiratory infection • Paroxysmal or episodic cough • Poor feeding/refusal to feed • Wheezing (musical sound from narrowed airways) • Chest retractions, grunting, cyanosis • Fever (usually low-grade) • Hyperresonant percussion • Reduced breath sounds, prolonged expiratory rhonchi • Fine crepitations • Palpable, non-tender liver (diaphragm descent)
34
Investigations in bronchiolitis?
• Full blood count: usually normal • Chest X-ray: patchy atelectasis, hyperinflation (not routinely required) • Arterial blood gas: if severe • Pulse oximetry: monitor oxygen saturation • Rapid viral antigen/nucleic acid testing of nasal/pulmonary secretions (rarely done)
35
Differential diagnoses of bronchiolitis?
• Bronchial asthma: recurrent wheeze, positive family history, eosinophilia • Bacterial bronchopneumonia: high-grade fever, coarse crepitations, no rhonchi unless severe • Pertussis: paroxysmal cough, post-tussive vomiting • Foreign body aspiration • Gastroesophageal reflux disease (GERD)
36
Management principles of bronchiolitis?
Mainly supportive care: • Humidified oxygen for hypoxemia • Adequate fluids and calories • Nebulized hypertonic saline • Antibiotics only for secondary bacterial infection • Ribavirin by nebulization in select cases • Trial of bronchodilators (first-time wheezers) • Corticosteroids are controversial; combined nebulized epinephrine + dexamethasone may be used but not standard
37
Prophylaxis of bronchiolitis?
• Passive immunoprophylaxis with palivizumab (RSV monoclonal antibody) • Prevent child-to-child transmission in day care, hospitals, crowded settings
38
Prognosis of bronchiolitis?
• Generally good if treatment is instituted early • Most critical period: first 48–72 hours • Case fatality rate <1% • Death usually due to apnea, respiratory arrest, or severe dehydration
39
Which age group is most at risk for bronchiolitis?
Children < 2 years, peak incidence 2–10 months.
40
What is the most important initial intervention for a hypoxemic infant with bronchiolitis?
Administer humidified oxygen and monitor saturation.
41
Which features help differentiate bronchiolitis from bacterial pneumonia in a child?
Bronchiolitis: viral, low-grade fever, fine crepitations, wheezing, hyperinflation on CXR. Bacterial pneumonia: high-grade fever, coarse crepitations, focal consolidation.
42
Which of the following statements about bronchiolitis is FALSE?
C) Bacterial pneumonia is a common primary cause. (Trick: RSV is primary; bacterial confusion is secondary.)
43
The most likely pathogen in a 6-month-old infant with first episode wheezing in the rainy season is:
B) RSV
44
Which of the following clinical features is most characteristic of bronchiolitis?
B) Fine crepitations with prolonged expiratory wheeze
45
Which of the following interventions is CONTRAINDICATED in routine bronchiolitis management?
C) Corticosteroids
46
All of the following are risk factors for bronchiolitis EXCEPT:
C) Exclusive breastfeeding
47
Which CXR finding is typical of bronchiolitis?
B) Patchy atelectasis with hyperinflated areas
48
The most critical period for deterioration in bronchiolitis is:
B) First 48–72 hours
49
A 9-month-old presents with cough and wheezing. You suspect bronchiolitis. Which of the following would MOST likely differentiate it from asthma?
B) Exposure to older sibling with URTI (Trick: Age + viral exposure = bronchiolitis; recurrent attacks/family hx = asthma)
50
What is your provisional diagnosis?
Bronchiolitis
51
List three key clinical features you would examine for.
Chest retractions, Wheezing / expiratory rhonchi, Hyperresonant percussion
52
What vital signs are most important to check?
Respiratory rate, Oxygen saturation, Heart rate, Temperature
53
What investigations would you request immediately?
Pulse oximetry (mandatory), FBC (non-diagnostic, rule out bacterial infection), ABG if severe hypoxia or hypercapnia, CXR only if diagnosis uncertain or severe disease
54
What supportive management steps would you initiate at the bedside?
Humidified oxygen if SpO₂ < 90%, Adequate fluids/NG feeding if poor intake, Nasal suctioning, Nebulized hypertonic saline
55
Would you start antibiotics immediately? Why or why not?
No. Only if secondary bacterial infection is suspected (e.g., high-grade fever, toxic-looking child)
56
Parent asks about prognosis. What do you say?
Generally good; most recover with supportive care, Critical period is 48–72 hours, Case fatality <1%, death usually due to apnea or respiratory arrest
57
What prophylaxis can be offered to high-risk infants?
Palivizumab (RSV monoclonal antibody)
58
How do you differentiate bronchiolitis from bacterial pneumonia in the infant?
Bronchiolitis → low-grade fever, fine crepitations, wheezing, hyperinflation on CXR. Bacterial pneumonia → high-grade fever, coarse crepitations, consolidation on CXR.
59
How do you explain the cause of hypoxemia in bronchiolitis to parents?
Viral inflammation narrows bronchioles → impaired alveolar gas exchange → reduced oxygen in blood.
60
Which complication would make you escalate care immediately?
Apnea, persistent hypoxemia, respiratory failure, severe dehydration.
61
Age peak for bronchiolitis?
2–10 months
62
Gender predilection?
Male > Female (2:1)
63
Most common causative virus?
RSV (50–75%)
64
Seasonality?
Rainy season, cold harmattan months
65
First-line bedside management?
Humidified oxygen, fluids, suctioning
66
Contraindicated routine therapy?
Corticosteroids
67
When is ribavirin indicated?
Severe RSV infection or immunocompromised infants
68
How to differentiate asthma vs bronchiolitis?
Age <2, first episode, exposure to URTI = bronchiolitis; recurrent attacks/family atopy = asthma
69
Typical CXR?
Patchy atelectasis with hyperinflated lungs
70
Critical period for deterioration?
48–72 hours
71
Which of the following statements about bronchiolitis is FALSE?
C) Bacterial pneumonia is a common primary cause. (Trick: RSV is primary; bacterial confusion is secondary.)
72
The most likely pathogen in a 6-month-old infant with first episode wheezing in the rainy season is:
B) RSV
73
Which of the following clinical features is most characteristic of bronchiolitis?
B) Fine crepitations with prolonged expiratory wheeze
74
Which of the following interventions is CONTRAINDICATED in routine bronchiolitis management?
C) Corticosteroids
75
All of the following are risk factors for bronchiolitis EXCEPT:
C) Exclusive breastfeeding
76
Which CXR finding is typical of bronchiolitis?
B) Patchy atelectasis with hyperinflated areas
77
The most critical period for deterioration in bronchiolitis is:
B) First 48–72 hours
78
A 9-month-old presents with cough and wheezing. You suspect bronchiolitis. Which of the following would MOST likely differentiate it from asthma?
B) Exposure to older sibling with URTI (Trick: Age + viral exposure = bronchiolitis; recurrent attacks/family hx = asthma)
79
What is your provisional diagnosis?
Bronchiolitis
80
List three key clinical features you would examine for.
Chest retractions, Wheezing / expiratory rhonchi, Hyperresonant percussion
81
What vital signs are most important to check?
Respiratory rate, Oxygen saturation, Heart rate, Temperature
82
What investigations would you request immediately?
Pulse oximetry (mandatory), FBC (non-diagnostic, rule out bacterial infection), ABG if severe hypoxia or hypercapnia, CXR only if diagnosis uncertain or severe disease
83
What supportive management steps would you initiate at the bedside?
Humidified oxygen if SpO₂ < 90%, Adequate fluids/NG feeding if poor intake, Nasal suctioning, Nebulized hypertonic saline
84
Would you start antibiotics immediately? Why or why not?
No. Only if secondary bacterial infection is suspected (e.g., high-grade fever, toxic-looking child)
85
Parent asks about prognosis. What do you say?
Generally good; most recover with supportive care, Critical period is 48–72 hours, Case fatality <1%, death usually due to apnea or respiratory arrest
86
What prophylaxis can be offered to high-risk infants?
Palivizumab (RSV monoclonal antibody)
87
How do you differentiate bronchiolitis from bacterial pneumonia in the infant?
Bronchiolitis → low-grade fever, fine crepitations, wheezing, hyperinflation on CXR. Bacterial pneumonia → high-grade fever, coarse crepitations, consolidation on CXR.
88
How do you explain the cause of hypoxemia in bronchiolitis to parents?
Viral inflammation narrows bronchioles → impaired alveolar gas exchange → reduced oxygen in blood.
89
Which complication would make you escalate care immediately?
Apnea, persistent hypoxemia, respiratory failure, severe dehydration.
90
Age peak for bronchiolitis?
2–10 months
91
Gender predilection?
Male > Female (2:1)
92
Most common causative virus?
RSV (50–75%)
93
Seasonality?
Rainy season, cold harmattan months
94
First-line bedside management?
Humidified oxygen, fluids, suctioning
95
Contraindicated routine therapy?
Corticosteroids
96
When is ribavirin indicated?
Severe RSV infection or immunocompromised infants
97
How to differentiate asthma vs bronchiolitis?
Age <2, first episode, exposure to URTI = bronchiolitis; recurrent attacks/family atopy = asthma
98
Typical CXR?
Patchy atelectasis with hyperinflated lungs
99
Critical period for deterioration?
48–72 hours
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