Bronchiolitis

Question 1

stridor is pathognomonic for upper aiway ___

Answer 1

narrowing

Question 2

theres a tendency for the airway to ___ when you breathe in

Answer 2

inspiration

Question 3

wheeze is an ____ sounds due to intra-thoracic dynamic airway ___. such as:

Answer 3

wheeze is an EXPIRATORY sound due to intra-thoracic dynamic airway collapse.

• astham or bronchiolitis

Question 4

crackles are inspiratory or expiratory and are intermittent. sounds like ____

Answer 4

velcro

Question 5

If someone presents with RTI/bronchiolitis, who does poorly?

Answer 5

Question 6

huge factor that increases the number of infections/bronchiolitis per year

Answer 6

if they are in day care

Question 7

this to check on PE and history if you suspect a LTI or bronchiolitis

Answer 7

• can they complete sentences?
• vitals
• saturation
• RR and HR!

Question 8

normal resp rates for infants

Answer 8

30-60

Question 9

inspiratory muscle use/indications that there is labored breathing

expiratory muscles

Answer 9

inspiratory: nasal flare

scalenes and SCM

tripodding; pec pulls chest wall open

intercostals

expiratory: abdominal muscles

Question 10

definition of bronchiolitis

Answer 10

VIRAL infection of the lower respiatory tract characterized by inflammation, edema and necrosis of epithelial cells lining small airways, increased mucus production and bronchospasm

Question 11

epidemiology bronchiolitis

Answer 11

at 2 years, 90% have had RSV

Question 13

in addition to RSV, what other viruses cause bronchiolitis

Answer 13

human metapneumoviris, para influenzea, influenza, adenovirus

Question 14

bronchiolitis pathophysiology

Answer 14

mucus buildup and inflamed tissue. causes necrosis and loss of epithelium. constriction. smooth muscle tightens around bronchiole tubes. alveoli collapse

ex/ in RSV. major mucus and inflammation causes cell to sluff off (necrotize) and then clog everything up. Causes “synsytium”

Question 15

RSV clinical course of bronchiolitis

Answer 15

1. incubation period (2-8 days)
2. upper respiratory infection: 1-3 days
3. worsening lower airway disease: 3-5 days
4. full recovery: 2-8 weeks

Question 16

baby presents with wheeze. you suspect bronchiolitis and want to admit the child. what tests?

Answer 16

chest radiograph

blood gas

complete blood count

electrolyes

viral culture

Question 17

” for sure” treatment for bronchiolitis

Answer 17

oxygen and supportive care.

• there is less evidence for steroids and bronchodilators. some still give this.
• nebulized epi reduced day 1 admission rate, not much of an effect.

steroids+ epi-neb might reduce re-admission, but most still got admitted.

• no evidencce for antibiotics, anticholinergics.

Question 19

for kids with bronchiolitis who are really sick, you need to maintain adquate ____

Answer 19

adequate PEEP. Maintain airway patency at end expiration. prevents airway collapse. gives inspiratory pressure and maintains resistance on airway to prevent collapse.

Question 20

RSV link to chronic resp disease

Answer 20

rsv may increase risk of long tem asthma.

Question 21

differentiating astham vs bronchioloitis

Answer 21

• is wheeze lasts over 9 months, think astham.
• this is important to differentiate because asthma can be treated by long term inhaled cortcosteroids, whereas there is no benefit to steroids for bronchiolitis

Question 22

R