Resp - bronchiolitis\

Question 1

what is bronchiolitis

Answer 1

viral infection of the bronchioles

Question 2

mc causative organism for bronchiolitis

Answer 2

respiratory syncytial virus (RSV)

Question 3

what age does bronchilotis affect

Answer 3

usually affects children under the age of 2.

mainly in winter and spring months

Question 4

what physiological changes occur in response to viral infection in the bronchioles

Answer 4

Proliferation of goblet cells causing excess mucus production

IgE-mediated type 1 allergic reaction causing inflammation

Bronchiolar constriction

Infiltration of lymphocytes causing submucosal oedema

Infiltration of cytokines and chemokines

Question 5

what causes the clinical features present in bronchiolitis

Answer 5

The combination of mucus, oedema and increased cells in the bronchioles leads to a ball-valve effect resulting in hyperinflation, increased airway resistance, atelectasis and ventilation-perfusion mismatc

Question 6

RF for bronchilotis

Answer 6

Being breast fed for less than 2 months

Smoke exposure
Having siblings who attend nursery or school (increased risk of exposure to viruses)

Chronic lung disease due to prematurity

Question 7

symptoms of bronchilotis

Answer 7

increasing symptoms over 2-5 days,
Low-grade fever
Nasal congestion
Rhinorrhoea
Cough
Feeding difficulty

Question 8

clincial findings on examination of bronchilitis

Answer 8

Tachypnoea
Grunting
Nasal flaring
Intercostal, subcostal or supraclavicular recessions
Inspiratory crackles
Expiratory wheeze
Hyperinflated chest
Cyanosis or pallor

Question 9

ddx for bronchilotis

Answer 9

pneumonia
croup
heart failure
bronchitis

Question 10

investigations for bronchiolitis

Answer 10

pulse oximetry
Nasopharyngeal aspirate or throat swab for RSV
blood and urine culture
FBC
ABG
Chest x ray

Question 11

features seen on bronchiolitis chest x ray

Answer 11

Hyperinflation
Focal atelectasis
Air trapping
Flattened diaphragm
Peribronchial cuffing

Question 12

how to manage bronchiolotis at home

Answer 12

fluids, good nutrition and temperature control

Question 13

when shpuld urgent hospial referral be made for bronchiolitis

Answer 13

Apnoea
Child looks seriously unwell
Severe respiratory distress eg. grunting, marked recessions, respiratory rate >70
Central cyanosis
Oxygen sats < 92%

Question 14

treatment of bronchiolitis in hospital

Answer 14

Give oxygen if sats < 92% in room air

Give fluids via nasogastric or orogastric tube if inadequate oral intake

Consider CPAP if there is impending respiratory failure

Perform upper airway suctioning if there are upper airway secretions or apnoea

Question 15

when should non urgent hospital admission be made for bronchiolitis

Answer 15

Resp Rate > 60
- Clinical dehydration

Question 16

complications of bronchiolitis

Answer 16

Hypoxia
Dehydration
Fatigue
Respiratory failure
Persistent cough or wheeze
Bronchiolitis obliterans

Question 17

how long does bronchilotis last

Answer 17

usually lasts 7-10 days
Most children who require hospital admission can cough for up to 6 weeks,

Question 18

signs of respiratory distress

Answer 18

Raised respiratory rate
Accessory muscle use (e.g., sternocleidomastoid, abdominal and intercostal muscle use)
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tug
Grunting