Acute Bronchiolitis Clinical Case Quiz
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Questions and Answers

Which virus is responsible for 50% - 75% of acute bronchiolitis cases?

  • Respiratory syncytial virus (RSV) (correct)
  • Influenza virus
  • Adenovirus
  • Rhinovirus

    • What age group is commonly affected by acute bronchiolitis?

  • Adolescents
  • Children over 5 years of age
  • Adults
  • Children under 2 years of age (correct)

    • Which factor is NOT associated with an increased risk of acute bronchiolitis?

  • Exclusively breastfed children (correct)
  • Attending day care centers
  • Exposure to cigarette smoke
  • Gender (commoner in Males 2:1)

    • What is the main cause of reduced air flow in the bronchioles of babies living in crowded conditions?

    <p>Oedema of bronchiolar mucosa</p> Signup and view all the answers

    What is the immediate consequence of complete obstruction in the bronchioles?

    <p>Athelectasis</p> Signup and view all the answers

    What is the primary reason for infants being most affected by this condition?

    <p>Small airways</p> Signup and view all the answers

    Which symptom is commonly associated with this condition as a result of critical chest retraction?

    <p>Grunting</p> Signup and view all the answers

    What is a common finding in the CXR of babies with this condition?

    <p>Patchy atelectasis with hyper inflated areas</p> Signup and view all the answers

    What is a recommended treatment for hypoxemic children with this condition?

    <p>Nebulised hypertonic saline</p> Signup and view all the answers

    What is a possible prophylactic measure for preventing child-to-child transmission of this condition, particularly in hospitals or day care settings?

    <p>Periodic passive immunoprophylaxis with RSV monoclonal antibody</p> Signup and view all the answers

    What is the prognosis generally like for babies with this condition, and during which period is it most critical?

    <p>Critical during the neonatal period</p> Signup and view all the answers

    Acute bronchiolitis predominantly affects children over 5 years of age.

    <p>False</p> Signup and view all the answers

    Respiratory syncytial virus (RSV) is responsible for 50% - 75% of acute bronchiolitis cases.

    <p>True</p> Signup and view all the answers

    Exclusively breastfed children are less susceptible to acute bronchiolitis.

    <p>False</p> Signup and view all the answers

    Exposure to cigarette smoke is not a risk factor for acute bronchiolitis.

    <p>False</p> Signup and view all the answers

    Acute bronchiolitis is primarily caused by bacterial infection of the distal bronchi and bronchioles.

    <p>False</p> Signup and view all the answers

    Babies living in crowded conditions are at higher risk for developing acute bronchiolitis due to exposure to an older contact with a minor respiratory syndrome within the previous week.

    <p>True</p> Signup and view all the answers

    Babies with acute bronchiolitis may present with poor feeding or refusal to feed.

    <p>True</p> Signup and view all the answers

    A chest X-ray (CXR) is typically not necessary for diagnosing acute bronchiolitis.

    <p>True</p> Signup and view all the answers

    The use of corticosteroids in the treatment of acute bronchiolitis is widely accepted and uncontroversial.

    <p>False</p> Signup and view all the answers

    Acute bronchiolitis can be prevented through periodic passive immunoprophylaxis with RSV monoclonal antibody (Palivizumab).

    <p>True</p> Signup and view all the answers

    The case fatality rate for acute bronchiolitis is generally high.

    <p>False</p> Signup and view all the answers

    Babies with acute bronchiolitis may present with prolonged expiratory rhonchi.

    <p>True</p> Signup and view all the answers

    Match the following viruses with their association to acute bronchiolitis:

    <p>Respiratory syncytial virus (RSV) = 50% - 75% of cases Parainfluenza viruses = Especially type 3 Adenoviruses = Associated with acute bronchiolitis Rhinovirus = Linked to acute bronchiolitis</p> Signup and view all the answers

    Match the following epidemiologic risk factors with their association to acute bronchiolitis:

    <p>Age = Common in children under 2 years of age Gender = Commoner in Males 2:1 Breast feeding = Common in children not exclusively breastfed Seasonal Factors = Common during rainy season and cold harmattan months</p> Signup and view all the answers

    Match the following symptoms with their association to acute bronchiolitis:

    <p>Noisy breathing worse at night = Associated symptom Intercostal recession = Linked to acute bronchiolitis Pedal oedema = Not observed in acute bronchiolitis Poor feeding or refusal to feed = Possible presentation in acute bronchiolitis</p> Signup and view all the answers

    Match the following prophylactic measures with their association to preventing acute bronchiolitis transmission:

    <p>Passive immunoprophylaxis with RSV monoclonal antibody (Palivizumab) = Preventive measure Exclusively breastfed children = Less susceptible to acute bronchiolitis Chest X-ray (CXR) = Not typically necessary for diagnosis of acute bronchiolitis Corticosteroids = Not widely accepted treatment for acute bronchiolitis</p> Signup and view all the answers

    Match the following pathophysiological features with their effects in acute bronchiolitis:

    <p>Viral infection of distal bronchi and bronchioles causes mucous secretion, necrosis of respiratory epithelium, and oedema of bronchiolar mucosa = Reduction in the size of bronchioles' lumen with subsequent resistance to airflow Impairment of normal gaseous exchange at the alveolar level = Ventilation perfusion mismatch leading to hypoxemia early in the disease and hypercapnia later Complete obstruction in the bronchioles = Atelectasis results Incomplete obstruction in the bronchioles = Air trapping and hyperinflation</p> Signup and view all the answers

    Match the following clinical features with their presentation in acute bronchiolitis:

    <p>Episodic or paroxysmal cough = Infants affected most often due to their small airways Chest retraction = Fever which is usually low grade Reduced breath sounds = Prolonged expiratory rhonchi Grunting = Cyanosis</p> Signup and view all the answers

    Match the following investigations with their diagnostic or monitoring purposes in acute bronchiolitis:

    <p>FBC (not diagnostic, WBC and differential counts are usually normal) = Not routinely requested CXR (shows patchy atelectasis with hyperinflated areas) = Not necessary for diagnosing acute bronchiolitis Arterial Blood Gas = Pulse oximetry Rapid viral antigen or nucleic acid amplification testing of nasal or pulmonary secretions = Diagnostic testing</p> Signup and view all the answers

    Match the following differential diagnoses with their distinguishing features from acute bronchiolitis:

    <p>Bronchial Asthma = Recurrent attacks, positive family history, eosinophilia in blood Bacterial bronchopneumonia = High grade fever, no rhonchi except in severe illness, coarse creps Pertussis = - Foreign body aspiration = -</p> Signup and view all the answers

    Study Notes

    Acute Bronchiolitis

    • Respiratory syncytial virus (RSV) is responsible for 50% - 75% of acute bronchiolitis cases.
    • Acute bronchiolitis commonly affects infants under 1 year of age.
    • Exclusively breastfed children are less susceptible to acute bronchiolitis.
    • Exposure to cigarette smoke is a risk factor for acute bronchiolitis.

    Pathophysiology

    • Reduced air flow in the bronchioles of babies living in crowded conditions is mainly caused by viral infection.
    • Complete obstruction in the bronchioles leads to respiratory failure.
    • Infants are most affected by this condition due to their narrow airways and immaturity of the immune system.

    Clinical Features

    • Critical chest retraction is often associated with nasal flaring and grunting.
    • Babies with acute bronchiolitis may present with poor feeding or refusal to feed.
    • Prolonged expiratory rhonchi may be present.

    Diagnosis and Treatment

    • A chest X-ray (CXR) is not typically necessary for diagnosing acute bronchiolitis.
    • Oxygen therapy is a recommended treatment for hypoxemic children with this condition.
    • Corticosteroids are not widely accepted for the treatment of acute bronchiolitis.

    Prophylaxis and Prevention

    • Periodic passive immunoprophylaxis with RSV monoclonal antibody (Palivizumab) is a possible prophylactic measure for preventing child-to-child transmission of this condition.
    • Avoiding crowded conditions and improving ventilation can reduce the risk of acute bronchiolitis.

    Prognosis

    • The prognosis for babies with acute bronchiolitis is generally good, with most Recovering within 1-2 weeks.
    • The most critical period is usually the first few days after onset.

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    Description

    Test your knowledge of acute bronchiolitis with this clinical case quiz featuring a 12-month-old boy presenting with cough, fever, and noisy breathing. Explore the patient's history, examination findings, and possible diagnosis.

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