Clin Med Bronchitis, Bronchiolitis, Croup

Question 1

Type of course for viral respiratory bronchitis

Answer 1

self-limiting

Question 2

What are common viruses that cause acute bronchitis

Answer 2

Influenza
parainfluenza
coronavirus
rhinovirus

Question 3

How often is acute bronchitis caused by bacterial infection

Answer 3

not really ever

*exception in airway abnormalities like intubation and tracheostomy

Question 4

How long can acute bronchitis cough last

Answer 4

1-2 weeks, up to 4-6 weeks

Question 5

acute bronchitis S&S

Answer 5

1. cough (w/ or w/o sputum)
2. upper airway congestion, rhinitis, chest congestions
3. wheezing secondary to bronchospasm
4. rhonchi - clears with cough

Question 6

Bronchitis vs. pneumonia

• fever
• system sx
• breath sounds
• percussion findings
• labs

Answer 6

Bronchitis:

• afebrile
• lack of systemic sx
• rhonchi, clear with cough
• percussion/egophany normal
• unremarkable labs typically

Pneumonia

• febrile
• chills, rigors, lack of appetite
• rhonchi, rales, decreased breath sounds
• dullness to percussion due to consolidation
• abnormal labs

Question 7

How to dx. acute bronchitis

Answer 7

mostly clinical, no lab or radiology usually needed

Question 8

Great way to distinguish between acute bronchitis and pneumonia?

Answer 8

CXR

• bronchitis: perihilar congestion, non-specific findings
• pneumonia: consolidations and interstitial infiltrate

Question 9

When to order a CXR for respiratory issue?

Answer 9

Abnormal vital signs:

• tachycardia >100
• tachypnea >20
• Febrile >100.5F
• Hypoxia <92%

Question 10

Two labs can be run for acute bronchitis

Answer 10

• CBC but imperfect test, high or low don’t make dx

- procalitonin - helps determine viral vs. bacterial etiology, released in bacterial infections, not usually used…

Question 11

Symptomatic tx of acute bronchitis

Answer 11

1. NSAIDS
2. Decongestants
3. Antihistamines
4. Antitussives
5. Mucolytics
6. Bronchodilators
7. Steroids

**differs slightly from Dr. Letassy

Question 12

Should use Abx to tx acute bronchitis?

Answer 12

NO

• unless old/infirm
• artificial airway (tracheostomy)
• sx for more than 10 days

Question 13

What are common upper respiratory pathogens

Answer 13

S. pnuemonia
H. Flu
M. cat

Question 14

Bronchiolitis

• def
• results in what

Answer 14

Lower respiratory tract infection

- results in edema and mucous accumulation of small distal airways

Question 15

Bronchiolitis etiology

Answer 15

Viral most common:

• RSV
• Rhinovirus
• Parainfluenza

Question 16

Bronchiolitis most common population? when?

Answer 16

• Infants and children <2 yr

- fall and winter

Question 17

Bronchiolitis risk factors

Answer 17

• premature <37 weeks
• <12 weeks old
• congenital dz
• immunocompromised

Question 18

Bronchiolitis pathogenesis

Answer 18

• Terminal bronchiolar epithelial cells are damaged by virus
• Inflammation of small bronchi and bronchioles
• Edema, mucous, sloughed epithelial cells crowd airway - obstruction

Question 19

Bronchiolitis

- clinical features

Answer 19

• typically starts as URI sx (rhinorrhea, congestion, cough)

- sx progress to fever, cough, respiratory distress

Question 20

Signs of respiratory distress

Answer 20

• wheezing (inspiration and expiration)
• crackles
• retractions (intercostal, supraclavicular, abdominal breathing)
• nasal flaring/grunting
• Tachypnea (50-70!!!)

Question 21

Bronchiolitis associated complications

Answer 21

• dehydration

- respiratory failure

Question 22

How to dx Bronchiolitis

Answer 22

CXR

• usually only used on severe cases
• patchy infiltrate with perihilar congestion
• peribronchial cuffing (KNOW THIS ONE)

Lab
- RSV rapid antigen tests (quick, easy, nasopharyngeal swab)

Question 23

Bronchiolitis

- how to assess severity

Answer 23

Frequent re-eval to assess improvement or decompensation

Question 24

Bronchiolitis indications for hospitalization

Answer 24

• toxic appearance, lethargy, dehydration
• mod-severe respiratory distress
• hypoxia/need for supplemental O2

Question 25

Bronchiolitis | - Non-severe case tx

Answer 25

Symptomatic tx - nasal suctioning (very common) - up fluids, monitor I&O - Tylenol/ibuprofen for fever

Question 26

Bronchiolitis what 2 drugs are not indicated

Answer 26

albuterol | steroids

Question 27

Bronchiolitis | - how long do sx last

Answer 27

3-5 days | self-limiting

Question 28

Bronchiolitis | - severe treatment

Answer 28

- Albuterol nebulized solution (2.5mg - 5mg) - Nebulized hypertonic saline: secretion mobilization - supplemental O2, intubation if necessary - supportive care: IV, nutrition, monitorin

Question 29

What is not indicated for severe Bronchiolitis tx but is often used

Answer 29

Oral steroids: - Decadron (dexamethasone) - Orapred (prednisone)

Question 30

Bronchiolitis prevention

Answer 30

- standard precautions (hand washing, etc.) | - immunoprophylaxis: Palivizumab

Question 31

Palivizumab - what is it - reserved for what population

Answer 31

- humanized monoclonal antibody vs. RSV glycoprotein | - premature infants and children or who have bronchopulmonary dysplasia

Question 32

Croup | - def

Answer 32

Variety of upper respiratory conditions that produce a characteristic cough, inspiratory stridor, hoarseness

Question 33

Croup - etiology - common population - when

Answer 33

- Most often viral, parainfluenza most common virus - children 3-36 months - fall and winter months

Question 34

Croup | - length of illness

Answer 34

3 days

Question 35

Croup | - clinical feature

Answer 35

Anatomical narrowing of trachea in subglottic region of upper airway

Question 36

Croup S&S

Answer 36

- barking cough - stridor (inspiratory) - congestion, rhinorrhea, fever - respiratory distress

Question 37

What used to score severity of croup?

Answer 37

Westley Croup Score - determines score: mild, moderate, severe, impending respiratory failure - gives guidelines of action based on score

Question 38

What are the 5 criteria used in Westley Croup score?

Answer 38

1. LOC 2. Cyanosis 3. Stridor 4. Air Entry 5. Retractions

Question 39

How to dx croup

Answer 39

Don't need CXR | - CXR will show "steeple" sign (subglottic airway narrowing)

Question 40

How to treat mild croup

Answer 40

symptomatically - cool mist humidifiers - fever reduction - oral fluids - cool air (freezer/outside) Decadron (Dexamethasone) - long half life = only need one dose

Question 41

Decadron/dexamethasone dose

Answer 41

0.6 mg/kg | max 10 mg

Question 42

How to tx moderate to severe croup

Answer 42

- Decadron/Dexamethasone - Nebulized (racemic) epinephrine - intubation if respiratory failure likely - symptomatic control (O2, fluids, cool mist)

Question 43

Nebulized racemic epinephrine dose

Answer 43

0.05 ml/kg per dose | max 0.5 ml

Question 44

Nebulized racemic epinephrine dose | - what is it

Answer 44

systemic alpha and beta adrenergic agonist | - relaxation of smooth muscles of bronchial tree (beta 2 activation)

Question 45

Nebulized racemic epinephrine dose monitoring

Answer 45

half life only 1-2 hrs | must monitor to watch for rebound effects

Question 46

How to distinguish Croup from epiglottis from retropharyngeal abscess - fever

Answer 46

Croup - sometimes epiglottitis - yes abscess - sometimes

Question 47

How to distinguish Croup from epiglottis from retropharyngeal abscess - barking cough

Answer 47

Croup - yes epiglottitis - no abscess - no

Question 48

How to distinguish Croup from epiglottis from retropharyngeal abscess - difficulty swallowing

Answer 48

Croup - no epiglottitis - yes abscess - yes

Question 49

How to distinguish Croup from epiglottis from retropharyngeal abscess - drooling

Answer 49

Croup - no epiglottitis - yes abscess - yes

Question 50

How to distinguish Croup from epiglottis from retropharyngeal abscess - throat pain

Answer 50

Croup - no epiglottitis - yes abscess -yes

Question 51

How to distinguish Croup from epiglottis from retropharyngeal abscess - trismus (lockjaw)

Answer 51

Croup - no epiglottitis - no abscess - yes