Pbr Bronchiolitis 1

Front 1

What’s most common respiratory illness in infants in first year of life

Back 1

RSV - bronchiolitis

Front 2

What are risk factors for development of apnea w/ viral bronchiolitis?

Back 2

Young age, premie, h/o apnea of prematurity;
Others: Low birth wt; day care; lack of breast feeding; school age siblings; mutlitple births; passive smoke exposure; birth w/in 6 mo of RSV season

Front 3

How is RSV transmitted?

Back 3

Direct inoculation of virus onto naal or ocular mucous membrane not by exposure to airborne virus

Front 4

Know pathologic findings of infectious bronchiolitis

Back 4

-nectrosis of cilated cells/ proliferation of nonciliated cells (lymphs, plasma cells, macrophages) in peribronchial area
-submucosal edema, congestion; mucous plugs; impaired secretion clearance
-airway wall thickening; interstitial edema

Front 5

What does hypoxemia ~ bronchiolitis occur

Back 5

Due to v/p mismatch

Front 6

What’s a late finding of pts w/ viral bronchiolitis?

Back 6

CO2 retention

Front 7

When do most toddlers have immunity to RSV?

Back 7

By 2 yo

Front 8

When is most outbreaks of RSV?

Back 8

Late fall (nov) –spring (april)

Front 9

What’s average incubation period? What isit for infants?

Back 9

Avg: 5 days; infants – 2 weeks

Front 10

What are infants dx w/ RSV bronchiolitis later in life at risk for ?

Back 10

Wheezing and decreased PFTs; may pre-dispose to asthma

Front 11

What are sx of bronchiolitis?

Back 11

Fever; URI sx w/ nasal congestion and cough – abrupt onset of LRT sx by 2-3 days; irritable w/ progressive feeding difficutly
-RTx; tacky; cyanosis; HPM; aspiration

Front 12

Why does hypercarbia occur?

Back 12

Expansion of dead space/tidal volume ratio and respiraotyr muscle fatigue

Front 13

What are predictors of severe bronchiolitis?

Back 13

6: ill or toxic looking; RR > 70; O2 sats < 95%**; GA <34 wks; younger than 3 mo
**single best predictor

Front 14

What are CXR findings of bronchiolitis?

Back 14

Hyperinflation; increased AP diameter; peribronchial thickening; lobar or segmental atelectasis(esp RUL); diffuse interstitial infiltrate

Front 15

What’s lung response to bronchiolitis?

Back 15

Increased FRC, airway resistance, and dead space; Decreased compliance

Front 16

What’s lung response to bronchiolitis?

Back 16

Increased FRC, airway resistance, and dead space; Decreased compliance

Front 17

How do you prevent RSV transmission?

Back 17

*maximal hand washing, limit contacts;
-transmission via: droplets, large particles, fomites;
(lasts 8 hrs on stethoscope), hands

Front 18

What’s gold standard dx tests? And when should u test?

Back 18

Viral cultures; also can do PCR assay;
-test: shoulder months; < 2 months w/ Fever/resp sx; palvizmab baby; immunocompromised infant

Front 19

RSV infected mice release what from where?

Back 19

Release pro-inflammatory neuropeptide substance P from sensory nerve fibers

Front 20

Expression of what receptor increases during rSV infx?

Back 20

Neurokinin 1

Front 21

When would u start O2?

Back 21

Hypoxemi in RO with SaO2 < 92%;
-younger than 6 mo;
-can’t maintain oral hydration; severe resp distress (tachypnea, tacky)
-h/o cardiopulm diz;
-apnea

Front 22

When would u use steroids and antbx?

Back 22

Rarely indicated for infants w/ uncomplicated viral bronchiolitis

Front 23

What SE do bronchodilators do ?

Back 23

Promote tacky and ventilation perfusion mismatch

Front 24

What is palvizumab

Back 24

Humanized monoclonal ab made by recombinant DNA; directed to an epitpe in the A antigenic site of F protein of RSV

Front 25

What are high risk infants that shud get palvizumab?

Back 25

-kids < 2 w/ CLD (BPD)
-premies:
-born < 28 wks GA- < 12 mo at start of RSV season
- 29-32 wks GA; < 6 mo start of RSV
-32-35 wks GA, < 3 mo at start of RSV AND 1 risk factor: Daycare or siblings < 5

Front 26

When does viral pneumonias occur?

Back 26

Fall/winter; esp parinflu 1

Front 27

What’s most common cause of viral lower resp tract infx in neonates?

Back 27

Enterovirus; then rsv; cmv

Front 28

What are sx of adnovirual bronchiolitis?

Back 28

Hi fever, pharyngoconjunctival fever;
-breatkout: summer camps; pools;
-later developed: lobar PNA and/or atelectasis with recurrent pneumonias over time

Front 29

What ethnic groups are susceptible to complx of adenoviral bronchiolitis?

Back 29

Native American infants and kids in Canada

Front 30

Which virus is commonly seen in school age kids w/ Lower resp trac sc?

Back 30

Parainflu

Front 31

What ages are adeno usu seen?

Back 31

< 4,5

Front 32

What viruses cause LRTI in immunocompromised kdis?

Back 32

CMV; EbV; HSV; HIV; varicella

Front 33

Which virus causes intracellular inclusion bodies on staining?

Back 33

Cmv

Front 34

Rapid ag tests are available for which viruses?

Back 34

rSV, parinflu 1,2,3; influ A, B; HMPV; and adeno

Front 35

How does albuterol worsen/cause hypoxemia?

Back 35

By overperfusing poorly ventilated regional lung units resulting in V/Q mismatch

Front 36

What’s treatment for LTRI?

Back 36

IVF for dehydration; bronchodilators for kids w/ wheezing and asthma;

Front 37

What meds are available for prevention and treatment of flu?

Back 37

Oseltamivr; ramantidiine; zanamivir

Front 38

What med is indicated for congenital cmv and viral pneumonitis in bone marrow transplant patients?

Back 38

Ganciclovir; decreases viral shedding; prevents hearing loss @ 6 mo