Bronchiolitis and Pneumonia

Chapter 109 Bronchiolitis and Pneumonia




Clinical Case Problem 1: A 4-Month-Old with Cough, Fever, and Wheezing


A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3   days, but symptoms worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35   weeks but was discharged home after 3   days. Birth weight was 7 pounds, and maternal group B strep was negative. Immunizations are current.


Vital signs include a rectal temperature of 100.8° F, pulse of 120 beats/minute, blood pressure within normal limits, and respiratory rate of 60 breaths/minute. The infant is well hydrated but appears ill. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical examination. Chest radiographs show patchy atelectasis and hyperinflation of the lungs.



Select the best answer to the following questions




1. Which statement regarding management of this condition is true?


a. bronchodilators provide a consistent benefit for this illness

b. corticosteroids are routinely indicated for initial management

c. ribavirin should not be used routinely in this condition

d. intravenous fluids are required for infants younger than 1 year

e. chest physiotherapy provides proven benefit for this condition

2. The most common cause of bronchiolitis is


a. human metapneumovirus

b. adenovirus

c. parainfluenza virus

d. respiratory syncytial virus (RSV)

e. influenza virus

3. Which of the following statements about RSV is untrue?


a. diagnosis is most often made by clinical examination

b. infection with RSV confers lifelong immunity in healthy individuals

c. 90% of children are infected with RSV within the first 2   years of life

d. the highest incidence of infection occurs between December and March

e. mortality from RSV has decreased during the past two decades

4. All except which of the following are associated with increased risk of severe bronchiolitis?


a. premature birth (gestational age <37   weeks)

b. bronchopulmonary dysplasia

c. cystic fibrosis

d. immunocompromised status

e. hemodynamically insignificant atrial septal defect

5. Pathologic features of acute bronchiolitis include all of the following except


a. necrosis of respiratory epithelial cells

b. lymphocytic infiltration of the peribronchial tree

c. increased clearance of mucus

d. destruction of epithelial ciliated cells

e. mucous plugging with small airway obstruction

6. In which of the following patients is palivizumab not indicated?


a. 3-month-old boy born at 39   weeks of gestation with tetralogy of Fallot

b. 2-month-old girl born at 28   weeks of gestation

c. 1-month-old girl born at 33   weeks of gestation with no current health issues

d. 2-month-old boy born at 34   weeks of gestation who is in daycare and has school-aged siblings

e. 2-month-old boy born at 30   weeks of gestation with bronchopulmonary dysplasia requiring oxygen therapy

7. Which of the following statements regarding antibiotic use in bronchiolitis is true?


a. use of antibiotics is recommended in all infants younger than 3 months

b. antibiotics are likely to benefit infants with severe bronchiolitis who require mechanical ventilation

c. there is an elevated risk of bacteremia in febrile children with bronchiolitis

d. numerous randomized controlled trials (RCTs) support the use of antibiotics for bronchiolitis

e. antibiotics significantly improve the clinical course of bronchiolitis


Clinical Case Problem 2: A 3-Year-Old with Fever, Cough, and Wheezing


A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4   days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to daycare during the week. There are no sick contacts.


On physical examination, he has a temperature of 38.5°   C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung examination. Localized rales and wheezing are noted over the right lower lung zones.



8. Which of the following interventions provides the most useful information at this time?


a. chest radiograph

b. pulse oximetry

c. complete blood count with differential

d. rapid antigen tests for influenza A and B

e. C-reactive protein level

9. Which of the following statements about childhood pneumonia is true?


a. pneumonia accounts for approximately 5% of childhood deaths worldwide

b. 1.9 million children worldwide die annually of acute respiratory tract infections

c. the majority of deaths from childhood community-acquired pneumonia (CAP) occur in Central and South America

d. human immunodeficiency virus (HIV) has a minor influence on the incidence and severity of childhood pneumonia

e. conjugated pneumococcal vaccines are ineffective in children younger than 5 years

10. Which of the following statements about CAP in neonates is false?


a. group B streptococci and gram-negative enteric bacteria are the most common pathogens

b. infection occurs by vertical transmission

c. nontoxic neonates may be managed as outpatients with close follow-up

d. intravenous ampicillin plus gentamicin is recommended antibiotic therapy

e. blood, urine, and cerebrospinal fluid should be obtained before antibiotic therapy is begun

11. What is the most common bacterial cause of CAP after the neonatal period?


a. Streptococcus pneumoniae

b. Haemophilus influenzae type b

c. Staphylococcus aureus

d. Moraxella catarrhalis

e. Mycoplasma pneumoniae

12. Which of the following signs is (are) suggestive of hypoxemia?


a. inability to feed

b. altered mental status

c. cyanosis

d. head nodding

e. all of the above

13. Which of the following statements is true regarding CAP in infants older than 4   months and preschool-aged children?


a. bacterial infections are the most common cause of CAP in this age group

b. bacterial infections most frequently occur during the winter

c. fever, arthralgia, and cough in a school-aged child suggest pneumococcal pneumonia

d. viral pneumonia is most frequent in the spring

e. withholding of antibiotic treatment is appropriate if a virus is suspected and close follow-up is possible

14. Which of the following statements about antibiotic therapy in CAP is true?


a. antibiotic therapy should be continued for a total of 5 days

b. follow-up of patients treated as outpatients is required within 1 week

c. a transition to oral antibiotics is appropriate after 48 hours of intravenous antibiotics

d. the choice of antibiotics for children with CAP is generally made on an empirical basis

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Bronchiolitis and Pneumonia

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