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Bronchiolitis — MRCPCH FOP MCQ

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ModerateRespiratoryBronchiolitisMRCPCH FOP

A 4-month-old boy is on day 4 of coryzal symptoms and cough. He is feeding half his usual volume, has moderate subcostal recession, respiratory rate 64/min and oxygen saturations 88% in air. What is the most likely cause?

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Correct answer: C — Viral inflammation and oedema of the small airways

The age, coryzal prodrome, feeding difficulty, recession and hypoxia are typical of bronchiolitis, caused by viral inflammation, oedema and mucus in the small airways. Asthma-like IgE-mediated bronchospasm is less likely in a 4-month-old with classic bronchiolitis. Focal bacterial pneumonia would usually give focal signs rather than diffuse bronchiolitic features. The pearl is that bronchiolitis severity is judged by feeding, work of breathing and oxygenation.

Reference: NICE NG9 Bronchiolitis in children