Review Question - QID 102585

This patient’s presentation is consistent with bronchiolitis given his cough, runny nose, increased work of breathing, and wheezing/crackles on exam. In a patient with a classic history, no further testing is needed.

Bronchiolitis typically presents in young children during the winter with a cough, runny nose, increased work of breathing, and "dishwasher lung exam" corresponding to crackles and wheezing throughout all lung fields. Inflammation of the smaller airways of the lower respiratory tract results in expiratory wheezing and subsequent increased work of breathing which can manifest as suprasternal retractions, intercostal retractions, and abdominal breathing. The diagnosis of bronchiolitis in a patient with a classic presentation can be confirmed clinically. Treatment is monitoring and supportive therapy.

Incorrect Answers:
Answer 1: Chest radiograph is not indicated in the management of bronchiolitis; however, it could be indicated in the management of pneumonia which presents with a fever, cough, and increased breath sounds over the pneumonia.

Answer 3: Polymerase chain reaction may be used to confirm the diagnosis but is not indicated routinely as it is a very costly test that does not change management.

Answer 4: Sputum culture may be indicated in the workup of pneumonia if a patient is being treated with antibiotics but not improving, and a source and sensitivities are needed.

Answer 5: Viral culture is generally not performed in bronchiolitis and would not change management of this condition.

Bullet Summary:
Bronchiolitis with a classic presentation can be diagnosed clinically and requires no further diagnostic tests.