A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 3-month-old male infant, born at term, presents to the emergency department in February with a 2-day history of cough, wheezing, and decreased feeding. His temperature is 37.5°C (99.5°F), heart rate is 160/min, and respiratory rate is 50/min with intercostal retractions. Oxygen saturation is 92% on room air. The mother reports that an older sibling recently had a 'bad cold.' Which of the following is the most appropriate next step in management for this patient?
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A
Initiation of high-flow nasal cannula oxygenCorrect. High-flow nasal cannula supports hypoxemic infants with RSV bronchiolitis and reduces intubation need.
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B
Immediate intubation and mechanical ventilationIncorrect. Immediate intubation is premature when noninvasive oxygen support has not been trialed.
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C
Use of bronchodilator nebulizationIncorrect. Bronchodilators are not routinely recommended in bronchiolitis as they show no consistent benefit.
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D
Admission for intravenous antibioticsIncorrect. IV antibiotics are unnecessary without evidence of secondary bacterial infection.
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E
Administration of inhaled corticosteroidsIncorrect. Inhaled corticosteroids are not recommended for acute bronchiolitis management.
↑ Tap an answer to reveal the reasoning
Answer: A. The infant likely has bronchiolitis, commonly caused by RSV, presenting with cough, wheezing, and respiratory distress. High-flow nasal cannula oxygen is appropriate for hypoxemia and respiratory support. Inhaled corticosteroids and bronchodilators are not routinely recommended for bronchiolitis. Intravenous antibiotics are not indicated without bacterial infection signs. Intubation is premature unless the patient fails high-flow oxygen.