The Sound Of Stridor
A 2-week-old infant presents with inspiratory stridor. It is much worse when the child is upset. What is the most likely diagnosis?
Laryngomalacia.
A 15 y/o M with a current history of active influenza A presents with abrupt onset of fever, tachypnea, tachycardia, and cyanosis. CXR shows distinct pneumatoceles. What is the most likely bacterium causing this illness?
Staph aureus
In the last 4 weeks, a 6 y/o F has had 2 episodes of wheezing and coughing at night, requiring albuterol treatment. Is her asthma well controlled?
No. The criteria for asthma control are strict for children < 12 years of age. Well-controlled asthma for this age range is defined as ≤ 2 episodes per week during the day and/or ≤ 1 episode per month during the night.
A 3 y/o M with cerebral palsy and seizure disorder presents with chronic cough, wheezing, and recurrent pneumonia. What is the most likely underlying cause?
Chronic aspiration
In October, a 2 y/o M presents with a high-pitched, barking cough, inspiratory stridor, and subglottic narrowing on anteroposterior neck x-ray. What is the diagnosis?
Viral Croup (aka laryngotracheobronchitis)
An 8 y/o M presents with abrupt onset of high fever, cough, chills, and chest pain with dyspnea. On exam, decreased breath sounds over the right middle lobe; SpO2 87% in room air. What is the most likely bacterium causing this illness?
Strep pneumo.
A 2 y/o M presents acutely with choking, coughing, wheezing, diminished breath sounds on the right. Normal CXR. What is the most likely etiology of his symptoms?
Aspiration of a foreign body.
A child has chronic wet cough, recurrent sinopulmonary infections, nasal polyps, poor growth, steatorrhea, and a “salty” taste when kissed. What does the newborn screening test look for?
Elevated blood immunoreactive trypsinogen (IRT)
A patient presents with stridor and respiratory distress after sometime following extubation. What is the most likely diagnosis?
Subglotic Stenosis
A 15 y/o M boy presents with gradual onset of fever, cough with wheezing, sore throat, joint pains, and rash. What is the most likely bacterium causing this illness? What is the best test to confirm diagnosis?
Mycoplasma pneumoniae. Diagnosis is most commonly confirmed using Mycoplasma pneumoniae PCR from a nasopharyngeal or throat swab.
A kindergartner with asthma is admitted to the hospital because of an acute asthma exacerbation. What is the most likely cause of the acute asthma exacerbation in this child?
Viral infection.
A 17 y/o M has chronic sinusitis, bronchiectasis, situs inversus. What is the most likely diagnosis?
Primary ciliary dyskinesia (PCD), Kartagener syndrome
A 2 y/o F presents with high fever, brassy cough, and stridor. She is given treatment for croup but does not respond, and she deteriorates rapidly. She is intubated in the emergency department. What is the most likely diagnosis?
Bacterial Tracheitis.
A 17 y/o M from northwest Arkansas who hunts frequently presents with a 1-month history of low-grade fever, cough with occasional hemoptysis, Chest pain, 10-lb weight loss. She has several verrucous lesions with irregular borders and microabscess formation at the periphery on the left arm. CXR shows upper lobe infiltrates with a cavitary lesion. What is the most likely diagnosis?
Blastomycosis
First line management of an acute asthma exacerbation.
Inhaled bronchodilators and oral corticosteroids.
A 15 y/o F with asthma presents with recurrent episodes of malaise, coughing up brownish mucous plugs, occasional hemoptysis, peripheral eosinophilia and, high IgE. She improves with corticosteroid therapy, but 2-3 months later, the signs and symptoms recur. What is likely causing the recurrent episodes?
Allergic bronchopulmonary aspergillosis (ABPA)
A 3 y/o M presents to the emergency department with high fever and loud stridor. He is leaning forward in his father's arms, drooling, and in obvious respiratory distress. History reveals that the child has not had any immunizations. What is the most appropriate next step in treatment?
A. Secure the airway immediately using a rapid sequence technique
B. Transport to the operating room, then perform an intravenous induction and intubation
C. Transport to the operating room, then perform an inhalational induction with intubation
D. Immediate antibiotics and high flow oxygen
C. Transport to the operating room, then perform an inhalational induction with intubation
A 17 y/o F visited her grandfather in Bakersfield, California. Today she presents with fever, cough, several pounds weight loss, chest pain, marked fatigue, and erythema nodosum. What is the likely etiology for her symptoms?
Coccidioidomycosis (aka San Joaquin Valley fever)
A 6-hour-old newborn presents with respiratory failure, heart failure, abnormalities of pulmonary venous drainage What is the likely diagnosis?
Congenital pulmonary venolobar syndrome
An 8 y/o F presents with iron deficiency anemia that was initially diagnosed 1 year ago, progressive dyspnea, fatigue and recurrent cough with new onset hemoptysis. Sputum that shows hemosiderin-laden alveolar macrophages. What is the most likely diagnosis?
Idiopathic pulmonary hemosiderosis (IPH)