You are evaluating a 5-month-old with fever, tachypnea, and mild respiratory distress in the emergency department. You hear mild basilar rales. The child does not appear toxic.
Which one of the following tests would be most appropriate as an initial study?
Correct Answer D:
Pulse oximetry should be obtained on all paediatric patients with significant tachypnea, pallor, or respiratory distress. It has been found that CBCs, C-reactive protein levels, and erythrocyte sedimentation rates are not effective in differentiating between viral and bacterial pneumonia. Chest radiographs are also ineffective in distinguishing viral and bacterial pneumonia, and should be obtained in cases of ambiguous clinical findings, prolonged pneumonia, and pneumonia that is unresponsive to antibiotic therapy, as well as when there is the possibility of complications such as pleural effusions.
The most common cause of pneumonia in preschool-age (3 months - 4 years) children is:
Correct Answer E:
Viruses are the most common cause of pneumonia in preschool-aged children. Streptococcus pneumoniae is the most common bacterial pathogens.
A 10-year-old female presents to your office with a 4-day history of non-productive cough, low grade fever of 38.1°C (100.5°F), and now complains of a rash for one day. She has been taking an over-the-counter cough suppressant and Tylenol. She is otherwise healthy. On physical exam, she has a temperature of 37.7°C (99.9°F) and a respiratory rate of 20. Her lung exam reveals no rhonchi or wheezes. Her skin has several “target” lesions scattered on her trunk and upper arms. A chest x-ray reveals a fine interstitial pattern with normal cardiac silhouette.
She most likely is infected with what organism?
Correct Answer C:
This school-age child has an atypical pneumonia with erythema multiforme, which is consistent with mycoplasma pneumonia infections. Mycoplasma is the most common cause of atypical pneumonias in school-aged children.
A. Streptococcus pneumoniae is the most common cause of typical bacterial pneumonia in children. Patients usually are tachypneic and febrile with a consolidated lobar infiltrate on chest x-ray.
B. Chlamydia pneumoniae may cause interstitial, atypical pneumonias. Patients are usually afebrile. There is no associated with erythema multiforme. See Answer A.
D. Haemophilus influenzae is a cause of bacterial pneumonia in children, again with a consolidated lobar infiltrate.
E. Influenza A may cause a viral pneumonia with interstitial infiltrates, but patients typically have systemic symptoms such as fever, malaise, and myalgias.
Click to expand