Master the board step 3

Pediatrics
Respiratory Diseases
Condition
Classic
Presentation
Diagnosis
Steps in
Management
Complication(s)/
Prognosis
Croup
Parainfluenza 1 or 3,
influenza A or B
Notes: Parainfluenza
is an enveloped,
single-stranded
RNA virus.
Influenza is an RNA
virus of the family
Orthomyxoviridae.
Child age 3 months
to 5 years with
URTI symptoms:
rhinorrhea, sore
throat, hoarseness
and deep barking
cough, inspiratory
stridor, tachypnea
Symptoms are worse
at night.
Diagnosis is made
clinically; however,
neck x-ray positive
for steeple sign can
be diagnostic.
1. Humidified
oxygen
2. Nebulized
epinephrine and
corticosteroids
Antitussives,
decongestants,
sedatives, or
antibiotics are
not used in the
management of
croup.
Spontaneous
resolution in 1
week
Always suspect
diagnosis of
epiglottitis
Epiglottitis
H. influenzae type
B (now less
common)
S. pyogenes, S.
pneumoniae, S.
aureus, Mycoplasma
Notes: H. influenza
is a gram-negative
coccobacillus. S.
pneumonia is a
gram-positive,
alpha-hemolytic
bacterium. S.
pyogenes is a
gram-positive
coccus that
causes group A
streptococcal
infection.
Sudden onset,
muffled voice,
drooling,
dysphagia,
high fever, and
inspiratory stridor
Patient prefers
sitting in the
tripod position.
Patient has a toxic
appearance.
This is a medical
emergency.
Go straight to
management
based on clinical
diagnosis.
Perform diagnostic
workup after
stabilization:
• Neck x-ray (thumbprint
sign)
• Blood cultures
• Nasopharyngoscopy
in the OR
• Epiglottic swab
culture
1. Transfer to
hospital/OR
2. Consult ENT and
anesthesia
3. Intubate
4. Give antibiotics
(ceftriaxone) and
steroids
5. Give rifampin
prophylaxis
to household
contacts if H.
influenzae positive
Airway obstruction
and death
Bacterial tracheitis
S. aureus
Notes: S. aureus is a
gram-positive
coccus that occurs
in clusters.
Brassy cough, high
fever, respiratory
distress, but
no drooling or
dysphagia; child
< 3 years; usually
occurs after viral
URTI
Clinical plus
laryngoscopy:
• Chest x-ray
shows subglottic
narrowing plus
ragged tracheal air
column
• Blood cultures
• Throat cultures
Antistaphylococcal
antibiotics
May require
intubation if
severe.
Airway obstruction
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