Master the board step 3

Master the Boards: USMLE Step 3
Diagnostic Testing
Diagnosis is clinical. Following are diagnostic tests to perform:
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Best initial test: Chest x-ray shows hyperinflation with patchy atelectasis
(may look like early pneumonia)
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Most specific test: Viral antigen testing (IFA or ELISA) of nasopharyngeal
secretions
Treatment
Is supportive only:
Ribavirin has not been
shown to have clinical
benefit and is generally not
recommended.
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Hospitalize if severe tachypnea (> 60/minute), pyrexia, and intercostal
retractions are present. Give trial of beta-agonist nebulizers.
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Steroids are not indicated.
Prevention
In high-risk patients only, is by giving hyperimmune RSV IVIG or monoclonal
antibody to RSV F protein (palivizumab). High-risk patients include
those with bronchopulmonary dysplasia and those born preterm. General
prevention methods include hand-washing, avoiding secondhand smoke, and
avoiding sick contacts.
Pneumonia
Classic presentations:
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Viral: Most common cause in children < 5 years. Most commonly RSV.
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URI symptoms
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Low-grade fever
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Tachypnea (most consistent finding)
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Bacterial: Most common cause in children > 5 years. Most commonly
S. pneumoniae, M. pneumoniae, or C. pneumoniae (not trachomatis).
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Acute-onset, sudden, shaking chills
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High fever
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Prominent cough
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Pleuritic chest pain
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Markedly diminished breath sounds
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Dullness to percussion
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Chlamydia trachomatis: Infants 1–3 months of age with insidious onset
(usually > 3 weeks).
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No fever or wheezing (distinguishes from RSV) ± conjunctivitis at birth
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Classic findings are staccato cough and peripheral eosinophilia.
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