infectious disease/bronchiolitis

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Question 1 / 4

686463876c78b8d82816dccb

Pediatrics

infectious disease

bronchiolitis

Case History

A 2-year-old female presents to her pediatrician's office with a history of recurrent cough and wheezing episodes. She had a severe admission for respiratory syncytial virus (RSV) bronchiolitis at 4 months of age, requiring oxygen support. Since then, she has experienced intermittent episodes of cough and wheezing, often triggered by viral upper respiratory infections, approximately every 2-3 months. Her parents report that these episodes last for about 5-7 days and are accompanied by mild tachypnea but no cyanosis or significant feeding difficulties. Between episodes, she is asymptomatic and growing well. On examination today, her temperature is 37.2°C, heart rate 105 beats/min, respiratory rate 28 breaths/min, and oxygen saturation 98% on room air. Auscultation reveals mild inspiratory and expiratory wheezes bilaterally, without crackles or diminished breath sounds. There are no signs of respiratory distress, retractions, or nasal flaring. Her growth parameters are at the 50th percentile for age. What is the most appropriate initial diagnostic consideration and management strategy for this patient's recurrent respiratory symptoms?

Lab Parameter	Value	Reference Range
White Blood Cell Count	10.5 x 10^9/L	6.0-17.0 x 10^9/L
Eosinophil Count (absolute)	0.5 x 10^9/L	0.0-0.4 x 10^9/L
Sodium	138 mmol/L	135-145 mmol/L
Potassium	4.2 mmol/L	3.5-5.0 mmol/L
Chest Radiograph	Mild peribronchial cuffing with hyperinflation	Normal

A ) Diagnosis of recurrent viral-induced wheezing and a recommendation for continued supportive care with bronchodilators as needed.

B ) Diagnosis of acute bacterial bronchitis and initiation of a broad-spectrum oral antibiotic course.

C ) Diagnosis of gastroesophageal reflux disease and a trial of proton pump inhibitor therapy.

D ) Diagnosis of probable early childhood asthma and initiation of a daily inhaled corticosteroid.

E ) Diagnosis of cystic fibrosis and immediate referral for a sweat chloride test.

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Question 2 / 4

686463876c78b8d82816dccd

Pediatrics

infectious disease

bronchiolitis

Case History

A 3-month-old girl is brought to the emergency department by her parents for 2 days of escalating respiratory distress. She was born at 34 weeks gestation and had a brief neonatal intensive care unit stay but has since been otherwise well. Her symptoms began with a runny nose and mild cough, which have progressed to significant difficulty breathing and poor feeding. On examination, her temperature is 37.9°C, blood pressure is 70/45 mmHg, pulse is 165/min, respirations are 60/min, and oxygen saturation is 90% on room air. Pulmonary exam reveals diffuse expiratory wheezing and fine crackles, prominent intercostal and subcostal retractions, and nasal flaring. Her oral mucosa appears dry, and capillary refill time is prolonged at 3 seconds. Considering her clinical presentation, what is the most appropriate initial management strategy, and what common complication should be vigilantly monitored?

Lab Parameter	Value	Reference Range
White Blood Cell Count	14.2 x 10^9/L	5.0-12.0 x 10^9/L
Sodium	131 mmol/L	135-145 mmol/L
C-reactive protein	9 mg/L	<5 mg/L

A ) Outpatient supportive care with oral rehydration and monitoring for secondary bacterial pneumonia.

B ) Inpatient admission for supplemental oxygen, intravenous fluid resuscitation, and monitoring for severe dehydration.

C ) Inpatient admission for heated, humidified high-flow nasal cannula (HFNC), close monitoring for apnea and impending respiratory failure.

D ) Trial of nebulized albuterol and systemic corticosteroids with close monitoring for intussusception.

E ) Initiation of broad-spectrum antibiotics and chest physiotherapy with monitoring for pneumothorax.

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Question 3 / 4

686463876c78b8d82816dcc9

Pediatrics

infectious disease

bronchiolitis

Case History

A 7-month-old male infant is brought to a pediatric urgent care center by his mother, who reports a 3-day history of increasing respiratory effort and a low-grade fever. Initially, he had clear rhinorrhea and a mild cough, but over the past 24 hours, his breathing has become notably rapid and he occasionally exhibits a whistling sound. The infant was born at term without complications and has no significant past medical history, and no known allergies. On examination, his temperature is 37.90C, heart rate 135 bpm, respiratory rate 55 breaths/min, blood pressure 70/40 mmHg, and oxygen saturation is 93% on room air. He is irritable but consolable, with moderate intercostal and subcostal retractions, nasal flaring, and diffuse expiratory wheezes with fine inspiratory crackles heard bilaterally. Capillary refill time is 2 seconds, and mucous membranes appear moist. Lab results: Given this presentation, what is the most likely diagnosis and the most appropriate initial management approach?

Lab Parameter	Value	Reference Range
White Blood Cell Count (WBC)	9.8 x 10^9/L	6.0-17.5 x 10^9/L
C-Reactive Protein (CRP)	2 mg/L	< 5 mg/L
Sodium	138 mmol/L	135-145 mmol/L

A ) Bronchiolitis and supportive care including nasopharyngeal suctioning and close monitoring.

B ) Viral pneumonia and admission for oxygen therapy and empiric antiviral medication.

C ) Acute asthmatic exacerbation and inhaled albuterol with oral corticosteroids.

D ) Bacterial tracheitis and intravenous antibiotics with airway management consultation.

E ) Foreign body aspiration and urgent bronchoscopy with close observation.

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Question 4 / 4

686463876c78b8d82816dcc7

Pediatrics

infectious disease

bronchiolitis

Case History

A 10-month-old female infant, with a history of prematurity (born at 32 weeks gestation), presents to a primary care clinic with her mother. She has had 3 days of low-grade fever, clear rhinorrhea, and a mild cough. Over the past 12 hours, her cough has worsened, becoming more frequent and moist, and she appears to be breathing faster. Her mother reports difficulty feeding due to increased work of breathing. On examination, the infant is irritable but consolable, with inspiratory and expiratory wheezes, prominent intercostal retractions, and nasal flaring. Her temperature is 38.2°C (100.8°F), heart rate 145 bpm, respiratory rate 55 breaths/min, and oxygen saturation on room air is 92%. Lung auscultation reveals diffuse fine crackles and prolonged expiratory phase. Cardiac exam is normal with regular rhythm and no murmurs. Abdomen is soft, non-tender, with no organomegaly. Capillary refill time is less than 2 seconds. Given these findings, what is the most likely diagnosis and the immediate priority in management?

Lab Parameter	Value	Reference Range
White Blood Cell Count	9.8 x 10^9/L	6.0-17.0 x 10^9/L
Sodium	139 mmol/L	135-145 mmol/L
Potassium	4.1 mmol/L	3.5-5.0 mmol/L

A ) Viral Croup; administer humidified oxygen and consider a single dose of racemic epinephrine.

B ) Acute Asthma Exacerbation; initiate albuterol nebulization and systemic corticosteroids.

C ) Bronchiolitis; commence nebulized hypertonic saline and assess for need of continuous positive airway pressure (CPAP).

D ) Bronchiolitis; provide nasal suctioning, supplemental oxygen to maintain saturation above 90%, and ensure adequate hydration with oral or intravenous fluids.

E ) Epiglottitis; prepare for urgent intubation and administer empiric intravenous antibiotics (e.g., ceftriaxone).

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