Approach to Diagnosis

Look for a symptom, sign, laboratory finding pointing to an organ or part of an organ system

Tan, Joshua C.

Presenting Manifestations
1 month history of febrile episodes (39C 40C) Cough and Colds Difficulty of Breathing Intercostal and Subcostal Retractions Crackles

Tan, Joshua C.

Differential Diagnosis
Pneumonia Bronchial Asthma PTB Foreign Body Aspiration Acute Bronchitis

Tan, Joshua C.

DIFFERENTIAL DIAGNOSIS

Patient
1 year old male

Bronchial Asthma
More common in children; males>females in children 0-17 yrs No

Pneumonia
Neonate, school age, adolescents and adults Yes

Age and Gender

Difficulty of breathing

Yes

Cough

2 week history of cough

Non-productive cough Cough at night or with exercise

No

Productive cough; acute onset and course

Yes

Fever

1 month history of febrile episodes (39C 40C)

Lung/Chest PE

Lungs dull on Percussion, hazy breath sounds, palpable Lymph nodes cervical, decreased vocal and tactile fremiti, hyperemic posterior pharyngeal wall, clear watery discharge
Cough and colds not relieved by Salbutamol, lower lung infiltrates family history of bronchial asthma Exposure of PTB

Frequent episodes of wheezing, symptoms that persist after age 3, (-) crackles, (+) alar flaring, (+) retractions
Tightness of chest, (+) response to salbutamol challenge test Aeroallergens, exercise, respiratory infections, strong emotional expression, tobacco smoke, family history

Cyanosis, tachypnea, nasal flaring, retractions, dsypnea, crackles and decreased breath sounds

Other Symptoms/Signs

Fever usually accompanies respiratory symptoms, may show infiltrates/consolidation Pre-school attendance, poor hygiene, contact with individuals with pneumonia

Risk Factors

Tan, Joshua C.

DIFFERENTIAL DIAGNOSIS

Patient 1 year old male

PTB Any age group and gender (highest during the 6 months after infection and remains high for 2 years) Yes Cough of more than 2 weeks duration Yes Retractions, decreased breath sounds, crackles, wheezing, nasal discharge, painless cervical and/or other lymphadenopathies

Foreign Body Aspiration Any age group and gender (usually in young patients) Yes Non-productive cough

Age and Gender

Difficulty of breathing Cough

Yes 2 week history of cough

Fever Lung/Chest PE

1 month history of febrile episodes (39C 40C) Lungs dull on Percussion, hazy breath sounds, palpable Lymph nodes cervical, decreased vocal and tactile fremiti, hyperemic posterior pharyngeal wall, clear watery discharge Cough and colds not relieved by Salbutamol, lower lung infiltrates

No wheezes, crackles, alar flaring, retractions

Other Symptoms/Signs

(+) PPD Skin Test, weight loss or poor (-) response to salbutamol weight gain, hemoptysis, CXR: challenge test/no response to infiltrates more on apical area, thick salbutamol walled cavities HIV infection, close members with PTB, effects of poverty (crowding etc.), malnutrition, chronic illness, epidemiological data Philippines History of choking

Risk Factors

family history of bronchial asthma Exposure of PTB

Tan, Joshua C.

DIFFERENTIAL DIAGNOSIS

Patient 1 year old male

Acute Bronchitis Highest in children in the 2nd year of life, Decreased gradually in teenagers Higher in males, most pronounced during first 6 years of life Yes dry, hacking cough develops, which may or may not be productive absent or low-grade fever

Age and Gender

Difficulty of breathing Cough

Yes 2 week history of cough

Fever

1 month history of febrile episodes (39C 40C)

Lung/Chest PE

Lungs dull on Percussion, hazy breath sounds, palpable Lymph nodes cervical, decreased vocal and tactile fremiti, hyperemic posterior pharyngeal wall, clear watery discharge

Nasal discharge, congested turbinates, diffuse pharyngeal erythema, rhonchi, course and fine crackles and scattered high-pitched wheezing

Other Symptoms/Signs

Cough and colds not relieved by Salbutamol, lower lung infiltrates

upper respiratory signs (nasopharyngitis, conjunctivitis, and rhinitis), no evidence of lung infiltrates or consolidation

Risk Factors

family history of bronchial asthma Exposure of PTB

History of upper respiratory infection, irritants to respiratory system such as cigarette smoke

PCAP Risk Classification

Clinical Impression
PCAP-B t/c PTB

Tan, Joshua C.

References
French's Index of Differential Diagnosis, 15 ed Kliegman et al. 2012. Nelsons Textbook of Pediatrics, 19th ed Illustrated Textbook of Paediatrics, 3rd Ed

Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th Ed

Expert Ddx Pediatrics Clinical Practice Guidelines for Pediatric Community Acquired Pneumonia ( Philippine Pediatric Society) 2004

Approach to Diagnosis

Does the child have a neurologic disorder? Where is the neurologic problem? What is the neurologic problem?
Tan, Joshua C.

Presenting Manifestations
1 month history of febrile episodes (39C 40C) upward rolling of the eyes shaking and stiffening of the whole body

Tan, Joshua C.