1. Case 1: Joy Joy, a 3 year old girl from a Rwandan orphanage, was adopted and brought to Canada 2 months ago. She has not received any vaccinations. She presents with fever, stridor, drooling, a runny nose, and a muffled voice. The MOST LIKELY diagnosis is: a.Bronchiolitis b.Laryngotracheobronchitis c.Retropharyngeal Abscess d.Epiglottitis e.Tuberculosis Joy (after she’s recovered)

2. Late night call While preparing for CBL, your sister calls and interrupts your studying. She’s worried about her 22 month old son, who’s her first child. He has a fever and a cough. What is the BEST indicator that he has a respiratory viral infection? a.Fever b.Cough c.Runny nose d.Wheezing e.Sore throat Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi

3. Back to Joy Joy sees you again a year later with fever and, severe cough, and difficulty breathing. Her pediatrician has been catching up on her immunizations. Which of the following physical signs is the MOST SPECIFIC sign that she has pneumonia? a.Crackles b.Dullness to percussion c.Tachypnea d.Tachycardia e.Focal area of reduced air entry Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi

4. Joy’s Pneumonia Joy’s chest radiograph shows lobar consolidation and a moderately-large pleural effusion. Which of the following organisms is UNLIKELY to cause this clinical picture? Choose all the appropriate answers. a.Streptococcus pneumoniae b.Mycoplasma pneumoniae c.Staphylococcus aureus d.Influenza Virus e.Haemophilus influenza Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi

5. Merry Christmas! Joy’s family have adopted another 2 year old. On Christmas Eve, they take him to the Emergency Department. The family was decorating their Christmas tree when they noticed that their son was playing with the decorations in his mouth. The child coughed a lot, but appeared generally well. However, he was making a new whistling noise when breathing in. What is this noise called? a.Sturtor b.Coryza c.Paroxysmal cough d.Wheezing e.Stridor Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi

6. The Emergency Department The child’s oxygen saturation in the Emergency Dept. is 100% in room air. Does a 100% saturation reassure you in this situation? Briefly explain your answer. 1)Yes ___ 2)No ___ Reasoning: ______________________________________________ Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi

7. It’s a Boy! Joy’s adoptive mother becomes pregnant. Unfortunately, she delivers prematurely. Her son requires intubation, and spends 3 weeks on a ventilator. After extubation, he’s noted to have stridor and respiratory distress. List TWO likely causes of this problem. 1)_____________________________ 2)_____________________________ Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi

8. Baby on Board Joy’s mother becomes pregnant a second time, and delivers a healthy baby boy at term. He’s noted to have stridor about 2 weeks later. Laryngoscopy demonstrates that he has laryngomalacia. What do you tell the parents about laryngomalacia? a.Usually requires surgery b.Usually goes away within the first year c.Usually interferes with breast feeding d.Often leads to cyanosis e.Usually caused by parainfluenza virus

9. Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi ANSWERS

10. Case 1: Joy Joy, a 3 year old girl from a Rwandan orphanage, was adopted and brought to Canada 2 months ago. She has not received any vaccinations. She presents with fever, stridor, drooling, a runny nose, and a muffled voice. The MOST LIKELY diagnosis is: a.Bronchiolitis b.Laryngotracheobronchitis c.Retropharyngeal Abscess d.Epiglottitis e.Tuberculosis Joy (after she’s recovered)

11. Late night call While preparing for CBL, your sister calls and interrupts your studying. She’s worried about her 22 month old son, who’s her first child. He has a fever and a cough. What is the BEST indicator that he has a respiratory viral infection? a.Fever b.Cough c.Runny nose d.Wheezing e.Sore throat Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi

12. Back to Joy Joy sees you again a year later with fever and, severe cough, and difficulty breathing. Her pediatrician has been catching up on her immunizations. Which of the following physical signs is the MOST SPECIFIC sign that she has pneumonia? a.Crackles b.Dullness to percussion c.Tachypnea* d.Tachycardia e.Focal area of reduced air entry Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi *World Health Organization Recommendation

13. Joy’s Pneumonia Joy’s chest radiograph shows lobar consolidation and a moderately-large pleural effusion. Which of the following organisms is UNLIKELY to cause this clinical picture? Choose all the appropriate answers. a.Streptococcus pneumoniae b.Mycoplasma pneumoniae c.Staphylococcus aureus d.Influenza Virus e.Haemophilus influenza Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi 2 marks!

14. Merry Christmas! Joy’s family have adopted another 2 year old. On Christmas Eve, they take him to the Emergency Department. The family was decorating their Christmas tree when they noticed that their son was playing with the decorations in his mouth. The child coughed a lot, but appeared generally well. However, he was making a new whistling noise when breathing in. What is this noise called? a.Sturtor b.Coryza c.Paroxysmal cough d.Wheezing e.Stridor Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi

15. The Emergency Department The child’s oxygen saturation in the Emergency Dept. is 100% in room air. Does a 100% saturation reassure you in this situation? Briefly explain your answer. 1)Yes ___ 2)No _X__ Reasoning: __If the foreign body moves, he could have life-threatening airway obstruction any time. Also, if it’s lodged in a bronchus, it places him at significant risk for developing pneumonia. _______________________________________ Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi 2 marks!

16. It’s a Boy! Joy’s adoptive mother becomes pregnant. Unfortunately, she delivers prematurely. Her son requires intubation, and spends 3 weeks on a ventilator. After extubation, he’s noted to have stridor and respiratory distress. List TWO likely causes of this problem. 1)_Subglottic Stenosis____________ 2)_Vocal Cord Paralysis___________ Unit 1 – TBL: Stridor and Acute Respiratory Infections in Children – Drs Bromwich and Kovesi 2 marks!

17. Baby on Board Joy’s mother becomes pregnant a second time, and delivers a healthy baby boy at term. He’s noted to have stridor about 2 weeks later. Laryngoscopy demonstrates that he has laryngomalacia. What do you tell the parents about laryngomalacia? a.Usually requires surgery b.Usually goes away within the first year c.Usually interferes with breast feeding d.Often leads to cyanosis e.Usually caused by parainfluenza virus