Pneumonia in Children: Clinical Case and Viva QnA

Clinical Case of Pneumonia in Children

Clinical Case: Community-Acquired Pneumonia in a 4-year-old

Patient: Sarah, a 4-year-old female

Chief Complaint: Fever, cough, and difficulty breathing for 3 days

History of Present Illness:

• Fever up to 39.5°C (103.1°F)
• Productive cough with yellowish sputum
• Increased work of breathing
• Decreased appetite
• Fatigue and irritability

Past Medical History:

• Generally healthy
• Up-to-date on vaccinations
• No known allergies

Physical Examination:

• Temperature: 39.2°C (102.6°F)
• Heart Rate: 130 bpm
• Respiratory Rate: 40 breaths/min
• O2 Saturation: 92% on room air
• Visible intercostal retractions
• Decreased breath sounds and crackles in the right lower lobe

Diagnostic Studies:

• Chest X-ray: Right lower lobe consolidation
• Complete Blood Count: WBC 18,000/μL with left shift
• C-reactive protein: Elevated at 80 mg/L
• Blood culture: Pending

Assessment:

Community-acquired pneumonia, likely bacterial (suspected Streptococcus pneumoniae)

Plan:

1. Admit for intravenous antibiotics (Ampicillin 50 mg/kg every 6 hours)
2. Supplemental oxygen to maintain O2 saturation >95%
3. IV fluids for hydration
4. Antipyretics as needed
5. Close monitoring of respiratory status
6. Reassess in 48-72 hours for clinical improvement

Clinical Presentations of Pneumonia in Children

Clinical Presentations of Pneumonia in Children

1. Classic Bacterial Pneumonia

   • Sudden onset of high fever (>39°C or 102.2°F)
   • Productive cough with purulent sputum
   • Chest pain or abdominal pain
   • Tachypnea and dyspnea
   • Decreased breath sounds and crackles on auscultation

2. Atypical Pneumonia (e.g., Mycoplasma pneumoniae)

   • Gradual onset of symptoms
   • Low-grade fever
   • Dry, hacking cough
   • Headache and malaise
   • Wheezing or rales on auscultation

3. Viral Pneumonia

   • Fever, often lower than in bacterial pneumonia
   • Nonproductive cough
   • Rhinorrhea and nasal congestion
   • Wheezing or diffuse crackles
   • Associated symptoms like conjunctivitis or diarrhea

4. Aspiration Pneumonia

   • History of choking or vomiting episode
   • Sudden onset of respiratory distress
   • Cough with foul-smelling sputum
   • Localized crackles in dependent lung areas
   • May have associated neurological or gastrointestinal disorders

5. Pneumocystis jirovecii Pneumonia (in immunocompromised children)

   • Gradual onset of dry cough and dyspnea
   • Low-grade or no fever
   • Severe hypoxemia out of proportion to physical findings
   • Diffuse interstitial infiltrates on chest X-ray
   • History of immunodeficiency or immunosuppressive therapy

6. Neonatal Pneumonia

   • Tachypnea, grunting, and nasal flaring
   • Poor feeding and lethargy
   • Temperature instability (fever or hypothermia)
   • Cyanosis and apneic episodes
   • May be part of early-onset or late-onset sepsis

7. Tuberculosis Pneumonia

   • Chronic cough (>3 weeks)
   • Low-grade fever and night sweats
   • Weight loss and failure to thrive
   • Hemoptysis in advanced cases
   • History of TB exposure or endemic area residence

Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30

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