Pediatric Problem Solving-Case17

Pediatric Problem Solving – Case 17
A 3 years old fully immunized child presents with fever and difficulty in breathing. She has had tonsillitis over the past week, for which she received oral antibiotics for 2 days. On examination, she looks unwell, she has mild recession, and a soft inspiratory sound is audible.

What is the most likely diagnosis:
A. Bronchial asthma

B. Retro-pharyngeal abscess

C. Epiglottitis

D. Pneumonia
Explanation of the case:

A fully immunized child, so most probably she doesn’t have pneumonia due to Hemophilus influenza. she has tonsillitis the week before, for which she received an inadequate dose of antibiotics (2days).now, her general condition is unwell, she has fever, dyspnea and stridor (i.e. soft inspiratory sound)
 Choice (A): Point against: the audible sound is inspiratory, in case of asthma, it is supposed to be expiratory

 Choice (B): the right answer: Points with: inadequate ttt + stridor which means this is an upper respiratory tract infection. in retropharyngeal abscess, the tongue is pushed upwards and backwards, so the main complication is difficulty breathing.
 Choice (D): Points against: stridor means an upper not lower respiratory tract infection.