PNCB Acute Care Exam with Questions and Answers

PNCB Acute Care Exam with Questions and Answers A previously healthy infant presents with three days of rhinorrhea, low-grade fever, and cough. Vital signs include temp 38.4 (101.1), HR 170, RR 58, BP 70/48, O2 89% on RA. On physical examination, mild to moderate intercostal and subcostal retractions are noted with diffuse crackles and wheezes auscultated over all lung fields. The MOST likely diagnosis is: A. asthma B. bacterial pneumonia C. bronchiolitis D. viral pneumonia ANSWER C. bronchiolitis On auscultation, bronchiolitis presents with diffuse (non-focal) wheezes and crackles. Depending on the severity, hypoxia may or may not be present and respiratory distress can be absent to severe. Respiratory syncytial virus is the most commonly associated virus with bronchiolitis. Asthma presents with bronchial obstruction and hyperresponsiveness. This results in diffuse wheezing or, if severely obstructed, decreased aeration. Crackles indicate the accumulation of mucus or fluid, which typically occurs with bronchiolitis or pneumonia rather than asthma . Bacterial pneumonia is a focal lung infiltrate resulting in localized crackles on auscultation. Wheezing is uncommon with an isolated bacterial pneumonia. Viral pneumonia is principally caused by Mycoplasma pneumoniae and is more commonly seen in school-age children rather than the infant age group. Signs and symptoms, such as fever, cough, and fatigue, may be similar to those of bacterial pneumonia but in a milder form. While the presenting symptoms and vital sign abnormalities in this case could represent the findings of bacterial pneumonia, bronchiolitis, asthma, or viral pneumonia, the auscultatory findings are most suggestive of bronchiolitis, particularly if the illness occurs in the fall and