PNCB Acute Care Exam with Questions and Verified Answers

PNCB Acute Care Exam with Questions and Verified Answers A toddler presents with a cough and fever greater than 102° F (38.8° C) for 3 days. On physical exam, decreased breath sounds and intermittent rales are auscultated over the left lower lobe. The MOST likely diagnosis is: A. Foreign body aspiration B. Laryngotracheobronchitis C. Pneumonia D. Tracheitis ANSWER C. Pneumonia Fever & cough are the most common presenting symptoms of pneumonia. Physical exam findings include tachypnea, hypoxia, rales (crackles), rhonchi, retractions, and nasal flaring. Laryngotracheobronchitis (or croup) typically presents with hoarseness, a barking cough, and stridor and is almost always viral in origin. Lower airway adventitious breath sounds are not typically noted as this disease occurs in the upper airway. Foreign body aspiration may or may not present with a known history of the toddler having swallowed something. Clinical symptoms are often non-specific with foreign body aspiration. In smaller children, left-sided aspirations are more common than right-sided due to the bronchial anatomy, which may cause decreased or absent breath sounds over the left lung. Tracheitis is typically bacterial in origin, so a high fever may be noted; however, it otherwise presents with upper airway symptoms such as copious secretions, stridor, and respiratory distress. As with laryngotracheobronchitis, lower airway adventitious breath sounds are not typically noted as tracheitis affects the upper airway. A one month old who presents with severe hypotonia, feeding difficulties, hypogonadism, and abnormally small hands and feet is determined to be at risk for failure to thrive. The MOST likely underlying diagnosis is: