D, C, E Common causes of pneoumonia in the 1-month to 2-year age group .

3–1
include respiratory

viruses, Streptococcus pneumoniae, Haemophilus influenzae type B and nontype

B, Chlamydia trachomatis, and Mycoplasma pnuemoniae. Escherichia coli, as

well as group B strep, Klebsiella, Listeria, and Chlamydia, would be more likely in

the neonate. Consider admission for persistent hypoxia, underlying disease, history

,of cyanosis or apnea, toxic appearance, age less than 3 months, presence of effusion

poor social situation of follow-up. All children discharged home should be followed

up in 24 to 48 hours, and provided with strict instructions for return for worsening

.respiratory problems or failure to take oral fluids or antibiotics

B, B, C Foreign body aspirations occur most commonly in the 1-year to 3-year .6–4
,age group

with food and toys being the most common aspirated objects. Physical exam is very

variable. Complete obstruction of airway will lead to respiratory, and eventually

cardiac

arrest. Partial obstruction can occur at any level in the airway. Classically, upper

airway obstructions produce stridor, and obstruction below the vocal cords produces

wheezing. This is extremely variable. Presentation can be late and a high index of

suspicion is required. Unilateral aspiration is more common, and right-sided foreign

bodies are more common than left-sided ones. Aspiration should always be
considered

in a unilateral wheeze. X-ray findings can be normal; subtle findings to look for

include hyperexpansion, atelectasis, and air trapping. Although food matter can lead

to a pneumonitis, antibiotic coverage is not recommended prophylactically. All

foreign

bodies must be removed, either immediately, during resuscitation, or by

.bronchoscopy

.Clinically suspected cases should be ruled out by bronchoscopy

D, C A right upper lobe infiltrate is visible; although this age group most .7,8
commonly will

,present with viral causes, the absence of bilateral infiltrates, the lobar presentation

and sudden onset make bacterial etiologies more likely. Antibiotic coverage should

consider Streptococcus pneumococcus, Streptococcus pyogenes, Staphylococcus

.aureus, and H. influenzae

C, C Hypocalcemia, VSD, and absence of the thymic shadow are consistent with .9,10
the

diagnosis of DiGeorge’s syndrome. This child was probably experiencing

hypocalcemic

.tetany, not seizure activity

E, E, B Pneumomediastinum is a rare complication in asthma and may .13–11

accompany a history

of vague chest pain. It can be seen on chest X-ray but may be subtle. With good
-follow

.up and small amounts of mediastinal air, patients may be managed as outpatients

,Large amounts of mediastinal air, complete lobar atelectasis, pneumothorax

,poor home resources, underlying cardiopulmonary disease, respiratory failure

return visits in less than 24 hours, persistent oxygen requirement, or persistent

symptoms

requiring treatment are all reasons for admission. Steroid burst as an outpatient

should be considered in all but the mildest of asthma exacerbations.

Pneumomediastinum

is also the result of trauma and should lead to diligent search for underlying

or concurrent pulmonary and chest injury in the absence of asthma exacerbation or

.any history of trauma

D, A, A This X-ray reveals a left-sided atelectasis, the result of complete .16–14
obstruction of the

airway distal to the obstruction. On close inspection you may be able to make out

.the faint outline of a 1.5-cm cylindrical foreign body in the left main stem bronchus

Shift of the mediastinal structures will be toward an atelectasis or away from a tension

pneumothorax. However, the vital signs are not consistent with an unstable

.clinical condition, nd lung markings are present throughout the right side of the film

Hemothorax is not consistent with this history. On X-ray, a hemothorax will

demonstrate

.a more typical fluid layer

B, B, C The X-ray reveals small bilateral, central pulmonary infiltrates leading .19–17
to a diagnosis

of viral pneumonia. Viruses are the most common pathogens in the first 2 years

of life. Outpatient therapy is warranted if the child is having no respiratory difficulty

,and continues feeding well. Bronchodilator therapy should be considered as well

.especially in any child with bronchiolitis-like symptoms