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Approach to Diagnosis

Look for a symptom, sign, laboratory finding pointing toan organ or part of an organ system

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Presenting Manifestations

1 month history of febrile episodes (39C 40C) Cough and Colds

Difficulty of Breathing

Intercostal and Subcostal Retractions

Crackles

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Differential Diagnosis

Pneumonia Bronchial Asthma

PTB

Foreign Body Aspiration

Acute Bronchitis

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DIFFERENTIAL DIAGNOSIS Patient Bronchial Asthma Pneum

Age and Gender 1 year old male More common in children;

males>females in children 0-17

yrs

Neona

and ad

Difficulty of breathing Yes No Yes

Cough 2 week history of cough Non-productive cough

Cough at night or with exercise

Produ

course

Fever 1 month history of febrile episodes (39C

40C)

No Yes

Lung/Chest PE Lungs dull on Percussion, hazy breath

sounds, palpable Lymph nodes cervical,

decreased vocal and tactile fremiti,

hyperemic posterior pharyngeal wall, clear

watery discharge

Frequent episodes of wheezing,

symptoms that persist after age

3, (-) crackles, (+) alar flaring, (+)

retractions

Cyano

retrac

decrea

Other Symptoms/Signs Cough and colds not relieved by Salbutamol,

lower lung infiltrates

Tightness of chest, (+) response

to salbutamol challenge test

Fever

respira

infiltra

Risk Factors family history of bronchial asthma

Exposure of PTB

Aeroallergens, exercise,

respiratory infections, strong

emotional expression, tobacco

smoke, family history

Pre-sc

hygien

with p

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DIFFERENTIAL DIAGNOSIS Patient PTB Fore

Age and Gender 1 year old male Any age group and gender (highest

during the 6 months after infection

and remains high for 2 years)

Any

(usu

Difficulty of breathing Yes Yes Yes

Cough 2 week history of cough Cough of more than 2 weeks

duration

Non

Fever 1 month history of febrile episodes (39C

40C)

Yes No

Lung/Chest PE Lungs dull on Percussion, hazy breath

sounds, palpable Lymph nodes cervical,

decreased vocal and tactile fremiti,

hyperemic posterior pharyngeal wall, clear

watery discharge

Retractions, decreased breath

sounds, crackles, wheezing, nasal

discharge, painless cervical and/or

other lymphadenopathies

whe

flar

Other Symptoms/Signs Cough and colds not relieved by

Salbutamol, lower lung infiltrates

(+) PPD Skin Test, weight loss or poor

weight gain, hemoptysis, CXR:

infiltrates more on apical area, thick

walled cavities

(-) r

cha

salb

Risk Factors family history of bronchial asthma

Exposure of PTB

HIV infection, close members with

PTB, effects of poverty (crowding

etc.), malnutrition, chronic illness,

epidemiological data Philippines

Hist

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DIFFERENTIAL DIAGNOSIS Patient Acute Bronchitis

Age and Gender 1 year old male Highest in children in the 2

gradually in teenagers

Higher in males, most pron

years of life

Difficulty of breathing Yes Yes

Cough 2 week history of cough dry, hacking cough developbe productive

Fever 1 month history of febrile episodes (39C 40C) absent or low-grade fever

Lung/Chest PE Lungs dull on Percussion, hazy breath sounds,

palpable Lymph nodes cervical, decreased vocal

and tactile fremiti, hyperemic posterior

pharyngeal wall, clear watery discharge

Nasal discharge, congested

pharyngeal erythema, rhon

crackles and scattered high

Other Symptoms/Signs Cough and colds not relieved by Salbutamol,

lower lung infiltrates

upper respiratory signs (nas

conjunctivitis, and rhinitis),

infiltrates or consolidation

Risk Factors family history of bronchial asthma

Exposure of PTB

History of upper respiratory

respiratory system such as

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PCAP Risk Classification

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Clinical Impression

PCAP-B t/c PTB

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References

French's Index of Differential Diagnosis, 15 ed

Kliegman et al. 2012. Nelsons Textbook of Pediatrics, 19th ed

Illustrated Textbook of Paediatrics, 3rd Ed

Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th Ed

Expert Ddx Pediatrics

Clinical Practice Guidelines for Pediatric Community Acquired Pneumonia ( Philippine Pediatric Society) 2004

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Approach to Diagnosis

Does the child have a neurologic disorder?

Where is the neurologic problem?

What is the neurologic problem?

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Presenting Manifestations

1 month history of febrile episodes (39C 40C) upward rolling of the eyes

shaking and stiffening of the whole body