PAGE INTERPRETATION (CASE 3)| Tutorial B-1 RS

130110110177|Gabriella Chafrina| 15/11/13

Page 1
Common cold: a catarrhal disorder of the URT, which may be viral, a mixed infection, or an allergic reaction. It is marked by
acute rhinitis, a slight rise in temperature , and chilly sensation

Common cold Flu
Symptoms Cold symptoms appear
gradually and include sneezing,
cough, stuffy nose and sore
throat. Fevers are very rare and
fatigue is mild. Headaches
sometimes occur.
Flu symptoms appear
quickly (within 3-6 hours)
and include fever, chills,
severe aches and chest
discomfort
Severity Usually does not cause severe
problem
Serious health problems,
such as pneumonia,
bacterial infections can
occur
Fever Rare Usually present
Fatigue Mild Moderate to severe
Chills Rare Common
Sneezing Common Rare
Chest
discomfort
Mild to moderate Often severe
Coughing Hacking, productive cough Dry, unproductive cough
Headache Rare Common
Stuffy nose Common Rare
Aches Slight, but only headaches Usual and often severe,
affects the entire body
Sore throat Common Rare
Treatment There is no cure for the
common cold. Cough syrup and
other cold medication is
available to ease some of
symptoms and make the
patient feel a little better. Tea
and nasal drops also sometimes
help
Sometimes antiviral
medication helps control
the flu but often patients
simply wait for their body
to fight the virus and
overcome the disease.
Medication is also
available to ease patient
comfort
Duration of
Illness
Symptoms typically peak two to
three days after infection
onset, and usually resolve in 7-
10 days
In children, the cough
lasts for more than 10
days in 35-40% of the
cases and continues for
more than 25 days in
10%. Adults usually feel
better in seven days.
Seasonality Not seasonal (occurs through
the years)
Seasonal (in winter). In
the U.S., flu season is
generally October to May
and peaks in February
Vaccination
possible
No Yes
Causative
organism
Adenovirus, coronaviruses,
rhonaviruses (most common
cause), respiratory syncytial
virus, parainfluenza virus,
influenza virus
Influenza virus
PAGE INTERPRETATION (CASE 3)| Tutorial B-1 RS
130110110177|Gabriella Chafrina| 15/11/13
Barking Cough
A barking cough is a dry, harsh cough that resembles the sound of a barking seal. This
type of cough is most often associated with croup (laryngotracheitis), a respiratory
disease usually caused by a viral infection that mainly affects infants and children.
A barking cough can also be caused by other factors that irritate and cause
inflammation and swelling of the vocal cords, such as a bacterial infection or exposure
to an allergen or an irritant, such as regurgitated stomach acid.

Upper Airway Obstruction by Location

Region Stridor Voice Retractions Feeding Mouth Cough
Oropharyngeal
obstruction
Inspiratory and
coarse; during
sleep
Unaffected
but may be
throaty or
full
Sternal and
intercostals, to
total chest when
severe
Difficult to impossible,
with drooling or saliva
Open; jaw
held forward
None
Supraglottic
laryngeal
Snooring;
Inspiratory;
Fluttering
Muffled or
throaty
None, until very late Difficult to impossible Open; jaw
held forward
None
Glottic obstruction Inspiratory early;
Ecpiratory also as
obstruction
Hoarse or
aphonic
Xiphoid early and
intercostals later;
Suprasternal and
Supraclavicular
Normal except with
severe obstruction
May be
closed; nares
flared
None
Subglottic
obstruction
Inspiratory early;
Expiratory also as
obstruction
Hoarse but
may be
husky or
normal
Xiphoid early and
intercostals later;
Suprasternal and
Supraclavicular
Normal except with
severe obstruction
May be
closed; nares
flared
Barking
Tracheobronchial
obstruction
Expiratory and
Wheezing; Becoming
to and from with
obstruction
Normal None except with
severe obstruction;
Xiphoid and sternal
Normal except with
severe obstruction or
when instrinsic
obstruction involves
esophagus
May be
closed; nares
flared
Brassy

Noisy Breathing

Location Congenital Inflammatory Neoplastic Neuromuscular Traumatic
Nose and
Nasopharynx
Choanal atresia/stenosis
Pyriform aperture stenosis
Craniofacial anomalies
Nasal polyp
Rhinitis
Retropharyngeal abscess
Adenoid hypertrophy
Encephalocele
Dermoid
Glioma
Foreign body
Oropharynx/
Hypopharynx
Glossoptosis/Macroglosia
Lingual thyroid
Vallecular cyst
Craniofacial anomalies
Tonsil hypertrophy
Retropharyngeal abscess
Dermoid Hypotonia,
neurologic
disease
Foreign body
Supraglotic Larynx Laryngomalacia
Laryngocele/ saccular cyst
Epiglotitis
Angioneurotic edema
Hemangioma
Lymphangioma
Papilloma
Foreign body
Glottic Larynx Web/atresia
Laryngeal cleft
Stenosis
Laryngitis
Spasm
Stenosis
Hemangioma
Lymphangioma
Papilloma
Granuloma
Vocal cord
paralysis
Hematoma
Fracture
Foreign body
Subglottic larynx Stenosis
Cyst
Croup (viral LTB)
Stenosis
Hemangioma
Papilloma
Stenosis
Fracture
Foreign body
Tracheobronchial Stenosis/web
Tracheomalacia
Vascular ring/
Sling/complete tracheal rings
Foregut cyst
Tracheoesophageal fistula
Membranous (bacterial)
tracheitis
Bronchitis
Asthma
Medianal tumor
Thyroid
Thymus
Papilloma
Stenosis
Foreign Body
tracheal or
esophageal
PAGE INTERPRETATION (CASE 3)| Tutorial B-1 RS
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Page 2
Pediatric Vital Sign










Stridor
Stridor : a harsh, high-pitched breath sound such as the one often
heard on inhalation with an acute laryngeal obstruction
Inspiratory stridor is generated by obstruction of the extrathoracic
airway (above the thoracic inlet) which includes supraglottic
structures,the larynx,the subglottic space, and the upper trachea.
Expiratory stridor or a monophonic wheeze may be generated by an
obstruction in the intrathoracic airway (the mid- to lower trachea and
central bronchi)


PAGE INTERPRETATION (CASE 3)| Tutorial B-1 RS
130110110177|Gabriella Chafrina| 15/11/13

Retractions

Retractions, the inward movement of the skin of the chest wall or the inward movement of the sternum during
inspiration, is an abnormal breathing pattern.
Retractions mean that the child is having to use chest muscles (not usually needed) and neck muscles to get air into
the lungs. The child is having to work too hard to breath.The trouble getting air into the lungs is due either to
obstruction of the airways or to stiffness of the lungs.
Mild to moderate difficulty breathing is associated with subcostal retractions, substernal retractions, and intercostal
retractions
Subcostal retractions are inward movement of the abdomen just below the rib cage.
Substernal retractions are inward movement of the abdomen at the end of the sternum.
Intercostal retractions are inward movement of the skin between the ribs.
Severe difficulty breathing is associated with supraclavicular retractions, suprasternal retractions, and sternal
retractions.
Supraclavicular retractions are inward movement of the skin of the neck just above the clvicula.
Suprasternal retractions are inward movement of the skin of the middle of the neck just above the top end
of the sternum.
Sternal retractions are inward movement of the sternum towards the back of the body.
The breathing difficulty that causes retractions can be of due to three different causes:
upper airway obstruction (an example is croup), lower airway obstruction (asthma or bronchiolitis), or lung tissue
disease which is also called parenchymal lung disease (for example, pneumonia, pulmonary edema, or acute
respiratory distress syndrome).



















PAGE INTERPRETATION (CASE 3)| Tutorial B-1 RS
130110110177|Gabriella Chafrina| 15/11/13
Page 3
Reference Range for Laboratory Test




Differential Count System: How many % in white blood cell
Sequence: Eosinophil / Basophils / N. Bands / N. Segmented / Lymphocyte / Monocyte
In our case: 0 () / 2 () / 4 / 67 () / 25 / 2 ()

Steeple Sign: radiologic sign found on a frontal neck radiograph where
subglottic tracheal narrowing. This finding may be useful in differentiating
croup from epiglottitis.

Border between Upper dan Lower Respiratory Tract