A three-year-old boy is brought into the emergency department by his mother and father because he’s been extremely sleepy all day, drooling, and seems to be breathing deeper Noted by his stomach movement.

PE: Temperature 103.0, heart rate 125, High pitched upper airway breathing, Lethargic, Responsive to pain, and decreased appetite. X-ray shows a “thumbprint” sign.

PMhx: Two months premature, C-section birth, and under vaccinated (last vaccination was age 2 months)

1. What Is your possible differential diagnosis using the SPIT module? (serious, probable, interesting, & treatable)

2. What is your recommendation for the patient’s mother?

3. What vaccinations should a five-year-old have by now which could cause respiratory symptoms?

 
 
 
 

4. What symptom can show a thumbprint on x-ray?

 
 
 
 

5. What infection can cause airway irritation and swelling?

 
 
 
 

6. What are the symptoms of RSV?

 
 
 
 

7. How many days does it take for RSV symptoms to appear?

 
 
 
 

8. Is there a vaccination that can be recommended for RSV?

 
 

Question 1 of 8

Reference:
Society for academic emergency medicine meeting 2013: Guth, T., Lovell E., Shaha S., & Epter, M. Taking advantage of the teachable moment: a workshop for efficient, learner centered clinical-teaching. Retrieve from https://www.rch.org.au/uploadedFiles/Main/Content/medicaleducation/SPIT%20the%20diagnosis.pdf

See the CDC Vaccination schedule and symptoms of listed diseases.