Case 12.1. You are a medical student doing your rotation at the local hospital when a 4-week-old black male child was transferred to your teaching hospital with a 10-day history of severe coughing spells. The illness had started with a "cold" but had gotten progressively worse in the last week. Think about what diseases you would consider given this limited amount of information. You might want to jot them down on a piece of paper in order of their likelihood. Question 1 - What are some causes/diseases you should be considering with this limited amount of information? Choose from the following list in the best order of priority. Explain 1: pneumonia 2: meningitis 3: epiglottitis 4: meconium inhalation 5: cystic fibrosis 6: diphtheria 7: gonorrhea 8: congenital syphilis 9: whooping cough 10: rat bite fever A) 2, 3, 8, 7, 9 B) 1, 9, 6, 8, 3 C) 1, 4, 6, 9,10 D) 4, 5, 8, 1, 3 Question 2. Which is the most likely bacterial cause of pneumonia in this age group? Explain Note also that a number of viruses can cause respiratory infections/pneumonia in this age group. Included among these viruses are RSV, CMV, and parainfluenza viruses. Ureaplasma (a relative of mycoplasma) is another agent that can cause respiratory problems in this age group. Question 3. What would you first look for to strengthen a diagnosis of pneumonia? Explain. Question 4. Diphtheria was definitely one of your first choices. What would be a defining characteristic for diagnosing diphtheria? Explain. Case 12.2. Coughing Baby You are a medical student doing your rotation at the local hospital when a 4-week-old black male child was transferred to your teaching hospital with a 10-day history of severe coughing spells. The illness had started with a "cold" but had gotten progressively worse in the last week. Think about what diseases you would consider given this limited amount of information. You might want to jot them down on a piece of paper in order of their likelihood. Note: The baby's coughing was so violent that he often became cyanotic and gasped for breath when the coughing subsided. In addition, he had several episodes of vomiting associated with his coughing. You note that his pulse is quite rapid and that he is also breathing rapidly. Question 1 - What are some causes/diseases you should be considering with this limited amount of information? Choose from the following list in the best order of priority. Explain 1: pneumonia 2: meningitis 3: epiglottitis 4: meconium inhalation 5: cystic fibrosis 6: diphtheria 7: gonorrhea 8: congenital syphilis 9: whooping cough 10: rat bite fever A) 2, 3, 8, 7, 9 B) 1, 9, 6, 8, 3 C) 1, 4, 6, 9,10 D) 4, 5, 8, 1, 3 Question 2. What would you specifically look for to strengthen a diagnosis of whooping cough? Explain Question 3 - You have listened to the chest and note that it is clear. What tests would you want to do to positively rule out pneumonia? Explain. Question 4 – A high preponderance of lymphocytes is consistent with a diagnosis of? Explain Question 5 - How would you confirm a diagnosis of whooping cough? Explain Question 6 - What is the treatment of choice for whooping cough? Explain Case 12.3. Coughing Baby You are a medical student doing your rotation at the local hospital when a 4-week-old black male child was transferred to your teaching hospital with a 10-day history of severe coughing spells. The illness had started with a "cold" but had gotten progressively worse in the last week. Think about what diseases you would consider given this limited amount of information. You might want to jot them down on a piece of paper in order of their likelihood. Note: The baby's coughing was so violent that he often became cyanotic and gasped for breath when the coughing subsided. In addition, he had several episodes of vomiting associated with his coughing. You note that his pulse is quite rapid and that he is also breathing rapidly. Question 1 - What are some causes/diseases you should be considering with this limited amount of information? Choose from the following list in the best order of priority. Explain 1: pneumonia 2: meningitis 3: epiglottitis 4: meconium inhalation 5: cystic fibrosis 6: diphtheria 7: gonorrhea 8: congenital syphilis 9: whooping cough 10: rat bite fever A) 2, 3, 8, 7, 9 B) 1, 9, 6, 8, 3 C) 1, 4, 6, 9,10 D) 4, 5, 8, 1, 3 Question 2 - How do you explain the preponderance of lymphocytes in whooping cough? Explain Question 3 - What is/are the major virulence factor(s) of B. pertussis? Explain Question 4 - What would have prevented this baby from getting whooping cough? Explain. Question 5 - What are some of the problems associated with pertussis vaccination? Explain. Question 6 - What new strategies for immunization against whooping cough are now recommended by the CDC? Explain. .