Assignment
Advanced Diagnostics and Skills Case Study
The purpose of the case study is to evaluate a clinical situation and determine the appropriate treatment based on the principles learned.
Case Study
A 5-year-old girl comes to your clinic for the first time with complaints of fever, malaise, and increased cough for 2 days. She has a history of asthma for which she uses a steroid inhaler daily and an albuterol inhaler as needed. She has been tried on various OTC cold and allergy remedies, but her respiratory symptoms have been worsening over the past several months with an almost daily cough, and sometimes she expectorates blood-tinged mucus. Her past medical history is notable for an episode of rectal prolapse and "sinusitis" during each of the past two winter seasons. Her mother also reports that her daughter has "always been small for her age." Your examination reveals a moderately ill-appearing child whose height and weight are at the 5th percentile for age. Her temperature is 101 F (38.3 C) and respiratory rate is 32 breaths/min. She has scant purulent rhinorrhea bilaterally, wheezes in all lung fields, and diminished breath sounds on the right side. Heart sounds and capillary refill are normal, yet she has digital clubbing.
Required
A. What is the diagnostic approach in the evaluation of this child?
B. What is the most likely diagnosis?
C. What is the next step in evaluation?