[Verified Answer]: Chief Complaint A 13 m

Chief Complaint A 13 m.o. male presents to pediatric office with complaining of fever, cough, and wheezing for 3 days. Patient started with cough and runny nose 3 days ago. Fever and wheezing started the following day. Fever noted to be between 100.5 and 102 axillary and responds to Tylenol or Advil. Mother started nebulizer treatments yesterday with patient when she noted cough worsening. She describes the child as “choking on mucus.” Cough and wheeze are briefly better following a treatment but increase again over the next hour. Appetite is down, and sleep is decreased. Past Medical History Term vaginal delivery with tight nuchal cord noted. Infant was in NICU initially for TTN that resolved over 24 hours. During infancy, he was noted to have occasional retractions and tachypnea at rest, and this was determined to be his baseline. He was admitted twice (at 3 and one-half months and at 5 months) for bronchiolitis. In recent months he has used his nebulizer intermittently with URIs but has been otherwise healthy. No surgical history. Vaccine history shows he has received only one vaccine: DTaP 1 month ago at his 12-month well-child appointment (parents chose to delay vaccines due to concerns regarding autism diagnosis in siblings). Family History Mother, age 30, asthma Two older siblings, ages 5 and 3, autism Psychosocial History Lives with his parents and two older siblings in a nonsmoking, pet-free home. Attends day care 5 days a week. Review of Systems General: Fever with T max of 102 axillary. Fussy with decreased sleep and appetite. Four to five wet diapers in 24 hours. HEENT: Cloudy runny nose. No eye discharge or ear tugging. Respiratory: Persistent cough, leading to gagging. One episode of post-tussive emesis. Audible wheezing and occasional retractions. GI: No vomiting (except above noted post-tussive) and no diarrhea. MS: No change in gait or movement. Physical Examination: Vital signs: T 98.2 ax, HR 150, RR 50, O2 saturation 97%, WT 19.12 lbs. General: WM noted to have continuous cough with intermittent choking/gagging. HEENT: Eyes clear, noninjected. Nose reveals clear to cloudy mucus. TMs bilaterally dull but not red or full. Oropharynx clear with moist mucous membranes and no obvious sores. CV: RR&R without murmurs. Respiratory: Subcostal retractions noted. Constant cough. Grunting between coughing fits. Soft, expiratory wheezes noted in all lung fields. Abdomen: Soft, non-tender. BS present times 4 quadrants. MS: No obvious joint swelling or tenderness. Skin: Good turgor. No obvious rash. Questions What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)? What further history, further examination, and diagnostic studies are warranted to explore your differential diagnosis?