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Environmental Medicine: Integrating a Missing Element into Medical Education
A 14-year-old child, daughter of a dental technician, with cough, wheezing, and low-grade fever
A mother brings her 14-year-old daughter to you for consultation. The patient has developed a troublesome cough and sometimes at night cannot catch her breath. The child’s cough has worsened with increase in sputum production and chest discomfort. Last night she had a particularly rough time, but she had no wheezing or fever. Chart review reveals no history of asthma or allergies. The patient’s height and weight are appropriate for her age; her two siblings, aged 12 and 6 years, are in good health. History of previous illness reveals three episodes of otitis media but no other significant illness. There is no history of eczema or food intolerance.
In response to your questions, the mother tells you that her husband, a dental technician, has been diagnosed with sarcoidosis. He recently had flu-like symptoms similar to those of his daughter including fatigue, nasal congestion, sneezing, and cough. Although her husband, who smokes cigarettes, has had a cough for several years, the mother states that her daughter developed symptoms a few days after her husband’s latest bout. She wonders if her husband’s sarcoidosis could have been transmitted to their daughter.
Examination shows a cheerful girl in no acute distress. Her temperature today is 100°F, respiratory rate is 24 without retractions or audible wheezing, and her pulse is 90 and regular. Significant findings include a mildly inflamed pharynx and anterior cervical lymph nodes that are slightly enlarged and mildly tender. Tympanic membranes are clear. Auscultation of the lungs reveals mild and diffuse expiratory wheezing with occasional rhonchi. Results of cardiac and abdominal examinations are normal. Chest X ray shows minimal peribronchial thickening and is otherwise normal.
(a) Construct a problem list and a differential diagnosis for the daughter.