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Differential Diagnoses for Cough
Acute Bronchitis: Given Timothy’s history of asthma, exposure to triggers could have led to inflammation of the bronchial tubes, resulting in coughing. It typically presents with a productive cough, but in asthmatic patients, it might be non-productive initially.
Pneumonia: Though there’s no fever reported, pneumonia can present without fever in certain cases, especially in children or those with compromised immune systems. The cough could be a result of a lower respiratory tract infection (de Oliveira et al., 2018).
Allergic Rhinitis: Timothy’s cough could also be due to allergic rhinitis, especially considering his history of asthma. Allergens can trigger inflammation in the nasal passages, leading to post-nasal drip and subsequent coughing (de Oliveira et al., 2018).
Differential Diagnoses for Right Ear Pain
Otitis Media: The ear pain could be indicative of otitis media, an infection of the middle ear. Children with asthma are at a higher risk for otitis media, and it often presents with ear pain, especially after upper respiratory tract infections.
Otitis Externa: Also known as swimmer’s ear, otitis externa is an infection of the outer ear canal. It can cause ear pain, itching, and redness. If Timothy has been swimming recently, this could be a possibility.
Temporomandibular Joint (TMJ) Dysfunction: TMJ dysfunction can sometimes manifest as ear pain, especially in children who may be prone to grinding their teeth or clenching their jaw due to stress or discomfort (Bernkopf et al., 2022).
Differential Diagnoses for Dry, Scaly Patches
Atopic Dermatitis (Eczema): Dry, scaly patches behind the knees and on the elbows are classic locations for atopic dermatitis, especially in children with a history of asthma or allergies.
Psoriasis: Psoriasis can present with dry, scaly patches on the skin, commonly found on the elbows and knees. While less common in children, it’s still a possibility, especially with a family history of psoriasis.
Contact Dermatitis: If Timothy has come into contact with any irritants or allergens, it could result in contact dermatitis, presenting as dry, scaly patches on the skin.
Most Likely Final Diagnosis: Considering Timothy’s history of asthma, the most likely final diagnosis that encompasses all his symptoms is Atopic Dermatitis (Eczema). It explains his cough (associated with asthma), right ear pain (which can be related to atopy), and the presence of dry, scaly patches on his skin (de Oliveira et al., 2018).
Comprehensive Plan of Care:
Prescription Details:Topical Corticosteroid Cream: Apply a thin layer to affected areas twice daily for two weeks, then once daily for two weeks.
Antihistamine Syrup: Take 5ml orally once daily at bedtime for relief from itching and to aid sleep.
Albuterol Inhaler: Prescribe a new albuterol inhaler for Timothy’s asthma, with instructions to use as needed according to his previous regimen.
Patient Teaching:Instruct Timothy and his mother on the proper application of the topical corticosteroid cream, emphasizing the importance of using a thin layer and avoiding excessive use.
Educate them on triggers for asthma and eczema and how to avoid them (e.g., allergens, and irritants).
Teach proper inhaler technique for Timothy’s albuterol inhaler and ensure they understand when and how to use it.
Guide skincare practices to help manage eczema, including using gentle cleansers, moisturizing regularly, and avoiding hot baths or showers.
Follow-Up:Schedule a follow-up appointment in two weeks to assess Timothy’s response to treatment, monitor his asthma control, and adjust the treatment plan if necessary.
Advise Timothy’s mother to contact the clinic sooner if his symptoms worsen or if they have any concerns before the scheduled follow-up.
By addressing Timothy’s eczema along with his asthma, we aim to improve his overall quality of life and reduce the likelihood of future exacerbations.
References
Bernkopf, E., Cristalli, G., de Vincentiis, G. C., Bernkopf, G., & Capriotti, V. (2022). Temporomandibular joint and otitis media: A narrative review of implications in etiopathogenesis and treatment. Medicina, 58(12), 1806. https://doi.org/10.3390/medicina58121806
de Oliveira, T. B., Klering, E. A., & da Veiga, A. B. G. (2018). Is recurrent respiratory infection associated with allergic respiratory disease? Journal of Asthma, 56(2), 160–166. https://doi.org/10.1080/02770903.2018.1445266