History of Present Illness (HPI)

The patient is a child who has been experiencing a dry cough for the last 5 days. The cough started after the child had a sore throat for 2 days, which has since resolved. The child has tried various over-the-counter (OTC) medications without any relief. Notably, the child has a history of experiencing similar "barky" cough episodes 2-3 times a year. The mother denies any possibility of aspiration, as the coughing did not start during eating. The household was recently sick with "sore throat" symptoms the week before, but everyone else recovered without needing medical intervention. The child's cough began after the household's illness had resolved.

Differential Diagnosis

• Single Most Likely Diagnosis
  • Croup: Given the description of the cough as "barky" and its recurrent nature, croup is a strong consideration. Croup often follows a viral upper respiratory infection, which aligns with the child's recent sore throat and the household's illness.
• Other Likely Diagnoses
  • Viral Bronchitis: The child's symptoms of a dry cough following a sore throat are consistent with viral bronchitis, especially given the context of a recent viral illness in the household.
  • Asthma: Although not directly implied, the recurrent nature of the cough could suggest an underlying condition like asthma, especially if the cough is triggered by viral infections.
• Do Not Miss Diagnoses
  • Pertussis (Whooping Cough): Despite vaccination, pertussis can still occur, especially in areas with low vaccination rates. The "barky" cough and its recurrent nature, along with the recent illness in the household, make it crucial not to miss this diagnosis due to its potential severity and contagiousness.
  • Foreign Body Aspiration: Although the mother denies aspiration, this diagnosis is critical not to miss due to its potential for severe complications. The history should be carefully reviewed, and if there's any doubt, further investigation is warranted.
• Rare Diagnoses
  • Tuberculosis (TB): While less likely, TB can present with a chronic cough. Given the recent illness in the household, if there's any suspicion of exposure or if the child is from a high-risk area, TB should be considered.
  • Cystic Fibrosis: This condition can cause recurrent respiratory infections and cough. Although it's rare, if the child has a history of recurrent, unexplained respiratory issues, cystic fibrosis might be considered in the differential diagnosis.