Primary Impression and Differential Diagnoses

The patient, a 9-year-old Filipino female, presents with fever, vomiting, productive cough, colds, and post-tussive vomiting. Based on the provided history and physical examination, the primary impression is a respiratory infection. The differential diagnoses are categorized as follows:

• Single Most Likely Diagnosis
  • Acute Bronchitis: This is the most likely diagnosis given the patient's symptoms of productive cough, colds, and post-tussive vomiting, which are consistent with a respiratory infection. The patient's history of bronchial asthma also supports this diagnosis.
• Other Likely Diagnoses
  • Influenza: The patient's symptoms of fever, cough, and colds are consistent with influenza, especially given the time of year and the fact that the younger sibling has similar symptoms.
  • Pneumonia: Although the patient's chest X-ray was not provided, the symptoms of fever, cough, and post-tussive vomiting could be indicative of pneumonia, especially if the patient's condition worsens or does not respond to treatment.
• Do Not Miss Diagnoses
  • Pertussis (Whooping Cough): This diagnosis is crucial to consider due to the patient's symptoms of productive cough and post-tussive vomiting, which could be indicative of pertussis, especially if the patient's vaccination history is incomplete or uncertain.
  • Tuberculosis (TB): Although less likely, TB is an important consideration in a patient with a persistent cough and fever, especially if there is a history of exposure to TB or if the patient's symptoms do not respond to treatment.
• Rare Diagnoses
  • Cystic Fibrosis: This diagnosis is less likely but should be considered in a patient with a history of recurrent respiratory infections and bronchial asthma, especially if there is a family history of cystic fibrosis.
  • Immunodeficiency: A rare but important consideration in a patient with recurrent infections, especially if there is a family history of immunodeficiency or if the patient's symptoms are severe or persistent.

Each of these diagnoses has a brief justification based on the patient's symptoms, history, and physical examination. The single most likely diagnosis is acute bronchitis, while other likely diagnoses include influenza and pneumonia. The do not miss diagnoses include pertussis and tuberculosis, and rare diagnoses include cystic fibrosis and immunodeficiency.