Differential Diagnosis for a 15-year-old Female with Respiratory Symptoms
Single Most Likely Diagnosis
- Acute Bronchitis: This is the most likely diagnosis given the patient's symptoms of cough, nausea, vomiting, productive cough, chills, fever, and hoarseness, despite having clear lung sounds. The presence of a productive cough and hoarseness suggests an upper respiratory tract infection that has potentially descended to involve the bronchi, which is consistent with acute bronchitis.
Other Likely Diagnoses
- Influenza: The symptoms of cough, chills, fever, and hoarseness could also suggest influenza, especially during flu season. The absence of clear lung findings does not rule out influenza, as it primarily affects the upper respiratory tract.
- Asthma Exacerbation: Given the patient's history of asthma, an exacerbation could present with cough, wheezing (not explicitly mentioned but possible), and shortness of breath (not mentioned). However, the presence of fever and hoarseness might suggest an infectious component rather than a pure asthma exacerbation.
- Pneumonia (atypical or viral): Although the lung sounds are clear, atypical or viral pneumonia can sometimes present with minimal or no abnormal lung sounds, especially early in the course of the disease. The symptoms of cough, fever, chills, and hoarseness could be consistent with a mild or early pneumonia.
Do Not Miss Diagnoses
- Pertussis (Whooping Cough): This diagnosis is crucial not to miss due to its potential for severe complications, especially in non-vaccinated or under-vaccinated individuals. The symptoms of cough, hoarseness, and potentially vomiting after coughing fits could suggest pertussis.
- Epiglottitis: Although less common, epiglottitis is a life-threatening condition that requires immediate recognition and treatment. Symptoms can include severe sore throat, difficulty swallowing, high fever, and in severe cases, respiratory distress. Hoarseness and cough could be early signs.
- Pulmonary Embolism: While less likely in a 15-year-old without specific risk factors, pulmonary embolism can present with cough, fever, and tachypnea. It's a diagnosis that could be deadly if missed.
Rare Diagnoses
- Tuberculosis (TB): TB can present with a variety of symptoms including cough, fever, and hoarseness, especially in endemic areas or in individuals with exposure history. It's less likely but should be considered in the appropriate context.
- Cystic Fibrosis Exacerbation: If the patient has undiagnosed cystic fibrosis, an exacerbation could present with similar symptoms. However, this would be less likely without a known history of the disease or other suggestive symptoms like recurrent infections or failure to thrive.
- Foreign Body Aspiration: This could present with sudden onset of cough, potentially with fever if there's an associated infection. It's more common in younger children but can occur in adolescents, especially if there's an history of inhalation of small objects.