1. 1 Welcome to Case Discussion linli97@126.com 2011.5.23

2. 2 Case report Present History A 14 – month – old male was admitted with cough and wheezing for a week He had no apena and cyanosis, also had no fever, no vomitting and diarrhoea He had lost his appetite, but had not lost his weight apparently

3. 3 Case report Previous History He had a history of airway disease and wheezing before one month ago, and was admitted to our hospital for pneumonia There was no history of eczema There was no history of food or drug allergy

4. 4 Case report Personal History Natal: First birth born at 37th week of gestation, normal delivery with birth weight 2.7 Kg. No cyanosis, asphyxia, convulsion or bleeding. Development: Able to raise head at 2 nd m. The first tooth erupted at 6 th m, began to walk at 1 st y. Normal intelligence. Nutrition: Breast feed till 6 th m, then the additives were added. Weaned from the breast at 12 th m. Immunization: Vaccinated according to the standard schedule, such as B.C.G

5. 5 Case report Family History There was no history of atopy or asthma in the family There was no history of tuberculosis disease in the family

6. 6 Case report Physical examination T 39, HR 110/min, RR 55/min, BP 94/72 mmHg Well developed and moderate nutrition Pale and drowsy, passive position Perioral cyanosis and throat congestion No pitting edema, no jaundice, no clubbing

7. 7 Case report Physical examination Lungs: Intercostal, subcostal and supra- clavicular retractions Nasal flaring, mild perioral cyanosis Using of accessory respiratory muscles Expiratory wheezing rales and asymmetric al breath sounds on chest auscultation

8. 8 Case report Physical examination Heart: moderate heart sound, regular rhythm without murmur, capillary refill time was normal Abdomen: abdominal distention. Liver palpated 2cm under costal arch. Shifting dullness negative Neurological examinations: unremarkable

9. 9 Case report Laboratory data Blood rutine test + CRP WBC 11.0×10 9 /L, N:45%, L:51%, RBC 3.8×1 0 12 /L, Hb 109g/L, PLT 460×10 9 /L; CRP:7mg /L Chest X-ray air trapping in the left lung

10. 10 Question What is the first impression of this case ? What further examination should he take ?