Kayla brings Riley, now 17 months, in for complaint of fever and rash. The fever began “a couple of days ago” and is of normal levels in the morning then gets as high as 103 to 104 degrees in the afternoons. Riley has also had clear rhinorrhea and in the last 24 hours he has developed a red, diffuse rash to the torso and abdomen that does not itch and a dry cough in the last day. Mother reports he is drinking, but not as well as usual. He did have a good wet diaper this morning, but is not really eating much and is not playing.
Medications: Mother is giving OTC Robitussin cough and cold at 1 tsp last night and this morning. Liquid Tylenol ½ a tsp last night and this morning.
She is very concerned about the level of the fever and the fact that after 3 days he is not improving.
Discussion Questions Part One
We will begin by focusing on gathering history in an ill child.
What ‘red flags’ did you note in the historical data?
What data is most important to include in this particular case and which historical data that might be gathered on a well-child exam can be left out of this ill visit?
What are your differential diagnoses?