I-HUMAN CASE STUDY WEEK 4: 18-MONTH-
OLD CHILD WITH COUGH LATEST AND
COMPLETE UPDATE 2026
1. General Case Information
Case Title & Summary:
18-month-old male with 3 days of cough and increased work of breathing;
evaluates common pediatric respiratory illnesses (viral bronchiolitis, croup,
pneumonia, pertussis, reactive airways), urgent evaluation triggers, and outpatient
vs inpatient management.
Reason for Encounter:
Persistent cough for 3 days with intermittent noisy breathing and reduced oral
intake.
Patient Demographics:
Name: (given as the child in the case)
Age: 18 months
, Sex: Male (if unspecified, default to male for pronouns — adjust if user
prefers female)
Height: 86 cm (≈2’10”)
Weight: 12.7 kg (20 lb)
Growth context: Weight and height appropriate for age (estimate ~50th
percentile — formal percentile charting recommended)
Case Mode: Learning mode (ED / urgent care emphasis with outpatient options)
Case Location: Pediatric emergency department / urgent care with point-of-care
testing, chest x-ray, and inpatient pediatric services available
Attempts Allowed: Unlimited (learning mode)
2. Chief Complaint (CC)
Caregiver report: “He’s had a cough for three days and tonight he seems to be
breathing harder and won’t take his bottle like before.”
Primary symptom: Cough (started 3 days ago)
Character: Initially dry, now sometimes wet; occasional “barking” sound at
night reported by caregiver
Timing: Worse at night and with exertion/crying
Associated: Mild noisy breathing (intermittent inspiratory stridor when
upset), decreased oral intake today, fewer wet diapers
Red flags denied at presentation: No witnessed apnea, no frank cyanosis at
home, no seizures
3. History of Present Illness (HPI)
Onset & Course: Cough began 3 days ago as rhinorrhea and intermittent
cough after exposure to older sibling with “cold.” Over 72 hours, cough
persisted and caregiver notes progressive nasal congestion, low-grade fevers
, (peak 38.3°C at home), and poor feeding today. Tonight the cough is worse
with occasional audible noisy inspiration and some chest “rattling.”
Symptoms detail:
o Daytime: Frequent coughing fits, able to take small amounts of fluids
but less than baseline.
o Nighttime: Barky cough episodes and brief choking/gagging with
cough; caregiver awake and comforting child.
o Activity: Child is more tired and less active than usual.
Associated Symptoms: Rhinorrhea, low-grade fever, decreased appetite,
irritability. No vomiting except occasional emesis after severe coughing. No
diarrhea.
Exposures: Attends daycare; several classmates with recent URIs. No
known TB exposure. Household: two adults, one older sibling; no smokers
reported in the home.
Immunizations: On schedule per caregiver — DTaP series completed in
infancy; confirm last immunizations when charting. (Important: verify
pertussis vaccination status and dates.)
Prior episodes: No prior hospitalization for respiratory illness; no known
reactive airway disease or chronic lung disease.
Medications at home: Acetaminophen PRN; infant multivitamin. No
inhalers or chronic meds.
Red flag review: No persistent cyanosis, no lethargy, no difficulty arousing,
no focal neurologic signs.
4. Past Medical History (PMH)
Term birth, uncomplicated neonatal course
No chronic illnesses (no congenital heart disease, cystic fibrosis,
immunodeficiency known)
No past hospitalizations for breathing problems
No history of prematurity
OLD CHILD WITH COUGH LATEST AND
COMPLETE UPDATE 2026
1. General Case Information
Case Title & Summary:
18-month-old male with 3 days of cough and increased work of breathing;
evaluates common pediatric respiratory illnesses (viral bronchiolitis, croup,
pneumonia, pertussis, reactive airways), urgent evaluation triggers, and outpatient
vs inpatient management.
Reason for Encounter:
Persistent cough for 3 days with intermittent noisy breathing and reduced oral
intake.
Patient Demographics:
Name: (given as the child in the case)
Age: 18 months
, Sex: Male (if unspecified, default to male for pronouns — adjust if user
prefers female)
Height: 86 cm (≈2’10”)
Weight: 12.7 kg (20 lb)
Growth context: Weight and height appropriate for age (estimate ~50th
percentile — formal percentile charting recommended)
Case Mode: Learning mode (ED / urgent care emphasis with outpatient options)
Case Location: Pediatric emergency department / urgent care with point-of-care
testing, chest x-ray, and inpatient pediatric services available
Attempts Allowed: Unlimited (learning mode)
2. Chief Complaint (CC)
Caregiver report: “He’s had a cough for three days and tonight he seems to be
breathing harder and won’t take his bottle like before.”
Primary symptom: Cough (started 3 days ago)
Character: Initially dry, now sometimes wet; occasional “barking” sound at
night reported by caregiver
Timing: Worse at night and with exertion/crying
Associated: Mild noisy breathing (intermittent inspiratory stridor when
upset), decreased oral intake today, fewer wet diapers
Red flags denied at presentation: No witnessed apnea, no frank cyanosis at
home, no seizures
3. History of Present Illness (HPI)
Onset & Course: Cough began 3 days ago as rhinorrhea and intermittent
cough after exposure to older sibling with “cold.” Over 72 hours, cough
persisted and caregiver notes progressive nasal congestion, low-grade fevers
, (peak 38.3°C at home), and poor feeding today. Tonight the cough is worse
with occasional audible noisy inspiration and some chest “rattling.”
Symptoms detail:
o Daytime: Frequent coughing fits, able to take small amounts of fluids
but less than baseline.
o Nighttime: Barky cough episodes and brief choking/gagging with
cough; caregiver awake and comforting child.
o Activity: Child is more tired and less active than usual.
Associated Symptoms: Rhinorrhea, low-grade fever, decreased appetite,
irritability. No vomiting except occasional emesis after severe coughing. No
diarrhea.
Exposures: Attends daycare; several classmates with recent URIs. No
known TB exposure. Household: two adults, one older sibling; no smokers
reported in the home.
Immunizations: On schedule per caregiver — DTaP series completed in
infancy; confirm last immunizations when charting. (Important: verify
pertussis vaccination status and dates.)
Prior episodes: No prior hospitalization for respiratory illness; no known
reactive airway disease or chronic lung disease.
Medications at home: Acetaminophen PRN; infant multivitamin. No
inhalers or chronic meds.
Red flag review: No persistent cyanosis, no lethargy, no difficulty arousing,
no focal neurologic signs.
4. Past Medical History (PMH)
Term birth, uncomplicated neonatal course
No chronic illnesses (no congenital heart disease, cystic fibrosis,
immunodeficiency known)
No past hospitalizations for breathing problems
No history of prematurity
