I-HUMAN CASE STUDY — WEEK 4
(CLASS 6541) FOR AN 18-MONTH-
OLD CHILD PRESENTING WITH
COUGH LATELY UPDATED 2026
📋 Case Overview & Chief Complaint
Patient: 18-month-old child (often named Grady
Turner or Ava in simulations).
Chief Complaint: Parent reports toddler has been coughing for
3–4 days with worsening at night; cough described as "barking,"
"like a seal," or "croupy".
Associated Symptoms: Inspiratory stridor (audible at rest in
moderate cases), increased work of breathing (retractions, nasal
flaring), low-grade fever, rhinorrhea, and decreased oral intake.
, Key Negative Findings: No drooling, no dysphagia, no toxic
appearance, and up-to-date Hib vaccination (helps rule out
epiglottitis).
🔍 History of Present Illness (HPI) – Must-Ask Questions
1. Single most important opening question: "When did the cough
start, and what does it sound like?" – Characterizing the cough
(onset, quality, timing) narrows the differential immediately; the
"barking seal" quality is hallmark for croup.
2. Daycare/Exposure history: Ask about sick contacts at daycare or
home; daycare attendance is a major risk factor for viral
respiratory infections.
3. Onset and progression: Symptoms began 3 days ago with viral
prodrome (rhinorrhea, low-grade fever) and have progressively
worsened, especially at night – typical for croup evolution.
4. Hydration & intake: Determine if the child is taking oral fluids
(breastmilk, formula, water, juice) and urine output (wet diapers) –
crucial for assessing dehydration risk.
5. Past medical history: Prematurity, prior history of croup,
intubation, or airway anomalies increase risk for severe disease.
6. Immunization status: Confirm Hib (Haemophilus influenzae type
b) and pertussis vaccination to help rule out epiglottitis and
pertussis.
🩺 Physical Examination & Westley Croup Score
(CLASS 6541) FOR AN 18-MONTH-
OLD CHILD PRESENTING WITH
COUGH LATELY UPDATED 2026
📋 Case Overview & Chief Complaint
Patient: 18-month-old child (often named Grady
Turner or Ava in simulations).
Chief Complaint: Parent reports toddler has been coughing for
3–4 days with worsening at night; cough described as "barking,"
"like a seal," or "croupy".
Associated Symptoms: Inspiratory stridor (audible at rest in
moderate cases), increased work of breathing (retractions, nasal
flaring), low-grade fever, rhinorrhea, and decreased oral intake.
, Key Negative Findings: No drooling, no dysphagia, no toxic
appearance, and up-to-date Hib vaccination (helps rule out
epiglottitis).
🔍 History of Present Illness (HPI) – Must-Ask Questions
1. Single most important opening question: "When did the cough
start, and what does it sound like?" – Characterizing the cough
(onset, quality, timing) narrows the differential immediately; the
"barking seal" quality is hallmark for croup.
2. Daycare/Exposure history: Ask about sick contacts at daycare or
home; daycare attendance is a major risk factor for viral
respiratory infections.
3. Onset and progression: Symptoms began 3 days ago with viral
prodrome (rhinorrhea, low-grade fever) and have progressively
worsened, especially at night – typical for croup evolution.
4. Hydration & intake: Determine if the child is taking oral fluids
(breastmilk, formula, water, juice) and urine output (wet diapers) –
crucial for assessing dehydration risk.
5. Past medical history: Prematurity, prior history of croup,
intubation, or airway anomalies increase risk for severe disease.
6. Immunization status: Confirm Hib (Haemophilus influenzae type
b) and pertussis vaccination to help rule out epiglottitis and
pertussis.
🩺 Physical Examination & Westley Croup Score
