CASE STUDY

 

A 5-year-old girl comes to your clinic for the first time with complaints of fever, malaise, and increased cough for 2 days. She has a history of asthma for
which she uses a steroid inhaler daily and an albuterol inhaler as needed. She has been tried on various OTC cold and allergy remedies, but her respiratory
symptoms have been worsening over the past several months with an almost daily cough, and sometimes she expectorates blood-tinged mucus. Her past
medical history is notable for an episode of rectal prolapse and “sinusitis” during each of the past two winter seasons. Her mother also reports that her
daughter has “always been small for her age.” Your examination reveals a moderately ill-appearing child whose height and weight are at the 5th percentile for
age. Her temperature is 101 F (38.3 C) and respiratory rate is 32 breaths/min. She has scant purulent rhinorrhea bilaterally, wheezes in all lung fields, and
diminished breath sounds on the right side. Heart sounds and capillary refill are normal, yet she has digital clubbing.
What is the diagnostic approach in the evaluation of this child?
What is the most likely diagnosis?
What is the next step in evaluation?

 

 

 

Sample Solution

Love in Poems Verse love Robert Browning of verse “My keep going Duchess” depends on reality anecdote about the fifth Duke of Ferreira during the Renaissance time. He wedded a multi year old kid named Lucrezia and left her for a long time. She died at seventeen years old. In this section, the duke is searching for a second ex. Robert Browning was one of the extraordinary artists of the Victorian period. He composes sentimental verse and communicates love as a connection of this sonnet. The prosody of verse is an, a, b, b. This is a sensational monolog. The pith of lesbian love, for example, Rich, Marvel, Campion’s affection verse, Adrian Ricci’s “21 Love Poem”, Andrew Marvel’s “To His Coy”, and the great love of men composing for ladies Explore verse. Special lady “And Thomas Campion” has a nursery all over. “Rickey’s sonnet centers around the part of” we “of affection. The sonnets of adoration composed by men are increasingly strict, while appreciating their subjects nearly, the idea of two incredible yet defective ladies face all restriction. 21 love verse and coasting sonnets experience various connections. Each talks an alternate love and discusses a sonnet that divides them. Sonnets of want as opposed to adore. Skimming verse is sexy, however is remembered for 21 love sonnets as physical love between two ladies. She communicates it as fragile and kind love, making this sonnet a physical demonstration of affection and energy, not only a craving. Her darling ‘s body pestered her for the rapture they spent together. The reason for skimming verse is the evening of enthusiasm that is encircled by the sympathy and love days as 21 love verse. Coasting verse shows that sex isn’t just a physical demonstration yet additionally a feeling. How these refrains are consolidated is special These sonnets have likenesses, and the topic of adoration’s distress and triumph matches. Verse is a discussion among a couple, verse is about affection, the fundamental characters of the two sections are the equivalent. People lose their friends and family, yet in another way. One is dead and the other is battling. He should battle for his own nation. He follows the custom of the knight. Every sonnet has a plot to rhyme. In Suckling’s “The reason it was so pale and declining, most loved darling”, the plan of the refrain is (a b c b). In Lovelace’s “Lucasta to the war,” the jargon plot is (abdominal muscle stomach muscle).

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