07-07-2006, 01:16 PM
A 10-year-old boy is brought to the office because of a 4-month history of a non-productive cough. The mother tells you that the cough is usually worse a night when she hears him having "coughing spells" in his room. He denies any fever or chills now, but says that he did have a "cold" a few months ago, before the cough began. His gym teacher in school recommended that he "go to the doctor" when she noticed that he was coughing and was unusually short of breath after class for the past 4 months. Throughout the visit, the patient coughs and the mother says "cover your mouth." She looks at you and tells you that she is trying to teach him manners, and that he needs to cover his mouth so others do not "catch his germs." His temperature is 37.2C (99.0 F), blood pressure is 100/70 mm Hg, pulse is 70/min, and respirations are 20/min. Physical examination shows expiratory wheezes in the lower lungs. The remainder of the examination is unremarkable. He continues to cough and his mother goes over to him and puts her hand over his mouth. The most appropriate immediate step is to
A. administer a beta-agonist
B. measure oxygen saturation on room air
C. measure peak expiratory flow
D. order a chest x-ray
E. tell the mother that the patient does not need to cover his mouth when he coughs
A. administer a beta-agonist
B. measure oxygen saturation on room air
C. measure peak expiratory flow
D. order a chest x-ray
E. tell the mother that the patient does not need to cover his mouth when he coughs