Ben Adril
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You are on a GP taster doing the evening clinic this week. Ben Adril is a five year old boy who has presented with his father after experiencing a wheeze.
Please take a history from Ben’s father and perform an appropriate examination. You will then be asked to discuss the case with the examiner.
You are Mr Adril, a 29 year old father who has come along to the GP with your five year old son. You had a regular GP appointment because he has been making a funny noise with his breathing. Ben is quite a shy little guy and so you were a bit worried about bringing him along to the practice - but you’re pretty concerned by this point so you feel it was worth it.
HPC: The noise is a bit funny. It is quite quiet but when Ben breathes out sometimes it just sounds a bit tight. You think you’ve heard it on a few occasions over the past month. It doesn’t seem like he has been struggling to breathe, though. It’s just a bit weird! He does get a bit breathless when he plays tag with the other kids at school, and the teacher says he does have to stop running before them. But you’re not the athletic type, more the sit and game type, so you didn’t think much of that.
Thinking about it more, Ben has actually been waking up a lot throughout the night. He keeps getting this cough. You think he has a cold but then during the day he’s not quite as bad. Throughout the day he just has a runny nose and a never ending stream of snot, like any other kid. That’s what kids do, isn’t it? That happens maybe once or twice a week now actually. You hadn’t realised how common it had become. You haven’t noticed much phlegm coming up with the cough. Like you said it’s mostly at night and the wife normally deals with that. There’s never any blood or anything nasty like that.
He was born via C section after your wife decided she wanted that after her long first labour. He was a healthy weight with no other problems, other than his eczema. You make sure both he and his sister have all their vaccinations. You take them to get the jabs and then out for ice cream afterwards. Ben loves mint ice cream.
PMH: Ben has generally been quite healthy. He just has a bit of dry skin from time to time, for which he pops on some cream. Mum deals with that, though.
DH: Ben just has some moisturiser and creams for his skin.
FH: Your wife has some inhalers, and gets bad hay fever.
SH: Ben lives at home with you and your wife and his older sister who is 7. There hasn’t been any change in products used in the house and no new pets, just the fish (Calvin and Hobbes). There aren’t any smokers in the house.
Observe the student and give appropriate feedback for their history taking. A respiratory examination is the appropriate choice following the history. Ask them to summarise their findings succinctly, and then present their differentials.
Differentials should include asthma, allergic rhinitis, viral induced wheeze and bronchiolitis.
Points for discussion may include:
- What is the difference between asthma and viral induced wheeze?
- How would Ben be managed?
- How is acute exacerbation of asthma categorised and managed?
