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Case Introduction Patient History: Marie Chavez is a 16 year old girl who presents to her primary care physician complaining of a cough that has been getting worse over the last few months

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Case Introduction Patient History: Marie Chavez is a 16 year old girl who presents to her primary care physician complaining of a cough that has been getting worse over the last few months. Marie has been healthy until about 4 months before this clinic visit when she noticed a frequent productive cough, particularly when she was outside with friends or in smoke-filled areas. When asked if she herself smoked, she stated that she did not, but began vaping with a Juul about 2 years ago. She says that she doesn’t vape that much and maybe goes through 1 Juul pod per week. She does report coughing after smoking but thought it was normal because “doesn’t everyone who vapes cough?” What worries her now is that she’s been waking up at 2 or 3 in the morning coughing, waking her up from sleep. Taking a hot shower and inhaling the steam helps relieve her symptoms slightly. Cough drops and other over the counter cough medication has not seemed to help. Past Medical History: Marie’s past medical history is negative other than recurrent episodes of sinusitis since she was a little girl. She has no skin conditions other than acne and no known drug allergies Social History: Marie has two older brothers and one baby sister. Her mother works for a bank and her father works in a restaurant. In high school, she is on the soccer team and the cheer team. Marie’s biggest concerns, other than her cough, are her weight, facial acne, and peer pressure. She denied any real need for medical care for her cough. She vapes because all of her friends do. She loves her indoor cat, Sally. Family History: Nobody in her family smokes, and there is no history of respiratory problems. Q1) What parts of Marie’s history stand out to you the most? Q2) Is there anything you want to talk about more with Marie? Q3) What is the most likely diagnosis? What led you to that conclusion?