Step 1: Answering clinical questions of diagnosis
You are seeing Kerri, an 18-month old female, with her mother. Kerri has had 7 days of a productive cough and fevers to 101.5 degrees. Initially, she had rhinorrhea, but this has resolved. She has not been pulling at her ears, but her appetite is decreased. She is not sleeping through the night as well as she had been prior to this illness. She has had frequent ear infections in the past, but is otherwise healthy. On exam, she is tachypneic with a respiratory rate of 45 per minute. Her pharynx and tympanic membranes are normal. Her lungs are clear. You suspect pneumonia because of her respiratory rate, and you wonder if you need to obtain a chest xray to confirm this. Her mother would prefer that Kerri not have a chest xray and be treated with antibiotics.
Step 1: Define a clinical question