Can you help me with this one...?

L.O an 8 month old female infant from Consolacion was admitted for the first time at VGMH for cough and labored breathing.
Prenatal, Natal and Post natal history 鈥?unremarkable

HPI: Patient was noted to have coryza since 2 days PTA, with no consult done, nor medications given. One day PTA, patient had onset of cough and had decreased intake of solid foods, showing a preference for milk and juices. Her last intake was orange juice, 2 hours PTA. One hour PTA, mother noted labored breathing thus sought consult.

PE:
Patient examined lethargic, not interactive, afebrile with the following vital signs:
BP = 80/40 mmHg, HR = 140/min, RR = 50/min T = 36.8C weight = 7.5Kg

Skin: pale, (-) rashes
HEENT: (+) alar flaring, (+) watery nasal discharge, (+) nasal congestion, (-) tonsillopharyngeal congestion
Neck: supple
C/L: (+) subcostal, intercostals and suprasternal retractions, (+) expiratory wheeze, prolonged expiratory phase
CVS: (-) murmur
Abdomen: soft, no organomegaly
GUT: grossly female
Ext: no edema, no rash
Neurologic: lethargic

1. What is your impression?
2. What is your differential diagnosis? (give at least 2)
3. How would you manage this patient?

Pneumonia/ RSV bronchiolitis vs RAD

Oh, gosh , I should have included FBO. The detractor for me was coryza,and (-) tonsillopharyngeal congestion, which means a visual exam of oropharyngeal area r/o upper fbo, lower airway obstruction then would be suspected and a lateral neck Xray indicated. Report It