A 6-Year-Old Boy Is Brought to the Emergency Department by His

question 229

Multiple Choice

A 6-year-old boy is brought to the emergency department by his mother due to new-onset chest pain.  A week ago, he developed a low-grade fever with nasal congestion and a dry cough.  Over the past few days, he has had paroxysms of coughing that seem to be worse at night.  Last night, the patient developed pain in his chest that did not improve after he was given acetaminophen.  He has no chronic medical conditions and takes no daily medications.  Temperature is 37.3 C (99.1 F) , blood pressure is 106/76 mm Hg, pulse is 130/min, respirations are 36/min, and pulse oximetry is 98% on room air.  There is clear rhinorrhea.  The posterior oropharynx and tonsils are erythematous.  There is mild swelling of the neck and crepitus over the anterior chest.  Pulmonary examination reveals clear and equal breath sounds bilaterally.  Cardiac examination shows a normal S1 and S2 with no murmurs, rubs, or gallops.  Which of the following is the best next step in evaluation of this patient?

• A)Bronchoscopy
• B)Chest x-ray
• C)Contrast esophagography
• D)Pulmonary function tests
• E)Throat culture

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