A 6-year-old girl with a history of gastroesophageal reflux is hospitalized with a primary lung abscess in the right upper lobe, diagnosed by chest CT. She is started on intravenous ampicillin-sulbactam. After 9 days of appropriate antimicrobial therapy, she remains febrile with persistent cough and chest pain, and a repeat CT shows no change in the abscess size. What is the most appropriate next step in management?
A 16-year-old boy with no significant past medical history presents to the emergency department with acute-onset fever, dyspnea, and cough over the past 48 hours, rapidly progressing to respiratory failure requiring mechanical ventilation. His family reports he started smoking cigarettes for the first time about three weeks ago. Laboratory results are notable for the absence of peripheral eosinophilia, but bronchoalveolar lavage fluid shows 30% eosinophils. What is the most likely diagnosis?
A 2-year-old had a sudden episode of choking and coughing while eating nuts one hour ago, which has since resolved. He is now playing comfortably with normal breath sounds on examination. The parents are concerned. What is the most appropriate interpretation of this asymptomatic interval?
A 10-year-old child presents with a six-month history of a persistent, localized wheeze in the right lower lung field that has not responded to bronchodilator therapy. A chest computed tomography scan reveals a well-circumscribed, centrally located endobronchial mass with associated distal atelectasis. Which diagnosis represents the most common primary malignant pulmonary tumor in this pediatric age group?
A 13-year-old boy with obesity is hospitalized for COVID-19. He rapidly decompensates, requiring high-flow nasal cannula for hypoxemia (SpO2=91%), and has markedly elevated inflammatory markers, including C-reactive protein. According to treatment guidelines for severe COVID-19 in children, which therapeutic combination is most appropriate for this patient?
A 15-year-old male develops an acute onset of severe cough, dyspnea, and wheezing within two hours of being exposed to a large chlorine gas leak from a chemical pump malfunction at the swimming pool. He has no prior history of respiratory illness. This clinical presentation is most consistent with which of the following?
A 3-month-old infant presents with a 2-month history of biphasic stridor and a barking cough, symptoms consistent with persistent croup. On physical examination, a large cutaneous hemangioma is noted covering the preauricular area, chin, and neck. What is the significance of this “beard distribution” hemangioma?
A 3-week-old infant who underwent a complex cardiothoracic surgery develops a large right-sided pleural effusion. A thoracentesis is performed, revealing a milky white fluid. Laboratory analysis confirms a triglyceride level of 150 mg/dL and the presence of chylomicrons. In addition to nutritional modifications and drainage, which pharmacologic agent has been effectively used to manage chylothorax by reducing chyle flow?
A 12-year-old girl with a history of difficult-to-control asthma presents with foot drop and a skin rash. Laboratory workup reveals a peripheral eosinophilia of 18% (> 1,500 cells/μL). A diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA) is being considered. According to the American College of Rheumatology criteria, which of the following findings would most strongly support this diagnosis?
A 3-year-old boy is hospitalized with bacterial pneumonia. After 48 hours of intravenous antibiotics, he remains febrile and develops respiratory distress. A chest radiograph reveals a large pleural effusion, and thoracentesis yields purulent fluid. Which of the following is the most common causative organism for empyema in this age group?
