Published 8 July 2009, doi:10.1136/bmj.b2150
Cite this as: BMJ 2009;339:b2150

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A 2 year old with fever and cough

A Gupta, specialist registrar1, D S Urquhart, specialist registrar1, A Devaraj, specialist registrar2, I M Balfour-Lynn, consultant1

1 Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, 2 Department of Radiology, Royal Brompton Hospital, London SW3 6NP

atulgupta@doctors.org.uk

The first 150 words of the full text of this article appear below.

A previously well, fully immunised 2 year old boy presented to his general practitioner with a five day history of cough and fever. He was initially prescribed oral amoxicillin, which did not improve his condition. On examination, the patient was febrile, tachycardic, and tachypnoeic; he was also in respiratory distress and had markedly reduced air entry on the right side of the chest with stony dullness on percussion. Cardiovascular and abdominal examinations were unremarkable. Inflammatory markers were raised (white cell count 28x109/l–1 and C reactive protein 340 mg/l–1). A chest radiograph was taken (fig 1).Go


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  		Chest radiograph (posteroanterior view)

 
1 What abnormalities are shown in the chest radiograph?
2 What further investigations are indicated in this case?
3 What is the likely diagnosis?
4 What is the most likely pathogen?
5 What specific treatment plan would be most suitable for this patient?

1 The chest radiograph . . . [Full text of this article]

Box 1 British Thoracic Society guidelines for the management of community acquired pneumonia in children12

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Errors in this case
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Response: Errors in this case
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