Case Fridays - A lungful

This week's case is from Medscape's massive library. Please note that I tend to modify cases slightly firstly to avoid direct copying, secondly to provide a regular format to each weeks case and sometimes just to make it a bit more interesting.

Presenting Complaint
Jill, a 5 year-old girl presents with a fever and severe cough. Mother reports that her daughter is just not feeling herself.

Past Medical History
On taking a history it becomes apparent that the Jill had a 2-3 week history of fever, cough, and occasional posttussive emesis. She went to her local GP six days ago who diagnosed her with a viral upper respiratory infection after an unremarkable physical examination. No further testing was done and only symptomatic care was recommended. Jill's health improved over the subsequent three days before deteriorating again. There has been one episode of vomiting with coughing recently, but no diarrhoea.
Her mother gave her some acetaminophen to control fever. No other significant medical history. No travel history.

Physical Examination
39.2 C (Fever)
RR: 28/min (tachypnea)
HR: 152bpm
BP: 103/62mm Hg
Oximetry: 98%
Non-productive cough
No noticeable abnormalities on physical examination (e.g. breath sounds, organomegaly)

As the fever and cough are recurrent you feel that is necessary to order a chest x-ray.

To continue the case click here.

Think about likely diagnoses and what other tests you might order to assist you.

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