Approach to a cough (pediatrics) Quiz: Ace Your Exams
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A 7-year-old boy is brought to the clinic for evaluation of a chronic wet cough. The caregiver reports frequent episodes of nasal congestion and recurrent respiratory infections, including multiple episodes of bronchitis and two prior hospitalizations for pneumonia. There is no history of wheezing or known allergies. Growth has remained at the lower end of the normal range without significant weight loss. Newborn screening was normal. Vitals are within normal limits. Digital clubbing is noted, and lung auscultation reveals scattered rhonchi and coarse breath sounds bilaterally. Chest X-ray shows mild bronchiectasis, and paranasal sinus imaging reveals chronic sinusitis. Basic labs, including a complete blood count, are within normal limits. A sweat chloride test is normal. Which of the following additional tests is most likely needed to confirm the diagnosis?
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