Approach to lower airway obstruction (pediatrics) Quiz: Ace Your Exams

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A five-year-old girl presents to the pediatrician for a follow-up visit. She has recently been treated for recurrent otitis media. She has a medical history of recurrent pansinusitis, recurrent pneumonias, and chronic productive cough. Her weight is in the 25th percentile and height is in the 15th percentile. Temperature is 37°C (98.6°F), pulse is 95/min, respiratory rate is 18/min, blood pressure is 110/65, and oxygen saturation is 99% on room air. On physical examination, she is thin and has nasal polyps as well as bilateral middle ear serous effusions with loss of landmarks and light reflex. Cardiac exam reveals regular rate and rhythm, no murmur, but the heart is auscultated on the right side of the chest. Which of the following tests will confirm the most likely diagnosis?  

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