Fatigue and persistent cough
Author and Disclosure Information [Show]

Karl J. D'Silva, MD, Clinical Assistant Professor, Department of Medicine, Tufts University School of Medicine, Boston; Medical Director, Department of Oncology and Hematology, Lahey Hospital and Medical Center, Peabody, Massachusetts.

Karl J. D'Silva, MD, has disclosed no relevant financial relationships.

Question 1 of 3

An 11-year-old boy presents to his pediatrician. He has been experiencing fatigue, persistent cough with wheezing, dyspnea, and loss of appetite for the last month. Findings on physical exam show nothing remarkable; his heart rhythm is normal, he has slight wheezing on auscultation, and there is no lymphadenopathy. The patient appears pale and tired.

CT reveals a 3-cm ground-glass opacity with a small, central-solid component in the upper left lobe. There is no evidence of lymphatic, vascular, or pleural invasion and no tumor necrosis. Laboratory findings were all within the normal range complete blood cell counts and liver and kidney function, as well as for the biomarkers carcinoembryonic antigen, alpha fetoprotein, carbohydrate antigen 19-9, carbohydrate antigen 72-4, cytokeratin 19 fragment, neuron-specific enolase, and serum ferritin. Ultrasonography of the liver, spleen, pancreas, and gallbladder were negative, as was brain MRI.

What is the next step in the diagnostic process for this patient?

Thoracoscopy

Transthoracic needle biopsy and molecular testing

Sputum cytology

Bronchoscopy

This quiz is not accredited for CME.

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