A vaccinated, well-appearing 2-year-old girl with upper respiratory infection symptoms for 1 day and fever to 38.3°C (101°F) presents to your urgent care. She is well-hydrated and has normal work of breathing on examination. You auscultate some transmitted upper airway sounds and scattered rales. You should:
- Refer the child to the emergency department.
- Give expectant guidance and return precautions before discharging the girl home with appropriate follow-up.
- Order a chest x-ray, laboratory studies, and a blood culture.
- Prescribe amoxicillin.
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Answer: B. Viruses are the predominate cause of community-acquired pneumonia (CAP) in children aged <5 years; as a result, antibiotic treatment is not recommended for preschool-aged children with CAP. Other clues to viral etiologies of CAP include the presence of wheezing, prior history of wheezing, and up-to-date immunization status. In general, laboratory and radiographic evaluation are not recommended for healthy children with suspected CAP who are candidates for outpatient treatment. Testing will not reliably differentiate between viral and bacterial etiologies, so extensive workup is not necessary in uncomplicated cases.
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