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Foreign body aspiration — MRCPCH FOP MCQ

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ModerateRespiratoryForeign body aspirationMRCPCH FOP

An 18-month-old boy has sudden coughing while eating peanuts and remains wheezy. He is afebrile, has reduced air entry on the right and an expiratory chest radiograph shows right-sided hyperinflation. What is the most appropriate investigation?

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Correct answer: D — Urgent rigid bronchoscopy

A witnessed choking episode with unilateral signs and air trapping is highly suggestive of foreign body aspiration, and bronchoscopy is both diagnostic and therapeutic. Steroids would be inappropriate because the unilateral findings and choking history make asthma unlikely. Waiting for interval imaging risks persistent obstruction and infection. The pearl is that a normal or subtle chest radiograph does not exclude aspiration when the history is convincing.

Reference: NICE CKS Cough; APLS principles