a. Begin outpatient treatment with ampicillin
b. Culture throat for β-hemolytic streptococci
c. Admit to intensive care unit and obtain otolaryngology consultation
d. Schedule for chest x-ray
e. Obtain Epstein-Barr serology
This patient, with the development of hoarseness, breathing difficulty, and stridor, is likely to have acute epiglottitis. Because of the possibility of impending airway obstruction, the patient should be admitted to an intensive care unit for close monitoring.
The diagnosis can be confirmed by indirect laryngoscopy or soft tissue x-rays of the neck, which may show an enlarged epiglottis. Otolaryngology consult should be obtained. The most likely organism causing this infection
is Haemophilus influenzae. Many of these organisms are β-lactamaseproducing and would be resistant to ampicillin. The clinical findings are not consistent with the presentation of streptococcal pharyngitis. Lateral neck films would be more useful than a chest x-ray. Classic findings on lateral neck films would be the thumbprint sign.