Check out today’s Step 2 CK Qmax Question Challenge.
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An 8-year-old boy is brought to the physician because of refusal to walk for 3 days. On questioning, he states that both his legs hurt. His mother states he has “not been himself” for the past month and has been sleeping much more than usual. His temperature is 38.4°C (101.1°F), heart rate is 164/min, respiratory rate is 42/min, and blood pressure is 90/54 mm Hg. The child is pale and listless. Severe hepatomegaly is noted. The child also limps when walking. There are no obvious deformities of the lower extremities or hip, knee, or ankle joints. A peripheral blood smear is shown below. Laboratory tests show:
WBC count: 9,500/mm³
Hemoglobin: 8.9 g/dL
Platelet count: 75,000/mm³
Na+: 135 mEq/L
K+: 4.0 mEq/L
Cl-: 104 mEq/L
Blood urea nitrogen: 8 mg/dL
Creatinine: 0.6 mg/dL
What is the best step in the management of this patient?
A. A CT scan
B. Bone marrow biopsy
C. Emergent chemotherapy
D. Multiple-gated acquisition scans
E. Platelet transfusion
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