Question

A 6 year old boy from Ghana presents with chest and abdominal pain for the past day. His pain began suddenly while at rest last night, is a 9/10 in intensity and unrelieved by ibuprofen, and is localized mainly to his epigastrium and left upper quadrant, back, and chest. Past medical history is unremarkable, and immunizations are up-to-date. On physical examination, the patient is afebrile and normotensive but tachycardic. Lungs are clear to auscultation, and there is moderate tenderness to palpation in the left upper quadrant. Laboratory evaluation shows a white blood count of 11,000 and a hematocrit of 31%. Chest x-ray shows no atelectasis or infiltrate, and abdominal x-ray shows no free air and moderate enlargement of the spenic silhouette. The patient is given i.v. fluids, ceftriaxone, and morphine. Which of the following is the most appropriate next step in the management of this patient?

A. ELISA for HIV-1 antibodies
B. Hemoglobin electrophoresis
C. CT of chest
D. Vancomycin
E. Hydroxyurea

Answer 1

The correct answer is option B. The hemoglobin electrophoresis is the most appropriate next step in management due to the symptoms and the high prevalence of sickle cell disease in Ghana.

Step-by-step explanation:

The most appropriate next step in the management of this patient, a 6-year-old boy from Ghana with chest and abdominal pain, moderate tenderness to palpation in the left upper quadrant, and an enlarged spleen silhouette on x-ray, is to perform a hemoglobin electrophoresis.

The symptoms, combined with the boy's geographical location and hematocrit levels, suggest a potential diagnosis of sickle cell disease, a common condition in sub-Saharan Africa.

Hemoglobin electrophoresis is a key diagnostic test that identifies abnormal hemoglobin variants associated with sickle cell disease.

Given the current clinical presentation and considering the most likely diagnoses, other options such as ELISA for HIV-1 antibodies, CT of the chest, Vancomycin, or Hydroxyurea are less immediately pertinent or indicated after getting results from the electrophoresis.