08-07-2007, 11:26 PM
A 3-year old boy with acute lymphoblastic leukemia has had fever for 3 days. He completed his last course of chemotherapy 6 days ago. He has had no malaise, rash, or anorexia and has had no known contact with sick children in preschool. He appears well. His T is 38.6 degree, BP is 75/60mm Hg, pulse is 100/min, and respiration are 22/min. Examination shows normal findings. Laboratory studied show: Hb 10.1 (n=11.5-15.5)
Leukocyte count 2200/mm3, segmented neutrophils 5%, Bands 1%, lymphocytes 65%, atypical lymphocytes 11%, monocytes 18%, platelet count 35000/mm3. Which of the following is the most appropriate next step.
A.Schedule a follow-up visit and discharge without medication
B.Observe him in the office for 3 hours, discharge without medication if examination remains unchanged
C.Discharge him with oral broad-spectrum antibiotic therapy
D.Admit him to the hospital for observation
E.Admit him to the hospital for intravenous broad-spectrum antibiotic therapy
Leukocyte count 2200/mm3, segmented neutrophils 5%, Bands 1%, lymphocytes 65%, atypical lymphocytes 11%, monocytes 18%, platelet count 35000/mm3. Which of the following is the most appropriate next step.
A.Schedule a follow-up visit and discharge without medication
B.Observe him in the office for 3 hours, discharge without medication if examination remains unchanged
C.Discharge him with oral broad-spectrum antibiotic therapy
D.Admit him to the hospital for observation
E.Admit him to the hospital for intravenous broad-spectrum antibiotic therapy