prasannakumar
Forum Senior
Topics: 24
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A 17-year-old, college student, comes to his physician with a 3-day history of fever, malaise, and sore throat. His vitals are, PR: 96/min; Temperature: 37.9C(100.1F); BP: 110/70mm Hg; RR: 15/min. His pharynx, soft palate and tonsils are erythematous and swollen. There are tender cervical adenopathy, splenomegaly and petechial lesions on skin and mucosa. Lab studies show: Hemoglobin: 14g/dL; WBC count: 15,000/microL; Neutrophils: 42%; Lymphocytes: 50%; Monocytes: 5%; Basophils: 1%; Eosinophils: 2%; Platelet count: 20,000/microL. Large basophilic lymphocytes with vacuolated appearance are seen. Monospot test is positive. What is the most appropriate next step in the management of this patient?
A) Serological tests
B) Penciclovir
C) Acetaminophen and ampicillin
D) Glucocorticoids
E) Splenectomy
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| dr in trouble
Forum Guru
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I think its E as plaelet count is very low.
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| sprint123
Forum Guru
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A--Ruled out--> Monospot test 95% specific
B-->Antivirals not effective
C--->Ampicillin contraindicated
D--->Steroids only in extreme tonsillar enlargement causing airway obstruction.
Spleen has enlarged to a greater extent to cause platelet count to be 20,000--So answer E!
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| ashfaque
Forum Newbie
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e
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| arlete
Intern in 2009!!!!!
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Good question!
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| dr19
Forum Senior
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I choose D.....
glucocortcoids can be used to treat severe thrombocytopenia.
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| prasannakumar
Forum Senior
Topics: 24
Posts: 55
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yup...dr19 ur right. sprint123...i agree with ur explanations for the options A,B,C..
Glucocorticoids r indicated in IM when it is complicated by upper airway obstruction,autoimmune hemolytic anemia,thrombocytopenia.
Splenectomy is an emergency procedure, performed when splenic rupture occurs.
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