A 5-Year-Old Boy Is Brought to the Emergency Department by His

question 450

Multiple Choice

A 5-year-old boy is brought to the emergency department by his parents due to difficulty walking.  The patient first developed pain in the legs this morning and has not wanted to walk today.  He played 2 soccer games yesterday with no pain or trauma.  A week ago, the patient had a low-grade fever and cough that have since resolved.  He has had no nausea, emesis, diarrhea, weight loss, or night sweats.  The patient has no significant medical history and takes no daily medications.  Temperature is 36.7 C (98.1 F) , blood pressure is 90/40 mm Hg, pulse is 138/min, and respirations are 20/min.  Examination shows an uncomfortable-appearing boy lying in bed; the patient cries with any attempt to move his legs.  A purplish, nonblanching rash is noted over the buttocks and posterior thighs.  The abdomen is soft with active bowel sounds.  There is mild, diffuse tenderness to palpation with no rebound or guarding.  Lower extremity joints demonstrate no deformity, erythema, swelling, or warmth.  The patient refuses to walk due to pain in his legs.  Laboratory results from urinalysis are as follows: This patient is at greatest risk for developing which of the following complications?

• A)Hemolytic anemia
• B)Intussusception
• C)Joint destruction
• D)Urethritis
• E)Uveitis