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A 3-Year-Old Boy Is Brought to the Emergency Department Due

question 309

Multiple Choice

A 3-year-old boy is brought to the emergency department due to refusal to walk. The patient's mother first noticed a mild limp 3 days ago after picking him up from day care. The patient tends to climb and jump on furniture, so she initially attributed the limp to rough play. The symptoms worsened today, and the patient now refuses to stand, falling when held up by his mother. He has no chronic medical conditions but has had a runny nose and fever intermittently for 2 months since starting day care. Temperature is 38 C (100.4 F) , pulse is 90/min, and respirations are 24/min. Pulse oximetry is 100% on room air. The patient appears comfortable while lying supine on the examination table. He has clear rhinorrhea with several soft and mobile anterior cervical lymph nodes approximately 1 cm in diameter. The abdomen is nontender and the liver edge is palpable. The hips are held flexed bilaterally. During movement of the left hip, the patient wails and resists. Sensation is normal, and reflexes are intact. Babinski sign is negative bilaterally. Laboratory results are as follows: Which of the following is the best next step in management of this patient?

Definitions:

Intellectual Development Disorder (IDD)

A disorder characterized by significantly impaired intellectual and adaptive functioning, diagnosed based on below-average intelligence and difficulty managing everyday tasks.

Sheltered Workshop

A supervised workplace for individuals with disabilities, providing specialized employment opportunities and training.

Displays Resiliency

Exhibiting the capacity to recover quickly from difficulties or adapt effectively in the face of adversity.

Intellectualization

A defense mechanism where reasoning is used to block confrontation with an unconscious conflict and its associated emotional stress, focusing instead on abstract and intellectual thought.