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An 18-Month-Old Boy Is Brought to the Emergency Department by His

question 343

Multiple Choice

An 18-month-old boy is brought to the emergency department by his adoptive mother due to increasing irritability. The patient has been tiring easily for the past 3-4 days; now he is irritable, constantly crying, and inconsolable. The mother tried to comfort him by playing with his toys, but he refuses to pick them up and cries more when he attempts to walk. The patient has had no recent trauma, fever, cough, or runny nose. He was adopted 6 months ago from Nigeria and has been healthy. Immunizations are up to date. Family history is unknown. Temperature is 37.8 C (100 F) and pulse is 120/min. The patient is alert and appears uncomfortable. Pupils are equal and reactive. Scleral icterus is present and the conjunctivae are pale. Cardiopulmonary examination is normal. The hands and feet are mildly swollen and tender to palpation. Hemoglobin is 9 g/dL. Which of the following tests would establish the underlying diagnosis in this patient?

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