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Acute chest syndrome — RACP Paediatrics MCQ

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HardRespiratoryAcute chest syndromeRACP Paediatrics

A 15-year-old with HbSS has fever, chest pain, a new multilobar infiltrate and oxygen saturation 86% despite supplemental oxygen. Haemoglobin has fallen markedly below baseline and respiratory effort is increasing. What escalation is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Treat acute chest syndrome and plan urgent transfusion and respiratory support with PICU

Explanation lettering: C = shown as A · A = shown as C · E = shown as D · D = shown as E

B is correct because hypoxaemia, fever, chest pain and a new infiltrate define life-threatening acute chest syndrome; antibiotics, oxygen, analgesia, careful fluids and early critical-care support proceed while haematology plans simple or exchange transfusion according to severity. C repeats the original incorrect label. D under-treats progressive lung disease. E ignores infarction and infection. A delays empirical coverage in a rapidly deteriorating, functionally asplenic patient.

Reference: Royal Children’s Hospital Melbourne, Sickle cell disease: https://www.rch.org.au/clinicalguide/guideline_index/Sickle_Cell_Disease_Guideline/