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Sickle cell acute chest syndrome — USMLE Step 3 MCQ

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ModeratePediatricsSickle cell acute chest syndromeUSMLE Step 3

A 8-year-old girl with sickle cell disease has fever and cough. Temperature is 38.8°C, oxygen saturation is 91% on room air, hemoglobin is 7.6 g/dL from baseline 8.8 g/dL, reticulocyte count is elevated, and chest radiograph shows a new left lower-lobe infiltrate. Which of the following is the most appropriate next step in management?

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Correct answer: A — Hospital admission with IV antibiotics and oxygen

Acute chest syndrome is defined by new pulmonary infiltrate with respiratory symptoms or hypoxemia in sickle cell disease. Management includes hospitalization, oxygen, antibiotics, pain control, incentive spirometry, and transfusion when indicated.

Reference: NHLBI Sickle Cell Disease Expert Panel Report