Bobby Jackson's Stomach Ache



The Molecular Basis of Medicine

Step 1

Case 1

Bobby Jackson's Sore Knee

Course Director: W. Marshall Anderson, Ph.D.

Tutors: W. Marshall Anderson, Ph.D.

Mary Ann Kirkish, Ph.D.

Susanna Alverez-Banks, M.D.

Case Author: David Crabb, M.D., and W. Marshall Anderson, Ph.D.

Case Editors: Case Review Committee

The Molecular Basis of Medicine

Step 1

Case 1 first session

Bobby Jackson's Sore Knee

Bobby Jackson, a three-year-old African American male, is brought to the emergency room by his mother. Mrs. Jackson tells the emergency room physician, Dr. Kasan, that Bobby has been complaining about a sore right knee over the past two days, Bobby denied injuring the knee and there is no evidence of insect sting. Today Bobby was screaming in pain and unable to put weight on his right leg.

A quick physical exam reveals a small African American male (weight and height below the 10th percentile) with an acutely swollen right knee. Temperature, heart rate and blood pressure are within normal limits. Sclera’s are icteric. An IV line is started and blood is drawn and a urine sample obtained and sent to the lab for analysis.

1-1

The Molecular Basis of Medicine

Step 1

Case 1 first session Continued

Family history

Bobby has two siblings, a six-year-old sister and an 8-year-old brother. Both siblings and the parents appear healthy. Bobby’s maternal grandmother had some bouts of weakness and frequent infections and was found to be mildly anemic. She died at age 52 of a massive heart attack. Bobby’s paternal uncle was severely anemic, had multiple upper respiratory infections and died at age nine from pneumonia.

Bobby’s mother reports that Bobby tires easily, has swollen knees often especially when exercising, and is discouraged that he cannot play with his friends because of his lack of stamina.

1-2

The Molecular Basis of Medicine

Step 1

Case 1 first session Continued

Routine laboratory test results are as follows:

|Analyte |Bobby Jackson |Normal in parentheses |

|Hb |7 g/dl |(14-16 g/dl) |

|Hematocrit |21 |(45) |

|WBC |9,500/μl |(5-10,000/μl) |

|Platelets |320,000/μl |(150-300,000/μl) |

|Reticulocyte count |15 % |( ................
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