Correct!
3. Mental health consultation
Although the patient may have a mental health condition, there are some suggestions that she may have a physical ailment. Her low BMI and adenopathy could be due to anorexia but also could be secondary to a physical ailment such as infection (e.g., tuberculosis, histoplasmosis, mononucleosis), gastrointestinal disorders, cancer (e.g., lymphoma). For this reason, a CBC and chest x-ray are indicated. The chest x-ray is shown in Figure 1.
Figure 1. Initial PA of chest.
CBC showed a white blood cell count of greater than 400,000 and a platelet count of 1,357,000. Hemoglobin was 7 g/dL. Additional laboratory obtained was a lactate dehydrogenase (LDH) which was elevated at 1980 IU/L (normal 110-283). Urinanalysis was unremarkable.
Which of the following is appropriate at this time? (Click on the correct answer to proceed to the fourth of seven panels)