BOF: 88
A 66 year old male presents with a
history of fever and cough of a few days duration. He had previously been
reasonably well although he had been complaining of feeling tired and weak for
several weeks prior to admission. He was a diet controlled diabetic and was
not on any other treatment. He smoked 10 cigarettes a day and had done so for
the last 40 years.
He was a retired banker married and
had 3 children. He lived with his wife and had been managing independently
until admission.
On examination he looked unwell, was
febrile, had a pulse rate of 110 beats per minute, BP 110/80. There was
evidence of a left basal consolidation. On examination of his abdomen he was
noted to have a moderately enlarged spleen.
Investigations
Hb 8.5 g/dL
WBC 55.7 x 109/L
Neutrophils 40 %
Metamyelocytes 10 %
Myelocytes 21%
Myelocytes 4%
Blast cells 20 %
Nucleated red cells 5%
Platelets 34 x 109/L
In this patient which one of the
following investigations would you arrange in order to reach the underlying
diagnosis?
a)
Bronchoscopy
b)
CT scan of chest
c)
Bone marrow examination
d)
Leucocyte alkaline phosphatase score
e)
Blood cultures
