- A social worker brings a 10-month-old boy to the emergency department for an examination before placing him in a foster home. He was removed from his own home because of concerns involving his school-aged sister. His clothes are stained, somewhat dirty, and frayed. On physical examination, he appears thin and long; he has a normal head size and redundant skin folds, and he cannot sit unsupported. He does not seem to be dysmorphic. Which of the following is the most likely cause of his condition?
A. Inborn error of metabolism
B. Insufficient caloric intake
C. Intestinal atresia
D. Intracranial neoplasm
- An acutely poisoned patient presents with a severely depressed level of consciousness and tachypnea. Blood pressure and heart rate are normal. Blood gas analysis reveals a pH of 7.23, Pco2 of 23 mm Hg, and a serum bicarbonate level of 10 mEq/L. Which of the following toxins is most consistent with this presentation?
A. Ethylene glycol
B. Isopropyl alcohol
- Which of the following statements regarding cystic fibrosis is correct?
A. Hypernatremic hyperchloremic dehydration is common.
B. Most patients are colonized with Aspergillus fumigatus by age 18 years.
C. Recurrent episodes of pancreatitis with increased levels of amylase and lipase become more frequent with age.
D. Treatment includes therapies that can help clear mucus, such as N-acetylcysteine aerosols.
- A 65-year-old man presents with severe respiratory distress and a history of both COPD and heart failure. Blood pressure is 195/115, and respirations are 32. Which of the following additional findings would support the decision to use BiPAP?
A. Altered level of consciousness
B. ECG evidence of acute MI
C. Elements of both heart failure and COPD
D. pH level of 7
- A 3-year-old boy with a history of chiari malformation and ventriculoperitoneal shunt placement is brought in by his mother because he has had intermittent headache, nausea, vomiting, and abdominal pain for 4 days. His siblings have recently been ill with influenza A. On examination, the child is irritable. He is afebrile, and there are no external signs of infection around the catheter. The chamber is easily compressible, and refill time is less than 3 seconds. What are the appropriate next steps?
A. Order head CT, shunt series, and shunt tap
B. Treat with acetazolamide to decrease CSF production
C. Treat with antiemetics and rehydration and attempt to feed
D. Treat with oseltamivir and discharge with instructions to follow up with pediatrician