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* 36
 #140908  
  angioplasty - 11/23/06 22:02
 
  35. A 45-year-old homeless man is admitted to the hospital because of myalgias and jaundice. He has no known past medical history and denies alcohol or drug abuse. Vital signs are: temperature 37.1°C (98.8°F), pulse 90/min, respirations 18/min and blood pressure 117/75 mm Hg. On examination he appears malnourished. Pupils are round and reactive with scleral icterus. Dentition is poor. Gums are swollen and friable. Neck is supple without adenopathy or bruits. No jugular venous distention is noted. Lungs are clear. Cardiac examination demonstrates a normal S1 and S2 with a 2/6 systolic murmur at the left sternal border. Abdomen is distended, but otherwise normal. Examination of the skin discloses diffuse perifollicular hemorrhages on the legs with purpura and ecchymosis. There is no clubbing or cyanosis of the hands, but splinter hemorrhages of the nail beds are noted. Neurologic examination shows normal cranial nerves. Sensation to touch in the legs is decreased, bilaterally. Laboratory studies show:


Serum



Blood



AST

120 U/L

Hemoglobin

9.2 g/dL

Bilirubin

4.2 mg/dL

WBC

5500/mm3




MCV

82 μm3Platelets

234,000/mm3




PTT

23 sec




PT

12 sec




INRWhich of the following is the most likely underlying cause for this patient's symptoms and laboratory findings?

A

) Acute viral hepatitis

B

) Endocarditis

C

) Vitamin C deficiency

D

) Hemochromatosis

E
36. An 8-hour-old neonate, who was born via cesarean delivery at 38 weeks' gestation, is in the neonatal unit. The cesarean delivery was done due to fetal distress. The mother is a healthy 25-year-old woman and this was her first pregnancy. There were no complications during the pregnancy, but bloody amniotic fluid was noted at the time of delivery. The neonate's Apgar score was 8 at 1 minute and 9 at 5 minutes; points were taken off for color only. At 30 minutes of age the infant was noted to have some mild grunting and tachypnea. These symptoms resolved spontaneously during approximately a 40-minute period, but the on-call physician ordered a complete blood count and blood culture for suspected sepsis. Because the symptoms resolved so quickly, no antibiotic therapy was started. You are now satisfied that further pursuit of infectious problems is not indicated. The neonate appears normal, and the mother's initial attempts at breast-feeding seem successful. Laboratory studies on the neonate return and are normal except for a hematocrit of 40% (N=4565). Maternal and infant blood type are both O, Rh-positive. The best course of action at this time is to do which of the following?

A

) Obtain hematology consultation) Obtain serum iron studies, including total iron-binding capacity

C

) Order an Apt test on the neonate's stool

D

) Order hemoglobin electrophoresis

E

) Repeat the hematocrit determination


B

) Vitamin K toxicity


1.05



 
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* Re:36
#569716
  pk007 - 11/23/06 23:25
 
  35. VIT C DEF.
36. ORDER AN APT TEST
 
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* Re:36
#569729
  anand11anupa - 11/23/06 23:31
 
  35. endcarditis.If you look at the complete picture-tricuspid murmur(rt sided)
splinter haemorraghes,fever
 
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* Re:36
#569745
  pk007 - 11/23/06 23:40
 
  is that the fever of ie, 38.6? is that tricuspid murmur?confused........help me.  
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* Re:36
#569784
  tea - 11/24/06 00:27
 
  c, gum swelling, prefollicular hemorrhage, reduce sensation, anemia-high output HF-murmur
e
 
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