q1&2 - zurba

[ArchivalUser]

A mother brings her 1-yearold child because she is concerned about potential exposure to lead. Renovations are being made in their older home, and the mother is now considering moving to another house until the work is completed. You want to check the child™s blood lead level. Which of the following is the most accurate method of screening for lead poisoning?


1. Erythrocyte protoporphyrin
2. Capillary blood lead
3. CBC
4. Venous blood lead
5. Ferritin


While you are on duty in the emergency room, a 12-year-old boy arrives with pain and inflammation over the ball of his left foot and red streaks extending up the inner aspect of his leg. He remembers removing a wood splinter from the sole of his foot on the previous day. The most likely infecting organism is ?





1. Clostridium perfingens
2. C. tetanus
3. Staphylococcus
4. Escherichia coli
5. Streptococcus

[ArchivalUser]

1. ans 4
2.ans1

[ArchivalUser]

1 A . rbc protoporphyrin
2A Cl perfringens ??

[ArchivalUser]

1. Is it 2?
2. is it 1

[ArchivalUser]

1. 4. Venous blood lead is correct



2. 5. Streptococcus


The significant observation in this question is the description of lymphangitic inflammatory streaking up the inner aspect of the patient™s leg. This is highly suggestive of a streptococcal infection, and the presumptive therapy should be high doses of a bactericidal antibiotic. However, the clinician must be alert to the possibility of a more fulminant and life or limb-threatening infection by clostridia, microaerophilic streptococci, or other potentially synergistic organisms that can produce rapidly progressive deep infections in fascia or muscle. Smears and cultures of drainage fluid or aspirates should be taken. Close observation of the wound is essential, and aggressive debridement in the operating room is mandatory at the slightest suggestion that fasciitis or myonecrosis may be ensuing.

[ArchivalUser]

thanks for the question and explanation.

[ArchivalUser]

@ zurba
thanks for explaination of 2nd q
I am not satisfied with ans of 1st q
CMDT 2008 mentions
"Diagnosis is based on measurement of the blood lead level. Whole blood lead levels less than 10 mcg/dL are usually considered nontoxic. Levels between 10 and 25 mcg/dL have been associated with impaired neurobehavioral development in children. Levels of 25“50 mcg/dL may be associated with headache, irritability, and subclinical neuropathy. Levels of 50“70 mcg/dL are associated with moderate toxicity, and levels greater than 70“100 mcg/dL are often associated with severe poisoning. Other laboratory findings of lead poisoning include microcytic anemia with basophilic stippling and elevated free erythrocyte protoporphyrin."
Where it is mentioned about venous blood level?

[ArchivalUser]

medneo please read this hope it helps...thanks a lot zurba for the explanation...=

Whole BLL is the criterion standard for confirming the diagnosis of lead poisoning. A BLL of 10 mcg/dL or higher denotes poisoning. For convenience, a fingerstick capillary lead level has been used for screening. Properly collected capillary samples have a 10% false-positive rate. Once an elevated lead level is detected, a venous lead level is assessed for confirmation.

[ArchivalUser]

Thanks mohammed for explaination