08-01-2009, 07:01 AM
34. Two days after admission to the hospital because of a 3-day history of slurred speech, double vision, and dysphagia, a 24-year-old woman becomes quadriplegic and requires intubation and
mechanical ventilation. Her medical history is unremarkable. One week ago, she attended a
family picnic; several of her family members have had abdominal cramps and diarrhea since the picnic. Her temperature is 37C (98.6 F), blood pressure is 120/80 mm Hg, and pulse is 120/min.
Examination shows dry mucous membranes, large unreactive pupils,ophthalmoplegia, and profound facial weakness. There is areflexia,quadriplegia, and no movement of the palate and tongue. Sensation is normal. Babinski's sign is absent. Which of the following is the most appropriate pharmacotherapy?
A) Antitoxin
B) Azathioprine
C) Interferon
D) Pyridostigmine
E) Riluzole
35. A 2325-g (5 lb 2 oz) male newborn is delivered at 33 weeks' gestation; Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. The 13-year-old mother had no prenatal care and did not know how much weight she gained. During the pregnancy, the mother smoked marijuana and took over-the-counter vitamins occasionally; she did not drink alcohol and had no illness except for an upper respiratory tract infection 4 months ago. She did not know she was pregnant until 2weeks ago; her family is unaware of her condition. She has had one sexual partner. During the hospital stay, the newborn and his mother have no complications. The newborn is at greatest risk for morbidity and mortality from which of the following?
A) Child abuse
B) Congenital syphilis
C) Hypocalcemia
D) Lead poisoning
E) Seizures
36. A 2-month-old girl is brought to the physician because of a 2-week history of progressive difficulty breathing and poor feeding. She has had rapid and labored breathing and sweating during feedings. There
is no history of fever or viral illness. Her temperature is 37 C (98.6 F), blood pressure is 80/60 mm Hg, pulse is 130/min,and respirations are 40/min. Bilateral crackles are heard at both lung bases. A grade
4/6 holosystolic murmur is heard along the left
sternal border; the precordium is hyperdynamic. The liver edge ispalpated 4 cm below the right costal margin. An x-ray film of the chest shows cardiomegaly and pulmonary congestion. Which of the following is the most likely underlying mechanism for this child's condition?
A) Decreased systemic vascular resistance
B) Increased pulmonary vascular resistance
C) Increased systemic vascular resistance
D) Intracardiac left-to-right shunt
E) Intracardiac right-to-left shunt
mechanical ventilation. Her medical history is unremarkable. One week ago, she attended a
family picnic; several of her family members have had abdominal cramps and diarrhea since the picnic. Her temperature is 37C (98.6 F), blood pressure is 120/80 mm Hg, and pulse is 120/min.
Examination shows dry mucous membranes, large unreactive pupils,ophthalmoplegia, and profound facial weakness. There is areflexia,quadriplegia, and no movement of the palate and tongue. Sensation is normal. Babinski's sign is absent. Which of the following is the most appropriate pharmacotherapy?
A) Antitoxin
B) Azathioprine
C) Interferon
D) Pyridostigmine
E) Riluzole
35. A 2325-g (5 lb 2 oz) male newborn is delivered at 33 weeks' gestation; Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. The 13-year-old mother had no prenatal care and did not know how much weight she gained. During the pregnancy, the mother smoked marijuana and took over-the-counter vitamins occasionally; she did not drink alcohol and had no illness except for an upper respiratory tract infection 4 months ago. She did not know she was pregnant until 2weeks ago; her family is unaware of her condition. She has had one sexual partner. During the hospital stay, the newborn and his mother have no complications. The newborn is at greatest risk for morbidity and mortality from which of the following?
A) Child abuse
B) Congenital syphilis
C) Hypocalcemia
D) Lead poisoning
E) Seizures
36. A 2-month-old girl is brought to the physician because of a 2-week history of progressive difficulty breathing and poor feeding. She has had rapid and labored breathing and sweating during feedings. There
is no history of fever or viral illness. Her temperature is 37 C (98.6 F), blood pressure is 80/60 mm Hg, pulse is 130/min,and respirations are 40/min. Bilateral crackles are heard at both lung bases. A grade
4/6 holosystolic murmur is heard along the left
sternal border; the precordium is hyperdynamic. The liver edge ispalpated 4 cm below the right costal margin. An x-ray film of the chest shows cardiomegaly and pulmonary congestion. Which of the following is the most likely underlying mechanism for this child's condition?
A) Decreased systemic vascular resistance
B) Increased pulmonary vascular resistance
C) Increased systemic vascular resistance
D) Intracardiac left-to-right shunt
E) Intracardiac right-to-left shunt