07-26-2016, 02:12 PM
Q1. A 2-year-old girl is brought to the physician because of episodes of turning blue while playing over the past 6 months; the episodes have been increasing in frequency over the past month and occur most often when she is agitated. She was born at term and weighed 3317 g (7 lb 5 oz). She has a normal diet for her age. She is at the 25th percentile for height and weight. Her temperature is 37°C (98.6°F), pulse is 100/mm, respirations are 26/mm, and blood pressure is 80/46 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 87%. The lungs are clear to auscultation. There is a heave at the left sternal border. A grade 3/6, harsh systolic murmur is heard at the left sternal border with radiation to the axilla. An x-ray of the chest shows decreased pulmonary vascularity and a prominent right ventricle.
For each patient with cyanosis, select the most likely diagnosis.
A) Asthma
B) Bronchopulmonary dysplasia
C) Congenital heart disease with right-to-left shunt
D) Cystic fibrosis
E) Hypertrophic cardiomyopathy
F) Idiopathic pulmonary hypertension
G) Methemoglobinemia
H) Patent foramen ovale
I) Persistent pulmonary hypertension
J) Pneumococcal pneumonia
K) Respiratory distress syndrome
Q2. A 7-year-old boy with type I diabetes mellitus has had fever, cough, and rhinorrhea for I week and lethargy for
3 days. His pulse is 100/mm, respirations are 30/mm, and blood pressure is 100/65 mm Hg. He appears lethargic; no
other abnormalities are noted. Serum studies show:
Na 120 mEq/L
Cl- 95 mEq/L
7.5 mEq/L
HCO3- lOmEq/L
Glucose 690 mg/dL
Urea nitrogen 23 mg/dL
Which of the following is the most likely explanation for the hyperkalemia?
A) Adrenal insufficiency
B) Cellular shift
C) Excessive potassium intake
D) Hemolysis
E) Respiratory acidosis
For each patient with cyanosis, select the most likely diagnosis.
A) Asthma
B) Bronchopulmonary dysplasia
C) Congenital heart disease with right-to-left shunt
D) Cystic fibrosis
E) Hypertrophic cardiomyopathy
F) Idiopathic pulmonary hypertension
G) Methemoglobinemia
H) Patent foramen ovale
I) Persistent pulmonary hypertension
J) Pneumococcal pneumonia
K) Respiratory distress syndrome
Q2. A 7-year-old boy with type I diabetes mellitus has had fever, cough, and rhinorrhea for I week and lethargy for
3 days. His pulse is 100/mm, respirations are 30/mm, and blood pressure is 100/65 mm Hg. He appears lethargic; no
other abnormalities are noted. Serum studies show:
Na 120 mEq/L
Cl- 95 mEq/L
7.5 mEq/L
HCO3- lOmEq/L
Glucose 690 mg/dL
Urea nitrogen 23 mg/dL
Which of the following is the most likely explanation for the hyperkalemia?
A) Adrenal insufficiency
B) Cellular shift
C) Excessive potassium intake
D) Hemolysis
E) Respiratory acidosis