07-26-2016, 08:09 PM
1.. A previously healthy 10-year-old boy is brought to the emergency department by his parents because of a 2-hour history of increasing headache, dizziness, and nausea. His father is a butcher and says his son ate a new batch of sausage shortly before he became ill. Earlier today, the patient was given the task of cleaning out the garage. On arrival, the patient is alert and is not in respiratory distress. His pu!se is 136/mm, respirations are 20/mm, and blood pressure is 104/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 73% that increases to 80% when 15 L/min of oxygen is administered via face mask. Examination shows profound central cyanosis. The pupils are equal and reactive to light. Cardiopulmonary examination shows no abnormalities. His methemoglobin is 40.5%
of his total hemoglobin. Arterial blood gas analysis on room air shows:
pH 7.37
Pco2 42 mm Hg
Po2 48 mm Hg
HCO3- 24mEq/L
Which of the following is the most appropriate next step in management?
A) Administration of atropine
B) Administration of deferoxamine
C) Administration of methylene blue
D) Administration of naloxone
E) Administration of pyridostigmine
F) Hyperbaric oxygen therapy
2...A 3-month-old girl is brought to the emergency department 30 minutes after the onset of lethargy. There is no history of trauma, and she has not had fever, diarrhea, or vomiting. She was born at 27 weeks’ gestation, and required 2 months of ventilator support and a 2-week course of dexamethasone therapy for respiratory distress syndrome of the newborn and bronchopulmonary dysplasia. She had an umbilical arterial and venous catheter in place during the first 2 weeks of life. Her temperature is 36.7°C (98.1°F), pulse is 140/mm, respirations are 20/mm, and blood pressure is 110/85mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. Doppler ultrasonography shows renal artery thrombosis. Which of the following is the most likely explanation for this patient’s hypertension?
A) Chronic obstructive pulmonary disease
B) Idiopathic intracranial hypertension
C) Increased renin production
D) Prematurity
E) Prolonged use of corticosteroids
of his total hemoglobin. Arterial blood gas analysis on room air shows:
pH 7.37
Pco2 42 mm Hg
Po2 48 mm Hg
HCO3- 24mEq/L
Which of the following is the most appropriate next step in management?
A) Administration of atropine
B) Administration of deferoxamine
C) Administration of methylene blue
D) Administration of naloxone
E) Administration of pyridostigmine
F) Hyperbaric oxygen therapy
2...A 3-month-old girl is brought to the emergency department 30 minutes after the onset of lethargy. There is no history of trauma, and she has not had fever, diarrhea, or vomiting. She was born at 27 weeks’ gestation, and required 2 months of ventilator support and a 2-week course of dexamethasone therapy for respiratory distress syndrome of the newborn and bronchopulmonary dysplasia. She had an umbilical arterial and venous catheter in place during the first 2 weeks of life. Her temperature is 36.7°C (98.1°F), pulse is 140/mm, respirations are 20/mm, and blood pressure is 110/85mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. Doppler ultrasonography shows renal artery thrombosis. Which of the following is the most likely explanation for this patient’s hypertension?
A) Chronic obstructive pulmonary disease
B) Idiopathic intracranial hypertension
C) Increased renin production
D) Prematurity
E) Prolonged use of corticosteroids