06-28-2016, 09:00 AM
1) A 16-year-old boy is brought to the emergency department 20 minutes after the onset of a generalized tonic-clonic seizure lasting 5 minutes. He has hypertension treated with a calcium-channel blocking agent, but he has not been taking his medication. On arrival, he is unarousable. His blood pressure is 250/154mmHg. Examination shows proliferative retinopathy. Urinalysis shows 1+ protein. Which of the following is the most appropriate intravenous pharmacotherapy.
A. Diazoxide
B. Furosemide
C. Hydralazine (wrong choice)
D. Lorazepam
E. Sodium nitroprusside
2) A 3-year-old boy is brought to the emergency department because of a 1-day history of fever, abdominal pain, and diarrhea containing blood and mucous. He has a history of recurrent ear infections treated with antibiotics. He completed a 10-day course of amoxicillin-clavulanate 1 day ago. He appears moderately ill. His temperature is 38.4C, pulse is 104/min, respirations are 20/min, and blood pressure is 100/62mmHg. Abdominal examination shows moderate left lower quadrant tenderness with no rebound. The remainder of the examination shows no abnormalities. Test of the stool for occult blood is positive. Which of the following is the most likely causal organism?
A. Clostridium difficile
B. Salmonella enteritidis
C. Shigella sonnei (wrong choice)
D. Staphylococcus aureus
E. Yersinia enterocolitica
3) A 3-month-old boy is brought to the physician by his mother because of a 1-day history of fever, vomiting, and fussiness. He was born at 39 weeks gestation following an uncomplicated pregnancy and delivery. He is alert and mildly irritable but easily consoled by his mother. His rectal temperature is 39C, pulse is 160/min, and respirations are 38/min. Examination of the skin shows no abnormalities. The tympanic membranes are mildly erythematous with normal landmarks and motility. The lungs are clear to auscultation. The abdomen is soft with no palpable masses. The patient is uncircumcised. Laboratory studies show:
Hemoglobin 11.9 g/dL
Leukocyte count 12,200/mm3
Platelet count 240,000/mm3
Urine:
Nitrites 2+
Leukocyte esterase 3+
Results of blood and urine cultures are pending. Which of the following is the most appropriate pharmacotherapy?
A. Cefazolin
B. Cefotaxime
C. Nafcillin
D. Penicillin
E. Vancomycin
4) A 3-year-old boy is brought for a well-child examination. His mother states that his belly seems big. His vital signs are within normal limits. Examination shows aniridia. There is a palpable mass in the right flank. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?
A. Measurement of serum catecholamine concentration
B. Measurement of urine vanillylmandelic acid and homovanillic acid concentrations (wrong choice)
C. X-ray of the abdomen
D. X-ray of the chest
E. Ultrasonography of the abdomen
5) A 5-year-old boy is brought to the physician because of a 4-day history of increasing difficulty breathing. His temperature is 37.5C, pulse is 116/min, respirations are 36/min, and blood pressure is 116/80mmHg. Examination shows jugular venous distention and mild swelling of the face and upper extremities. There are moderate intercostal retractions. Inspiratory and expiratory wheezes are heard bilaterally. An x-ray of the chest shows a mass in the superior mediastinum and a large pleural effusion in the right hemithorax. Thoracentesis yields 400mL of reddish brown serosanguineous fluid containing numerous erythrocytes. Which of the following is the most likely cause of the pleural effusion?
A. Congestive heart failure
B. Malignant pleural effusion
C. Nephrotic syndrome
D. Traumatic hemothorax (wrong choice)
E. Tuberculous pleural effusion
What are the answers to these questions and please give explanations too!!
A. Diazoxide
B. Furosemide
C. Hydralazine (wrong choice)
D. Lorazepam
E. Sodium nitroprusside
2) A 3-year-old boy is brought to the emergency department because of a 1-day history of fever, abdominal pain, and diarrhea containing blood and mucous. He has a history of recurrent ear infections treated with antibiotics. He completed a 10-day course of amoxicillin-clavulanate 1 day ago. He appears moderately ill. His temperature is 38.4C, pulse is 104/min, respirations are 20/min, and blood pressure is 100/62mmHg. Abdominal examination shows moderate left lower quadrant tenderness with no rebound. The remainder of the examination shows no abnormalities. Test of the stool for occult blood is positive. Which of the following is the most likely causal organism?
A. Clostridium difficile
B. Salmonella enteritidis
C. Shigella sonnei (wrong choice)
D. Staphylococcus aureus
E. Yersinia enterocolitica
3) A 3-month-old boy is brought to the physician by his mother because of a 1-day history of fever, vomiting, and fussiness. He was born at 39 weeks gestation following an uncomplicated pregnancy and delivery. He is alert and mildly irritable but easily consoled by his mother. His rectal temperature is 39C, pulse is 160/min, and respirations are 38/min. Examination of the skin shows no abnormalities. The tympanic membranes are mildly erythematous with normal landmarks and motility. The lungs are clear to auscultation. The abdomen is soft with no palpable masses. The patient is uncircumcised. Laboratory studies show:
Hemoglobin 11.9 g/dL
Leukocyte count 12,200/mm3
Platelet count 240,000/mm3
Urine:
Nitrites 2+
Leukocyte esterase 3+
Results of blood and urine cultures are pending. Which of the following is the most appropriate pharmacotherapy?
A. Cefazolin
B. Cefotaxime
C. Nafcillin
D. Penicillin
E. Vancomycin
4) A 3-year-old boy is brought for a well-child examination. His mother states that his belly seems big. His vital signs are within normal limits. Examination shows aniridia. There is a palpable mass in the right flank. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?
A. Measurement of serum catecholamine concentration
B. Measurement of urine vanillylmandelic acid and homovanillic acid concentrations (wrong choice)
C. X-ray of the abdomen
D. X-ray of the chest
E. Ultrasonography of the abdomen
5) A 5-year-old boy is brought to the physician because of a 4-day history of increasing difficulty breathing. His temperature is 37.5C, pulse is 116/min, respirations are 36/min, and blood pressure is 116/80mmHg. Examination shows jugular venous distention and mild swelling of the face and upper extremities. There are moderate intercostal retractions. Inspiratory and expiratory wheezes are heard bilaterally. An x-ray of the chest shows a mass in the superior mediastinum and a large pleural effusion in the right hemithorax. Thoracentesis yields 400mL of reddish brown serosanguineous fluid containing numerous erythrocytes. Which of the following is the most likely cause of the pleural effusion?
A. Congestive heart failure
B. Malignant pleural effusion
C. Nephrotic syndrome
D. Traumatic hemothorax (wrong choice)
E. Tuberculous pleural effusion
What are the answers to these questions and please give explanations too!!