Help with Peds questions?

Discussion in 'Clinical Rotations' started by Delacroix22, 09.23.14.

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  1. Delacroix22

    Delacroix22 2+ Year Member

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    Anyone who helps me answer these will win my undying affection <3

    A 12 yo girl has the onset of headaches and a change in mental status. She received the diagnosis of type 1 DM earlier today and was admitted to the hospital for treatment of DKA. Three IV boluses of 0.9% saline were administered during the past 2 hours, and her serum glucose concentration ahs decreased from 874 mg/dL to 400 mg/dL during this time. She responds to painful stimuli only. Her temperature is 97.9, pulse 56/min, respirations 12/min, and BP is 146/88. Fundoscopic examination shows absence of venous pulsations. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient’s altered mental status?
    A) Cerebral edema
    B) Hypoglycemia
    C) Hypovolemia
    D) Metabolic Acidosis (WRONG)
    E) Persistent hyperglycemia


    A 12-hour-old female newborn becomes irritable, has difficulty breathing and then has a 2-minute generalized tonic-clonic seizure. She was born at 36 WGA by c-section for breech presentation and weighed 3997g. Her mother had gestational diabetes poorly controlled with diet, she refused insulin therapy. Apgar were 7/8 at 1/5 minutes. Exam shows decreased tone and lethargy. Pulse ox shows sat of 99%. EKG shows prolonged QT interval. In addition to measurement of serum glucose concentration, the most appropriate next step is measurement of:
    A) Bicarbonate
    B) Bilirubin
    C) Calcium
    D) Magnesium (WRONG)
    E) TSH


    A 6 month old boy is broght ot doctor because of 1 day history of fever and foul smelling urine. UA shows 30-50 WBC/hpf, positive nitrites, and positive leukocyte esterase. Urine culture grows E. coli. ABX therapy is initiated, and his syptoms resolve. Renal ultrasound shows no abnormalities. Which of the following is the most appropriate next step in management?
    A) observation for recurrent symptoms (WRONG)
    B) Repeat urine culture in 3 months
    C) Intravenous pyelography
    D) Voiding cystourethrography
    E) Cytoscopy


    A 3 year old girl comes to ED 10 minutes after an episode of syncope followed by generalized tonic clonic movements lasting 30 seconds. Two minutes after the episode she is fully alert. On arrival she stops talking, closes her eyes, and has 3 to 4 rhgytmic jerks of the right upper extremity. During the episode an ECG shows P waves at 80/min with no QRS complexes, NSR resumes in 20 seconds. One minute later she is fully alert. Which of the following is the most likely Dx?
    A) Absence seizure
    B) Adams-Stokes attack
    C) Adverse effect of medication
    D) Breath-holding episode (WRONG)
    E) Carotid artery trauma
    F) Narcolepsy cataplexy
    G) Vasovagal syncope
    H) Ventricular tachyarrhytmia

    Previously healty 16 yo boy comes to doctor 6 hours after onset of fever and right foot pain. He ahs a 1 week Hx of progressive itching rash that started between 2nd and 3rd toes of both feet. Has an active lifestyle and plays baseball and football. Temp 101.1. Exam of right foor shows erythema and induration from the interdigital spaces to the medial malleoulus. Exam of left foot shows dry scaly skin between toes. A tender lymph node is palpated in right side of groin. Which organism is most likely?
    A) E. coli
    B) Mycobacterium tuberculosis
    C) Pseudomonas aeruginosa
    D) Staph aureus
    E) T. rubrum (WRONG)

    14 yo girl comes to ED 4 hours after 3 minute generalized tonic clonic seizure that occurred at a party. Sx began with bizarre behavior. Has low grade fever and cough for 3 days. On arrival she is arousable but confused, she does not answer questions appropriately and can’t follow commands. Temp 102. Exam shows mild resistance to neck flexion. DTR are brisk in all extremities. Babinski present bilaterally. CT of head without contrast shows mixed areas of hyperdensity and hypodensity in right temporal lobe. CSF shows:
    Glucose 60mg/dL
    Protein 45 mg/dL
    Leukocyte 35/mm^3 (20% neutro, 80% lympho)
    Erythro count 1250
    What is the organism?

    A) Arbovirus
    B) B. burgdorfrei
    C) CMV
    D) Enterovirus (WRONG)
    E) HSV
    F) HIV
    G) Listeria
    H) R. ricketsii
    I) T. gondi
    J) VZV
     
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  3. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    In the South African market, never hedge pro rata long positions.
     
  4. animando

    animando 2+ Year Member

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    A 12 yo girl has the onset of headaches and a change in mental status. She received the diagnosis of type 1 DM earlier today and was admitted to the hospital for treatment of DKA. Three IV boluses of 0.9% saline were administered during the past 2 hours, and her serum glucose concentration ahs decreased from 874 mg/dL to 400 mg/dL during this time. She responds to painful stimuli only. Her temperature is 97.9, pulse 56/min, respirations 12/min, and BP is 146/88. Fundoscopic examination shows absence of venous pulsations. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient’s altered mental status?
    A) Cerebral edema

    A 12-hour-old female newborn becomes irritable, has difficulty breathing and then has a 2-minute generalized tonic-clonic seizure. She was born at 36 WGA by c-section for breech presentation and weighed 3997g. Her mother had gestational diabetes poorly controlled with diet, she refused insulin therapy. Apgar were 7/8 at 1/5 minutes. Exam shows decreased tone and lethargy. Pulse ox shows sat of 99%. EKG shows prolonged QT interval. In addition to measurement of serum glucose concentration, the most appropriate next step is measurement of:

    A) Bicarbonate
    (not 100% sure)


    A 6 month old >>>boy<<< is broght ot doctor because of 1 day history of fever and foul smelling urine. UA shows 30-50 WBC/hpf, positive nitrites, and positive leukocyte esterase. Urine culture grows E. coli. ABX therapy is initiated, and his syptoms resolve. Renal ultrasound shows no abnormalities. Which of the following is the most appropriate next step in management?

    D) Voiding cystourethrography
    E) Cytoscopy (why not)


    A 3 year old girl comes to ED 10 minutes after an episode of syncope followed by generalized tonic clonic movements lasting 30 seconds. Two minutes after the episode she is fully alert. On arrival she stops talking, closes her eyes, and has 3 to 4 rhgytmic jerks of the right upper extremity. During the episode an ECG shows P waves at 80/min with no QRS complexes, NSR resumes in 20 seconds. One minute later she is fully alert. Which of the following is the most likely Dx?

    B) Adams-Stokes attack


    Previously healty 16 yo boy comes to doctor 6 hours after onset of fever and right foot pain. He ahs a 1 week Hx of progressive itching rash that started between 2nd and 3rd toes of both feet. Has an active lifestyle and plays baseball and football. Temp 101.1. Exam of right foor shows erythema and induration from the interdigital spaces to the medial malleoulus. Exam of left foot shows dry scaly skin between toes. A tender lymph node is palpated in right side of groin. Which organism is most likely?

    D) Staph aureus


    14 yo girl comes to ED 4 hours after 3 minute generalized tonic clonic seizure that occurred at a party. Sx began with bizarre behavior. Has low grade fever and cough for 3 days. On arrival she is arousable but confused, she does not answer questions appropriately and can’t follow commands. Temp 102. Exam shows mild resistance to neck flexion. DTR are brisk in all extremities. Babinski present bilaterally. CT of head without contrast shows mixed areas of hyperdensity and hypodensity in right temporal lobe. CSF shows:
    Glucose 60mg/dL
    Protein 45 mg/dL
    Leukocyte 35/mm^3 (20% neutro, 80% lympho)
    Erythro count 1250

    E) HSV
     
  5. Kaustikos

    Kaustikos Archerize It 7+ Year Member

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    Two is calcium
    And kidney I'd say IV pyelogram
     
  6. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Lifetime Donor SDN Chief Administrator 10+ Year Member

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    SDN does not allow posts designated as "homework help", so closing.
     

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