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Nov 26, 2013
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any thoughts on these qs?

A 2-year-old boy ¡s brought to the emergency department 10 minutes after he was found coughing and choking near an open can of peanuts. His parents attempted a Heimlich maneuver, but his condition did not improve. On arrival, he is agitated and unable to speak because of shortness of breath. His pulse is 150/mm, respirations are 35/mm, and
blood pressure is 95/60 mm Hg. Examination shows intercostal and suprasternal retractions. There are wheezes and poor air movement on the right. An expiratory x-ray of the chest is shown. Which of the following is the most likely explanation for these findings?
A) Aspiration pneumonia on the left
B) Complete obstruction and collapse of the left lung
C) Obstruction of the midtrachea
D) Partial obstruction of the right main stem bronchus
E) Pneumothorax on the right

A 9-month-old boy is brought to the physician 2 months after his parents noticed that he seemed to be ignoring them. On questioning, they note that he does not appear to be startled by loud noises. Growth and development have been otherwise normal. He was born at term to a 28-year-old woman, gravida 2, para 1. His mother's blood group is A. Rh-negative, and his blood group is A. Rh-positive. He had a serum total bilirubin concentration of 25 mg/dL at the age of 2 days and received phototherapy for 2 days. He continued to be mildly jaundiced until the age of 1 month. Serum studies since then have shown no abnormalities. Examination today shows no abnormalities. which of the following is most likely to have prevented this patient's current condition?
A. Avoidance of breast-feeding
B. Water supplementation
C. Longer course of phototherapy
D. Antibiotic therapy
E. Exchange transfusion

A month old infant has large post. fontanelle, a large tongue, and hypotonia. He was born at 38 wks gestation. pregnancy and delivery were uncomplicated. apgar scores were 7 and 9 at 1 and 5 miinutes, respectively. which of the following is the most likely underlying mech of dz?

A. anterior horn cell degeneration
B. connective tissue disorder
C. cortical dysfunction
D. electrolyte imbalance
E. myopathy
F. peripheral neuropathy
G. spinal cord dysfunction
H. thyroid dysfunction

I am thinking Down syndrome, but I am not sure about the "large post fontanelle." Any thoughts?
Last edited:
May 24, 2017
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1. D. peanuts are the one of the most common objects to be aspirated, and if it is as far as the right mainstem bronchus, Heimlich would not be able to expel it. Would help to see CXR.
2. E. trigger for exchange transfusion is 20. Dx likely hearing loss due to brain damage from kernicterus. Extended phototherapy may be right though, as exchange transfusion is usually second-line when phototherapy has failed.
3. H. thyroid dysfunction. I don't think Down syndrome is associated with large tongue.
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