A 5-year-old girl is brought to the physician because of a 2-day history of temperatures to 39.5 C (103.1 F) and pain in the right side. She has had two episodes of vomiting during this period but no diarrhea or symptoms of upper respiratory tract infection. She has vesicoureteral reflux and a history of recurrent urinary tract infections. She appears ill. Her temperature is 39.8 C (103.6 F), blood pressure is 110/60 mm Hg, pulse is 150/min, and respirations are 25/min. Examination shows right-sided costovertebral angle tenderness. In addition to obtaining urine cultures, which of the following is the most appropriate next step in management?
A ) Intravenous pyelography
B ) Renal ultrasonography
C ) Voiding cystourethrography
D ) Intramuscular antibiotic therapy and reexamination in 24 hours E ) Intravenous antibiotic therapy
A 2325-g (5 lb 2 oz) male newborn is delivered at 33 weeks' gestation; Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. The 13-year-old mother had no prenatal care and did not know how much weight she gained. During the pregnancy, the mother smoked marijuana and took over-the-counter vitamins occasionally; she did not drink alcohol
and had no illness except for an upper respiratory tract infection 4 months ago. She did not know she was pregnant until 2 weeks ago; her family is unaware of her condition. She has had one sexual partner. During the hospital stay, the newborn and his mother have no complications. The newborn is at greatest risk for morbidity and mortality from which of the following?
A ) Child abuse
B ) Seizures
Seriously, what's the diagnosis???
A 1-week-old newborn has had poor feeding, vomiting, and progressive lethargy over the past 4 days. She was born at term; pregnancy, labor, and delivery were uncomplicated, and she had no congenital anomalies. She is being breast-fed. She has a healthy 2-year-old brother; a sister died at 10 days of age after a full-term birth. Examination shows decreased muscle tone and poor responsiveness;
reflexes are normal. Serum bicarbonate level is 8 mEq/L, pH is 7.15, and plasma ammonia level is 10 times the upper limit of normal. Which of the following is the most likely cause?
A ) Mitochondrial disorder
B ) Mucopolysaccharidoses disorder
C ) Organic acid metabolism disorder
D ) Renal tubular acidosis
E ) X-linked leukodystrophy
A 57-year-old woman is extubated and transferred to the recovery room after a cholecystectomy. She appears restless. Her blood pressure is 120/70 mm Hg, pulse is 80/min, and respirations are 10/min. Arterial blood gas analysis on room air shows: pH 7.24 PCO2 85 mm Hg PO2 60 mm Hg Intravenous naloxone therapy is begun, but she does not improve. Which of the following is the most appropriate next step in management?
A ) Encouraging deep breathing and cough
B ) Administration of 40% oxygen via nasal cannula
C ) Reintubation and mechanical ventilation
A 72-year-old man is brought to the physician by his daughter because of painless jaundice for 1 month. His wife died 10 years ago, and his daughter is his only child. Before examining the patient, the daughter asks to speak privately with the physician and asks that she be given the results of any tests. She specifically requests that he not be given any "bad news." The patient is alert. His vital signs are within normal limits. Examination shows scleral icterus and jaundice. There is mild abdominal tenderness on palpation. He is oriented to person, place, and time. A CT scan of the abdomen shows a pancreatic mass with bile duct obstruction and probable metastatic lesions in the liver. Which of the following is the most appropriate next step?
A ) Ask the patient if he wishes to discuss his test results, preferably with his daughter present
B ) Tell the daughter it is a legal requirement to tell the patient any and all results of medical testing
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