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  #1  
Old 07-16-2014
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Default Few questions need help

1. Healthy 2 y/o boy brought to ER b/c of 5 day history of fever 40 C (104F). On arrival, he appears ill. BP 90/60, pulse 130/min. On cardiac exam, a grade 3/6 systolic murmur is heard best at the left lower sternal border. The pt has no other history of a murmur. The spleen tip is palpated 4 cm below the left costal margin. In addition to echo, which of the following studies is most likely to confirm the diagnosis?
a)ANA assay
b)Determine ESR
c)Measure serum cardiac enzyme activities
d)Serial blood cultures
e)ECG

I really don't know what this kid has. Is it congenital heart disease? Why is there splenomegaly? Should we get cardiac enzyme (D)?


2. A 12 hour old female newborn becomes irritable, has difficulty breathing, and then has a 2 min generalized tonic clonic seizure. She was born at 36 weeks gestation by C section delivery due to breech presentation and weighed 4kg. Her mom had gestational DM poorly controlled with diet; she refused insulin therapy. Apgar score were 7 & 8 at 1 & 5 mins. Exam shows decreased tone and lethargy. Pulse oximetry shows O2 sat of 99%. ECG shows a prolonged QT interval. In addition to measurement of serum glucose level, the next step is the measure which?

a) HCO3
b)bilirubin
c)Calcium
d)Magnesium
e)TSH


this is a case of infant of diabetic mother, so we have high bilirubin, and high calcium and high Mg. But they are all in the choices. So does it have something to do with the ECG finding? One of the electrolyte can alter the heart? SO im assuming it's either Ca or Mg? I really don't know plz help
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  #2  
Old 07-17-2014
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1st might be a infective endocarditis? I would get blood cultures.
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Old 07-17-2014
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Iodm we have high bilirubin but low calcium and low magnesium, hypocalcemia causes long qt.
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Old 07-17-2014
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I know but the thing is its MCQ right so is it Mg or Ca and why?
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Old 07-17-2014
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First is ie
Second is calcium, dm causes the neonate to develop hypocalcemia......it's in u world.......
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Old 07-17-2014
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I know but DM baby can also get low Mg. So u saying the answer is Ca is b/c of prolonged QT interval on the EKG? Thanks
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Old 07-17-2014
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Quote:
Originally Posted by irisiqi View Post
I know but DM baby can also get low Mg. So u saying the answer is Ca is b/c of prolonged QT interval on the EKG? Thanks
Yes...and I haven't read abt hypomagnesemia in dm mothers neonates....nowhere in uworld
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Old 07-17-2014
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its in mtb and kaplan
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Old 07-17-2014
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Page number?
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  #10  
Old 07-17-2014
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N yes hypocalcemia causes prolonged qt......hypomagnesemia can cause torsades...nt sure abt this thu
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