Elytrolyte Para (chas)

A 1-day-old normal-appearing infant develops tetany and convulsions. He was born at 34 weeks’ gestation with Apgar scores of 2 and 4 (at 1 and 5 minutes, respectively) to a woman whose pregnancy was complicated by diabetes mellitus and pregnancy-induced hypertension. Which of the following serum chemistry values is likely to be the explanation for his condition?

A 13-year-old patient with sickle-cell anemia presents with respiratory distress; she has an infiltrate on chest radiograph. The laboratory workup of the patient reveals the following: hemoglobin 5 g/dL; hematocrit 16%; white blood cell count 30,000/μL; and arterial blood (room air) pH 7.1, PO2: 35 mm Hg, and PaCO2: 28 mm Hg. These values indicate which of the following?

A 14-year-old boy comes to the physician because of a 2-day history of fever and nasal discharge. He has also had malaise, fatigue and myalgia. His temperature is 38.8°C (101.9°F), blood pressure is 130/70mm Hg, pulse is 90/min, and respirations are 15/min. Examination shows no abnormalities. Urine dipstick testing shows proteinuria but there is no hematuria or pyuria; urinalysis otherwise shows no abnormalities. Which of the following is the most appropriate next step in management?

A 20-year-old white male is found to have an elevated calcium level on routine pre-employment screening blood tests. He denies any polyuria, polydipsia or constipation. He has no significant past medical history and does not take any medication. He does not use tobacco, alcohol or drugs. His pulse rate is 82/min, blood pressure is 110/70 mmHg, temperature is 37.0°C (99°F) and respirations are 14/min. Complete physical examination is unremarkable. Laboratory studies show the following: Serum sodium 140 mEq/L, Serum potassium 4.0 mEq/L, Chloride 103 mEq/L, Bicarbonate 24 mEq/L, Blood urea nitrogen (BUN) 18 mg/dl, Serum creatinine 0.8 mg/dl, Calcium 11.2 mg/dl, Blood glucose 98 mg/dl, Serum PTH level 55 pg/ml (normal 10-65 pg/ml), Urine calcium/creatinine clearance ratio < 0.01. Which of the following conditions is most consistent with this patient's findings?

A 23-year-old woman presents to the ED complaining of lower abdominal pain and vaginal spotting for 2 days. Her menstrual cycle is irregular. She has a history of ovarian cysts and is sexually active but always uses condoms. Her BP is 115/75 mm Hg, HR is 75 beats per minute, temperature is 98.9°F, and RR is 16 breaths per minute. Which of the following tests should be obtained next?

A 3-year-old African American boy is brought to the emergency department with sudden onset of difficulty walking. His mother reports that his right hand also seems "clumsy." The boy's past medical history is significant for a hospitalization one year ago for severe upper extremity pain and hand swelling. On physical examination, he has a blood pressure of 90/60 mmHg, heart rate of 120/min, temperature of 36.7°C (98°F), and respiratory rate of 22/min. Which of the following would be most helpful in diagnosing his condition?

A 30-year-old man presents to the emergency department with sudden onset of severe epigastric pain and vomiting 3 hours ago. He reports a 6-month history of chronic epigastric pain occurring nearly every day and relieved by antacids. On examination, he appears sweaty and avoids movement. Vital signs reveal a temperature of 100°F, BP of 100/60 mmHg, pulse rate of 110/min, and respiratory rate of 12/min. The remainder of his examination reveals diminished bowel sounds and a markedly tender and rigid abdomen. A chest x-ray and abdominal films reveal pneumoperitoneum. Which of the following is the most appropriate next diagnostic test?

A 32-year-old Caucasian female comes to the physician because of a one-week history of fatigue, progressive worsening of shortness of breath and swelling of feet. She denies any chest pain. She has no other medical problems except a recent cold two weeks ago. She is not taking any medication. Her temperature is 36.7°C (98°F), blood pressure is 110/65 mmHg, pulse is 90/min, and respirations are 20/min. Bilateral basal crackles, elevated jugular venous pressure, and 2+ bilateral pitting edema of the ankles are noted. Complete blood count is unremarkable. Transthoracic echocardiogram of her heat will most likely show?

A 34-year-old Caucasian man presents to your office with a several day history of difficulty walking. He also describes some "funny" sensations in his feet. He denies any recent skin rash, diarrhea, or joint pain. His past medical history is significant only for a recent mild respiratory infection. He visited his friends in Connecticut one month ago. He smokes one pack of cigarettes a day and admits to occasional IV drug use. He is not sexually active. His temperature is 36°C (98°F), heart rate is 90/min, respirations are 20/min, and blood pressure is 160/100 mmHg. Chest examination is unremarkable. Abdomen is soft and non-tender. The liver span is 8 cm and the spleen is not palpable. Cranial nerves II-XII are intact. Muscle strength is reduced in the lower extremities but well preserved in the upper extremities. Lower extremity sensation is decreased. Stroking the soles of the feet elicits extension of the great toe. Which of the following is most likely to diagnose this patient's condition?

A 35-year-old bank executive is brought to the emergency department after the sudden onset of a severe (10/10) headache, followed by a brief period of unconsciousness. His headache started while he was at a meeting and shortly thereafter, he vomited and lost consciousness. He regained consciousness soon afterwards, but was quite confused and irritable. His blood pressure is 160/100 mm Hg, pulse is 90/min, temperature is 37.2°C (99°F), and respirations are 16/min. The physical examination reveals a normal pupil size, no congestion or inflammation of the eye, and no focal neurological deficits. The ECG reveals nonspecific ST and T wave changes. The CT scan shows a subarachnoid hemorrhage. What is the most likely expected electrolyte abnormality with the patient's disease?

A 35-year-old male is brought to the emergency room with headaches and confusion for the past 2 days. He denies any focal weakness or sensory symptoms. His past medical history is significant for HIV and hepatitis C infections for which he is not receiving therapy. The remainder of his medical history is unobtainable due to his mental status. On physical exam, he has a temperature of 37.9°C (100.2°F), a blood pressure of 140/86 mm Hg, a pulse of 96/min, and respirations of 16/min. Mild icterus is present. The patient's oropharynx is clear and his neck is supple and without rigidity. Examination of his chest and abdomen are unremarkable. Neurologic examination reveals no focal deficits. Laboratory studies show: Complete blood count:Hemoglobin 7.6 g/L, MCV 85 fl, Reticulocytes 8.1%, Platelet count 80,000/mm3, Leukocyte count 3,500/mm3. Chemistry panel: Blood urea nitrogen (BUN) 30 mg/dL, Serum creatinine 2.2 mg/dL, Serum calcium 10.0 mg/dL, Blood glucose 98 mg/dL. Liver studies:Total bilirubin 3.6 mg/dL, Direct bilirubin 1.0 mg/dL, Alkaline phosphatase 120 U/L, Aspartate aminotransferase (SGOT) 178 U/L, Alanine aminotransferase (SGPT) 255 U/L. Which of the following is the most appropriate next step in the management of this patient?

A 35-year-old male with severe persistent bronchial asthma requiring multiple medications presents complaining of weight gain over the past several months despite no changes in appetite, diet, or activity level. He denies alcohol, tobacco, and drug use and has no other significant past medical history. On physical examination, he has a blood pressure of 143/92 mm Hg, a heart rate of 65/min, a temperature of 98.7°F, and a respiratory rate of 16/min. There is moderate supraclavicular fullness, and his skin is thin with areas of bruising and acne. Neurologic exam reveals decreased proximal muscle strength. Which of the following findings is most likely to also be present in this patient?

A 36-year-old woman presents to the ED with sudden onset of left-sided chest pain and mild shortness of breath that began the night before. She was able to fall asleep without difficulty but woke up in the morning with persistent pain that is worsened upon taking a deep breath. She walked up the stairs at home and became very short of breath, which made her come to the ED. Two weeks ago, she took a 7-hour flight from Europe and since then has left-sided calf pain and swelling. What is the most common ECG finding for this patient’s presentation?

A 42-year-old woman presents to the emergency department with multiple complaints. She reports that she had been feeling well until approximately one month ago, when she began to feel increasingly fatigued and weak. For the past two weeks, she has had anorexia, nausea, and abdominal pain. In the past three days, she has had two syncopal episodes. Her medical history is unremarkable and she takes no medications. She denies tobacco and drug use and drinks wine only occasionally. Physical exam reveals a temperature of 36.7°C (98°F), blood pressure of 86/52 mmHg, heart rate of 90/min, and respiratory rate of 18/min. Her cardiac exam is normal and her lungs are clear to auscultation bilaterally. You note hyperpigmentation of the skin in the palmar creases. Which of the following additional findings is most likely to be present in this patient?

A 45-year-old female with severe depression, migraine and rheumatoid arthritis is brought in after she was found to have nausea, fever and upper abdominal discomfort. The patient describes severe tinnitus and vertigo. She admits that she overdosed on one of her medications. Her temperature is 38.5°C (101.3°F), blood pressure is 120/76 mm Hg, pulse is 90/min and respirations are 24/min. Physical examination is unremarkable. Which of the following acid-base statuses is most likely in this patient? pH, PaCO2 (mm Hg), HCO3- (mEq/L)

A 45-year-old white male comes to the emergency room with "all sorts of things going wrong with him", for the last few months. He has a severe headache, chest and abdominal pain. He is sweating profusely. He has lost weight recently, has diarrhea and palpitations. He is feeling hot all the time. Vital signs reveal BP: 190/100mm of Hg; PR 124/min; RR 18/min; Temperature 37.7° C (99.8°F). On physical examination he has enlarged cervical lymph nodes. Examination of the thyroid reveals multiple thyroid nodules. FNA biopsy reveals thyroid C-cell hyperplasia. Which of the following can also be found on laboratory results?

A 46-year-old white male presents with chronic diarrhea, abdominal distention, flatulence, and weight loss. He also has arthralgias and bulky, frothy stools. He has never had blood transfusions, tattooing or highrisk sexual behaviors. His temperature is 38.3°C (101°F), blood pressure is 130/90 mm Hg, pulse is 84/min, and respirations are 16/min. Physical examination shows generalized lymphadenopathy and skin hyperpigmentation. Which of the following is the most appropriate diagnostic test?

A 5-year-old boy is brought to the clinic by his mother because he was sent home by the school nurse. The nurse claims to have heard a murmur in his chest. The child has always been healthy, and has never had any shortness of breath, chest pain, dizziness or any other illnesses. On examination, the child appears alert, and his vital signs are stable. Auscultation of the chest reveals a grade-2 systolic ejection murmur at the left sternal border, but no other extra sounds. The murmur changes with position. What is the best next step in the management of this patient?

A 50-year-old male undergoes vagotomy and pyloroplasty for a peptic ulcer perforation. His early postoperative course is complicated by fever and hypotension, which are treated with broad-spectrum antibiotics and IV fluid support. He then recovers well; however, on post-operative day 6 he develops nausea, vomiting, abdominal pain, and profuse, watery diarrhea. His temperature is 38.9°C (102° F), blood pressure is 110/70 mmHg, pulse is 120/min, and respirations are 18/min. Abdominal examination shows tenderness in the sigmoidal area. Test of the stool for occult blood is negative. Laboratory studies show: Hb 11.5g/dL, Platelet count 180, 000/cmm, Leukocyte count 17, 500/cmm, segmented neutrophils 75%, Bands 10%, Eosinophils 1%, Lymphocytes 14%. Which of the following is the most appropriate next step in management?

A 53-year-old man presents to the emergency department with severe epigastric abdominal pain. His temperature is 37.2°C, blood pressure 110/70 mm Hg, pulse 110/min, and respirations 20/min. Examination of the heart and lungs is normal, and his abdomen is tender in the epigastric region. His white count is 15,000/mL and amylase is 450 U/L (25–125 U/L). Which of the following laboratory abnormalities is also most likely to be present?

A 60-year-old man comes to office with persistent complaints of malaise and easy fatigability, for the past 8 months. On examination, he appears pale. PR 93/min; BP 127/84mm Hg; Temperature 37°C (98.6°F); RR 16/min. Fecal occult blood test is negative. Further testing is ordered that include CBC, serum electrolytes and colonoscopy. The results are: WBC 7,600/mm3, Hemoglobin 8.8 gm/dl, Hematocrit 30%, RBC count 3.6 million, Platelets 211,000/mm3. RBC Indices were:MCV 65 fl, MCH 16.5 pg, MCHC 26%, Reticulocyte count 0.5%. Which one of the following is expected on iron studies in this patient? (Serum Iron, Ferritin, TIBC, Transferrin Saturation)

A 65-year-old black female presents for an annual examination. Physical examination is unremarkable for her age. In completing the appropriate screening tests, you order a dual x-ray absorptiometry (DXA) to evaluate whether the patient has osteoporosis. DXA results reveal a T-score of -3.0 at the total hip and −2.7 at the spine, consistent with a diagnosis of osteoporosis. Since her Z-score is -2.0, you proceed with an initial evaluation of secondary osteoporosis. Laboratory evaluation reveals: Calcium: 9.7 mg/dL, Cr: 1.0 mg/dL, Bun: 19 mg/d, Glucose: 98 mg/dL, 25, OH vitamin D: 12 ng/mL (optimal > 25), WBC: 7700/μL, Hg: 12 g/dL, HCT: 38 g/dL, PLT: 255,000/μL. Based on the above information, additional laboratory would most likely reveal which of the following?

Her son brings a 50-year-old female to the emergency room because she is confused and sweating a lot. She does not have any medical problems, except hypertension for which she takes hydrochlorothiazide. She is not taking any other medication. He tells you that his mother complained of profound weakness, and inability to stand, because of lightheadedness 3 hours ago. On examination, the patient is drowsy, confused, and appears sick. Her temperature 36.8°C (98.2° F) BP 153/83mm Hg PR 128/min. Her clothes are damp from perspiration. No other abnormalities are noted on physical examination. Initial laboratory studies show: Sodium 144 mEq/L, Potassium 3.6 mEq/L, Bicarbonate 26 mEq/L, Blood urea nitrogen: 12 mg/dl, Creatinine 0.6 mg/dl. You order a few more tests and on the basis of which you diagnose insulinoma. What set of following results leads to this diagnosis? (Serum Glucose, Insulin, C-Protein)

An 87-year-old female is brought to the emergency department for evaluation of altered mental status. Her medical history is significant for multi-infarct dementia, hypertension, stroke, coronary artery disease, severe degenerative joint disease, chronic atrial fibrillation, constipation and urinary incontinence. Her medications include aspirin, acetaminophen, atenolol, nitroglycerin, multivitamins, pravastatin, docusate, senna, digoxin and glucosamine. She lives in a local nursing home, and the people who brought her to the ED deny any history of new symptoms. Her blood pressure is 110/70 mmHg, pulse is 98/min, respirations are 16/min and temperature is 36.1°C (97°F). Physical examination reveals dry mucus membranes and decreased skin turgor. There are no new focal neurologic deficits. Which of the following is most likely to be present in this patient?