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maternity last quiz Developmental Milestones G.8 part two Peds -
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(4) A 15-year-old female has a 1-month A. The obese adolescent in this case has findings of diabetes mellitus. Her cutaneous
history of urinary frequency without dysuria candidiasis is likely an indication of secondary immunosuppression related to
and recent onset of an itchy rash beneath hyperglycemia. In diabetes, hyperglycemia promotes neutrophil dysfunction, and
both breasts. She has been gaining weight circulatory insufficiency contributes to ineffective neutrophil chemotaxis during
over the past year and regularly complains infection. HIV infection is possible and antibody testing might be reasonable, but this
of fatigue. She is febrile with a weight scenario is most consistent with hyperglycemia.
greater than the 99th percentile and has an
erythematous, macular rash beneath both
breasts characterized by satellite lesions.
UA is significant for 2+ glucosuria, but no
pyuria. Which of the following is the most
likely diagnosis?
A. Diabetes mellitus
B. Fanconi syndrome
C. Human immunodeficiency virus
D. Occult malignancy
E. Severe combined immunodeficiency
(SCID)
, (4) A mother notes her 6-week-old son's C. You suspect leukocyte adhesion deficiency (LAD) as the etiology of this child's
umbilical cord is still attached. His activity problem. LAD is an inheritable disorder of leukocyte chemotaxis and adherence
and intake are normal; there has been no characterized by recurring sinopulmonary, oropharyngeal, and cutaneous infections
illness or fever. Delivery was at term with delayed wound healing. Neutrophila is common with WBC counts of typically
without problems. His examination is more than 50,000 cells/mm. Severe, life-threatening infection is possible with
notable for a cord without evidence of Staphylococcus species, Enterobacteriaceae, and Candida species. Good skin and
separation and a shallow, 0.5cm ulceration oral hygiene are important; broad-spectrum antimicrobials and surgical debridement
at the occiput without discharge or are early consideration with infection.
surrounding erythema. Mother declares
that the "sore," caused by a scalp probe,
has been slowly healing since birth and
was deemed unremarkable at his 2-week
checkup. Which of the following is
consistent with this child's likely diagnosis?
A. Defective humoral response
B. Functional leukocyte adherence
glycoproteins
C. Marked neutrophilia
D. Normal wound healing
E. Purulent abscess formation
(4) A 6-month-old girl is seen after an C. SCID is an autosomal recessive or X-linked disorder of both humoral and cellular
emergency room visit for decreased intake, immunity. Serum immunoglobulins and T cells are often markedly diminished or
emesis, and watery diarrhea for the past 3 absent. Thymic dysgenesis is also seen. Recurring cutaneous, gastrointestinal, or
days. She was diagnosed yesterday with pulmonary infections occur with opportunistic organisms such as cytomegalovirus
"stomach flu" and given IV fluids. She is (CMV) and PCP. Death typically occurs in the first 12 to 24 months of life unless bone
doing better today with improved intake marrow transplantation is performed.
and resolution of her emesis and diarrhea.
The father is concerned about her thrush
since birth (despite multiple courses of an
oral antifungal) and that she has been
hospitalized twice for pneumonia over the
past 4 months. Her weight has dropped
from the 50th percentile on her 4-month
visit to the 5th percentile today. She has no
findings consistent with dehydration, but
she does appear to have some extremity
muscle wasting. Her examination is
remarkable for buccal mucosal exudates
and hyperactive bowel sounds. Vital signs
and the remainder of her examination are
normal. You suspect severe combined
immunodeficiency (SCID). Which of the
following is consistent with the diagn