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All posts with tag: "metabolic"

PEM Questions

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You are seeing an 18 month old with 3 days of cough and congestion and 4 hours of tachypnea. On exam, she has diffuse scattered wheezes and mild intercostal retractions. Her vital signs are: temperature of 38.6, HR 160, RR 40, and O2 sat 94% on room air. As part of her fever work-up her urine is dipped, and while there are no signs of UTI, she has glucosuria. Her serum glucose is 160, and her lytes are Na-138, K-4.2, Cl-110, CO2-17. 

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A 20-month old child is brought in by ambulance for lethargy and altered mental status. You find out his grandmother has been administering frequent doses of milk of magnesia to treat constipation. You suspect hypermagnesemia. 

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You are seeing a 15 year old girl who presents with acute bilateral lower leg weakness / near-paralysis. She is found to be hypokalemic, which led to her weakness and paralysis. She also has a hyperchloremic (non anion gap) metabolic acidosis. She was previously healthy and denies ingestion of any substances. She has not been having diarrhea. Her urine pH is 6.0. 

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You are seeing a 13 year old boy with vague complaints of malaise, nausea, morning headaches, loss of appetite, and intermittent abdominal pain. When he first stands up, he feels dizzy. His exam is notable for tachycardia and hyperpigmentation of his gingiva, lips, knuckles, and palmar creases.

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A 14-month old boy presents with altered mental status. He has had 2 days of vomiting and diarrhea, but no fever. He weighs 10 kg. Bedside blood glucose measurement is 38 mg/dL. A 22 gauge peripheral IV is obtained in his right hand.

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Last week’s 10 day old patient presented with seizures and jitteriness due to hypocalcemia. In the ED, he has a peripheral 22 gauge IV placed. 

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You are seeing a 3yo girl brought in by ambulance after a new-onset seizure. The patient has no past medical history, but has been having an acute viral gastroenteritis for the last 24 hours, as have several family members. She has had decreased oral intake, vomited 3 times non-bloody non-bilious, and had 3 episodes of watery non-bloody diarrhea. She is afebrile. She went to bed at 9:30pm, sleeping next to her parent, and the parent was awakened by her having a generalized tonic-clonic seizure at 6am. Per EMS, seizure had resolved on their arrival but she was lethargic; point-of-care blood glucose was 40 mg/dL in the field, and she was given 5 mL/kg of D10W IV with patient becoming more alert. In the ED, her urine dip is positive for ketones.

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(Click the link to comment and to vote - voting not working through email, sorry!) You are seeing a 10 day old infant born via midwife-assisted water birth at home, brought in for lethargy and vomiting. Physical exam is significant for lethargy, jaundice, and fever to 38.5. He is exclusively breastfeeding. Labs include pH 7.34, ammonia 80, point of care glucose 80, urine trace ketones. [yop_poll id="172"]
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(Click the link to comment and to vote - voting not working through email, sorry!) You are asked to evaluate a 3 day old male with severe lethargy and hypotonia. He is mildly tachypneic. He is afebrile. As part of your work-up, you evaluate him for inborn errors of metabolism. Which of the following is false about urea cycle disorder as a diagnosis for his findings? [yop_poll id="127"]
(Click the link to comment and to vote - voting not working through email, sorry!)   Match the classic serum electrolyte / acid-base findings with the pediatric condition: 1) hypochloremic hypokalemic metabolic alkalosis 2) hyponatremic hyperkalemic metabolic acidosis 3) hyponatremic normokalemic metabolic acidosis 4) hypercalcemic metabolic alkalosis A) DKA B) pyloric stenosis C) milk alkali syndrome D) congenital adrenal hyperplasia [yop_poll id="63"]

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