A baby comes to the ER

Question...


Mother brought her baby to the ER

Patient history and chief complains:

  • 8m old baby boy.
  • 2 soft stools per day.
  • Recent trip to Brazil.
  • After trip mother noticed 4 loose stools per day (smelly and different colors than usual).
  • Healthy appetite and lifestyle.
  • No current illness in siblings and parents. (No diarrhoea)
  • Working mother (baby attends day care center while mother works)

Physical examination:

  • Healthy baby.
  • Soft abdomen.
  • No masses felt.
  • A. What would be the diagnosis?
  • B. Investigations and advice!?

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Can KCL and MgSO4 be mixed together?

Can kcl and mgso4 be mixed together?

Today Pharmacy received an order for electrolytes (kcl and mgso4). the patient had severe electrolytes imbalance and the ICU physician ordered some corrective measures.

The order came as follows:
[20MEQs of KCL + 2GM of MgSO4] mixed to 200ML of D5W in 0.45% NACL.

Our pharmacy stock of Potassium chloride is from PSI factory in Jeddah, and it comes as 20MEQs in 10ML, Magnesium sulphate comes as 2.5GM in 5ML. The needed preparation was supposed to be mixed as follow:

  1. 1
    10ML of KCL that gives 20MEQs.
  2. 2
    4ML of MgSO4 that gives 2GM.
  3. 3
    186ML of D5W 0.45% NACL.

Physical Compatibility: Physically compatible. No visible haze or particulate formation, color change, or gas evolution.
Chemical Stability: Chemically stable. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours.
Storage: Room temperature of 22 °C.

Reference:

Quay I, Tan E: Compatibility and stability of potassium chloride and magnesium sulfate in 0.9% sodium chloride injection and 5% dextrose injection solutions. Int J Pharmaceut Compound: 2001. 5: 323-4.
https://www.ncbi.nlm.nih.gov/pubmed/23981924

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Perpetual Motion Machines

Perpetual Motion Machines

devices that can do work indefinitely without any external energy source have captured many inventors’ imaginations because they could totally transform our relationship with energy. There’s just one problem: they don’t work. Why not?

  1. 1
     Energy can't be created or destroyed - you can't create more energy than you put in within a device.
  2. 2
    Friction
  3. 3
    Machine must be operated in vacuum
  4. 4
    Machine must be soundless, as sound is a way of lost energy!!
  5. 5
    Something more?!!!

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Normal Meconium Passing Was Noted (MCQ)

Question

A 5-day-old boy, delivered by cesarean for fetal bradycardia, was evaluated for nonbilious vomiting since birth and loss of 10% of his birth weight (2,980 g). Normal meconium passing was noted. An upper gastrointestinal X-ray analysis was ordered (showin to the right)

What is the likely diagnosis?

  • A. Hirschsprung's Disease.
  • B. Inguinal Hernia.
  • C. Meconium ileus.
  • D. Duodenal Atresia.
  • E. Intestinal Malrotation.

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Clinical Presentation of Meconium Ileus (MCQ)

Question

A female infant was born by vaginal delivery at 33 weeks and 5 days of gestational age with respiratory distress and severe abdominal distension and bilious vomiting.

The plain radiograph is shown to the right.

What is the likely diagnosis?

  • A. Meconium ileus.
  • B. Duodenal Atresia.
  • C. Hirschsprung's Disease.
  • D. Inguinal Hernia.
  • E. Intestinal Malrotation.

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Patient History of Breast Cancer (MCQ)

Question

A patient, a 30-year-old woman, with family history of her cousin and grandmother both had breast cancer, but they are on her father's side. Verifying her family history reveals that her paternal grandmother had breast cancer at age 50. A first cousin (daughter of her father's sister) was diagnosed with breast cancer a year ago at age 42. Her father is in good health at 62. She has two older sisters, aged 33 and 35 years, who are also worried about their risk.

What is the next step of choice?

  • A. Recommend a risk-reducing oophorectomy.
  • B. Recommend a risk-reducing mastectomy.
  • C. Measurement of serum CA-125 level on this patient.
  • D. BRCA1/ BRCA2 testing to this patient's first cousin who was diagnosed with breast cancer.
  • E. Prescribe prophylactic tamoxifen.

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Help in diagnosis of Dengue fever (MCQ)

Question

​What is the name if the test where you apply a blood pressure cuff and inflate it to the midpoint between the systolic and diastolic blood pressures for five minutes. and the test is positive for diagnosis of Dengue fever is there are more than 10 to 20 petechiae per square inch?

  • A. Prothrombin time.
  • B. Plasma fibrinogen.
  • C. Tourniquet test.
  • D. Activated partial thromboplastin time.
  • E. Clot retraction.

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Docusate

About Docusate:

It's a stool softener medication that is used in prevention of straining during defecation and constipation associated with hard, dry stools; relief of occasional constipation.

Docusate is used for:

  • Constipation.
  • Ear wax removal.
sodium;1,4-bis(2-ethylhexoxy)-1,4-dioxobutane-2-sulfonate

sodium;1,4-bis(2-ethylhexoxy)-1,4-dioxobutane-2-sulfonate

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Accumulating in this patient’s alveoli (MCQ)

Question

A patient presents with a constant cough. A CT SCAN of the thorax reveals diffuse infiltrates in an alveolar pattern. The patient is known to be suffering from idiopathic pulmonary hemosiderosis.
Which of the following substances would be expected to be accumulating in this patient's alveoli secondary to the disease caused by idiopathic pulmonary hemosiderosis?

  • A. Glandular cells.
  • B. White blood cells.
  • C. Schiff positive materials
  • D. Cardiogenic pulmonary edema
  • E. Red blood cells.

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Help identify this distinct subset of scleroderma!! (MCQ)

Question

A 49-year-old man, full-time ceramic sculptor, presented with increasing numbers of firm indurated plaques that produced a band-like tightening on his abdomen, which diminished his appetite and impaired his ability to breathe. His disease progressed to involve his upper thighs and lower legs, limiting his ability to walk.
He also complained of extensive esophageal reflux but no history suggestive of Raynaud's phenomenon.
On physical examination, the upper extremities demonstrated diffuse firm, indurated plaques from the dorsal hands to the shoulders .
There was extensive tightening and induration of the skin on the abdomen, back upper buttock, and the lower extremities from the hips down to the dorsal feet, with sparing of his face.
He was suspected of having a distinct subset of scleroderma characterised by the absence of vasculopathy, a male predisposition and more frequent tower gastrointestinal in votvements .

Which antibody when negative , helps identify this distinct subset of scleroderma?

  • A. ANCA.
  • B. Rheumatoid factor.
  • C. Anti centromere .
  • D. Antinuclear antibody.
  • E. Anti Fibroblast antibodies.

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