2 1oyeacoi patient th sic cal disease comes tothe physician fr arutne vist The patent has 2 riety af mute pan cess andpnesmenae. He wae started on hytosyurea one year ago and Meo hadanyfatherpan enses snce then. He has had norezentinessosorhaspatzatons. Hs hysica ‘Samwatanisuremaratie The paeresbotatoy resus we shonn Bla Complete baad court emogtin soa yh cant 22min? wey fis FRetcusetes 20% Finis 2120000? Leulosye count 500mm? Neutophis| se Eosnophi En Lymehocyes 0% onocees a Wich ene along best describes thereof ycragureainthe reament of paieres wh sie cet Grease? Block ‘© & Removes scled re aed cells Fam he cation © B Lyses merotmorei nt ereuaton (© © Protest aganst encapsuited nactealitactone © 0 treraass etal emogabio Chelate rons prevertrantoaety e aioeeee | Dato male brought othe emergency department fr evan of cyanosis, ich occured {arorths ay whe rYarewoe tang eto. In, he became Ws) and eves tan Ne ater Totced tach imedbli=. He became mtrmtteryfachypnec andeontnuedta crys the cng Coreruot the cyanosa worsanad He tempera le =7°e (G07), toad pressure ia S80 mm PSE fs Teuimn andresprstay rate inn On saminton the eh’ er syanoe. anatachyone {Cardiac auscutaon reveals anormal floned by 2st section cick. grade 2 ‘rescenoodesrescend ssi econ muri head ate uber steal ode! Te att ltr paced ins knee ches poston Ths mansuver wil prone dve patents cendban by nich ot thafoloning mechanisms? (© A hntessed systemic venous ren © 8 Decreased pulnanary led ow © C trereasd aystemic vascular resistance © 0 reread espraary ive (© E Increased ght at shunting Poot‘Barth old male is brought to your office for 2 routing chec-up. He has me al ofthe expected Gdeweepmenta miesianes and lo his vaccinabans are upto-dats. On pica eainaten hs porigherl Pulses are somcuat ccorticiedCarsar auscuston fridge athe let stra border ar gen ow, Uinatis the mast ely ass? (© A Endocardial cushion detect © B Niralvave prolapse © C Paterecucts aterosus © 0. Wilms sysrome ele fo oe nePeer 2 2yeald eid is bout othe physician for afutne ist. He's roning and developing appropiate He aiinke 24 gacces ohne rik each doy. Hee taring to patnaré tngeter mo stat eetencee Hie ‘mothers na concerns. Physical expmnalon shaw ml plor Labraary tues saw te lori Hemaaohin B50a. ROW 20 cw 7an Piste cunt 4. 000In Lewes court 5510 nich che faloning atonal ings is mast hay inthis pant? (© A Abnarmal hemogetin eecropheresis © © Low reteulcete count © © Law serum tataion tnd capsty © 0 Hehindet beatin © E Paste fecal occultblocd test ele fo Pooteee 2 2.yeald eid is brounhtothe physician for arate ist. He's roning and deveoning appropiate. He eats avant fonds incudng meat, vegetal, anafruts, and ais 2-4 dass of hale ik ach Say. He ssa to pul words fogeter tt shat senences His mar hos na concems Physical ‘summaton ie uremenatie. Rautne tarry ssies show Me alaans Hemaglein 9598 ROW ie cv ot Retculocte cont 3.0% Pate cont 212 00m Leukocyte court Sauer ec 300 mosis 220-450 meni) * Fenn Tapmgme (740mm) Whats the most they case fr this eis emis? © A Fon decency © B Anemia ocronic disease © ©-Thalasemia tra © 0 .Cyanacceaamin decency © E Soneonysis ele fo PootA Smee nfant th hypoplast lt heat synsame comes tothe physi iiartwa bor arta he est of 3 pais heart isis t6uImn esperar rates & oom ar. Hs iy cys raughoutine recordin. His chest param dchargeandtoday ate shan bala Discharge Day wi Toda er © Peualefusion .Pericar E MjocarnsCee 2 d.yeal femal brauhtta the emeroency dapatment far evan of vagal dscharge. She has had foucsmaling vaginal diecarg for! ook Het mater Na alee nated a mal amount of vagrabeeda, {The maher led her prmany pyc and as tlsto use an ovehe-caunter cream ano sop np treciate tute pane. Hawavey, he sytams Nae at proves The ed compan a pris hervagial area. She was pony ward at ge. \hie aber ist war te baby is wen her stepramer Gnocaminaton the pavned reas aytemsous ih 3 purvent fulmaling vagal iecharpe Viva Inspection oft vag reveals a greenshoregi bag nsietevagna, WMch oe alloy he nest best step? © 8 igaton wh warmed aa (© 8 Bimal eamnetion unter general anesies © © Cultwes for aonenhie ad chlamydia © D Neiy Chg Prteive Serices immediately © E CTscanatthe poh PootCee 2 Smathold bay i baught far acute checkup. He was banat 37 weeks’ gestation andhas had persistent nneezing ence shorty afer br deepte Wald trenchedltr arora carcostrid eran. Feet consists of 2 cnees croft cows mlebosedfrmula day On physical examination, he (his appears wel nowrshed andappy. Youre modefste elt chs wheenng wah eck eansin inch cFne along ste mast ike mechanm ofthis infants wheering? (© A. Alri eacton to cows rik © B Asprtion of afercign boy © ©. Compression che aiay by avascular ing (© D Chan upper espiaontract fection © E Asthma ele fo PootCree precious healthy Syearol is brougt the physician fr evaluation of nit anakennas. She nas woken up streaming nach fe pat oe ngs aout ane neu sar gongto Seep. When het parents {gota er room she's xing, sweat, nd oaks gered. She doesnetrespanéto ret parts ae does Farszem uly ane When Mer paris hls eth ca sn aa ques back sleep The nad ‘marin. she doesnot realleincdert. She satealondergaren his week has just begun gong {ayonhat taking anap. On examination, she afebie andor otal signe se wit nara. oreel pyscal erammaton is uremarable What iste most hey dagnoss? © A Namare © 8 Samambuism © C.Eplepsy © D Miers © E Benign pareysalvriga Pootftom: 10 of 44 | yes boy is bought the ER wi ato. sary of decreased epost neck seeing, and iniabity. He keepshis Read rotated slot ether se. He ovate paves foun of tie eck and rolon tothe lt side Wich of the flowing isthe best neat slepnrmaraaha Ws patent? © A Diectiannnsco6y © B Satineck clr © © Xrayat he nock © D Lumar puncture © E Batu oun econ © F Sat eave bicnsy ele fo Pooteee) 2 previous heat 15.morth.cld iis raughtto he emergency depatmert ater she had sever {spsodes n whic se ostconsciousness afi crying. Herparrts state Dats episodes slays occur hen the che gets Fustated or upset She has ro cyanoss oF neornence The epsodes lot abou 45 ‘heanda coc ater tne pid sa in lst and sproprats Pyslew evamnnstan = unveartabie, What Isthenes best otop nine management ths poner © A Reaeeue paren (© B Oban an eecroencephalogram © C. Obtain an decrcatiogam (© D.Campitedomosrapty ofthe head © E Nogretc resonance magna ae bran ele fo Pootom nursery to evaate 3 tem malaga every th 0 co hours ater inh The arehas inated, thos aetumperatie 38°C 652°, puse Tellman respraary rae dma. On eamratn, he aedemen UwematkabisAn atdomnalradagraph is shown belaeyere te ales On sarnaton eit arm ie .Braoal ary uyD.Comps eieee 2 Byezold mais brougtta the emergency depatment with respi disease ater being sting by bos. He requres reeusciaton wah eprepmninemechon. On discharge, nich ofthe floeing recenmmendatins tthe bays mothers ros ppropate? © A Da natal nmto pay cutee (© 8 Wearconul cles we ctsde © ©. Give propilac anthstarine agents day © D. Prove epingphin to cay wth im © € Use neactrepeate ele fo Pootard Block err 2 yea boys baught the physician by his parents fr evaiton oun and Hood in his stool The chidhas had mupsepeodes of ns media and has bee haspealzoa wice wih pneurona, Euthas never hs leeaing o 2255 busing nthe post. He hasbeen eatng and drrkng wel th ne ‘oring area. He atau a eat reo thm ae a Hae esau f 200 mg. Ch ‘Sraronaton nels veedevelpes wal aunaned angna star corpsnen. Ther ted sea panes ‘nhie hooks andlor esremtie He ago hee rung an purrs onic lawer serie. Hi pet Corts 3 sat eroure at occu led pastwestoo|butnofesules a2 seen on ctl examination. Te ‘anand ofthe gryacd ecaminton sunremarabi. Latest sues shor Complete boo’ count “Hemodchio pers anand Fimwetcoure as Lauhosyte count £00? Neurons, 76% Eosnophis menses 138 Monocytes 10% 2 perieral smear evel alow umber flat, andthe platelets hat ae seen are smal. Which ofthe {alning isthe mosrike cause of hse? © A Bane marowinflaton © & Plater ameeaes © © Maina aeseeney (© D Platt activation and consumption © E Impsted patelet production aioeeee 2 yea boys bcughtto the physician for evaluston af beh problers. Hs parents ep he “ryperacie alte tne They cannegethmta st el, Whan ne doe ane fgets and wee o get out of heseat Heis easy dstacteg and Requenty changes rom one acbiy to anaes He des ot seem sen hens presto rm ana ten fgets ts cos chores. Hetakexcensuely ander inarupts cher peape. Hs pareres stat hat he has been Ike is for afew years, ut ey ad ongnaly {ssumed his bahavor was normal far hs age. He physical examinations unvamarkable. Which oe faloring wile of ast hap in eststishing Me dass? (© A Feamly hist of simir behavior © 5 Etucatoraltssing © © Teacerevauaoons © 0 Step histo © E.Symptams ofan arity discret Pooteee | yeaa AticanAmaisan bay strug ta the emergney dapatmnt ih sudden ans of culty walang. Hs raha report tat his ght hand aa sae ‘cumsy" The boy's past mascal MS is ‘Sipiicart fer shosptaizabon ore year ago for severe upper esters pan andhand swing. On physical {Srammaton neat bloodpressure of s60/mmig Nera of 120m. eripeatite a 8.72 (9) land respatory rat of 22m. Which the folaning Wauldbe mosthaplinlagrasng his canon ‘© A. Caras uiratonegaoty © B CBC mdreboloyte count © © Aatineuropileaplsmic nto (© D-Tampara arr tipsy © E Lumbar puncture © F Ekcramyesraphy ule = 2] fo Pooteee | 25 yeacold woman cames in yur office for causing. She says thather husband has cyst boss, andi she has nearly story of is disease. They ae panning to have ach. She wonders wha ine probably fr hertabytohavecyste ress. Whch of he flings your best response mths ‘© A Cyst fivosi i an assomal dominant dseate co the cid wil have he disease © Syste ross an autosomal recessive dese, ste chid has 25% probity of geting he ‘seme 6 6. ee anata scsve cea, co the cid hae 60% probably of geting the © 0 The protabity camat be determined because er came stasis uninoan The orobaiycannatbe determines tecause cyst Noss does notolon Wendelan ele fo Poot"Yar are cae tothe defer roomto value an ifareborn at 2-necks gstntoal ge, The foes {ecmypnase and cyanate, Evamnaton revels marco! and subcostal erator tong wih nasa ‘ang. Lungs nave coarse tream sounds blrraly Arnal resuscnon, the pater is gen respiratory Sigpotnh continu poste Sry pressure aed rm totheneoraainersvs care unt Te ater respraory sais conindes a worsen over the nest 24 Nous. A chest adored Vm Ne patent ‘shown bean Imation to prematurity, which ofthe flowing is iskfactr forthe development of tis disease? 'A Prolonged upureof mamtranes 6 Inrauterine grant escton 1 Matera hypertension > Artanatal coriconteraide niedtom: 20 of 44 2 18yeacoid male presets to he emergency department complaing of palptatins. He is dghorstc and hae aera of 210min ang aod peseure 1176 mma. bn ecroaraegram medi taned and sows narow ORS complex suravenbicuatarhycarda. An ravenous als of medion Ssaurneesand rerun cazaan ef he seravcar acters, afaowpHecaraaopam = famyaepeyn le Sree Wich ene faloning i he most ie undthjng cause this patents supraveticlar tachycardia? © A Prpetyradm (© & Accessory atoventicurpatw4 © © Cocaine abuse © 0 Provaus corse surseny © E Diatedcardamyopayeee A prevoush heat 18.mort-old mak comes tothe physian or evasion offexer He mone reports thathe nas had a ever ranging Yom 102. (290°C to 1D8 OF (2 °C) athe paste days. He has also became mcreasnal wntabl wih decreased sped. Hs mote repas tht he does con 0 ake Some nus. There aren non st contoets On examination hearts empertire e102 (28 2 yrpuse s 2am ang espa ratei 20min. He sacle dngihe eamnatan Three Conuncialeyhema tera, th eras Grange fam bath ej. Fis cropnarymsenerateus and Fig Iips are fesured. Threis 22cm ante cerical ph nade palpi on he tat side. His ackis tahenise epee ang he 6 atleast chnto hie chet without GMeuty. There Ms anna Tenderness a palpaban shan and fel are sly enynemataus and esemaious 2nd eels 3 ‘aculopapul’ ash entha urk tem sof Ucn he faloning is the most hey agnosis? © A Seat fever © B Stapylocaccal scaled shin syteme © © Tooe shock syntrome © 0 Konak dsease © E Roy Mountain spied fever Pooteee tema of2 ich etre faloning i te most sereus complcaton that may develo ram hs disease? © A Orchts (© B.Coronary tery ancuryem © C Hepatts © D.Mcarsue © E Rheumatic fever Poot2 12yearold males brovatt tthe ayican for evan of rtermitert i inex pam hat nose thre ‘morte ago Ha dos nt reremtse any aura tolveknex The pan veraere ter besathal games, bat Imgraves some wih rest. Ha has bes tahingnan-seradal arc-nfammatay medcabons wih some ‘let Onpiysea examination he hos edema and tenemess overt prosal aa he sof he Bala tendan eran Examination fhe kes at ¢ naa anda etusin present kee pans Fepreducele oy exenang he ince agansresstance Alora radcgran ath nee shonn Eee Wich othe faloning i tho most hey cause of his patints nee pan? (© A Prpatela bursts © B Tracten apophysts © C Patetartendones © 0 Tihs osteoryeits © E Patloferara etecs yndrometom: 24 of 44 ‘A 4-oayla re rough othe physian oan oat flarcup st. The moter pregnancy and feivry ate uncompicates Te fart mghed 844g (7 5b] and was 19in(€82cmjlong bith He tel intne naam nursery nd wae charg arth natal an ay 2 otf. Today ie mathe pote, thot he is excuskely treated, ond nurses for 10 mutes cwry hours. Hetas twee pore 2d. od ras chad atonel moverenifer tao ays. On exennaiun Re welghs 2 S519 (85) ands 131m (202 fm)leng_H= appears aunseed ant face ang chest The emma tne physi xamnnaton © lnrsmatlable. Laboratory vaes are shorn bela. “Tota aon tempat Drecttinn tmp Inarésthodtyp2 Opastve Naihersboodtype Aposbve tem 4 0f2 Which etre faloning i te most hey cause of his infant's ypsrbirutineria? © A Bly aves © B Breach jaundice © © Bresateasing uncce © D.Galactosemia © E ABO incampatity Pooteee tema of2 ich othe foloning ithe best nt step nthe managemort of isan? (© A Siar phototherapy (© 8 Parfarn change taneuson © ©. Shiten fom treaseedng to 8 cow's milcbased formula © 0 merase teeing to 16-20 minutes every 2 hours © E Resevlustetheinantin one week Pooteee 2 18yeacoidbay with ast of ulcerabve colts presents tathe physician camplaining of lathes and rah, He sats hath apetts has been dereasedrecery, and aa complains of nausea and storia pan aidon'o watery dh. He hasan enteratous rsh on his dst as and kgs tha ‘eure His mine repre athe Nas had pa! convertion and hasbeen tabi Val gre are stable. Examinaon reveals a bety ea tangue te appears snolen Abdominal sxamnaton is Tormsi.Therahresembsca sunbury andi ote an hie Get re aninge. Ris symmetrical nd Tender ta glpaton.Neurdogea exarinanon is nama. Ths patents mgm ae mast Nay a 2 Aetceney of which ofthe felowng warns? © A Thamine © 8 Rtotinn © C.Macin © D.Pytdosne © E Cyarocetalarin Poottom: 27 of 44 An fant ba aterm to 2 22yearld woman has a wal cry ands cya at bith, He figerps anol rmucasa appear blue. His bod pressures D0 mir and his hear rato HOfman. Chestcray shows ‘lear ung felis Eatery. PO mensuredty anal camdatonts 2 mre, andimproves onary a 10% inspred oagen. Wich ofthe flavin is the best re sep in managing ths pate? © ALeop dretcs (© B Packes ea tlaes cel ransuson © © Prostgandin Et itusn © D Low dose beta blecer © Sige dose otindomemacn Pooteee 2 previa heat 13.ye ald bay is brauht athe physician fr evan of delved puberty. Hels ‘word because hes he sertest ale nis clase He feels wl oherise. On examin he fn (0m) tal and weighs 4g (et) Hs mathe s C6 (15cm) alae is fathers Tan (18cm) al Hs Send mary sores 22. Atadogiagh of hele hand s cansert wh abane age cf Iyeas-al HS ont chats srovn Elon=e Wich che faloning isthe best ne step nthe management of his patient) (© A Stattestorterone supplemantston ‘© 8 Begn gown normane wetapy © © Checkthyed stmuainghermane ad fee ryan eels © 0 Esplantothe chia he ll remain shor © E Schedule folowupvistin 8 mains Paoeee 2 18. year. male undergoes elective hamia epi. Dring be operatian he sues consiseablbaod lots, and ecsies aboodansuson. Hotnan sxperences an anaphyactc ransusioneatton. He's Fesusctated an fuer hosptal course is uncomplicated. His past mesic history ssgicant fr recrert Srupurmanary ecto ang asimereepodesc-darmea ance ahahoad Wich Be alonng he ‘ost ike cause ots sypsoms? © A decency © 8 Deng Symarame {© © Xinkes apammaplctulinia © D.Wslteadrch syndrome © € cyste merous © F Hyper syntrome ele fo Poottom: 30 of 44 ‘nanbom male has agua anda mine massinthe lower some. Whats the most ikaly diagnosis? (© A Bladder exrophy © 8 wats uae © Cthpospadas © D Postenorurebalvaes © Crptorenasm © F Parent uscrus © G Omphalomesereni cyst Pooteee | 22. marth bay whorecanty mmigate from Easter Europe ith his fay is rout your atic by Fe mater wn is waried hat he seems tor eaiy. She desenbes how he becames shart brea wth ver mil physical acy are canncteep up wit) hs pers curing play. The bay atthe a!” percent for heat nd 20! percanil for waht. On ganar examiatn, thee na cui, cyansi, a perpheral ema, tt heres ahah ls elosystle murrur oer the lve eral borser and arumbing Sfoste murmur overthe cards apex Which af fe fang se mos hey cause of hs Symptoms? © A TerabgycfFatet (© B il septal defect © © Nantieuar sepa detect, (© 0 Transposon othe gest vessels (© E Mira stenosis Pooteee 2 1Syeacol Caucasian femal comes to your effce because her menses have natyet stated. Her breast developments Taner tage 2 andthe e scant pic har. Physica examinaton is alsa sgnfcat or decreased emaral uses. Wh ofthe floning isthe best net step nevalatng her condton? © A Absomina CT stan (© B Progesterone change © Serum prtsin vel © D Kanaypesrayis © E Uine 1Phdanprogesterone ra ele fo eeuRy aed 5 PootA previusy heathy year-old males brought tothe emergency department wn abdominal pain. The ‘smi pain bagon several hours ago. Sis then he has had several epeadesnstich he cliches Wis Slomaon and scream. Tess eecodes are assocaed wih nontogss rans vom a nse. vse stoi. Bebeen he episodes, te paler denesabiamna pan anais play On examination his Temperanre © 990° (37°C), puss Oda, resp atais 2Ofrin, and lod pressures EEO mm Hp The chit alee andin ne acute dsbess.hdomina eaminaton reveals» so ronende, andstanded abdomen vith bowel sounds reser mal fot quatars A ular mass'sotin he ht Upper quacrar, and a retl exam shamoscutpastve, An Ulasaund image ofthe paps absomen is ‘shoanbeter Whats the best nat stp in the management otis pater? '8 Emergeelaparatomy |B Compunadtaporaphy af he absomen CLaparoscope chleystectamy 1D Mec scan > E Ak contrastenema nied| 2a fart brought tothe prysianfrevalutan of fever The fant as tom at 7 weeks gestion a narmal spartaneous vaginal deivry, His aber had an uncooled pregnancy and Seivery. He ha Geen song wel url ts moming when Ne Geveone temperature or 01 SF (a8 SC). iS ‘ater eparshat hes staking his formulae eas same clea fhnorhessniteatert Snesaing. Hs Sear abromer had ar upper eepaorytact fection ane weak ga. The pabets chest Fadogrph is shonn belo Wich othe floning best describes the ings on his paints chest radogragh? '© A ight oper bbe inte 15 Right mile be init (© Htarympnadenopaby © 0 .Cardomegaly © E.Narma cardcthync sihouetis niedtom: 35 of 44 flr neonate beng evaluates flog an uneamplised pregnancy and ley on day of fe. He ‘eae 3 Ura (2), 20n (5) 22m) al ang Mae head currence ot 198m (Siem). He py rarinaton is uremarkatle, Intl abratay data shawn tlor Compete nod court emogebn 203! Hemancrt 73 Flalets 200 000m Leulosye court 5 6000mm Newrophis 56% Eosrophis 1% Lmonscyes 32% * Menacyes 10% = Wich the falaning frdngsis mos ikl tbe detected inthis neonate? 2 © A Respratoy dsbess a © B Necrotxng enterocotis =| © © Dssemnsesieraveseuar esagulton © D Hyperaycema © © Reraltaiue Pootesd Block err 2 yea eid is brounhttothe physician or arate st. He was ba tei wth 2 ith weight fib 802 (Sha) and abr ena of 20m 60 fem). He Rae hadrormajr nesses of hosptalzatons. parents repo that he wos breasted exclusively or Brnths He non eats a varity of baby fod a is eg anstoneato wae vc He can pul wp stans and clse sauna aig ara ejects ut cannat ak independerey yet He can feeahmsa mallpcesoface food wen he hum and stinger The ‘nt wordeeInawe armas dada anda He porerte ae concerned shee praethtecauce ome afte oer chiren ns dayeae das ae tage tan nm. On asia examiaton. ne weds 226s (fg) ax 301m (18 2em ang A compete exsmnatons umeracable, When othe follwing shoud ‘putelhis pers? © AHS weit is nomial uu RheDRUs essihan ements © & Hs welts ss tan expected, tuts relat is noma © CMs rows 's noma, tute has deayed maar devooment © His gor is norma, tut he has delved speech develpmert The chs gnth ant development are nema e aioeed Block err 2 7yeacold males brought the emergency department for a suspected femur acre Hehas had ruthie racture inh pst after mar aura Toda, is ether stats that he was uring a fel. He Compained of paminiisfgh ace fl His esrnston sremartatl ertesomess 2 plpaon ae sights ns ge pomnal igh eas Geceanarmnce unearth Wich ene faloning is he most hey associated finding? © A Aone rotation (© B Horseshoe trey © C.Opakscentizeh > 0 Metal retards © € Aan bat macules aioetom: 38 of 44 | yea boy is hospitals for sevarepreumoniaraquring earache nubition and mechanical ‘eration. Hshemaglotin lveis 182 mala. and his WC curtis 3200!mmn3. The sbsolus evel of COS- poste hmpheytes sna tthe evel of CDISepostwehrmhoctes every i Ths pater woud Eenatemoat om which a etaloning as 2 mantehance tera)? © A AnteoWa Teta [© 8 Inrnenaus inten atu gba (© © Aemiisraton ave ateruated varcies © .wmte tae ce warstuson (© Enzyme replacement therapy ele fo Pootele fo tom: 39 of 44 2-year Acar American boy resets ta your oie ih fcutywaling ft the pas several weeks. He complains o pan nthe ngthp. Ha deszrbes wv epsodes af sere hp pan ané one previous {psode of abdominal panrequinghasptalzaton. Phyte examination reveals aban reson nthe Farenp jr lareie not endhemstouso tender to papatan Ha Memstoart 22% Ths palet’s Crury waleng is mest ely secondary ta which a te falonng: © A Ostecantras © B Sepic ats © .Gauy artes © 0 Osteonecrosis © E Osteporsis © F Osteomaacia © © Osteosarcoma © H Charcot ates © LPagets asease © Jostens noosa ste3 Pootee Block err 2 18yeacol ican American male with sche call anemia presets companing of 2 weeks at ‘xartond djepre,fatgue, and penefalzod weakness. He dene fever, cls, nigh Swear, or cough. Hs ‘ony medcationsenycodoe fr chronic pan On physical examnaton, he weighs Bg (150s) ands 1 cm (68 nat His temperature 236°C (52°F) tod pressure e070 mmbig, pulse Tamm, snd ‘esprapane se 8mm Al organ ystime appear ners Lateran enise= sr Hematocrit 20% ‘Mean corpuscular volume 11041 Reaculocyleccunt 10% non orne along ihe most ey mechanm unseriing hese thangs? (© A Adverse dug reaction © 8 Gastrc mucosal avaphy © C Bacterial overgrown the smal rtestne (© D tmerease demande tote 201 (© € Increaees semana or amin B12 © F Malobsorron ieee | 1Syearolsferal wth aisty of tigalar dscrser and paychsic presente to har sins ofce requasng apreprancy test. Herlastmensvuapstiod was 2 morehs ago. She states that her menses Usual occur every 80 ays. She is sel acbe wih one pater and occasional uses condoms. Shes onczined because she hs gad 10 paunda nthe asta mans and aa compl cTeteas {enderess and miky white charge tam bam npples. She denies headaches, nausea, vamang, dares, brfevr Horvtal ne ae normal. Physics sxamnston merarabie A tine pegrancy eee negate. Vnich oe talaga is most ey resoonsble fortis ben's symptoms? © A Vapacacd © B Rispenaone © ©-Arpiprazoe © D.Lmum © E Lamatigine Pooteee yeaa femal brug ta the physician wh arash and jpn, Hermotarrepats that she hes been srenousy heathy eestor trot afew eke ag0, Ons nzekao, the vatartcevlopsd gan infer nees. The kr pan esohed aera few days, turow her arkes angus are tener She Nas fabs sevtoped apne rash on ner mune at's nan puta he re emperate 303°C (10°F) pulse {min and respistay rate 2min_ On exemnton, teres pan and stfnesscurngmanpultan ote vrs and ares. Aart, ntomatous, certfgaltash on er turk and promal ibs © present Laboratory stuses show Complete baad court ‘emogbin, weg wcHe! 2 wey ase FRencusete court bY Flatlet cure 200000mmF Leulosie court 200mm Neuroonis| 55m Eosnophis ‘ Lymgnscys 2 Wienares im ‘ceacve prten 35mg Eyivacje sedmentaionrate SE mv Wich etre along is the mest ie dagnesis? © Alone theuata atts © B Rneumatiotover (© © Acute mphablasti uke © D Systeme pus eyhematsus © & Feramyai Pooteer) Block err 1 -yeacoldfican Amarcan gl pesets tothe ER wh amis fever and svere gh sted igh pan, Sn eaptated an equostsquckpan elt. Hat neartate © aQlmin a logs peseur = 1270 Fig. She says tha she had a siviarepsode oe year ago and as placed nthe hosp fr ravenous fam managemere. Her baer had smiatepsades avd des can econ 210 yeas of age Wich of {he folowing weuldyaumest expects see an ths pater’ perpheral lad smear? © A Bur cells © B Pabeyheria © ©. Reticuocytoris © Den daficincy © E Hypersegmerted neurophis © F Eosnephila © G Blasts aioe aeee | ayeno Atican American by is brought to ER wih high ever poor appa, and italy. His haart ‘ate fm ad is lod preesure i SED meng. Hohas ben hespalzed sever ames bette or ouiyocalzeéatcomral pan. He asohes 2hstoyofhematuna. Te boyhas ntreceved several Flute vacations wecause hs mamaria aad ba hey wl cause aur. Hi huratote ie 22% andthe feteuiste courts Tos The ponent cles several nous aertne someon Tne ranents sesh may nave prevents by: (© A Foie acid siplereiaton| (© 8 Vaccinatian wth ave trusted ius © C-Naccinaton with bacterial cia (© D Vaccinabon wth arugate capsuer plrsacchoride © E Peto lead ranstusiens | Orsseae oe) Poot2 tocar patient with sic cal disease comes tothe physic fr artnet Te patent has 2 rico af mute pan sees andpnesmonae. He wae started on hyroxyrea one year go and Meo hadary fatherpan enses snce then. Hehas had norezent nesses orhasptatzatons Hs ysis ‘Samwaton i urematiatie. The paieresotaoy resus ae shonn Bla Complete baad court Hemogabin s0gt Exyivscye count 22min? wey sn Feicuoytes 20% Paster 212 000mm? Leukocyte count sf00imm ‘Neutophi sa Eosrophi * Lmphocyes 20 Monacees m rich ofthe long best describes hereof ycragureainthe resent ofpaerts with sie cel Siacose? '2 Removes siced red blood cells Fam te cclabon| B Lysos mirotwomtiintheceulaton CProtets against encepsuised bacterial inechons 1 © D.ioreases eta nemogtin E Chaatesronta prevertiton tty Hydioqucesis «chemotherapy agrtused n she cll dase ta decrease vaso ocluve gan ces 2 lola episades of acute chest name. Hysranurea wars by iereasngths arourt of fel hemogiatin Inthe creator neeasng he eal hemodatn ales the numero sels cetsin the cedsbon and ‘edu vaso occlusive spsades. Hjaraytea as bee shown decease pan cies eed lot .2 Removes sicHed te lod els Fam he cclaton| B Lyses mirotwortiinthecculaton C Protects against encepsuiated bacterial inectons © D.ioreses ea nemogobin Cheats ronta preverttontoscty — 7 Hydioquces isa chemsherany agertusedn sie cll ise ta decrease vaso-oclusve pain cses 2 ola apices of acute chest name. Hycronurea wars by ieeasngths arourt of eal hemogitin Intie creator neessng ie eal hemodatin ale the numero seed ets nthe cessbon and ‘duces vaso occlusive epaades. Hyarayteahas been shavnta decease pan crises tenet lor transtsions and episodes of acre chest ynarame. Side fects onc because Wsranrea supresses thebone marrow. Leukopena anemia, ad thombocjopenia may o2sur These eects ate gerealy Terpotaryantreversbietut ay pedonose te paleo mecton, (choles A) Hytrojures snes neeemove cies cele famine ereuston ‘The aplen respon for Fteong oun sched ed blaod cals, {Choice 5 crnrames cause he soe ets ae te cause To vasoactive pan cise. Fytasyres sees ner prevent or ete mara: biz dete ose he proposer esd as inthe ‘route, (holes 6) Prootyacicpenciin is avento Ne cel pats to prevert acon erespsues ganar {holes &) Patents wih sche cl iszase on require trachsions. Frequent ranstusions may ead to lrontonety Paters can te reste wt ran cheatrs suchas deeraxamne top eouee the ee ot thatranstson lated hemosiderosis éucatona objective: Hynes tenes nabs wth sce cll isace by creasing ftw hemealabn‘2th old mali brought othe emergency department fr evan of cyanosis, wich occured ‘arorths yt he fares tang eboney, ne became Wey and seat ten Ne mater atced tet his Ips tuedblue. He became niet ta:hyprac andcortnuedtscry AS the cng Corcruot the cyanaaa worsen. He tempera le =T°e (B07) eond pressure a S80 mm PSE is Tsuimn andrerprstay rte nn On saminion the ed's ae syanote snataehypne {Cardiac auscutaion reveals anoral SI flowed by 3st eecton cick Agrade 2 ‘crescendo decrescend syst econ mur ishead le uber steal o'er Te atts Itrnait pacedins knee ches poston. Ths manauer wll mprne dvs patents cendban by nich ot thafoloning mechanisms? ‘A neteared systemic venous run 5 Decreased pulmonary bond flow 6 C-lerensed systemic vascular resistance Dinreobedrespratry ove E increased rata et shuntng fn a “Tatlogy ot alot (TOF se mast common cause of cyanate congenial Near ease, and cones thefolawing out maformatians ulanaystnoss, 7 oerding aa vritclosstl defect an rght verbcuaryporrophy. The deg of pulmonary starosis the most mporantactar taming the Ssevertyet srs. Unwed patients wih TOF ate srisktor “rypercyanat "at spls. These splls ae on precited by even (such a fein) and as characterzed ty eat, cyanosis, andtaciygnea. Alou the cractetlog ol these epsaes is ucla fey ae beleved to be predspose3byperpheralvasoalton, Iyperertiaton andor cortracy oe Fa wera oun act RegarSs af ne soy, aoe, an noreased rho et shut across the verticular stl defect aevlops, causing a decrease pulmonary blood flw and ncreaed systemic veaus rum of deoygenated bos eadng to worsening Syanoss undead Tet spete can feadto syncope or deat, FD insesceerespratan ewe E increased ight ale shurtng — 7 “Texalogy af Flt (TOF isthe most common cause of cyano congenial hear dscass, and const the folowing feurmatormatins pulmonary stoss a overdng aorta, 2venelosetal defector rahe Vertu mypervophy Tne dears of pulmanary Strasse ast pra factar termine he ‘every ot symptoms, LUnteatespatients wth TOF are atrskfor"rypercyanote” ere spels. These splls are often precited by evertan (scr 9 feeding and ae characterized by tatty, vanes, ang erymnes. Mou the ‘tact eelogy these epsades is uclear fey ae beleveeta be prodgposedeyparpheralvasoalaton, Iyperertiatan andor cortracuty othe rah verscuar oufow vast. Regardless of he egy, aver, ‘anncreased ata et shut actoss ne vertovar Stl GetetOeveps, causing 2 doseage Pulmanay blad fw and ncteased systeme venus eum of dzone blood eadng to wersering Gyanose,Hunseatd, Te spele can ead to syncope o death ‘The tesiment 2" spllis to place the china knee to chest poston hich neeases syste Vascular raitance recut nneraase ldo oom fe ng enti tepuranaryerelaon, opine ad an ravens fuisbous can asabe ghen increase purnary Haas aw. Oxygen oF lite benef becouse he abrrmalyis decreased purmenary led ew, nt msuficient ygenaen Increases systemic venous eum (Chalee A) seereases pumorary isos Rau (helee 8), reasea ‘spat ave (CheleeO} ar inceases ont sung (CRelee ) ar alfesturesof2 et spel nda exacobste her tanimgrav tis patents erpame Eeuestona sjectve {Ferang ot Pat conse of pulmonary senose an overing sot, ayenticUosentl detect ans rat verbcurhyporrapy. “Hypercyanctc” spel ore’ spss car boimgravd wih aknee a chost poston, ‘heh necanessyetomicvasclar recat a heetar improves pulmonary ood fon fpoopeanewers ae (721/000‘Bima old males brought to your office fe 2 routing chec-up. Hz has me al ofthe expected Gdewepmenta miesianes and alo his varcinaans are upto dats. On phyiea ecainatan hs porigherl ses are somewhat accertucted. Cardiac aucun fringe a the et steal border are gen bow. Uinatis the mast ely asi? eats ‘A Endocardial cushion osfet B Aalvave prlapse 6 C.Paereusus aneresus D.Wiiars drome ‘This young clas continuous fw murmur whichis classical associated wt a patent acts sitroeu (PD). The cine nature ets POA murmur fe eausedtycortruave fer dough ie ucts ateresus from the aortato the pulnoary anerybecause arte pressure ishighe than plenary ‘teal preceure bab sytce and datale ne cine manfestaione seeneaed wena PDA sre qute, vanatie depending onthe degre cf at-o-grt runing, ich ntum's dependert on te length and size of the POA, Shee his parties been asymptorac and fs PDA was detected Meier on route ‘ardae auscufaon ne mos he¥ hos a ral POA. Pica examination i ten uteraratein patents ‘tha smal PDA, atnaugh mil accentuated pengheral puses can accu Explanation: {totes A) An crdocari custon defect (2. aioveticular septal detect chon assacistd it Donn Synajane and san ease avariy of normal hea sounds anor mamuts. Henever i wadDREk cause 2‘ eoruaus ow murmur (holes By Mralvabe prolapse is characterized by amiystac cick alate eytlc mum {Chotes bp vita synsame oan be associa wth several cerdar dbname mousing supraWaist mast Mey ages? r 7 Eniooardal shin seat B Miralvake prolapse 6 C.Patresuzue enerosue D.Wiliams sya — a ‘This young chia hos» contruous fw muumur, hich is classical associ wth a patent acs stnoaua (POS) The cnous nue eee POA murmur ealsedtycortruaue for Haugh ucts arerasus ram me aorato me puronary anerybecause art pressure fshighe than pulmenary Sista pereue bab syste and antala. "Te clned manfesaione sreovatec win 2 PDA are qute “arate depending onthe ear ct o-ort shunng, eich nurs dependert on We natn and size ot thePOA. Since is part has been asymplomac ard he POA was detected ncisertalyon toute Cardac ausculaion he msc llaj hae a small PDA. Physical examination i fan uemarateinpaterts tha smal FDA, though iy accentuated periperal pulses can occur (Chotew A) tn endocardial cushion detect (2 atioveticlar septal detect chen associat ih Donn ‘ynsrame and can cause avaney of ssrormal heat sounds andor mumurs. However wade cause ‘conus ow mira (hotew 5) Miraival prolapse is characterized by amisystac clk alate systolic murmur (holes 0) vitae eysrame can be anzontaswen several corse abramelties nsudnasupravler ore tens, pulmanary slenoss, cr sepa defects Honeverrone of hese abnormal produce 2 eueational abjezsve: 2 pitere duce tensus [PDAs associated uth 2 continous fw mur de to constant movement of Ubud rom te nan-pressute ante tothe lnvaressure pulmonary artery. Small PDAS af oten lsymglomabe and detected cisely an roe cards auscultation Last undtest(11 7/2008 nn.028 2yea-aa eid rounnt ote prysican ora futne Wek. He's grenng and sveonngapeoprat Hedints 4 gasses ohwnc mic each day. Hee staring ta putts agener to shat setences His ‘mater ties na concern. Physical wxaminaon shows mid palor. Latraarystdee saw te loning Hemlctin sepa ROW 26 cv van Platt count ze4 000mm? Lewacte court 500mm non ore along asstonaltnangs is mast Hein tn patent? ‘3. Abnamalhemogbin ekctopheesis 4 © B Low etovooye court C. Lew serum ttalron ining capacty DB Higindrect trin eran 7 Inthis age oroup,ricrocytc anemia is rast aly duo ta fan defcency or thatassamia. Abertay vabe {tat shaun dsinguring between ese twa condensin chiar ste ex ea toon wa (ROW. The ROW ie smeasure chon variable the ea load cel ae mtne sage. ates gat han 208 (such asin is pate) are much more suggesoveofron dficency nami, erzas Walessem ot fnema ot crane Asean sme lym chien enh anol OW Inchlten wth ran defen anemia, the most Ihe srormalty fom the chaicesohen above i alow Fateulate coum Renclocyes reprsert a youngest rea toad cas nt pergheral reuston ana are therefore armarerfertone marrow enftvopoess. ‘since ronisrequredto the pocucton ced bod ‘cols absence or bq levels of on woul esun decreased ert an neice aon reco Count enrepscementrenutsm anneresae imeem enfnepacns ans the mteunete oun {hotee a) Thaiasseriais a form of micracytc anemathat waulbe associates wth an abrarmal hemagbbn decionoress As mertaiaé above however palate wh iissema woUdTave 2 PoaE Pootve cel ceaut lastest Inns age syoup, maroc anemia is mast ely duets wan defeeney or thaassemi, Alora abe that hapulindlsonguning between ese toe candeens in chare ste res eal ouson wish (ROW). Tha ROW ies meszure chon variable tere load ce are mine sama. Vatuos greater tan 20% (sich asin Bis pale are much more sugges of ron decency ane, whereas Waessemia or nama af dvane dears mae lly chien wah anerrnal ROW. Inchon wth ran defcieney anemia, the mostly strormaliy fom he chices phen above is alow ‘absulcyte count Retaloctes reprsert he youngest ed toad ca ne pehera rcuston, and are thettorea mater fo wane maraw engrvopaess Since rons equredta the poducten ef fed bid cl sbsenoe ar level of Fen woul esuin decreased eryhvopaiesi ang hence alow race ountonrepscementresitsin anncreaseinbethengrepaess ans the rtcunoyte coun. (hotew 8) Taassemiais form of mcracjtcanemathat waudbe associated than abrarmal hemaghtinelectronoress. Aa mertoned above, however paterts wen Masssemi woud have 3 nara ROW. {hotee 6) Te wil on uindha capcty (TI) woud te elevate n patents nh on dency because Tansfemis less saurste wh ror meanng that thas 3 higher capac tad ran (Choice 0) emai: mema woul resukin an increased ndrect bmn. However, pater ath ton Sefoeneynavenormaltruin ves {holes £) ran deficiency ancmiaincharenis mare et be sacondaryts dary defcieny a cppasad {oUoodtoes ich ie he most common cauce made Eeucatonal objecove: Niracyes anemia causedby rn defiency can chan be dered fom taassemiaby mr clewted ROW, which i ticaly rater han 208 in on daficincy. The etculsye count pats th ran Sofveney deta docraased enaepaess cs at pcnle anne Last upd (1/20/20He eatsavanety feeds incudng meat. vepetales, anatruts ard stirs 24 gasses of hole mik ach a Gay. He staring put words ater vo sar sertoncss. Hs mate has fa cance. Physical feamaten is uremeriatle. Ravine ltertary scies show he faling Hemalctin 859 ROW ie ev ean FRetzubcfe count 3.0% Platt cont 212 000i? Leuacyte court 6500? Tec 300 megia 240-450 mepil) Fern “apmgnt (7-140 nl) mais tne most ely cause for bis chs emia? ‘8 Fon defen B nem cfchronc ease © C.Trasseemiatat 1 Oyaaccealamin deficiency E soheroovosis _— | ‘Thalassia are auoseral recessive diordrs of heraghin ssn most commaniin people of Neaterranean descent, inal syretms can rage ram mint severe depending onde number ot (otinchana that ar acted haute th halsexna at ull ave ro symptoms ad Sfagroced when ravine tara sue ved 2 mecocyte anemia yh a rarmal ROW. Cincy, thaassema fs con confused th rn deficiency anemia. mcrocyte anemia does ot respanto empiric ‘alan therapy, fan ses shoul te prlarmes. Ths patent as horal fon suskes WAeh ts 0 HON Geficiency ana makes maaseema rat much mae lkay Hemaglain electrophoresis canbe pefarmeda Conf te dagnes. Forindval wth tdaecaria ak, novesmentie usualy mecerea. {Chotee A) ron oslenoy ava one presents wh par pica andtataveatnougn hese symptoms ae than at presentinciurenLabersory suds prea shout amroeya,rypctrore anemia wth 3 onB Anamiactchranedssase © © Tasssemavat Oymoccbalamin deficiency Spheranpasis rer 7 ‘Thalasemis ate autosoral recess orbs at herogotn seen most commaniyin peace at Nesierranean descent inal reams can rege ram mina ta severe depending onthe numberof ‘atin chane that ar fst, fave nth naaceamva rat usvaly have me smtme ad a= Giagrosed when roune bortry sues reveal 9 microcvic anemia mt) areal ROW. Circa thagssema scflen canfused wth fon deficincyanema.f acrocyt anemia doz nol respond epic tralvan merapy, fan stusies shel te perfames. The patent hashormal ron suds which ts ou ron Geficency and makes tasserna rat much mae key" Hemogibineectphoresis can te permedto ortim me donness. Farinas wn faaccera ak no wear usval necessary. (holes A) kon sefiency anemia cen presents wth paar, pica andfatgueathaugh hese symptoms ae ‘en not resetinchisfen. Laboratory sis pica shove a merece, rypctromic anemia 3 on ‘etoulcte ceurt nah ROW, fw Serun on, hah TE, and iow germ een (Gholee 8) Aramis ochre seas sunk inti ch wth no meses patie Tis pe anes {canbe namocycormizragytc, labertry sus wl show lw serum an and lw TEC. 4 (holes 0) viarin 812 deren presen 3 a macrocyteanema wh an eevted NC. (Gholee £) Resculasytosis i physloic response ofthe bane marawta anemia provided adequate fon Stores are presont Infemahfc anemia, the eeuloci counts ae much higher sometimes as high as os) ueational abjecsve: Indhiual wih alassemia rat prosant wih microcyc anamia anda mild ebvated reticulocyte coun. ‘The ROW, MCHC. TEC ad ern let are bps roma (6/000A Qelcld fant wth yo infart was bom at term wa normal sportancousvapnal avery. Te panerthadhe fst f 3 palate near Surgeries shorty ater oh He id well afer surgery and was Sischarged fame one ek 3. Over ast hows te nara dMeuty feeding and ane encoaes of vortng On ecaminaton the are sete, pulse feumn recat rte esi loc pressure USD ana pulse carmen £0 an com at. He mls cyenat em Gur wel destoped. Hie cardavaecst era reveals tachycardia 3nd dling hear sou wth asia etn murmur nearahrougout he pecargum as chest ‘adogragns rem ascharg an toda ate show blo Discharge Day Today <) ¥ inti the mast ely agnosie? ‘A Cangestve hear fore B Endocardts © D.Peicarial efuson E Mjocarans© 0. Percarda fuson E.Mrocarss Reactive pticus wt s prc afuson can poser tr suger congental het disease aris Caled paxpencaractamy syndreme. Symptoms usualy occur VS weeks afer sugery Aah e cause Isnothrov,pospercaréatamy syerame sthougtts be an ataimmunerespanse, poss 33) lzion. Mostchigren develop mid syisiam wich ae et ied Inf, percardalefusons can present wn andomnel pan voritng ard decreased appetite Older cen may compli of chest pan Fevers fin present On vaminstun tings ae cansistart wih pacar ander pura riflaraton, Incr tachycarda, poo perfusion, puses poradows,detont Heat tanes, and jug verous dz. the stuston sarge anaugtoalet he uncon ctheheart pencardltempanads can occur {holes A) Congesive heat four isa complication sf corgent att seas, eepecialy when et Unesied. Sgns of congestive hearflure con rile poor eedng ae tachycara. neon, ng sided heat tatu pesers wih hepalaspenomegaly edema, ad juga venous dsteon. Laftsied heat falure presents win acrygnea ang respon dstess Chest eigraphs waulé show increased vancus congestion. (hotee 8 chisren tr congenital neat dseace ca ke ation endocareis. Chitra usa present ‘rh fever, and may nave a signs lung petechse spear Remnhages, Osler rads, Janeway lepine orBotn pote” Cardiac ie would netbe creased ona chet radoaragh (hotes 6) lel enusons can acew as prot gosperardotomy Syarome. However on chest Fadagrag he efuson wauldbe seen andthe costophrenc angles odd bs ured {holes ) wyocarts posers wi sign of congesve hea fale, including pcr feeding fague, and Tespratoy astess. However mocacts usvay resus fam ivectonanaisnotasiky 36 petcaid0s nd pencardal fusions n past sugeal pers éucatonal objective: Pencardialefusons can occur inpatients wy congenital hea deease ater cmd: supe fs tani anor Last upland (120/200‘A d.yeal femal rau ta the emeroency dapatment fr evasion of vaghal dscharge. She hat had foucsmaling vaginal diecharg for wook. Her mater Ma alee nated» mal amount vagra been ‘The maher led her pany physica and us tlsto use an ovehe-caunter cream ano sop en trmctistate nutele was. Havavey, he symgtams hae at proves The hd compara pr hervaghal area. She was poy wared at 922 shle aber is twa te bby Is wen her sepraner Gnovaminaton the pained reais aytremstous ih 3 purvent fulsmaling vagal charge Viva Inspecton one vaghe reves a areenshtaran baayneie tevagna, Wh oe alldng Me nest test te? © A tigaion wh warmed ud Biman examination under general anestesa © Cute er ganarhea and chiara 1. Noy Chil rote Seni immediately ECT scanaltne pals a 7 ogi foreign bes are common in gre-putetal chien. Presenting symptoms canine ate ot ove yagi dscharge futreting oir, and vagal beading te abct agers sharp woes, the patertmay also camplan of pan. The vagntspraducd by aforegn bony can cause fe chidto have sina complans aswel. The mest comman vagina foreign body found chien sole pape. Other [ems ncudetys or cons tac me cit as paced Mer vagina. ay chia with vagnal dena shou hve an examination ofthe vagina which usualy perma by pacing the chkdin shee ta chest or frogleggedpoitan. The oneal eras should te examined ae wel asthe vaghalirsctus. Felon bodes can oten be seen fhe cif ashedta wea crm he cxamnabon needed rasa specukm ‘maybe used examine the vagina, tafarign bay seen, igaban wih warmed fd hauls be Deformedin an stemot sus atte forsgnody.F mgstans unsuccessti, exerinetonandfersign ody remaval shoud be done mh son or pene anesthesia {hotee 5) 29 etamination under general anesmesia may ue necessary ta femove a vagina feign B04, Sspocisiy ttn foregn bo sarge Howsver due othe ie ot nest, omgn tony removal ie inition shouldbe started est,Explanation: Vagina frign bods are common in r-pubertal chien. Presenting symptoms can includ acute or cone vagal discharge. fouksmeling ade, ane vagral bleed Ie abct geo has sare eos thepatertmay aso complan of pan The vag praduced uy foregn boo can cause chido have Uunnar complarts aswel. The mast comman vagina foreign body feu nchisren taletpaper. Cher lems ncude toys or coms that he chil fas paced niher vagina. ary cid with vaghaldschae shou rave an examination ofthe vag fic is usvaly permed pacing echidna nee chest or froglegged postan. The enema entala shoul te examined a5 wel asthe vagal ruatus.Farign bodes can on be sesn fhe child askadtavasaNa ding he xamnaton. Hrecde, arasalepecubm ray be used te exarne the vagina. rafrian toy sen, migaon wih wae fui shoul be Performan an aeot a ush atthe forwanbooy, F mgatan fe unsuccess examination andor osyremaval shu don in seston ar gener Sne=nesa {hoice Ban exarination under general mesthesia may be necessary to feove a agi oreign body, ‘special Ft foragn boy is lrge Homaver due othe is of anes, baty renal ia Imgatan shoudbe semeted est, {hoice 6) Cutwres or gonorrhea and chsmyda we impotart in chide wh vail charge abuse is Suspected. Howeve inthis case ature bids Mavala ands moshe¥ We source of ie vai sieeharse {Choice 0 cid Protactve Sences (CPS) shouldbe noes any tme atuse fs suspected. ths case t lode bestc remove he oragn body Ms. he orn body Faas supioon for ase, ten CPS ‘Shaul be notes {holes &) rmaginaisnotrequited asthe forsgn body can te vsualzod on exarination. The use of CT ‘Spans shoudl imeedm chien Gecause of anoems ave! raaton exposure Educational abjecive: ‘Vagina fotgn bodes chou be cuspectod chien wth puree, fulsmeling vagal dlharge and besang etupdstes (921000A Smann-os oy itrunte fra cute cheskup. He as tam at 3 Weeks gestation anges had persatentnneezing snce shar after bth despte Whale anchadlt areal earcastra Detapy Fre det cont of 2 euncee oon fued cows milebaeedfrmuls call On physical xaminaton, he Chil appears welnourshed mid happy. Younce mater eet othe wheerng wth neck extension Unc ene along ste most ey mechanism af hs ants wheezing? 7 Allergic reaction cows ak Aspaton ot afore boy © ©. Compression ofthe ary ty avascular ong 1 Chron upper resto tect iectin E agnma conn | “This paterthas signs an symptoms of upper arway compression by 2 vascular fg. Nose due toa ube aor aro, pte adea ant, purnonary cing, o aramaaus morn or Bit caotd ate, vascular ngs an cause aches compression Patents present ul sgh of chron upper ary obstucton Incudng sor essing vari andshorbere ebresth.Symptama sean woos whe sine ard ‘alowed vat neck etensin. Pateres ate commey msdgnesed as Rava eacivearvay ase ba (nlnat respond a faled Wonchodlaors andcarteonrade The Yesmertfarsavere dasa surkery {holes A) Food aersos ae relatively comman inthe fisttree years oflife, particular a miko, emus, sy. andwem Sympome con nla dermatts heen and utara recy cores th Feadingéstan” Wheczing duets fod alergesimpraes wih bronchodlatars an crtcosterads and tat fect by body pasion, (Choice 8) Fccigntodyaspeton sa common cause of wheesing, cough andor especialy in Chisen agea@monnsts a years Honever Systane usualy ace aset In eras ate ns Gecanbes anave wna hs been syptoman: fr mens (Choice 0) Chidren th mmunadetcences or certain anatomic atnarmaites may have chronic poet ‘espratry rfectone at cause ewzng, However. thspatert oes nt nav oer Sons or conc Infecon such as poor gow orfever1. Chronic upper respiratory tact iectin| E ema ‘Ths pater as sigs and symptoms of oper aruay compression by «vascular ng. ost fan du ta a ube aoric aren, nigt-adea aura, pulmonary sing, ar remacus imormnat orf cree ater, Vascular fings can cause tocheal compression Pate presenti signs of chron upper aay obstuhon Ineuding sor esa, cougring, nd shores orbs Syngcns are aten worse wile sue and ‘leved wh neck eens. Parts at carmmaly msdaghesed as Ravng eacivearway ease bi ‘lat respond oiled bonchodlsare and crtcorterage, The raemere for snare diezae ie s3ey (holes a) F003 aees oe relatively common nthe ist vee years oie gator to mikes, Deans, sy andwhedt Symptoms can nla dermats,wheenng, and utc racy cael th Foadingestan. \Whoczing duos fod alorgesimpraves wh bronchodlators ad cortcesterads and fat aMfectea by body poston. (Choice 8 Fxsign tady sept is «common caus of wheening, cough, and sro, especialy in Chisron agea morte ts 4 years. Honevar sympa are Usual aut onsst, ncortrast steels Goscrbed above who as been syirlomat fr ments {Choice 0) Chiden tn mmunodsiences ar ceri anatamicstoarmaites may have chon par Fespratary nfectane hat cause wheezing, However, thspatert does at hae her sgn of chranc incon such as poor gor or fever (hoiee € stn crease sway daease a common among ehisen nthe Ud States. Yneeang, ough and snemees a brestn ae conan manfesmnens Une he ponent inv vignte ceartve Sy Seears responds to nhaed bronchodatrs and sytem coneactorase Eeueatona abjectve: "Teselse ange con compress the asnea an least srsor neeting ans shannese aren shart ater bith. Thay are often msdagnosed as reacve arvay dseate. The weaiment for sighiart campresson a pcnle nner (oi