B.U.C.O.M Qbank

#Hemato

وزاري سادس 2022 -2023 🫠🫠

A 3-week-old male newborn is brought to the physician because his mother has noticed that he tires easily and sweats while feeding. During the past week, she has noticed that his lips and nails turn blue while crying. He was born at 35 weeks' gestation and weighed 2100 g (4 lb 10 oz); he currently weighs 2300 g (5 lb 1 oz). His temperature is 37.3°C (99.1°F), pulse is 168/min, respirations are 63/min, and blood pressure is 72/42 mm Hg. Examination shows a 3/6 systolic ejection murmur heard over the left upper sternal border. A single S2 is present. Echocardiography confirms the diagnosis. Which of the following factors is most responsible for this patient's cyanosis?

An ECG shows prominent R waves in leads V5 and V6 and deep S waves in leads V1 and V2. An x-ray of the chest shows enlargement of the cardiac silhouette and erosions of the inferior aspects of the 4th through 8th ribs bilaterally. Which of the following is the most appropriate study to confirm the diagnosis?

A 32-year-old woman comes to the physician because of a 4-month history of headaches and frequent episodes of bleeding from her nose. Over the past 2 months, she has had shortness of breath and intermittent leg pain while jogging. She has no history of previous illnesses. Her father died of myocardial infarction at the age of 52 years. She smokes one-half pack of cigarettes daily and occasionally used methamphetamines and cocaine during college, but she has not used illicit drugs for the past 5 years. She is 163 cm (5 ft 4 in) tall and weighs 63 kg (140 lb); BMI is 24 kg/m2. Her temperature is 37.1°C (98.8°F), pulse is 92/min, respirations are 22/min, and blood pressure is 168/110 mm Hg. Physical examination shows decreased femoral pulses compared to the brachial pulses.

A 5-month-old boy is brought to the emergency department by his mother because his lips turned blue for several minutes while playing earlier that evening. She reports that he has had similar episodes during feeding that resolved quickly. He was born at term following an uncomplicated pregnancy and delivery. He is at the 25th percentile for length and below the 5th percentile for weight. His temperature is 37°C (98.6°F), pulse is 130/min, respirations are 42/min, and blood pressure is 83/55 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 90%. During the examination, he sits calmly in his mother's lap. He appears well. The patient begins to cry when examination of his throat is attempted; his lips and fingers begin to turn blue. Further evaluation of this patient is most likely to show which of the following?

One day after a 4700-g (10-lb 6-oz) male newborn is delivered to a 28-year-old primigravid woman, the newborn has bluish discoloration of the lips and fingernails. His temperature is 37.3°C (99.1°F), pulse is 166/min, respirations are 63/min, and blood pressure is 68/44 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 81%. Examination shows central cyanosis. A grade 2/6 holosystolic murmur is heard over the left lower sternal border. A single second heart sound is present. Supplemental oxygen does not improve cyanosis. An x-ray of the chest shows an enlarged cardiac silhouette with a narrowed mediastinum. Further evaluation of the mother is most likely to show which of the following?

A 3-year-old boy is brought to the emergency department because of increasing shortness of breath for the past 2 days. He is at 30th percentile for height and at 25th percentile for weight. His temperature is 37.1°C (98.8°F), pulse is 144/min, respirations are 40/min, and blood pressure is 80/44 mm Hg. Bilateral crackles are heard at the lung bases. Cardiac examination discloses a grade 3/6 holosystolic murmur best heard over the left lower sternal border and a grade 1/6 middiastolic murmur at the cardiac apex. Without treatment, this patient is at greatest risk of developing which of the following?

A 16-year-old boy is brought to the physician by his parents because of a 6-month history of progressive fatigue and worsening shortness of breath on exertion. The parents report that the boy “has always tired out a bit more easily than other kids.” The family recently immigrated to the United States from rural Bolivia. Pulse oximetry on room air shows an oxygen saturation of 96% on both index fingers. Cardiac examination shows a right parasternal heave on palpation and a pronounced S2 on auscultation. Pulses in the upper and lower extremities are synchronous bilaterally. There is mild bluish discoloration and bulbous enlargement of the distal toes bilaterally. Echocardiography is most likely to show which of the following?

A 4-hour-old male newborn has perioral discoloration for the past several minutes. Oxygen by nasal cannula does not improve the cyanosis. He was delivered by cesarean delivery at 37 weeks' gestation to a 38-year-old woman, gravida 3, para 2. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The mother has type 2 diabetes mellitus that was well-controlled during the pregnancy. She has not received any immunizations since her childhood. The newborn's temperature is 37.1°C (98.8°F), pulse is 170/min, respirations are 55/min, and blood pressure is 80/60 mm Hg. Pulse oximetry shows an oxygen saturation of 85%. Cardiopulmonary examination shows a 2/6 holosystolic murmur along the lower left sternal border. The abdomen is soft and non-tender. Echocardiography shows pulmonary arteries arising from the posterior left ventricle, and the aorta rising anteriorly from the right ventricle. Which of the following is the most appropriate next step in management?