A 7-year-old boy is brought to the emergency room because of severe, acute diarrhea. He is drowsy with a dull, lethargic appearance. He has sunken eyes, poor skin turgor, and dry oral mucous membranes and tongue. He has a rapid, thready pulse with a systolic blood pressure of 60 mm Hg and his respirations are 33/min. His capillary refill time is 6 sec. He has had no urine output for the past 24 hours. Which of the following is the most appropriate next step in treatment?
AStart IV fluid resuscitation by administering colloid solutions
BProvide oral rehydration therapy to correct dehydration
CGive initial IV bolus of 2 L of Ringer’s lactate, followed by packed red cells, fresh frozen plasma, and platelets in a ratio of 1:1:1
DStart IV fluid resuscitation with normal saline or Ringer’s lactate, along with monitoring of vitals and urine output
EGive antidiarrheal drugs
A group of investigators discovers a novel monomeric enzyme that cleaves glutamate-valine bonds in a bacterial exotoxin. The substrate binding site of the enzyme is rich in aspartate. A sample of the enzyme is added to two serum samples containing the bacterial exotoxin. One sample is assigned a test condition while the other is maintained as the control. The averaged results of several trials comparing Vmax and Km between control serum and test serum are shown. Vmax (μmol/min) Km (mM) Control serum 13.2 81.2 Test serum 28.8 80.9 Which of the following conditions in the test serum would best explain these findings?
APresence of a reversible competitive inhibitor
BIncreased exotoxin concentration
CIncreased enzyme concentration
DPresence of an irreversible competitive inhibitor
EIncreased serum pH
A 68-year-old woman presents to the hospital for an elective right hemicolectomy. She is independently mobile and does her own shopping. She has had type 2 diabetes mellitus for 20 years, essential hypertension for 15 years, and angina on exertion for 6 years. She has a 30-pack-year history of smoking. The operation was uncomplicated. On post-op day 5, she becomes confused. She has a temperature of 38.5°C (101.3°F), respiratory rate of 28/min, and oxygen saturation of 92% on 2 L of oxygen. She is tachycardic at 118/min and her blood pressure is 110/65 mm Hg. On chest auscultation, she has coarse crackles in the right lung base. Her surgical wound appears to be healing well, and her abdomen is soft and nontender. Which of the following is the most likely diagnosis?
AMalignant hyperthermia
BDrug-induced fever
CMultiple organ dysfunction syndrome
DSepsis
ENon-infectious systemic inflammatory response syndrome (SIRS)
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