15-month-old boy is brought to the emergency department with cyanosis. Over the past week, the patient has
been teething and has had mild nasal congestion and low-grade fevers. He has been eating and drinking
normally. The patient was extremely fussy today, despite his mother giving him acetaminophen and a topical
anesthetic that she used when she had a toothache. He was hospitalized for bronchiolitis 6 months ago but is
otherwise healthy, and immunizations are up to date. Blood pressure is 90/60 mm Hg, pulse is 158/min, and
respirations are 50/min. Pulse oximetry is 85% on room air. Physical examination shows a sleepy child with blue discoloration of the skin and nails. The lungs are clear to auscultation bilaterally. Cardiac examination reveals no murmurs or gallops. The abdomen is soft, nontender, and has no hepatosplenomegaly. Blood samples are
obtained for laboratory testing, and 100% oxygen is administered but fails to increase the pulse oximetry reading or the cyanosis.
Item 1 of 2
Which of the following laboratory findings would most likely be seen in this patient?
- QA. Elevated PaCO2
- 0 8. Elevated plasma osmolal gap
- 0 C. Elevated transaminase levels
- 0 D. Normal co-oximetry results
- 0 E. Normal PaO2
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47-year-old diabetic woman comes to the physician due to the recent onset of tremors. She has undergone
combined pancreatic and kidney transplantation secondary to end stage renal disease and diabetes. She takes multiple medications, including immunosuppressants. Her temperature is 36.1 °C (97°F), blood pressure is 152/90 mm Hg, pulse is 78/min, and respirations are 16/min. Examination shows gum hypertrophy. Laboratory studies
show:
Hb 13.0g/dl
WBC 8,000/cmm
Serum Na 135 mEq/L
Serum K 5.3 mEq/L
BUN 26 mg/dl
Serum 1.7 mg/dl
Creatinine
Which of the following immunosuppressants is most likely responsible for her presentation?
- 0 A. Tacrolimus
- 0 B. Cyclosporine
- 0 C. Azathioprine
- 0 D. Mycophenolate
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