NRNP 6541
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(4) A 15-year-old female has a 1- A. The obese adolescent in this case has findings of
month history of urinary frequency diabetes mellitus. Her cutaneous candidiasis is
without dysuria and recent onset of likely an indication of secondary
an itchy rash beneath both breasts. immunosuppression related to hyperglycemia. In
She has been gaining weight over diabetes, hyperglycemia promotes neutrophil
the past year and regularly dysfunction, and circulatory insufficiency
complains of fatigue. She is febrile contributes to ineffective neutrophil chemotaxis
with a weight greater than the 99th during infection. HIV infection is possible and
percentile and has an erythematous, antibody testing might be reasonable, but this
macular rash beneath both breasts scenario is most consistent with hyperglycemia.
characterized by satellite lesions. UA
is significant for 2+ glucosuria, but no
pyuria. Which of the following is the
most likely diagnosis?
A. Diabetes mellitus
B. Fanconi syndrome
C. Human immunodeficiency virus
D. Occult malignancy
E. Severe combined
immunodeficiency (SCID)
,(4) A mother notes her 6-week-old C. You suspect leukocyte adhesion deficiency
son's umbilical cord is still attached. (LAD) as the etiology of this child's problem. LAD is
His activity and intake are normal; an inheritable disorder of leukocyte chemotaxis
there has been no illness or fever. and adherence characterized by recurring
Delivery was at term without sinopulmonary, oropharyngeal, and cutaneous
problems. His examination is notable infections with delayed wound healing. Neutrophila
for a cord without evidence of is common with WBC counts of typically more than
separation and a shallow, 0.5cm 50,000 cells/mm. Severe, life-threatening infection
ulceration at the occiput without is possible with Staphylococcus species,
discharge or surrounding erythema. Enterobacteriaceae, and Candida species. Good
Mother declares that the "sore," skin and oral hygiene are important; broad-
caused by a scalp probe, has been spectrum antimicrobials and surgical debridement
slowly healing since birth and was are early consideration with infection.
deemed unremarkable at his 2-week
checkup. Which of the following is
consistent with this child's likely
diagnosis?
A. Defective humoral response
B. Functional leukocyte adherence
glycoproteins
C. Marked neutrophilia
D. Normal wound healing
E. Purulent abscess formation
, (4) A 6-month-old girl is seen after C. SCID is an autosomal recessive or X-linked
an emergency room visit for disorder of both humoral and cellular immunity.
decreased intake, emesis, and watery Serum immunoglobulins and T cells are often
diarrhea for the past 3 days. She was markedly diminished or absent. Thymic dysgenesis
diagnosed yesterday with "stomach is also seen. Recurring cutaneous, gastrointestinal,
flu" and given IV fluids. She is doing or pulmonary infections occur with opportunistic
better today with improved intake organisms such as cytomegalovirus (CMV) and
and resolution of her emesis and PCP. Death typically occurs in the first 12 to 24
diarrhea. The father is concerned months of life unless bone marrow transplantation
about her thrush since birth (despite is performed.
multiple courses of an oral
antifungal) and that she has been
hospitalized twice for pneumonia
over the past 4 months. Her weight
has dropped from the 50th
percentile on her 4-month visit to the
5th percentile today. She has no
findings consistent with dehydration,
but she does appear to have some
extremity muscle wasting. Her
examination is remarkable for buccal
mucosal exudates and hyperactive
bowel sounds. Vital signs and the
remainder of her examination are
normal. You suspect severe
combined immunodeficiency (SCID).
Which of the following is consistent
with the diagn
Save
(4) A 15-year-old female has a 1- A. The obese adolescent in this case has findings of
month history of urinary frequency diabetes mellitus. Her cutaneous candidiasis is
without dysuria and recent onset of likely an indication of secondary
an itchy rash beneath both breasts. immunosuppression related to hyperglycemia. In
She has been gaining weight over diabetes, hyperglycemia promotes neutrophil
the past year and regularly dysfunction, and circulatory insufficiency
complains of fatigue. She is febrile contributes to ineffective neutrophil chemotaxis
with a weight greater than the 99th during infection. HIV infection is possible and
percentile and has an erythematous, antibody testing might be reasonable, but this
macular rash beneath both breasts scenario is most consistent with hyperglycemia.
characterized by satellite lesions. UA
is significant for 2+ glucosuria, but no
pyuria. Which of the following is the
most likely diagnosis?
A. Diabetes mellitus
B. Fanconi syndrome
C. Human immunodeficiency virus
D. Occult malignancy
E. Severe combined
immunodeficiency (SCID)
,(4) A mother notes her 6-week-old C. You suspect leukocyte adhesion deficiency
son's umbilical cord is still attached. (LAD) as the etiology of this child's problem. LAD is
His activity and intake are normal; an inheritable disorder of leukocyte chemotaxis
there has been no illness or fever. and adherence characterized by recurring
Delivery was at term without sinopulmonary, oropharyngeal, and cutaneous
problems. His examination is notable infections with delayed wound healing. Neutrophila
for a cord without evidence of is common with WBC counts of typically more than
separation and a shallow, 0.5cm 50,000 cells/mm. Severe, life-threatening infection
ulceration at the occiput without is possible with Staphylococcus species,
discharge or surrounding erythema. Enterobacteriaceae, and Candida species. Good
Mother declares that the "sore," skin and oral hygiene are important; broad-
caused by a scalp probe, has been spectrum antimicrobials and surgical debridement
slowly healing since birth and was are early consideration with infection.
deemed unremarkable at his 2-week
checkup. Which of the following is
consistent with this child's likely
diagnosis?
A. Defective humoral response
B. Functional leukocyte adherence
glycoproteins
C. Marked neutrophilia
D. Normal wound healing
E. Purulent abscess formation
, (4) A 6-month-old girl is seen after C. SCID is an autosomal recessive or X-linked
an emergency room visit for disorder of both humoral and cellular immunity.
decreased intake, emesis, and watery Serum immunoglobulins and T cells are often
diarrhea for the past 3 days. She was markedly diminished or absent. Thymic dysgenesis
diagnosed yesterday with "stomach is also seen. Recurring cutaneous, gastrointestinal,
flu" and given IV fluids. She is doing or pulmonary infections occur with opportunistic
better today with improved intake organisms such as cytomegalovirus (CMV) and
and resolution of her emesis and PCP. Death typically occurs in the first 12 to 24
diarrhea. The father is concerned months of life unless bone marrow transplantation
about her thrush since birth (despite is performed.
multiple courses of an oral
antifungal) and that she has been
hospitalized twice for pneumonia
over the past 4 months. Her weight
has dropped from the 50th
percentile on her 4-month visit to the
5th percentile today. She has no
findings consistent with dehydration,
but she does appear to have some
extremity muscle wasting. Her
examination is remarkable for buccal
mucosal exudates and hyperactive
bowel sounds. Vital signs and the
remainder of her examination are
normal. You suspect severe
combined immunodeficiency (SCID).
Which of the following is consistent
with the diagn
