Следующие три вопроса.
Items 112-113
An obese 10-year-old boy with diabetes mellitus is admitted to the hospital because of severe ketoacidosis and cardiovascular
collapse. Initial management consists of cardiac monitoring and intravenous administration of fluids, electrolytes and insulin.
Because of the difficulty in obtaining satisfactory peripheral venous access, the left femoral vein is catheterized percutaneously. Six
hours later, his mental status is improved, blood pressure is 120/70 mm Hg and serum glucose concentration is 250 mg/dL.
Physical examination at that time shows a cold left foot with diminished pulses compared with those of the right foot.
112. Which of the following is the most likely explanation for this patient's diminished pulses?
(A) Paradoxical embolus from the femoral vein
(B) Diabetic arteriopathy
(C) Inadvertent injury of the femoral artery
(D) Intense arteriolar constriction induced by hyperosmolality
(E) Thrombosis of the catheterized femoral vein
113. A deficit of which of the following electrolytes in this patient is most likely to cause death?
(A) Bicarbonate
(B) Calcium
(C) Chloride
(D) Potassium
(E) Sodium
123. A 15-year-old African-American girl comes to the emergency department because, she says, "something is sticking out of
my bottom since I had a bowel movement this morning." She denies previous episodes, although for more than 1 year she
has had occasional difficulty passing stools. She is not in pain at present, but she is afraid to move her bowels for fear that the
problem will get worse. In response to your questions, she tells you that she moved away from home more than a year ago
and her parents contribute nothing to her support. She has a 6-month-old child and lives with a 28-year-old female cousin.
She has never been married and does not work or attend school. She has no other symptoms. In order to follow the correct
procedure for treating a minor, which of the following is the most appropriate step prior to evaluating this patient's rectal
problem?
(A) Accept the girl's consent as sufficient
(B) Obtain a court order permitting evaluation
(C) Obtain the written consent of at least two licensed physicians
(D) Obtain written consent from at least one of her parents
(E) Obtain written consent from her 28-year-old cousin