L:\usmle review 7 - Sinoe medical homepage.
L:\usmle review 7 - Sinoe medical homepage.
L:\usmle review 7 - Sinoe medical homepage.
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
Alcohol intoxication<br />
Diabetic hyperosmolar coma<br />
Diabetic ketoacidosis<br />
Heroin overdose<br />
Profound hypoglycemia<br />
57. The correct answer is C. The smell of acetone on the breath of a comatose patient is an<br />
important, rapid diagnostic clue that strongly suggests ketoacidosis and is usually seen in<br />
patients with poorly controlled type 1 diabetes. Other features of diabetic ketoacidosis include<br />
high blood glucose, increased serum osmolality, hypovolemia, acidosis, and electrolyte<br />
imbalance.<br />
In alcohol intoxication (choice A), the breath will smell like alcohol.<br />
Diabetic hyperosmolar coma (choice B) usually is seen in older patients with type 2 diabetes and<br />
is not characterized by ketoacidosis. Since there is no acetone production, there is no specific<br />
scent to the breath.<br />
In heroin overdose (choice D), no acetone production occurs and there is no specific scent to the<br />
breath.<br />
In hypoglycemic coma (choice E), which can occur in diabetics with insulin overdose, no acetone<br />
production occurs and there is no specific scent to the breath.<br />
58. A 24-year-old woman in her third trimester of pregnancy presents with urinary frequency and<br />
burning for the past few days. She denies fever, nausea, vomiting, or chills. She takes no<br />
medications besides prenatal vitamins and is generally in good health. Physical examination is<br />
remarkable for mild suprapubic tenderness, and a urine dipstick is positive for white blood cells,<br />
protein, and a small amount of blood. Culture produces greater than 100,000 colonies of gram-
Change language