Krok 2 Pediatrics Bases

Question: 1/15

A 9 year old girl with a history of intermittent wheezing for several years is brought to the pediatrician. The child has been taking no medications for some time. Physical examination reveals agitation and perioral cyanosis. Intercostal and suprasternal retractions are present. The breath sounds are quiet, and wheezing is audible bilaterally. The child is admitted to the hospital. Appropriate interventions might include all of the following EXCEPT:

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Laboratory values

Complete blood count

Laboratory value

Normal reference range

Erythrocyte count

Male: 4.3 − 5.9 · 10¹²/L

Female: 3.5 − 5.5 · 10¹²/L

Hemoglobin, blood

Male: 135-175 g/L
Female: 120-160 g/L

Color index

0.85 - 1.05

Reticulocyte count

0.5 - 1.5%

Platelet count

150 − 400 · 10⁹/L

Leukocyte count

4.0 − 9.0 · 10⁹/L

Basophils

0 − 0.065 · 109/L (0-1%)

Eosinophils

0.02 − 0.30 · 10⁹/L (0.5 - 5.0%)

Band neutrophils

0.04 − 0.30 · 10⁹/L (1 - 6%)

Segmented neutrophils

2.0 − 5.50 · 10⁹/L (47 - 72%)

Monocytes

0.09 − 0.60 · 10⁹/L (3 - 11%)

Lymphocytes

1.2 − 3.0 · 10⁹/L (19 - 37%)

Erythrocyte sedimentation rate (ESR)

Male: 0 - 15 mm/h
Female: 0 - 20 mm/h

Hematocrit

Male: 41 - 53%
Female: 36 - 46%

Biochemical blood analysis (Metabolic panel)

Laboratory value

Normal reference range

Total proteins

60-78 g/L

Albumin

35-50 g/L (52-65%)

Globulin:

23-35 g/L (35-48%)

α₁-Globulin

2-4 g/L (4.2-7.2%)

α₂-Globulin

5-9 g/L (6.8-12%)

β-Globulin

6-11 g/L (9.3-15%)

γ-Globulin

11-15 g/L (15-19%)

IgD

0 - 0.15 g/L

IgG

6.5-15 g/L

IgM

0.4-3.45 g/L

IgA

0.76-3.90 g/L

IgE

0-380 kU/L

Total Bilirubin

2-17 mcmol/L

Indirect (unconjugated) Bilirubin

2-17 mcmol/L

Direct (conjugated) Bilirubin

0-5 mcmol/L

Triglycerides

0.59-1.77 mmol/L

Total cholesterol

3.9-6.2 mmol/L

Total cholesterol

3.9-6.2 mmol/L

High-density lipoproteins (β-Lipoproteins)

<4.2 mmol/L

Low-density lipoproteins (α-Lipoproteins)

0.8-1.8 mmol/L

Low-density lipoproteins (α-Lipoproteins)

0.8-1.8 mmol/L

Glucose, blood

3.3-6.1 mmol/L (fasting)

Glycated hemoglobin

Iron, blood

9-30 mcmol/L

Potassium, plasma

3.5-5.0 mmol/L

Sodium, plasma Calcium, plasma 0.75-2.5 mmol/L

136-145 mmol/L

Calcium, plasma

0.75-2.5 mmol/L

Magnesium, plasma

0.75 - 1 mmol/L

Phosphorus (inorganic), serum

0.646-1.292 mmol/L

Chloride, blood

95-105 mmol/L

Urea, serum

3.33 - 8.32 mmol/L

Creatinine

53 - 106 mcmol/L

Uric acid

Male: 0.12-0.38 mcmol/L
Female: 0.12-0.46 mcmol/L

Lactate dehydrogenase (LDH)

45-90 U/L

α-Amylase (diastase), blood

25-125 U/L

Aspartate aminotransferase (AST)

15-40 U/L

Alanine aminotransferase (ALT)

10-40 U/L

Phosphatase (alkaline)

30-115 U/L

Coagulogram

Laboratory value

Normal reference range

Prothrombin time 80-100%

(< 12 seconds)

Fibrinogen

2-4 g/L

Partial thromboplastin time (activated)

< 28 seconds

Lee-White coagulation time

5-10 minutes

Bleeding time (Duke method)

< 4 minutes

Acid-base balance

Laboratory value

Normal reference range

pH arterial blood

7.35-7.45

Pco2 arterial blood

33-45 mm Hg

Po2 arterial blood

75 - 105 mm Hg

Bicarbonate, blood (HCO₃)

22-28 mmol/L

Other blood values

Laboratory value

Normal reference range

Cortisol, serum

230 -750 nmol/L

Osmolality, serum

275 - 295 mOsmol/kg H2O

Thyroid-stimulating hormone, serum or plasma

0.5-5 mIU/L

Thyroxine (T4), serum

65-155 nmol/L

Thyroid-stimulating hormone, serum or plasma

0.5-5 mIU/L

Triiodothyronine (T3), serum

1.77 - 2.43 nmol/L

Ferritin, serum

Male:15-200 mcg/L
Female: 12-150 mcg/L

Thymol turbidity test

<5 U

C-reactive protein (CRP)

<6 mg/dL

Antistreptolysin 0 (ASL0)

250 U

Antistreptohyaluronidase (ASH)

250 U

Urine

Laboratory value

Normal reference range

Urine specific gravity

1.016-1.022

Nechiporenko’s test: leukocytes

< 2 · 10⁶/л

Nechiporenko’s test: erythrocytes

< 1 · 10⁶/л

Proteins, total

<45.0 - 75.0 mg/24 h (<0.033 g/L)

Calcium

2.5 - 7.5 mmol/24 h

Creatinine clearance

Male: 97 - 137 mL/min
Female: 88 - 128 mL/min

Oxalate

90 - 445 mcmol/L

17-Ketosteroids (17-KS)

Male: 27.7 - 79.7 mcmol/24 h
Female: 17.4 - 55.4 mcmol/24 h

17-Hydroxycorticosteroids

(17-OCS) 5.5 - 27.6 mcmol/24 h

α-Amylase (diastase), urine

28-160 U/L

List of abbreviations

ACTH => Adrenocorticotrophic hormone
ADP => Adenosine diphosphate
ALT, ALAT => Alanin aminotranspherase
ALV => Artificial lung ventilation
AP => Arterial (blood) pressure
AST, AspAT => Aspartat aminotranspherase
ATP => Adenosine triphosphate
ВСG => Bacillus Calmette-Guérin
BP => Blood (arterial) pressure
CK => Creatine kinase
CNS => Central nervous system
СоА => Coenzyme A
CRP => C-reactive protein
CT => Computed tomography
COX => Cyclooxygenase
DIC => Disseminated intravascular coagulation
DTP (DPT) => Diphtheria-tetanus-pertussis vaccine
EDTA => Ethylenediamine tetra-acetic acid
ELISA => Enzyme-linked immunosorbent assay
ENT => Ear, nose, and throat (as a department in a hospital)
EPR (ER) => Endoplasmic reticulum
ESR => Erythrocyte sedimentation rate
EV => Enterovirus
FC => Functional class
GABA => Gamma aminobutyric acid
Hct Ht => Hematocrit
HDL => High-density lipoproteins
HR => Heart rate
IDL => Intermediate-density lipoproteins
IU => International unit
IUPAC => International Union of Pure and Applied Chemistry
LDH => Lactate dehydrogenase
LDL => Low-density lipoproteins
LOX => Lipoxygenase
MAO => Monoamine oxidase
MRI => Magnetic resonance imaging
NSAID => Nonsteroidal anti-inflammatory drug
PE (PATE) => Pulmonary embolism (Pulmonary artery thromboembolism)
PSA => Prostate-specific antigen
RBC => Red blood count
RR => Respiratory rate
SES => Sanitary-and-epidemiologic station
STD => Sexually transmitted disease
STI => Sexually transmitted infection
T/l => Trillion/liter
TABT => Typhoid-paratyphoid A and B plus tetanus toxoid vaccine
TMJ => Temporomandibular joint
TSH => Thyroid-stimulating hormone
TU => Tuberculin unit
URTI => Upper respiratory tract infection
V/f => Vision field
VLDL => Very-low-density lipoproteins
WBC => White blood count
WPW => Wolff-Parkinson-White syndrome