Q1 :
You are caring for an 8-month-old infant in the pediatric intensive care unit. She has been
hospitalized for 1 week with respiratory syncytial virus bronchiolitis. In discussions with the
mother, she reports that the child has very frequent, large, foul-smelling stools. Physical
examination of the child reveals a temperature of 37.0°C, heart rate of 140 beats/min, respiratory
rate of 35 breaths/min on the ventilator, and blood pressure of 80/40 mm Hg. Her oxygen
saturation is 90%, and her most recent arterial blood gas shows a pH of 7.25, Paco2 of 70 mm
Hg, and Pao2 of 70 mm Hg. Her weight is 7 kg, and she appears malnourished, with decreased
muscle development. No obvious congenital abnormalities are apparent. Her chest appears
hyperinflated, she has no heart murmur, her pulses are equal and strong, and her abdomen is
protuberant with normal bowel sounds. Computed tomography scan of her chest was obtained
earlier today to evaluate enlarging cystic-appearing lesions on her chest radiograph.
Of the following, the MOST likely underlying diagnosis in addition to bronchiolitis is
A. Clostridium difficile infection
B. congenital lobar emphysema
C. cystic adenomatoid malformation
D. cystic fibrosis
E. pulmonary sequestration
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