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Contributor score: 6

Comments ...

 +2  (nbme23#5)

At first I was thinking aha! Child abuse! But I guess wormian bones are more suggestive of OI, although the no family hx part was rather bleh.

thotcandy  Literally had it on OI until I saw no family hx... Isn't it AUTOSOMAL DOMINANT?

 +1  (nbme23#6)

To sum it up, even if you didn't memorize the whole immunization table, it's easy to remember HBV immunization is done at birth, 1mo, 2mo and 6mo roughly. Also added that the baby is of East Asian decent, and the fact that other infections on the list aren't screened for in the first place in healthy-looking patients, I think it's safe to deduce HBV was the answer here.

Subcomments ...

Irradiation of food products is one way to limit the risk of germ contamination and food poisoning. In the United States, some foods, such as spices, are routinely irradiated. Irradiated meats and other foods are also widely available. Because radiation is known to cause cancer, there has been concern that food irradiation may present a cancer risk. However, radiation does not remain in foods that have been irradiated

According to American Cancer Society... Learned something new

nukie404  I wonder though, is it not possible for irradiated food to change in their protein structure, possibly somehow affect us? Some suggest Regardless I guess since it as irradiate with gamma radiation, there's no chance of the radiation staying in the food. In that sense I guess the answer makes sense but... +3  

submitted by shaydawn88(8),

Is it intra-alveolar transudates because this patient might have HF d/t a. fib and left atrial enlargement-> inc hydrostatic pressure-> transudate pleural effusion?

sajaqua1  Basically. +1  
medschul  Why can it not be arterial hypertension? +1  
meningitis  I think Arterial HTN is referring to Pulmonary Artery HTN which would be present in LT HF in the long run with RT HF and edema. Pulm HTN would cause a backflow, and doesn't really answer the question "explain the patients Dyspnea". At least, that's how I saw it. Hope this helped. +3  
sugaplum  the question has 2 murmurs, so does she have aortic stenosis too? i guess it is not relevant since it asked for what is causing her SOB +  
nukie404  I guess pulmonary HTN would happen in response to increased pressure after the edema happens, and would cause backflow (to the RV) over pulmonary edema. +  
vulcania  There's a really great diagram in UWorld (QID 234) that explains what happens as a result of mitral stenosis. Very similar sounding to the patient in this question. +  

submitted by chetzy(0),

increase ph shows its magnesium ammonium phosphate crystals.ph 7.3

bulgaine  The image shows a staghorn calculi which content is usually magnesium ammonium phosphate (can also be cystine but pH would be decreased not increased) and is caused by urease positive bugs that hydrolyze urea to ammonia leading to urine alkalinization (page 586 of FA 2019) +1  
nukie404  Patient also has a fever, suggestive of a UTI +