A 5-year-old boy is admitted to the pediatric ICU for severe iron overdose after ingesting a large quantity of his mother’s ferrous sulfate tablets. He initially presented with vomiting, diarrhea, abdominal pain, and metabolic acidosis. His serum iron level was 650 mcg/dL (normal: 50-150 mcg/dL). He was started on intravenous deferoxamine therapy, which has been continued for the past 30 hours. Over the past few hours, he has developed progressive respiratory distress, requiring increased oxygen support. Chest X-ray shows bilateral pulmonary infiltrates with no evidence of cardiomegaly or pleural effusions. Question: What is the most likely cause of this patient’s new-onset respiratory symptoms?

A 3-year-old girl is brought to the emergency department after being found with an open bottle of iron supplements that belonged to her mother. The mother estimates that the child may have ingested multiple pills. The child is irritable and vomiting and has abdominal pain. Her vitals are: • Temperature: 37.8°C (100°F) • Heart rate: 140/min • Blood pressure: 85/50 mmHg Laboratory results: • Arterial pH: 7.30 • Anion gap: 20 • Serum iron level: 450 mcg/dL (normal: 50–150 mcg/dL) • Glucose: 65 mg/dL An abdominal X-ray shows multiple radiopaque pills in the stomach and intestines. Question: Which of the following is the most appropriate initial treatment for this patient?

A 35-year-old male farmer from a rural village in Ethiopia presents to the clinic with a 6-month history of progressive weakness and stiffness in his legs. He reports difficulty walking, particularly on uneven terrain, and has noticed a gradual loss of muscle control in his lower limbs. The patient denies any history of trauma, fever, or recent illness. He mentions that his diet has primarily consisted of grass peas (Lathyrus sativus) for the past two years due to a severe drought that has devastated local crops and livestock. His family and several neighbors have also reported similar symptoms, though they have not sought medical attention. On physical examination, the patient exhibits spasticity and hyperreflexia in the lower extremities, with a scissoring gait. Sensory examination is normal, and there are no signs of muscle atrophy or upper motor neuron involvement. Blood tests, including liver function tests and nutritional markers, are within normal limits. The patient is alert and oriented, with no cognitive deficits. Which of the following best explains the cause and effect relationship in lathyrism, a disease associated with legume consumption?

A 34 year-old female presents to the emergency room for trouble walking. She reports that over the last few days, she developed slurred speech, tremors, loss of coordination and trouble eating and swallowing. Four weeks ago, she went to Hawaii and ‘feasted on lots of barracuda and grouper’. Within a few minutes after the dinner, she developed diarrhea, vomiting and abdominal cramps. She developed ‘pins and needles’ sensations, first around her mouth and later in her limbs. She reports that her taste sensations ‘turned upside down’, like ‘ice cream feels like hot coffee and hot coffee feels like ice cream’. She developed an itching rash all over her body. Thinking she had an allergic reaction to food, she took, ‘tons of Benadryl which did nothing’ to alleviate her symptoms. She feels muscles ache with ‘shooting pains all over’. Her diarrhea, vomiting and abdominal cramps got better within a few days, but the burning sensations in the feet and tremors in hands and feet are still bothering her. She feels dizzy and her surroundings feel like spinning around her. Sometimes she hears sounds and voices nobody else hears. Vital signs: Temp = 98.9 F, BP = 80/60 mm Hg, Pulse = 54/minute, RR = 22/minute What is the most likely diagnosis in this patient?

A 2-year-old boy is brought to the pediatric clinic by his mother for a routine check-up. The family lives in an old house built before 1950 that is undergoing renovations. The mother reports that her son is often putting toys and objects in his mouth. On developmental assessment, the child has speech delay and difficulty following instructions. A blood test reveals a blood lead level of 20 µg/dL. Which of the following systems is most likely to be affected in this child, resulting in long-term complications?

A 50-year-old man who works in a battery manufacturing plant presents with fatigue, abdominal cramps, and memory problems. He reports difficulty gripping objects and recent episodes of constipation. His job involves melting and assembling lead-based materials in an environment with minimal ventilation. On examination, he has wrist drop, pallor, and bluish discoloration along the gumline (Burton’s lines). Laboratory findings reveal microcytic anemia with basophilic stippling and an elevated blood lead level.Which of the following is the most likely route of lead exposure in this patient?