Agrandmother brings her 13-year-old grandson to you for evaluation. she noticed last week when he took off his shirt that his breastbone seemed collapsed. he seems embarrassed and tells you that it has been that way for quite awhile. he states he has no symptoms from it and he just tries not to take off his shirt in front of anyone. he denies any shortness of breath, chest pain, or lightheadedness on exertion. his past medical history is unremarkable. he is in sixth grade and just moved in with his grandmother after his father was deployed to the middle east. his mother died several years ago in a car accident. he states that he does not smoke and has never touched alcohol. on examination you see a teenage boy appearing his stated age. on visual examination of his chest you see that the lower portion of the sternum is depressed. auscultation of the lungs and heart are unremarkable.
what disorder of the thorax best describes your findings?
a) barrel chest.
b) funnel chest (pectus excavatum).
c) pigeon chest (pectus carinatum).
d) thoracic kyphoscoliosis.

The parents of a 9-year-old girl bring their daughter to the ed. for the last 12 hours, the child has suffered severe nausea and vomiting, as well as diarrhoea and abdominal cramps. further discussion with the child indicates that she suffers from blurred vision and headache. the parents originally were worried about bringing the child to the ed because they feared deportation since the family are illegal immigrants employed to pick strawberries on a nearby farm. on direct questionning, the parents admit that the child was assisting with spraying crops with pesticides the previous day. none of the family members was wearing any protecting clothing. her bp is 88/48 mmhg, pulse is 90/min, rr 33/min, temp 38 c. the child appears sweaty and confused. auscultation of the lungs reveals a diffuse wheeze bilaterally. pupils are miotic and the child has diffuse muscle weakness. which of the following interventions is the most appropriate treatment? - atropine- charcoal- glucagon- naloxone- exposure: consider organophosphate poisoning, which inhibits cholinesterase and results in accumulation of ach in both muscarinic and nicotinic sites. pralidoxime activates achatropine competes with ach only at muscarinic receptors, but will not reverse nicotinic effectscharcoal = gastric decontaminationglucagon = reverse beta-blocker overdosenaloxone = reverse effects of opioids