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Question 1: A 23-year-old black female presents to urgent care with approximately 3 weeks of body and joint aches. Past medical history is significant for a kidney stone. She also reports fatigue, hoarse voice, and waxing and waning cough. She does not smoke and denies fever or sputum. She has a family history of hypertension and diabetes. Her vitals upon arrival are BP 130/80, HR 90, RR 20, Temp 99.1, and O2 Sat 99% on RA. What workup is required for this patient?

  1. PET scan

  2. No workup needed; treat with Levaquin for 1 week

  3. Peak flow and methacholine challenge

  4. Sed rate

  5. ACE level and bronchoscopy

 

Reference: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, eds. Chapter 175: Sarcoidosis. The Color Atlas of Family Medicine, 2nd ed. New York, NY: McGraw-Hill; 2013.

Question 2: An 81 year old male presents by ambulance to the emergency room for evaluation of new onset confusion. He has a history of hypertension, type 2 diabetes mellitus, hyperlipidemia, and congestive heart failure. He takes metformin, lisinopril, and pravastatin. He lives in a nursing home. He appears acutely ill and confused about the date and place. His blood pressure is 90/60 mmHg. His heart rate is 92 beats per minute, and his respiratory rate is 22/minute. His temperature is 35 degrees C. SaO2 is 92%. He has crackles in his lung bases. Auscultation of the heart reveals a regular rhythm without murmur, rub, or gallop.Which of the following is appropriate?

  1. Mechanical ventilation, CVP monitoring, vancomycin and imipenem pending cultures, renal-dose dopamine, and intensive insulin therapy targeted to normoglycemia

  2. Mechanical ventilation, vancomycin and imipenem pending cultures, empiric treatment for systemic candidiasis, and dopamine and insulin infusion

  3. Empiric antibiotics with coverage for systemic candidiasis and platelet and packed red blood cell transfusion

  4. Renal-dose dopamine, transfuse PRBCs, platelets, empiric antibiotics with coverage for candidiasis, and intensive insulin therapy

  5. Cultures, empiric antibiotics including coverage for disseminated candidiasis, supplemental oxygen, maintain blood pressure, and consider dobutamine

 

Reference: 1. http://survivingsepsis.org/Guidelines/Documents/Initial%20Resus%20Table.pdf 2.

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