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    (Medicalstudyzone - Com) Block 10

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    DEEJK

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    © All Rights Reserved
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    <1 -im> Ons « ‘20-year-old man comes tthe pysican because of a 2-day history ofa prac rash on bath eg. He etwne rom a ‘chace s aherha ang cance. Hs only medications a aslain suppository ce dally, He has smoked a pack of ‘gees day for years and drink ae shoe beverage daly He does tot ue ie rugs His tmpertre 2 36 8C (@82) pulse 65mm, respons are 167m and boed pressure i 127/78 mr Hg Examination shows mute crytematus plagues at vesices on Both ahes- A plete o the sons is sh below. The Feat fe be || Counsel patent on cael ake ply one esamine preparation Admins oa precitone ‘ison mesausne svapestones oats Omns al 1 20-year-old man comes tthe pysican because ofa 2-aay nse ofa put ash on bam ess Herenunearoma 2k Mla > ors Carin one day apo He hs ulcerative colts ad mbar pan he woke a ladcope ‘chtace Fs ahr ha ang cancer, Hs only maication is a eslain suppository ice dally, He has smoked a pack of (682) pulses 65mm, respratons are 16m, andbeed pressure i 127/78 mr Hg Examination shows TBE ‘plete ote lesions is shown below. The remade of te “This man has developed mutpeeythemtous plagues zd vesicles on is calves ater « hing ip indicating comact 2a “ hermecto used to eat scabies, pedo, ad ara cables presents th ching and erythematous papules in res ee the neil os onthe hands and feet, utc, and gentle 8 opposed to plagues and veces nae tthe ‘ales, Adetoraly no mie burows ar seen m te ptr, matng Sates ula In ths man. Neca Wil ot lp eee ns symptoms “Counseling pata on leo! ica is an important lemen in preventive madcne, especially in codons ike porphyria (ieee tar FT) Sa ec cel PCT emery pens th eae ders meee rot the plagues and vesces med fo the ower extremes Sen above oreaver, nus wth FCT have edesh-clres| Urine wich is mangoes noche, col cessation wl at melphissymgtons. om te al 20 eS CClamine ea zne-baad compound wed ata antpruntcin condone ike nic te, ermatie, and ath. Tp [peparaions he calamine are used for synporai va in poison ny drat ne nal staes. Once he vesicles start ees ‘fa prednisone maybe usedin peony deat the ndviual as severe ox reratry symotoms, oi te ah coves & luego soit face or ert aes ofthe bod, bu i nat he care hae Ths pater esr story 2-2 Timers (ny affeting pars of the gs), with no stay of aed veatment attempts. Teefore anther managerent Pemohigoiy hich can be seen iduals wth erate cot, which hs patent hs. However, bulous pempg.d resens wn ens an cy bull ove the unk ad extemtes ater han eyheraous plagues a vests lcal2ed {theese Cralpredninane may tobe ures nposan hy dermatte ft dual hat saves symptom or the ath eer 1 large aa ofthe body, but ss ot the case ere poson vy dematts sd oa pe & hypersentvyreacton, whch has a erent pathephysiiogy than he ‘ype hypersnsiuyreacuors War astarines ae bes Suites vo Wen. Howe, Sedabngastamines may Be Sed In thos ahohav dilysleping du othe thing erin mor severe cate. Mensazineis an aminealcyite viedo eat ifanmatary bone eate. While messlanbe can cause uticaral rashes 2 ‘hed drug eruption (FE, whch can resent wt aeematousPeques, he stone of FDE occurs win 2 mee of ‘exposure owe cu, adaonaty, tens a recur wh each expsute the dug TNS ar Mas no MSUoy of ashes whe ting metslzine continuing ent kal fo Rlp he puts and my ata worsen i cera cle. ge 8 Ons al <2 +0 > 1 56-year-old man comes tothe pysican because of 22-monh sory of worseing pal in i et buttock The pan "smoked one pack of cigarettes dally oth pst 3 yar and ek one Dereery nigh He dws not usec drugs, ‘examin stows no focal ngs. A x-ay ofthe pes Shows acm, poor defn, ostefceson nthe et ur witha moth-eatn pen of bone dstucven, multiple wel-deied Sle sions, and an ages pasta reaction. Th emander ofthe phys aminsto, needing rectal examination, shows no abnormalter Chee 35 {nd adominal lrasonegraphy stow no abnonalies Which ofthe fowing ste mos ikely agnosis? 2a (@) oxevecoma (©) Gan ce amor (© vosscoms| (©|rismscrom (© wing sarcoma (P) oxtocronaroma © chonsrosrcoma + BO Ons al <2 +0 > eo a ‘A so-yer-old man comes othe physician Decase of 2-morn sory of worsening aMRSTEEBUGEL Tre pansy eter ea dup, ul ache that HEESERGHE doo ot opr ny ear aun sha hyparptcoma hat Smoked oe pack of iets dally rte past 50 years and ds one ee very ight He does nt we ic dug a ‘examin stows no focal ning. A xa of the pes shows acm, poor defn, osteoblast nthe et ur witha ott path oF Boe dst, 2d an agoassive penta! reaction. The vemander of he phys aminsto,neleing rectal examination, shows no abnormalver Che 3 {nd asdominal lrasonegraphy stow no abnnralies Which ofthe fowing ste os key diagnosis? gs 88 an © Tretionme at ttre pes ae fps ms Tee wen tcl features fa primary tumer ae not evdent an he mort ey of teu pray moose 2 1 Scena weal Be he oo, ie, sh reste la Te noma rectal ex, ces ra, bdo tal iasonogray,Noweer makes Bone metastases es IG S02 Scena, mary Dane nor eB a cone 4a a ‘steosucomas hich the mos Common non-hemaolgKal pray Bove naligrances, can afc any ke, ing he beh, ened appar on ry asa miaed ysl son wi an aggresive pvt reaction isa sunburst [ppesane and Codman tangle. Nghe pan abo acharateratefesrec oneoaromss, However Primary ‘ntecearcomas Nave «peak cece cing the seco decade tea he metapyss of ong bones a he SS & ‘mur pronal a, proximal hunt} re mare comrmeny alee han at bos, eum). Wil oreo “anotrenreyexcuded a hs patent thou Hstopalogia evluton the pate age and We locaton fhe son — fake another hagnoss more ey Om ns al <2 > ‘lant cll tumor ofthe bone extzerlatoma) can caus progress wertanng pan and appear on x-ray at an oul lesion. However, osteaiastomaappeesin indus 20-40 years ofa, aes the eiphysel metaphyseal agin of he long bones ntal ferar,pronimal a, dtl acs) and peal shows up on Xray a a ele, Sap-puble-he lesion wth &ron-aogressve periosteal recon. vehement of he ai klar 5 UNCON, and {Sot iin te lesion woud mot be expected. ‘A vosarcoma of the bone woulé present with eogrssivl worsening gan a5 wll asa ostolacleson on x-ray and can (tect ary one ad oc at any age except the fst decade of We, Howeve, because Heosafomaof Doe sa putly ‘uta enon, eerans nti pe elon wou ot be expcted, anda pvorel ean in charcteritical sian ‘plasmacytoma, the most common primary bone malignancy in peters above the ae of 0 years, can involve the pes and presen ar «pafl ores lesan. However, plasmacytoma nou haracorintcall appear aa wel-sfined, punches Fesion, coast the poor defies sion wha mth-eaten pattem of Bone estuton seen Inti patent. Moreover, ‘seis tin Be lston would not be expected, and a esta reaction 1 pal absent. Cee ry om naka <2 > ting sarcoma can fect theft bos (he hu) and presen stay wh pan the buttock, an ostebtc lesion on {ct ana an aggtssvepestoselfeacuon (asscly at onion-pee appetance) Hone, sec eslons ae ot seen it ge i aa eee ‘commonly melies he lapses f long bones (ypc the femur, i, Houle or hme) ‘an eseachoraromais 2 benign, slow-growing pray bore tumor tats usually symptomatic and covered a an tredenel tg om taging, occurs te tatapt of eng bones seal the al emer protinl ty Sed proximal humerus) and would charactrscally appear as small bony protuson, in conrast othe poorly dfn ston with { motheeten pater of bore destracton seea nhs pater. ‘Chendiosarcoma she second most commen not-hematoagl primary bon malignancy Pimarychondosaicoma typically SR fs ofr preter prema rcirof ecietads -70 fours al ret proce ‘worsening pan seling can occasional be palpated but my ft be ready apparent al patents 5peO3y those wth pai 7 ptonimal amoral lnolvement. On sory, rondrosatcomas appear a ote leslons th a otr-ete ar one eres one eres <2 i> ‘an eseachonaromais 2 benign, sow-groning pray bore Lumar tats usually symptomatic and coveted a an tredenl tng om tnaging. occurs on erat of ong bones seal th tal emer proxi tae proximal humerus) and would charactrsticalyepper as smal bony protuson, in conrast othe poorly fined lston wit { motheeten patter of bore desracton seen mths patent. ‘Chandrosarcom iste stond mast common non-hemaoagcal primary bons alan. {Het the pela proinel em ce pron ume ef ddl 30-70 yours of age and presents wth progres ‘worsening pa sweling can occasional be palpated but my fot be ready apparent all alent 5peO3y those Wh pli oF ponimal amoral lalvement. On sory, chondrosarcomas appease lesen ith a math-eten ar Pormestne pattern of bone dentuction an splat, pearl, oringand-a slate hich ae character of ‘Chondrid mai eakifeaton Other radiologic fests inden aggressive pasta veacton and endosteal scalping, & Maina Cee eon Ons « <2 a> “Ten ays ater the vaginal every of area nt ita 27-year-old womans brought 1 the physic by her husband secsure of rquart mood changes he hat See eal an anaious nc he wat Home fom te hoe 2 days fer delvery. Se says tha she feels overran He new responsible and asics taking cae of her neatiom Secuse se fel constaty ed She onl sleeps fr 2 to 3 hous mighty becaue he bay“ keeping het {wake sometives, the patent chess oh her dager basa she tinks she Hera her ery fnge Ne seeing (ult) Her musband Says ta hes alae that something could nappen vo the Bay. she ofen ges any a im an has {eles hi uten hls up the Baby tout uring aha sane beforehand She beatfeede he aby withou ry problems. The pavers mother has tipear iserder wth psycho features, Te pten’s signs ae within ronal txaninaton enous able fect th no eucence of hemi su ixtn. abortion stoes sow 8 nemoaloi Corcenvatio of 13 g/d and ayo stalin Notmone elo 21 UU mL. Which of he olewing Ise most 2 B® senvaine meray (©) cogneve Bakara therapy (© Rawetone teapy (©) Aeasuance ‘upropon therapy (© Owlxenne ereoy (© secwoconvle eapy () Susprone tery (1) mteperonal psyenamerapy oats Omns al <2+> Jota ra it 7-yu-la woman room phys by ar — Pee reer er se eee aa oatmeal te uctees 2 day afer dey sh sys th sn es pruned whet ne aspen das tes aking creo ee eee Tae eae ee eee tale: some fe pater ches o dar esse ks he ard er yobs eseoe aah ae ede cl cee Tae ly oe byrne ac os oe eee eer Probl Th pars ter as pl ode oi sys: Te pe’ el ssw wn rr a eae ee tari rs ible ath eden ohmic ors HBO. ses show ahemogon Cocamvue or gata sce smirra momen eet Puree Who faery te nse “Th pant press wih lb fac, arfulnan, rainy, abi and fang ha sanad 2 dye potparun aed ‘have coined for 5 than 2 weeks, wich suggest a aagnoss of postpartum bes 2a “Anideprestants uch tsa, potting, ae noresvine ae safe toute dng lcaton andcan therefore be weeds ‘wea postparom depression, which would begin within te fs 4 wasks after Chibi and present th syns sich a8 & {preted mood, noma. ad fatigue a tn hee However a ast 2 more f the floating symptoms anda, paychomoter aataton sowna, feelings of worhessess or uit, suid Yeaton - mast epresen, ana the symoToMs Should ast fr = 2 weeks before a clagoss of postpartum depesion mao depresshe episode the postpartum pres) ‘an be mate, Ths patent's pretenaton andthe drain of smptoms (8 days) do not meet the error mse depressing ‘episode but stead, suggests postpartum Hues, for which, terapy with Sealine othe next Best Step ‘Cognitive behavioral therapy (CBD not nested fo postr blues but canbe used otra! postpartum depesion which woul beam hn te st # wks eter cniith and oreset wth smptoms Such as 2 depressed mood Insomnia, a Tague, a seen Ree Howes ateast2 mote o the oluingSympons- anhedonia,psyeremetoragkaten lane, OM Fae al <2 + san ‘Cognitive behavioral therapy (CBD not nested fo postr blues but canbe used otra! postpartum depesion which woul beam hn te st # wks eter cniith and oreset wth smptoms Such as 2 depressed mood Insomnia, a Tague, a seen Ree Howes ateast2 mote o the oluingSympons- anhedonia,psyeremetoragkaten lane, {esings of wothesncrs gu suc! eaon - must be poten andthe syrptor shoul fr = 2 weak before ‘iagnosis of postpartum depression injor dpresvespisods i the postpartum prod) canbe mae, ‘spendone is not nleatd fo postpartum blues but an be used o eat postrarum psychos which rpKal occurs wihin ‘te sto Weeks of lain ard can preset wi Sympioms Suh as depresses Mens Some ale) ANd WERE, {a5 tem hereto, the fal history of polar soar wth psycho fesse ts patient 2k aco fr postparum (sichoss However, postpartum psychosis would be characterized by the presence of alacnatins andor sions, 2h the Ireomia of postpartum payee would be uated to peter ae Festparcum Bus, Which are s2en n 30-60% af pregnancies, generally reso spontaneous wn 2 weeks. Therefore reassurance ana support ate often a tat fequres Psyoterapy aa ot poumacoterapy ae wniecesar UNE OE Patene macs ea fo porpatam depetion alr deprestv pods the postpartum pei). Bh. Mor depress dred ‘therapy be eaured rng te postpartum period, a derentanepressant hats known oe sf or muting Mothers pretered: Moreover sige effets of buprepontetap suchas aut an soma are unstable hs pate” WhO [Seedy sffeng rom ant a leepetnete Wah duloxetine merapy the ik of adverse fen the breat-fe infers unriown, Therefore, shuld amidepessane Oma a <2 +/0> ‘therapy be equred rng te postartm period, derentanageressant hats known co Be sf or using thes Pretered: Moreover sae effec of buprepion therapy Such as aut an soma are unstable hs pale” WhO [Sredysulferng rom anonty ad eepleanese With duloxetine therapy the ik of adverse effets the breast-fed infers urkrown,Theeor, should amiepessant therapy be equed rng the posipartm pera diferent antidepenant hats Know fo be sf or uring mates refered. Hlesroconvlte therapy canbe wed to rat severe postpartum depression ad eves postpartunpoyhoss that re teatro psychotherapy and pharmaclogclthetep. This patent has no yet lecehed psychetheepy or phatmacloial uspone canbe used to rst ant Ssorer, which may aso present fo the rst te dung the pensanum pred. [Altough i avert does have come ste, sa des ot mest he cara fr an ennety order (ag, generalize anny ‘corr, boca th ration of hereto ic 8 onthe Moreover, even ie pant woud ave an any cer, {an SSR oF SNR would be prefered a the istctine tetany ove usp Interpersonal sjchetheany snot inacated for postpartum blues But can be uses to rest postpartum depressor which wou begin wn the st weks alr Culgbth ad resent wth spt Such as 2 depeessed mood, sora, ad {esings of worthssres r gu, suidl eton - must be preset, andthe Spt shoud last for = 2 wees Defoe ‘hagas of postpartum depression major depres epaade i the postpartum pvod) canbe mae, |A77-yearld woman is ough 10 me cme gency fom by he on fr Conuslon for Me aS7 das. Te patent Sys she hat had nausea and fag fo the ast wesk but tunable to provid etal history. she as altho’ esas and ‘ype dabets melts, for which she akes sui. hele alone al aes or hele bu he on say he requ Forgets to take her isn Shes lethargic but niente to place, Her ple 85min rspratons are 16m, ane bood pressures 115/70 mm ng xarmaton shows ry mucous memorares. Urals shows high alucose and no ketones. Serum bta-naronybuyeteis negate. Which of he folowing abrator values are most Consistent wh hs Dents agnosie ‘Serum glucose (mara) Serum osmolany (msm ka) Serum sodium (mEq/L) Serum bicarbonate (t/t) as te 2 330 148 3 22 we oats Omns al <1 +> ‘77-year-old woman is trought 1 he emergency ‘com by Ne Son for cation ore st 7 das. The pant ays she or which she rakes MUI, She es lone an cars for hese, but her son says she eauart forgets o take her ial She etre bu need to pace, Her pulse a6 min respira are 16min a eo pressures 115/70 mm ng. xarmaton shows Serum ich of me following lbotoryvalus af most cnssten wih this pubes Serum alucosema/dt) Serum osmolality (mOsm/kg) Serum sodium méa/t)_ Serum bicarbonate (mE) Sbetemdronyettate, anal ay igs of deycration ry mucus membrane) lof hick sugges! aaghi of ‘yperosmolarrperaiemic state CHS) The development er HHS Ike te poor cmpance with her MSN, ue toner undevng Alzaimers ease, (ee 2a a. S| ‘tens wt iypercrntr ype at 8) cally prevent wih marked lyperijermt (oy, seram gars > 600 mgi du which n cu causes icieased Stu opel ea. usualy > 320 mos Kh Tee usualy neil tone formation due tthe presence of endogenous nuns compared '5 DA, bere theres ho endogenous mln and so ketones ar formed. soci lees ae usual lo, duet extracel nae shits om he hyperosmolar ype yponatiemah Whe bicarbonate s consumes apy eabec Ktoacidss (XA duals wth HHS en presen oral tony my decreased sum earsnat lvls otal = 18 63 Bo Om Ds a <1 > “This combination i consintet with habetc Ketones (OKAL Petits wth OXA typical present wih perce out Serum gucose usualy remans < 600 mg/dL increased serum osmolality sual > 290 mOsm kg ad formation of tore. Solum eels ae usual low o¢ noma ufo extracel Wat Sts hypertonic hyperemia. Serum breabonateie consumed apy aang to deccared rum bearsonats eee tually 2 8 me apa acidemia Wh he ‘ate’ presnations somes conitart wih OX the sbnice of ates i both the wie and blood make this very ‘ley She als ck ther pel Festus of OKA, auch ss a apd onset of ym, oma pai, uy oar on the beat rom exfaes acetone and hyperenation(ussml respons. ‘Wate is combination of hyperemia ana hyperosmoat otherwise Consistent wth he pales presentation ot Inyperosmalrhyperiyeara rss (the rosa eel ot eanseten th er potrtton conete for he Inypeolycema, te Sostum level wou be approximately 157 mgick mesure Sodium = O.O16(erum gucese00), and st that evel seers nerologe symptoms eg. seure, cma) wou be expected “Te combination ow osmalty an ow soaiwm eel Wnacates eter decreased inaascular volume eypovlemic Iypotrieyponsrr) and/or mnereased lvl f ADM (dus to SADH) ands net constant wth his pant ‘presetaon of ypeosmoarhyperghcemic tate HHS). Tis patent does hae ary vepores Stay of artes ad /or ‘omtingto nugget an eto or hyowoemehypontrerss Atenaly, er netessed serum laos [ich expected ‘en the presence of large lucosur shoul cause increase m Serum osroany, unlike the low esmalary seen here ‘This combination of hypematemia and increased serum osmlarty would be consistent wth Ghyaaton from umepaced OM ead Kot o> 3 patents prerentaton i somes consent wth A, the abrenc fktone In bth the une ap ood mate 2 very Unkly, She also acs othr ypc etues of DKA sich a rapid onset of yoo abdominal psn, funy ager he breath rom exhaled acetone and hypervenistion (smal respiration) ‘Wale this combraton of hyperaicemia and hyperosmolar otherwise consistent wth the ates resentation of Iyperosmolarhypergyerme sate), te sodium level ot conser wth er presente. Comected or Me Iypeaiceria, te socum lave! wou be ppronmtely 152 mg/akmestted tom « 001e[erum grote), and at ‘that ee Severe nerologkSyptoms eg, Seure, coma) wows be expected. “The combination of ow osmolarity and low sodium lvl nacre ether decreased invaasclr volume hypovlemc Inypatonicyponauerl andor cetsd ees oF ADH (eg, ue SADA and ot consistent wh Os pater presentation of hyprormla hyperglycemic state Hh) The patient dost hve an epoteg Retry af ares ahr ‘onng Sages an tonya porn pene aoray bet ceased sum se Wh ped I ecard eee perce Fete eecine eme e Ek emcee oe “Thi combination of hyparatremia and increased serum oxmlarty would te content wth hystaton fom unapaced te losses leg hom arte, nsensiti losses th hich cn present Sif spay mucous membranes, Flee Weer ered rec ec ed rca hte preregister paler, ana oes noc wh the ignoss of hyperosmolar hyperavem ite (HHS) OM ead Kot o> 3 patents prerentaton i somes consent wth A, the abrenc fktone In bth the une ap ood mate 2 very Unkly, She also acs othr ypc etues of DKA sich a rapid onset of yoo abdominal psn, funy ager he breath rom exhaled acetone and hypervenistion (smal respiration) ‘Wale this combraton of hyperaicemia and hyperosmolar otherwise consistent wth the ates resentation of Iyperosmolarhypergyerme sate), te sodium level ot conser wth er presente. Comected or Me Iypeaiceria, te socum lave! wou be ppronmtely 152 mg/akmestted tom « 001e[erum grote), and at ‘that ee Severe nerologkSyptoms eg, Seure, coma) wows be expected. “The combination of ow osmolarity and low sodium lvl nacre ether decreased invaasclr volume hypovlemc Inypatonicyponauerl andor cetsd ees oF ADH (eg, ue SADA and ot consistent wh Os pater presentation of hyprormla hyperglycemic state Hh) The patient dost hve an epoteg Retry af ares ahr ‘onng Sages an tonya porn pene aoray bet ceased sum se Wh ped I ecard eee perce Fete eecine eme e Ek emcee oe “Thi combination of hyparatremia and increased serum oxmlarty would te content wth hystaton fom unapaced te losses leg hom arte, nsensiti losses th hich cn present Sif spay mucous membranes, Flee Weer ered rec ec ed rca hte preregister paler, ana oes noc wh the ignoss of hyperosmolar hyperavem ite (HHS) ge 8 Ons al 1 20-year-old woman wh HIV comes tothe emergency Geparunert because offer an mul sha estos To 1 Week She altos nauten anrena, 2h abdornal pain The son eine ar top and ainles. he ae eked o ck of cigeers diy or 15 yaar and rinks 2 ers Sly She hasbeen wing ravenous rack fr 6 years. She [ppears il Her temperatures 38C (100. ple 10S/min bod pressures 11075 mm. Her 18.8 gi "Examination stows wack mark on bth cub fossa. Thee ae white patches on her palate that one scraped of “nar ate several red papules measuring 1 to 2c on he face and nk, Her CO4*T-ymphocy court i 43 rn? (= 00) Bop oa ln Ison shows ata polferton an smal blk Haren onan. Stary sa, Wh of ‘he folloning ithe most appropriate parmacoterapy? 4a @)Prrmetarine ae sessing @) vottetne (©) Aatwvomen and ethamoute) BO (©) Arphoteicne (©) evromye (P) Temetopin and sutameroxazce (© Neazovanise + ge 8 Ons al 1 20-year-old woman wh HIV comes tothe emergency Geparunert because offer an mul sha estos To 1 Week She altos nauten anrena, 2h abdornal pain The son eine ar top and ainles. he ae eked o ck of cigeers diy or 15 yaar and rinks 2 ers Sly She hasbeen wing ravenous rack fr 6 years. She [ppears il Her temperatures 38C (100. ple 10S/min bod pressures 11075 mm. Her 18.8 gi "Examination stows wack mark on bth cub fossa. Thee ae white patches on her palate that one scraped of “nar ate several red papules measuring 1 to 2c on he face and nk, Her CO4*T-ymphocy court i 43 rn? (= 00) Bop oa ln Ison shows ata polferton an smal blk Haren onan. Stary sa, Wh of ‘he folloning ithe most appropriate parmacoterapy? 4a @)Prrmetarine ae sessing @) vottetne (©) Aatwvomen and ethamoute) BO (©) Arphoteicne (©) evromye (P) Temetopin and sutameroxazce (© Neazovanise + Omns al o oO) sepa tscma mt coma mage pum tet dni sinc res. (GST o Se ea cee as pee er eee | necator eters fal Examination stows rack mart on bth cuba fossa. There ae white patches on her plate that cane scraped of “oer te Svea paps measuring | to 2c on we Tae and nk. Hat CD4°T-ymphocye courts #45/mn? a (= 00) ope ofan Ison shows etal polferston an smal bck BSCS GR UAINASSURY I, Wie of {he following th most appropriate pharmacotherapy? ae “Ths v-posiove pavenc presents wih cnsintonl symptoms ad angiometous sin lstons wih bacera detected on Ihe eet yee pee eet eee eee NU garonela henselazand Seton quiana ad can ase manest wh gasworesina isons hat case abdominal al, a me 20 « we ‘Combination therapy wth pymetharane an xufadizine fora minarum of 46 work the werent of chief a ‘oplesmosis Levcovern oi also sdministred to alate he meltonc ide eles of pyrimethamine [thaugh toxaplasmons sa common fection n patents with HV fection peicaaty wth a CDA" Tlymphoryt count “< 100 lle ener causes encepals, kin lesions woul ot occur massoaton WE texoplsmos Ialsonalsdinisration of vinblastine First-line estmen opcon for Kaos strom, an importa ciferenal iene se pall Ye ae comer cbc ope Ceci ae sarcoma and bcilaryanglomaoss can be very srr m appesance, making Kec deere them, However, BSy Ce a Om Ds al <5 10> alesonl edison iene se pall Ye ae comer cbc ope Ceci ae Sarcoma and eacilary angiomas can be very srr m appesance, making ect diferente them. However, Sy ‘a Kapst salma leon would show spre shaped cls leutoeyte slater, and anlogeass, and Wath Starty tan ‘tou be agate, making te dagen uh “Combination meray wit aktvonycin and emambuio me eaten of hace or Mpcodecerum au compen MAC) Infections, which re commen in patents with advanced mmanocmpronise du 0 HI fection arly ony ocets FEDS ‘-ymphocye count <$0/yh ough MAC fection could expla his patents constttonlsymproms and [pstmt symptoms, generally presents sa dnteriated fection estar meee cough) and ‘enerazed mphaderopsty sion lesions wow not be expected. “Arpoericn Bist wet system cand, which should be conser in nemunecompromised patents wih symptoms (of ehesarinatd dear (2. gatenenal msm, kin lesons, and conttutonal sypeore) Hane, the “ppearnce ofthe tn sons end biopsy results rent constant with his agnosis hough this patent Key has ora ‘Canaan, amphoterin Bis at conte fest ine therapy. Leyton i te fst-ne cup forme veziment ef Bacay coger. Pants shows general take orl eythorncln {or monn or una he gc tr hat enfant decline eter 1-6) thi ove aot ce or the dees relpze, ‘west sou be contin ul the patient egensmmunecomgetere, iteradey, oa doxyeyine canbe Peete pea a Ted mere vn reseed discal wen OO Tay meena Loop a Sennett Sn ear wre epee ‘Amphotericin Bs t wet systeme canis, whi should be considers mmmunecompromised puters wth symocons ‘ot aserinatea aseae (29. gstoinesual mlvamert kin lesions, and consttutonal syepions) Hone, the [Sppearace of th hn lsons al bape ete ve nt constant wih ne lags ough patie Maya ra ana, amphotericin 8s nt consieted fest nether. Enehromycm she fist- ne up forthe resment of clay enaomatos, Patents shoul general tke oral evtomcn Tord mons o url Be Cuter nas nian cecines eer « 1-64) Fs does aot occ ofthe dsease relapses, luesiman shoul be contin ul the patient egins mmunocanpetere. Aerator doxfeyeie can Be ‘mitered ora soe duration one “Trimethoprim an sllamethonarle(MP-SMN) are set reat peuroctspreumona (PCP. typically acu in patents wen iv infection anda CO¥* T-lymphocyte count < 200/n. Although hs patents constutealsymotoms are consent sh 1 25-year-old man is bxcuan ta the emergency depaimert because of 2-week histor of abdominal camps, vomits, 2nd conrtpatin He alo reports hong ont resuery and occtional lap pan eh aa ela epee he Das He hs pearson and epic ler eas, Curae melcaton Inlide captoor and adie He appeals tenderness There 1 no Feoourd or qardng He has restricted eet. Hs laboratory repos shows eetated sum puatytténormane levels, his serum callus 122 g/L Abdominal uvasonogapy shows mule smal leu a ‘ra presone therapy 1} BO Reducion fata nak of alum ‘Norma sine and iravenou foseide therapy »|@|G ‘Nona ssn ns invavencu ean! therapy @|¢ ‘wirieat Remo 4 Omns al <5 +> a oe. 4.2-yeld min rush emergency apanmer bce of 2a ory asomina cana vomsiog. (I vice tacoma ss ope hn © RE song pu. td dar pao Tec chebarcia oa pees reer rokacs wel ct da ec @ ‘eerste noes or asin, a ete ater ranean a a ee banal Oars sews mle 4 Cer ee Hees peas eres an Dtsmtances, stu ae ssp roma ypeeenia ceused by peruayonm, eaver aton thay sion el opiermes ieee Ree ie a aces eee ck eee pees eee ‘hssncmalcum nese teeny coma sot sry nhac Seve peat oeee ee eer cree 2 Analysis 40 ‘redntone ie nsieatd nhyparalemiaasocaed wth hypetalmntaion of min Do endogenous, etopie cael production (en Slcldesi or eter renlemaforming diseases) Prednisone wl ot be of we in this pave, Since in Primary nyerprathyoidam, the logy of hypercalamasexesbve bane esorton dt lve PTH eves Denosumab 5a RANKL inhibitor hat prevents the formation of mature esteodass, 1 sed mhyperclcami caused by malignancy hats etacory ta bsphasphonleMerapy I ths pan, elevaed PT ees make Myperalea 6 mabgnaney farina Epona a its mie ecient ae erty dace sen ncn Btsonosohontes are ndated In pants wi severe symotomatchypercalerna (a > 14 mg/l or malignant Iypatacema. However, oben pamiarorae’s slower onset of ctor (aks at 72), shuld be administered conuneion th thr fs apansthat edu aru alum more apy, Frtharmare, monatherapy ath bisphosphonates doesnot Ome al <5 i> farina Epona a its mie ecient ae erty dace sen ncn Btsohosohontes ar ndatd in pants wih severe symotomat hyperalcema (Ca > 14 mg/d or malignant Iypatacema. However, oben pamiarorae’s slower onset of ctor (aks at 72), shuld be administered conuneion lth thar fs agantsthat edu arm alum mare apy. Frtharmare, monatherapy wth bisphosphonates doesnot “bree this patience more acute prblam of volume comractonresuting from naphrogenic abst isp Wile reduced etary tae fcr can lp rece serum calm velo par of og-tetm management and ot seul for rez acute symptomatic nperaeemi oop drt deceare era Ca™luls hough tect uonaty "excretion th pas oop ues wer neta in symptom hypetclcamiao stimulate riney C3 excretion Neer Tst-ine wearer optns for ypecalcemis have repltced loop aurtis ay standard este, reducing the ak of sree aide effects of aggressive areas sachs peterson. elecrlyeimtalances, and ahh, Loop cures ae sl use, however, to West ypecacemc ates wth Aggrestve hydration wth normal ean nd amination of feta! woud be the tlie aut Westman or ace Paces prone ld epacement and hg=potncy pan convo Acute pares aso presen wegen Aendenes an orn, ann ae aes, maybe cased by hypercalcemia However, most pants wth acute ances Inve severe a that racates othe back uarna, and an actly stended abdomen, none of whieh represents ‘ace. Aaatonaly, ace pancreas assocated wih lo Clem lvls aesut Rem Seperate) Much emodass nccated a patients wth enteral levted Ca!" concentration from 18-20 gid eal ere andlor severe neurclogl symptoms (sychoss, tary, conve parent. Ths pater nl as my elevate serum alum OM Gs aft a <5 (40> loop duress deceae sera Ca™leuls hough tect urnaty Ca" excretion th pas oop duets wer neat ie symptomatic hyperclcamiao simulate riney C3 excretion Neer fstine vest opbons for ypecacenis hve repltced loop aurts ay tana restnene, reducing the ak of severe aie effects of agpressne arse suchas hpeterson,elecvlyemalanes, and arhythm, Loop cures ae Sl use, however, to eat ypecacemic ates wth ‘sages hatin wth arma elite nd dettetration of fentanyl woud beth re-enact trenton or ac Paces pred ud epacemens and hg =potncy pan cool Acie pares aso presen wt epgesre Aendenes and voring, ann ae ees, maybe cased by hypercalcemia. However, most patent th acute ances have severe pan tat ait to he Bac, alrang ara an acutely astended abdomen none of which are preser i his ‘case. Aaationaly, acute pancreas associated wi lo Clem lvls aesut Rom Seperate a fee) Much emodass ncaa paints wth enteral leuted Ca" concentration rom 16-20 gid real ere andor severe neurlol smptoms(sychoss, lethargy, cognive Impaler. This pater ni as mi levatea serum alum lel ais eusigic yma prsumaby secondary co pimary hyperarahyom) ae not severe enough 0 waa emedy Noval sins needed oreplesh okie tha the pave has ost hvough pyr duet nepnogeicdabetes isp in typerceleemia) il ane Rly to date the hypereaiamia Calton opposes pastor in fanetion, eng Bone resorvon.Togete, normal sal and canon ae the westmen of cole for aut, smotomatc Mperalcemia lpenrod esis “Two ays ater amsson for myocar arco and subsequent coronary angopasy 2 65-yat-lé man becomes lvrsted an daphoratic inthe carie mtnsve cave ut Suadonly he sh lone! reponse. Pulse suc os at ston a racing He as history of hypertension and depression. ri ois admission, his mediation inde ramp theatres. Examination shows mo ereti pulse: An ECG shown ich of the llowing i the met appropri sepin management of he patent Ay J 1 tn dl i H ‘i Wy Ru SY SY SY ANN My Wey VA a Omns al <7 +> and subsequent coronary angioplasty, «65-year-old man becomes res {fetresred and capone nt eae wens car nt. scot e's alee oxmety doce not Show 2 acing He has 2 istry of hypertension an depression. rt his assion, is mesicton ned amp Step m management of he pater “Ths pat has o pulse and veri acta (VT) On ECG UN Suan, he ACLS algo or pulses VT er bs sated rect, pairs wn ureabepulzlee VT, dfibadon shouldbe done mmacaty Mf paints wth unstable pues VF donot respon detriston, W epinapiene shuld be gue followed by Vamodarone fended, Frocanamide wedi the arate este of ventculrtachycaria (Ta patents wh are hemodynamcaly stable ae or ‘th long-term therapy of Homer th paints emodramicaly unstable: ang thus, he reeds another marageMENE ‘enccua tanya ne of We ery complications of macula lfrcon (ca eccutinup 12208 patent er Mittin the re hours, Management of depends onthe stably ofthe patent ara the presence of ple acy. The {absence ofa att pulse in cojuncon wth dhe EC ncngs in his pan indicates plslss VT, which equesewrnent Ce re) Omns al <7 +> and subsequent coronary angioplasty, «65-year-old man becomes res {fetresred and capone nt eae wens car nt. scot e's alee oxmety doce not Show 2 acing He has 2 istry of hypertension an depression. rt his assion, is mesicton ned amp Step m management of he pater “Ths pat has o pulse and veri acta (VT) On ECG UN Suan, he ACLS algo or pulses VT er bs sated rect, pairs wn ureabepulzlee VT, dfibadon shouldbe done mmacaty Mf paints wth unstable pues VF donot respon detriston, W epinapiene shuld be gue followed by Vamodarone fended, Frocanamide wedi the arate este of ventculrtachycaria (Ta patents wh are hemodynamcaly stable ae or ‘th long-term therapy of Homer th paints emodramicaly unstable: ang thus, he reeds another marageMENE ‘enccua tanya ne of We ery complications of macula lfrcon (ca eccutinup 12208 patent er Mittin the re hours, Management of depends onthe stably ofthe patent ara the presence of ple acy. The {absence ofa att pulse in cojuncon wth dhe EC ncngs in his pan indicates plslss VT, which equesewrnent Om ns al <7 10> ‘enccua tanya ne of We ery complications of macula lfrcon (ca eccutinup 12208 patent er ‘test th ee hour: Management of depends oth sab be pate ard the presence of pul acy. The {absence fa cart pulse in conuncon wth dhe EC ncings in his pan indicates pulls VT, which equesearnent By. verter achyearia magnesium sate decreases atau influx and prevents eat aterdepolanzalors. suse in the management table atts th teas de pointer hich analy occurs in patente wh prolonged Gites hough some ft-gearaton “ntpsyehae drugs ar now wo cause GT ptelongaton aripprazle is second-genetation antipsychotic has Not “rsocates wih QT prlongeton Inaction, ths patents EC doesnot show the character pater of torades de pointes Inwmen OFs complexes sri around the oF e oder ne ‘ete catetrzaon suse to evaluate the blood sup to the ctelac musculature anor apy or open narrow or Blocked segment of «cronary artery. Cara eatetrzaton might be necenay tule gut reinfection nts patient, Bt ‘the management of is VT the foremost sue at is pm. triers sears bused ete cts mantptinent of VT pints wh emery tale. table Pater th pulses VT V amieatore should only be gh fe here sn response te debit and epinephrine iA nn VM OM aD. <7 19> Magnesium sate decreases atu nlx and prevents eal aftrdeplaization. is used inthe management of sabe patents wth tonades de pontes which sun cca in patents wrth rlonged QT inter athough some fst generation “ntsyehete drugs ar kno t cause GT prelongaton arrazle Is = second-geeraton anipsycod hats not ‘associate wen QT prolongation. action, his salen Ga does no show the chatacesuc pattem of wrsades de poms Irth Qh complove tf sound th a of he alec tne ‘area eatetenzaon suse to eauate te blood sup othe cercac musculature angearspny or open naroW oF Docke segment ofa croraryaey. Cardlaccatelerzaton might be necessayt Ue out aYelfrcon TS pal, BU the managemant of he VT ithe fremont nue this pi eres din te imapeertfVT pith rs heme an ble paler rh useless VF, Vamledarorestould ony be aN fer har Is response te deri and iv epmeptrine ‘Sjchonized cadovesion scat ln ustble patents Wi natfow or wide QRS compen tachycardia entra {te > 150) wth palpable ple, tan rts bused to tet tale ptt wh rane that alo respere Imedctons, sch a5 verti tachycary sl iilan, ail ater, and supravertia eaeyctea Since is ‘ustbl patent th VT confirmed by EC hes ne plpsble ule, yncronized cardioversion int the most appropriate Ons al <5 > 1.22-yer-o woman comes 0 pan fr flop examin Sh nested or arnt stn 1 yg 5 ‘with madical expulsive therapy. There 's no personal or family history of serious illness. Her only madication is an oral a Convene pl shea ben king fr 2 ys. Se Apes ey Py rans hows 9 er Kee ddr i ep ree rere eg bier ‘somromal rts an loesound othe abdomen shouts wel-aemarnes ypc 3m 2) Rea sn A a Conrce-emunad Cr fie shoe sows owl emscted 3 hepa ton eget enrcomen on “ ‘Shsequert cnt! ow. Tae a0 hypestonsting etal ca rene. nda oop te Contos pl whch fh follwing the ost propriate next epin management ge 8 ont 2a '@| © Percutaneous ar bapsy eimagein 6 months @Oc 4 Omns al oO ms 1 22-year-old woman comes othe phys 0 follow-up examination. he was Usted or arnt stone 1 ye! £90 a] Oreniow ‘seh macel axle therapy. Tere sn przoal ofr htoy of eious ler. Re only mecesion san Bl a ‘She appees hel. Pyscl examination shows no _ [irormalies, & complete ocd cout serm esti, nd lect are thin the reference ange Unalsst fal ‘wen normal bts, An utvasound of te abdomen shows a wel-demarcate hypereol 3-cm 1.219 nna leson. A = ‘ter bere. In addion to orpng the of oniaceptine pl which ofthe folowing the mes appropriate nex stepn management eet ee eee ee erecta eee Or denoma HA tre most ey ag7055. 2a « me w “Transat embolization wshg cls or parcculte mane recommended for hepatic anomas AS) that are =yptomtc of sons tha af 5 cm in arc because ofthe higher Hk of emothage and magna cone. Shoe hepsocellr cena, Rent ties have ls foun ta ral ation wore expe wel or moe wt n patente iho ae ot good candidates forever surgery, a wll as ents wo have aie Berg om telson This patent tara esmpomatilsfon tat -c3 cr. herrea roe conteretv cour of raagenint i ecnmmended Fercuaneous Ie lop vecommnded to confi the agnoss imaging 's under oi hepatoelar carioma HCE) is Suspected. On Dole ulvasoune HCC shows sgcant arterial lod apply and nevanculretion sound round mass. ‘wen regular bosndares. on CT, HCC shows &hybodense lesion with wregl” borers and ges local mason. THE paler as reassutng imaging fais Tor hepa adenoma; fr hs ensn, a ner Bpsy snot wae ats Une aan ee ny & Om Ds al Fercaancous ner Bop Yecommended to confi the agnosis imaging is uncer oi hepatocellar carcinoma HCC) s Suspected. On Dole ulvasoune HCC shows sgcant arterial lod apply and nevanculretion sound round mass. ‘wen regular bosndares. on CT, HCC shows &hybodense lesion with wregl” borers and ges local mason. THE paler as reassutng imaging fais Tor hepa adenoma; fr hs ensn, a ner Bpsy snot wae ats Une “The rst step m managing hepanc adenomas st stp alors contracepts (OCPS hormene-contaning DS, nd anaboie Steroids, allt wren cous inceace he sizeof he tro. Tis pale Mas an asymptomatic Ha <5 cm lame, eh ay own wo increase in size after discontinuation of the OCPS or sterols thus, fllow-up imaging with CT or MR at toe stable, maging may be conducted annua [B.tenign er timers and hepatic ts adotrequenyebavon (EA) may be considered for pars with Mepaue adenoma lesions tat re symoromatc o> § cm in ameter, ge the nereatd ak of hemertnage and malignant Wanefrmation to hepstcalareatnoma However, maple Sessions ae oer equed ana residual adenoma may persist despite Wester. Therefor, RFA may be considered for a eet ttf cy ec ee ere ae epee eer Ve pte "Symtoms (<5 em ein, earng tha RPA Nok MaKe a tI “ener the ncesad ek of spntanens bemorhage and pote malgantaraformationthepstocalar camera n © WI Dsteu “The is step w managing hepatic adenomas te tp al orl conaceptves (OCP, hormne-containing IDS, and anabolic teas all of wich cull etesse the sz ofthe for This patent hasan abyptomate HA <5 ri meter, eh ay be manage conservatively a ts Unik f9 unergo rupture or mallgnantvansfomnation Hower Some HAS have Been noun wo nceace neat corinuton of he OCP or stris;ths, llow-up maging wth Cor MA t {ee stable, maging may be conducted anual Aiea A my be dee fr plicit hepatic wena sonst ie spre > Sn “lamer, qn th nereasea nk of hemorrhage and maignamt Wansformatonohepsocelrcacnoma However, mule Sesions af fen quran eiual adenoma may pass espe eater Theatre, AFA maybe conser or is acd at eae yaar al ee ae he eee ar ‘Symtomaticand sal (5 cr lesion, aring tha RFA no aad at me “Gen th increased rk of spontzneous femonfage and posse maanantransformavin thepatocelar caronom Inge heave adenoma lesion, surgical eecinfrecorimended fries tat are > $n n ameter Suid rececon pate who have pecunclated tumors, laparoscopic resection may be an option, The maory of tumors, onthe other hand, eure larger incsion th al resecton or aegmetal pati! lobe. ven thet tha pent’ anymptomat san ‘$5 cm, surgical managements ot ested ats me. Ons « <2 a> ‘24-year-old woman i brought 1 te emergency department by ne roommate because of baare Behar and ‘oom aight and has erred vary of expensive cotes ole, The patent say she flee han ev andes # lett hye Se ae were stereos wold andres tet gra af beaten ie ‘rages her ue. ne hasbeen otenwre neh and not nena shy meleston. se eel active wth Pe Doyen she dos not smoke, dirk alcool, o se NE dues rial at nauclop exainaions Show no ‘examination stows pressured and disorganized speech, fight of kas, lack of sigh, and affecine lab. Which of the La (©) Oven TS, prnCK, ane serum cease concensaton )| Pein ei lod ges analysis and sit mp examination (© evr unre ar testng ard bean conn behavorheepy (Foie am, HoANe bp lvls, ad prota leis BO oats Omns al ‘24-year-old woman i trought to he emergency dearer by her oommate because ot ea forthe part eat Het foarmateepot ht the patent has be and has ordre a vari of expensive cles onlin, The pense she els beter tha eve” a Shehed absene seizures 0 ch and remembers hat valposte had tbe continued becouse # Garages nerve he hasbeen eters Meth and not akong any median. se i sexual active Wi Re Doyen she dos not smoke, dirk alcool, o se NE dues rial at nauclop exainaions Show no normale, Herp 78, reeneations ae 2m nl blood peers e 122/60 mm, Meret examination stows ese an dr Genize Spach, Poh of wees, ac of wight, and aREANEEBIY. Which of re Follomng the bern step before deen on therapy orth pte conan? Tees ee ‘epatroney shoul be taken te consideration when dciing on he next Bes Sep 2a ss ier eel cl tere ade ec ot pur el pte eee eae ‘ump pharmacsteray. Valproate sao hgh tertogeni: pregnancy should e ued out ror fo tang treme ‘Given his paren’ stor of vapeoste-nauceshepatean cy ae Westen of absence Secures, ium, athe is-He tog for ate mart pene of tplar dcr shold be canted. then metabooed sed excreted analy, mesing Tie function ests wou not be equed. Ste-HCG should be considered though, since RS Se during pregnancy s sri wth increase rates of congenial eat defect pec ben anor ‘Assesing sll deaton san portant pa of eer syehlae essessmert. However, soda Weaton fare seen ‘uiing acute manic episodes pear dort consis a posse cca feature deeessive esos ipl ato linr hel fo prover alco ar adsense rk of ele daprectir pao, andl sere of the ‘ther fsttn drugs or Bipolar disorder may have ceili ie ees eg, prolonged CT neva, ahythmas: before and during tenment recommended, but echocadigraphy sot reine peformed pst tating eatment Om Ds al < om > Luu i ast-tne rug forme reatment of an acte manic episode i bipolar sede. However IS Se Hed by rumerour averse affects hum may Induce or wrsenpre-ckrthg hypothyr by black the production nd lace ‘of Lthyonine ts 2 teratogn creased risk of congenital heart defects ke Ese atoaly) may case him nephropathy or worsen chronic Kney ese. Therefore, pregnancy shoud be ruled eat and Key end thyroid ontion| Should be asessea rr fo beaming estment. tation ‘espratrydepesion and clsed-anle laucoma af sie ees of benzodiazepines. ABC anayss and ophhakroiog ssarnnation a performed in patents on bansocazepnes aha show symptoms of overdone of Tesces Win expecta “These tests ae not inated prof starting rete. Furthermoe, ong-acing beodazepnes ae generally ven 0 apport intial medial herapy of acate mane epaade biplane, but shld not be gen overlong pend duo ‘the gh risk of dependence “Cogntve behavior therapy ean miportant component of management nol decrde.& combination of madison a Paycotharepy hls prevent new mood pisodes in maanancetheapy and hes he songes impact on depressive episodes, ewever ths patent shows ace manic symp, 0 psychotherapy s felt execute nthe current sub. ‘abit ofthe astures affect ané mood va charmacetrerapy ota ness tbe he Hs step ofa combed eater Alough ule sug testing should be consider pants preseting WAM Manic ad) oF PoyHOU SYN, Ts Pa etn hoy of ice rogue etabolc idee, such a weg gan, hpealycemi, espe, nd hypeprlacunemi re common among scond-genertion anpaychatis, a theta option for mantherapy mare mane epacdes EM shouldbe record before ang during therapy wi antipsychotics, Henever, lid sul, hemoglobin Alc and serum plein ves are mest Importantyobned ducing weatmert. Furthermore, gun athe paar ot pychavc and requis rameenanceIeloy, ge 8 Ons al < ur > ‘44-year-old man comes tothe emergency depsrimenc cause of peste palpatons fr the past 2 nous. The day symptoms before Hea manager a safware company ad es fet had alot of workrelte tes. Hes there helhy a takes no meciations Hs temperature in 35.5 (07-79%, pulse 90min and regularly egal, Fespravons are 13min and his loe pressures 126/60 rm Hg. Psi examination shows no othr sbrovmalies. An ECC Ss performed. no Penaies can be denies. Cocacograpy shows Novia abnormal a noma venGier function One out ne arpeat 2 shows oral P wave flowed by nant QRS comple: He sl mparencig occasional paptatins Which of the flloving is the mst sopopite net step In managemen? a @|@| Heparin eapy oe ‘ens micton BO Oe ® on small eapy =) earl eteoersion 4 oats omnes a ee set moma meena stn ans te petmennesy 5 Hes manage ata software company and has ecerly ha tof werk=elated sess. He ‘these helhy ad takes no cats, His tempers i 36.5 7.79, Fespravons are 13min and his lee pressures 126/60 rm Hg. Physic examination shewsno othr sbrovmales. An ECC Ss performed. no Peas can be denied. C2ocacog'apy shows Novia abnormal a noma venGer function one out ter elma by narrow QS cmplxes He sll xperencing occasional paptatins Which of he allowing is he mest eopropite net Step n managemen? “This patie inl presented with palpation, an wegullyiegulrpuse and absent F waves on ECG, which s onsstent ith arial ibilation (fb) Bing ontng ara stress ae posible Wiggers of hye. One subsequent ONC ec even an hour ater te presence of waves flowed by ORS Complexes suggests & comet Sus tht 2a « “This pate inal reseed wth what was presumed tobe nen-onset symptomatic Bb, whe contoling (ate ano tytn a el a proving anticoagulation acocing to CHAZOS2 Vase aoe) af the key therapeu paces hie ‘condone patent's spomtaneeus conversion tus Myth and CHAZOS2-VASc store of Owaratfrerobseraton famer than mel or elecvophyllogicaltervnton atthe tne inte meri, organ cave ofA (euch organic hea eat, hyparhyosm, secros Imbalances) should be mertietas BB. Au nition Heparin amicoagulaon therapy shuld nated fr ete edging to warfarin therapy long-term ancoaglton e prior { uempting lect caranrson# aia iain has ated longer tan 24-48 hers Ts pte sportanecunly omer. sins tht ana cuenty des not reqare long-term arecsapuaton of ela cadovesion. ‘tached, ones aver short halflife 10 seconds and canbe used o unmask unde ata ation oral fuer ™ oR 10+ 02 per {achycrdas. ene very Short half 10 seconds ad canbe used to urmask unde a ibilaon or stl Rute Inaupreventnclrtchyaythrias oeer, adenine canta be ded ts erate ‘Pavents wit A-fo shoul be evaluated based onthe CHAZOS2-VASe Sor, Even hs patent Rad ne spontaneous ‘converted 19 ius yee woul net ee he cera fo long-term aeauguaion era. lnc ot one |etcoagultion th warfarin aguas bridging heapy ung Repti epi UH Detibnason the fist te in advanced card fe spar in patents wn veri bilan ape ymptomatie ‘vernclar eye m Afb, restoration af snus yt s aRemprd hough lect eaaovrson, which ees on the Same prnapes of della, buts syttrized oe Rwate a ORS compe, Since hs pale comvered 1 sus ‘hth, ater dfbristion or acral cadiwerson ar corey nested ‘cathere ablation of ectopic oi nd pulmonary vin olan are long-term tharapetcoptons for pte with curing oF ets Hocker are the Ste Derapeuc agents pets With Ab fr normalizing veRLcua ae sympcomanc pens target her rat of 3/man suggested asymptomaepatens, the venta ats shuld te lowered £110/min Hwevtthispatnt converted to sinus hth and doesn equ medical thereby with beta Backers 5 Om Ds a < 0/0 > Paes win Ab shoud be eve Usd Othe CHADDSD-VASC core ven pa id ot spomaneoUiy ‘convert 0 sinus tytn, he ul not mest he eter fr longterm iaagution hrs. naton of lange “anioagulation with wT eqs riging heapy using Meprin especialy UM, ‘efit 1 the frst step nabvanced cardiac Ie suppor patients win vent ilaon ané sympxomene Serer ween in A", restora a snus Myhm'scempted Wvough eeceal aaron, which ees On the {Tvs prmaper ef deflrlaion, but syoctroiond othe Rware ns CRS compas snc hc patent conrad true ‘yt, nie dfibrilaton or acta cardioversion ate crerty need Get et rg lu pkey eee a Sp opi ee pene ak we perssen tb if elect aivesion has ale, Pens arget her at of < 80min suggested asymptomatic patente ventilate shuld be lowered 0 [Saimin ewer ths putt converted asin yt and doesnot equie medical heany with beta acer 3 ve aeons A, urgent elec caaovesion nate for pets pesertng with symptoms face crema e.8 angina pect, organ hypoperfsion (acute doy mur red martl satu) o acute oraarbton of eat are In hemodynamically stable pte’, an attempt at elec ctclove'sion fe exclusion of ail hom i at arted fo testre sna hn This patient portanesualy converted to sinus tn, however, akg eect carson ge 8 Ons al ‘22-year-old woman tava 2, para a 12 Weeks gestaton comes to he psc fx her ial rental vst She : ‘mutating ae tin normal its. Pehcexaminaton shows aus conssent size wh a 12-mes {evan Une prc sponte fr aukayte serve and mite, Urine catre stows Eco {© 100,00 colo fermng uns mL Which of te fellowng I the most appropri nxt step n management? ‘Adit cetiaxone and asicvomycin ‘Adminis eiathopim sulfamethoxazole (TMP /SI5) Perform estoscopy Aémmister coreixaen Oe « Omns al <> ‘22-year-old woman tava 2, para a 12 Weeks gestaton comes to he psc fx her ial rental vst She = ‘muktaaa tin normal its. Fehcexaminaton shows aus consist size wh a 12-mes gestation rine psc is postive fr leukocyte esterase and nite. Urine clare sons Wath fe folming she mes appropriate net Step In management? “Ths patert has no unary Frequency or suri Mer wings poste for leukocie esterase and mitt and her ure G cettegrons g cou Ts cate asymptomatic bate ‘single-dose cefranone and aatvonycins the fst-tne westmen for gororhes which the patent was west for 5 months 200, Coron Is asymtomatt many cases, asympromate econ s suspected agnosis eg, Mule acd {rien esting would be nested por tothe nation of treatment. This combination af nats nt ured forthe “tezomenc of asymptomatic bacteria daring pregnancy, ‘Cetamicn should be avoided inthis patent because aminogvcsies ae teratogenic and an cause reverble tra eainess nthe fetus Furthermore, while arvnegicsides maybe adrustred mrororegnartpavens 3 a component of Secon ine weatment or pores wh ter aminapeiiis and bet-acamase Miso eptlospots, Zeya rot generlyuseain the wesnen of yt “TPS t-te dag for uncomplicated esis nonpregnant women ana aecond-ine entibet forthe estmen of turism regnant women he 2° and 3 eomester except nthe ast moth of preananc. However, ecru soul be {avode in hs patent because timetopi (TMP) aout aragonse which may cause eal mewral tbe defen the HSL ome a Asymptomatic bacteria should aay be veated prompt during pregnancy. This patients at 2 igh isk of developing ‘ptonepts from oymptomi bacteria than a panpegrant woman seca dng pregnancy the wend wees nd Increased alucose levels nthe une fact he ascension of orgznsms to he bony. Furthermore eR uneatee thers so an neansed 1k of prema and ow ich wee. ‘Renal luesound can be performed to eval for unary teenon and signs of pelonepi. This pregnant patens {sjmptorai bacteriia puts hea neessed nak of developing pyelonephits. Mower, she doe ot crrerly ave any features that would suggest upper unary war nvohement ey Flank Par fve oF cl) ‘ystoscopy is sometimes petormed to eauae cases of complicated cst ian undering urologic! pathology uspecad sucha stones, malgancien, 0 pope) or racuren Ui tout a Scermiblcaur, Houser, is pregnant pater has asymptomatic bacteria which does ht waren cStseopy| ‘Atnough cpofioraci' feavety used to reat complicates UT ferequroones ae convandicated during pregnancy. AS ‘hate are ote approved enubovc ages, point sheuld be avlded nts pregnant pet. “monte awlnat fst aove agnor aymptomati acca tng pregney rgrancy ntesoe the "isk of bacteria end ecrent UTIs because of erased pessute onthe blade rom the groin Utes, hay Sts and inmunoauppression. Screening fr asymptomatic bacteria recone’ for al reghat wore’ inthe fst mete ‘Asrmpromate acter dunn areprancy soul aMays Geeta sine eases the nsk of Plone the mothe, 1S wal as preterm ceiver and ow ih welt. Ons al ‘49-year-old man brought the emergency depaimert by his wie BecuSe hes vomiting Dood swe repos mat He hs evr experince his before, He hasnt hada load tel meena, or abaoninal pan He was daprosed wth takes ne meacaton, Hes confused ng donated place an ime hice examination shows aSces. Vl 3M a ‘ta oral ms MisRemalobn concercation 8 A Imvavenus fd esusctaion begun Hess fort [raged lod ain tmratenty ch contin: for 10 nets Wen tal hare essed apa, bs ple fe 135 min ard lod pressures 109/80 mig, Wich of he ellowing is the most appropiate nil stp in managenen? ge 8 ont 2a (@) race rasogasic ube (©) Administer packed ved blood cls (© Fevtorm endorse! nabation (© sewer (© Amine inravenown arrest (F) Pertorm upper endoscopy © Aarne cyoprecptae + oats Omns al <2 > ‘49-year-old man brought the emergency depaimert bys wie Becuse hes vomiting blood Hs wereors at haat Boon navsous forthe pat day ap that hat haa 2eprodes of vontng bight re bod aet he pat 2 hour He hs evr experince his before, He hasnt hada load tel meena, or abaoninal pan He was daprosed wth leche tons 6 months ag. He rank epronmaey 1 Ha of vada er the pst ay, whch is yea fori He takes ne meacatons, Physical examination shows aScres. alms ae ‘he oral Kms. He ravenous essen 5 begun ‘ehh cornu for 10 minutes. When tal ne ae meatofed apn he ple = 15 mun an lod pressures 108/80 mig. Wich of he ellowing is the mst appropiate inl stp in manage? “This paint’ repeated epiode fight rad hamarsmess suggest an upper gases bleed mecane ‘management of paves with acute, severe upper gntotestnal ending focued on reaction and sabzaton NL this patent appears emedynamialy sabe for fw but has teres mental stu. 2a Placement ofa nasogasic ube (NET er NGT lavage may be useful wo lp determin whee lod s coming from the upper (rove pacetecsnal ac nl whcher rnot pers fre ergtng Me sing ean en foe sk ocd oa ‘ter stomach cones facia upper gstomtestral endoscopy. Ts stent’ ongoma bright eS hematerests Suggests gang per utara eo NT sce wes Any Ab WO Seats ore ssopags Indications for wansfusion of packed ed stood calla GRC) n puters wih acte upper gantoitestinal bldg cue emmamic sti retractor tld vesuseaton, a hemenlobin concentration below 90 g/m high-risk stents (Gach ase elderly and paers wth unstable coronary aay seas) and a namogioinconcenvasenbetow 7.69/40 Town patents, However, th patent contuce toby hamadynamiel able and fats hetelebnconcetaton oF 85974. Om Ds al Le ‘Aémunsatin of omeprazoe, «proton sump ihibor (PD, Suppresses aad production an sinicant reduces the rte of {ealeecingnpaers with ace uopegasvlnastaal Meedng am pep ucts. Patents wih ongalng Remar ould not ese anything by meth parsculary thay ana have aces mental tt. Pe shoul be semintered irraverousy oat farther ishing espatin. The cause f ths patent’ hemsteet sil uncer, So empiri weatment ith Pris en important par of inal management, though i ot the next bes step forts patent who has tered rena se “Adminstration of ocreot de caves vaoconsiection, which can help conto eure ongoing bieding although does a “ares th primary cause of lading. is inportar in the management of pate wth siapeiedtoghagea ace] Tae Tis elo se es pene ec fr Rel een mes bene sae Tiere, We dics not medi require ineaveneusocveotce. A deent tap m managements mere Urge as tme- Upper endoscopy s bot ages and arapetc a patients wi uspergaswoitestnalading Wo ate hemodynamically "able. n parca, n patent ith suzporederophageal variceal esing, endoscope veal lation ca achieve ‘hemostasis an prevent recutentbkeing The goa for tese cents sto prform endoscopy within th rs 2 hous of presentation However, th pate! sll hasongomg hematemens and ered mart tatu, an heer, upper nosey Isnt te nent best sto fo im. “Admunnatin of eyopreeptats help o correc lw eee of brnogen andi important inthe management f patents wth “inhos's nc coanaon esos wo presen wth cute pes gasoestinalDesding Mowe reament of esophageal problem. ” ge 8 & Ons al a 1 22-year-old woman raid 2, pra 1,228 Weeks gestation admtted ore hospital 20 minutes ater Spomaneous rupture of membranes. Har pregnany has bean compleste by gestational bets teat with inulin er ft ce ‘as deinered vainly Her mmuntatins ate ypto-date. She delves the ida csaean Secon without eters Fare pgs for ef Fear ers afr eid hess tty yh mo ‘usm she hao chang her panies pasevry 2-7 Pours She has asominl ering, expec wen bret, Seas vol er blader four times ince te ith She appens uncomfortable He enpetatue 37.7 (10027 ‘onender. Ther is «healing ansvers suprapubic incision without erythema or discharge fim, nontender vere and tender, weno resness or papable nase, Which ofthe folowng I ee most poroprate ext step m menapeMen? za Ota and emerge (@) sean ofthe etomen and pets wth contat (© [reve wirmcune (©) Adminstration ofimavenous einaunycin and gemamych © Observation 4 BO Omns al <> 1 22-year-old woman gravida 2, pra 12128 wees gestation admatted 0 re hosp 30 minutes ater spontaneous rupture of membranes. Har pregnany has bean conpleste by gestational bets treated wth nul er ft che ‘ss deinered vainly Her mmuntatins ate ypto-date. She delves the ive ae SEC without Complications afte falte o progres fr Iehour Fourteen Rous ater bith, ae feparts hang Boy aches and feng ‘arm, She ras o change hr periea pac evry 2-3 Pours. She nas absomial ramon, especialy wnen brestesig Seas voided er blader four times ince te ian She appens uncool. He engetaure 37.9 (100.27 Pees 85/min respirations ar 18min, ana blond pestree 175/60 mang. The abdomen fs ated, ad ontenger Teves healing ansvers suprapubic i, montane ering ana tender, weno resness or papabe nase, Which of the folowing I te most peroprate ext step m menapeMen? “This patent has lca rubra, Gress engorgeent low-grade fever, and afepans folowing an uncomplicated eseean

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