A47-year-old man is postoperative day number 2 after an open cholecystectomy. He becomes short of breath and a medicine consultation is called to evaluate. Vital signs include a temperature of 100°F, pulse rate of 110/min, blood pressure (BP) of 110/60 mmHg, and respiratory rate of 24/min. Blood gas shows a pH of 7.52, carbon dioxide of 28, PO2 of 58, and calculated bicarbonate of 20. What is the primary acid- base disorder in this patient?
Answer(s): D
This patient has an elevated pH (normal is 7.40) indicating alkalosis. Alow carbon dioxide level is consistent with a respiratory etiology of the alkalosis. This occurs when alveolar ventilation is increased relative to CO2 production. Causes may include fever, anxiety, pain, pulmonary, and/or neurologic conditions. In a metabolic alkalosis, a high bicarbonate is seen (a bicarbonate of 20 is low normal).
A20-year-old female presents to the office complaining that her right eye has been itchy and watery. The patient reports that the onset was abrupt. The patient is noted to be afebrile with normal vital signs. Examination discloses a red eye with watery discharge. Minimal preauricular adenopathy is also found on examination. Tonometry is normal. Profuse tearing is noted. Which of the following is the most likely diagnosis?
Answer(s): A
Viral (follicular) conjunctivitis most often presents with minimal discharge and itching as compared to the moderate-to-profuse discharge of bacterial conjunctivitis. While mild pain and photophobia may be noted in viral, bacterial, fungal, and allergic conjunctivitis, preauricular adenopathy is common in viral and fungal conjunctivitis only. Allergic conjunctivitis presents with minimal discharge and marked itching. The patient's young age and normal eye pressure (tonometry) helps to rule out glaucoma.
A 54-year-old man presents to the emergency department complaining of epigastric discomfort, which began while he was walking his dog after dinner about one-half hour earlier. He has not received medical care for several years. On examination, he is moderately obese and in obvious discomfort and seems restless. His BP is 160/98 mmHg, and his examination is otherwise unremarkable. His ECG is seen in Figure below:Which of the following is the most likely diagnosis?
This ECG reveals ST-segment elevation in II, III, and AVF, indicating acute injury of the inferior wall of the myocardium. Inferior wall ischemia can be perceived as pain in the epigastric area. Anterolateral myocardial infarction would show loss of R-wave progression in V4 through V6. Pericarditis would show diffuse ST segment elevation in limb and precordial leads. Although his symptoms could suggest gastroesophageal reflux, this ECG shows this a cardiac event. Costochondritis is not present by examination. When ST segment elevation is present, a patient should be considered a candidate for reperfusion therapy or primary percutaneous intervention (PCI) such as angioplasty and stenting.If no contraindications are present and PCI is unavaliable, thrombolytic therapy should ideally be initiated within 30 minutes, right in the emergency department. The goal of both thrombolysis and PCI is prompt restoration of coronary arterial patency. Thrombolytic therapy can reduce the risk of in- hospital death by up to 50% when administered within the first hour of symptoms, so time is of the essence. Arranging for a bed may waste time for limiting infarct size. The ECG would obviously preclude the other two options:immediate trial of antacid or reassurance and arranging outpatient follow-up.
A 54-year-old man presents to the emergency department complaining of epigastric discomfort, which began while he was walking his dog after dinner about one-half hour earlier. He has not received medical care for several years. On examination, he is moderately obese and in obvious discomfort and seems restless. His BP is 160/98 mmHg, and his examination is otherwise unremarkable. His ECG is seen in Figure below:Which of the following is the most appropriate next step in management?
A59-year-old woman who lives independently and had been healthy, presents to the emergency department with cough and fever. She related she was well until 2 days before when she noted onset of fever, chills, and cough productive of yellow sputum. On examination, you note a tired appearing woman with BP of 160/90, pulse of 105, and respiratory rate of 32. You start her on ceftriaxone and azithromycin and admit her to the hospital. Which of the following factors is a poor prognostic sign in community acquired pneumonia?
Respiratory rate >30 is a poor prognostic sign in community-acquired pneumonia. Other patient factors include age greater than 65 years, coexisting illness such as cancer, liver disease, congestive heart failure (CHF), renal disease, systolic BP less than 90 mmHg, temperature greater than 40°C. Laboratory finding s associated with poor prognosis include arterial pH <7.35, BUN >30, sodium less than 130, glucose >250, and hematocrit <30%. These factors are often used to calculate the PORT (Pneumonia Outcomes Research Team) pneumonia severity index score which can be an aid in making treatment decisions. S.pneumoniae, Legionella, and S. aureus are the pathogens associated with poor prognosis, not Mycoplasma.
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q252: dns poisoning is the correct answer, not locator redirection. beaconing is detected from a host. this indicates that the system has been infected with malware, which could be the source of local dns poisoning. location redirection works by either embedding the redirection in the original websites code or having a user click on a url that has an embedded redirect. since users at a different office are not getting redirected, it isnt an embedded redirection on the original website and since the user is manually typing in the url and not clicking a link, it isnt a modified link.
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for this question - "which three type of basic patient or member information is displayed on the patient info component? (choose three.)", list of conditions is not displayed (it is displayed in patient card, not patient info). so should be thumbnail of chatter photo
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question # 208: failure logs is not an example of operational metadata.
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