By Y. Thordir. Westminster College, Salt Lake City. 2018.

A 60-year-old female with a history of urinary tract infection purchase aleve 250mg without prescription pain treatment sciatica, steroid- dependent chronic obstructive lung disease generic 500 mg aleve with amex knee pain treatment kansas city, and asthma presents with bilat- eral infiltrates and an eosinophil count of 15%. Drug effect of nitrofurantoin 47 Copyright © 2004 by The McGraw-Hill Companies, Inc. Chest x-ray shows an air-fluid level in the superior segment of the right lower lobe. For each numbered item, select the one lettered option with which it is most closely associated. A 30-year-old male is admitted to the hospital after a motorcycle accident that resulted in a fracture of the right femur. A 70-year-old patient with chronic obstructive lung disease requires 2 L of nasal O2 to treat his hypoxia, which is sometimes associated with angina. While receiving nasal O2, the patient develops pleuritic chest pain, fever, and purulent sputum. A 34-year-old black female presents to your office with symptoms of cough, dyspnea, and lymphadenopathy. A 64-year-old woman is found to have a left-sided pleural effusion on chest x-ray. Analysis of the pleural fluid reveals a ratio of concentration of total protein in pleural fluid to serum of 0. A 25-year-old male cigarette smoker has a history of respiratory infections and has also been found to have hematuria. A 25-year-old male with a long history of severe asthma presents to the emergency room with shortness of breath. He has previously required admission to the hospital and was once intubated for asthma. A 40-year-old man without a significant past medical history comes to the emergency room with a 3-day history of fever and shaking chills; a 15-minute episode of rigor; nonproductive cough; anorexia; and the devel- opment of right-sided pleuritic chest pain and shortness of breath over the last 12 hours. Sputum culture is more helpful than sputum Gram stain in choosing empiric antibiotic therapy b. If the Gram stain revealed numerous gram-positive diplococci, numerous white blood cells, and few epithelial cells, Streptococcus pneumoniae would be the most likely diagnosis c. Penicillin is the drug of choice in all cases of pneumococcal pneumonia Items 124–125 124. A 57-year-old man develops acute shortness of breath shortly after a 12-hour automobile ride. The patient consults his internist, and findings on physical examination are normal except for tachypnea and tachycardia. The patient should be admitted to the hospital, and, if there is no contraindica- tion to anticoagulation, intravenous heparin should be started pending further testing c. Normal findings on examination of the lower extremities are extremely unusual in this clinical setting d. An anxious young woman who is taking birth control pills presents to the emergency room with shortness of breath. The absence of which of the following would make the diagnosis of pulmonary embolus unlikely? A 65-year-old male with mild congestive heart failure is to receive total hip replacement. He has no other underlying diseases and no history of hypertension, recent surgery, or bleeding disorder. Which of the following is characteristic of asthma but not other obstructive lung disease? Exacerbation often occurs as a result of an upper respiratory tract infection Items 129–133 For each clinical situation, select the arterial blood gas and pH values with which it is most likely to be associated. A 30-year-old obese female bus driver develops sudden pleuritic left- sided chest pain and dyspnea.

This patient is excreting a large volume depletion cheap 500mg aleve otc pain management for osteosarcoma in dogs, diabetes discount 250 mg aleve with mastercard pain treatment center llc, congestive heart failure, mul- amount of dilute urine. He is not excreting >750 mosm tiple myeloma, or chronic renal failure have an increased in his urine daily, which would suggest diuretic use. The urine sediment is bland Either central or nephrogenic diabetes insipidus must be in mild cases, but with acute tubular necrosis, muddy the cause. Therapy is directed at limiting imaging should be obtained to rule out destruction of the further drug absorption by administering activated char- neurohypophysis. Hyper- ysis is reserved for severe cases, especially those involving glycemia and hyperlipidemia can cause hyponatremia, but fulminant renal failure. Diabetes insipidus is a hyperna- are caused by the presence of calcium oxalate in the tremic disorder caused by excess water loss. Calcium oxalate crystals are classically seen in eth- ylene glycol ingestion, which also causes a high anion 96. The respiratory compensation for a 1 g/dL from normal lowers the expected anion gap by metabolic alkalosis is limited by the hypoxic drive. Nursing home residents are at risk for institutionally acquired diarrheas, which are often infectious. Defects in the renin- sis can be divided into those disorders with extracellular angiotensin system, such as hypoaldosteronism, cause fluid contraction and normotension (or hypotension) and hyperkalemia, not hypokalemia. This patient has no evi- those with extracellular fluid expansion and hypertension dence of renal failure. N Engl J Med causing cardiogenic shock would result in an anion gap 338:26–34, 1998. It is absorbed in the small losis is caused by direct stimulation of the respiratory intestine and stored in the liver. The accumulation of lactic acid and the enzymatic carboxylation of glutamic acid residues on ketoacids leads to the concomitant metabolic acidosis. The three major causes of 552 Review and Self-Assessment vitamin K deficiency are poor dietary intake, intestinal thromboembolism sevenfold. Therefore, vita- with activated coagulation proteins and blocks their bio- min K deficiency manifests with prolongation of the logic activity. Both agents are therefore rea- reflects either a deficiency of one of these factors (e. Plasmapheresis has no role in the treatment of factor inhibitor or phospholipid inhibitor. Instead, they are at risk for exert antiviral effect but may be an immune modulator venous and arterial thromboembolisms. Hemolytic anemia history of recurrent unplanned abortions or thrombosis occurs in nearly 25% of patients receiving this therapy. Interferon has common side effects as well, including flulike symptoms, depression, sleep disturbances, person- 105. This disorder alone may account for broader spectrum of activity than fluconazole against ≤25% of inherited prothrombotic states, making it the Candida spp. It is avail- mutation increases an individual’s lifetime risk of venous able in oral and parenteral forms. Chemotherapy is most effec- interacts significantly with many other medications, tive for small cell lung cancer, lymphoma, or germ cell including immunosuppressive agents, such as tacrolimus, tumors. Some non–small cell lung tumors are responsive that are often used in patients at risk for systemic fungal to novel chemotherapy agents. Voriconazole may also cause liver toxicity and effective for palliation and may be considered to prevent photosensitivity. The minimum radiologic evidence for cord B-1,3-glucan synthase, a necessary enzyme for fungal compression is compression of the theca at the level of cell wall synthesis that does not have a human correlate. However, radiologic confirmation is not These agents are available only parentally, not orally. It is not a first-line therapy for Aspergillus noma, lymphomas, and melanomas may also cause spinal infection but may be used as salvage therapy. The most commonly affected site is the echinocandins, including caspofungin, have an extremely thoracic spine (70% of cases) followed by the sacral spine high safety profile. Pain is usually present for days or months before mucormycosis, paracoccidiomycosis, or histoplasmosis.