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Prep4USMLE Forum » USMLE Step 2 CK Forum » Internal Medicine Forum

nbme

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6 Posts

patpelletier
Forum Junior

Topics: 12
Posts: 32

07/23/07 - 07:16 PM

A previously healthy 52-year-old man comes to the emergency department because of hiccups for 1 week. He has smoked two packs of cigarettes daily for 30 years. He does not drink alcohol. He is alert and oriented. His temperature is 37 C (98.6 F), blood pressure is 150/95 mm Hg, pulse is 70/min, and respirations are 12/min. Physical and neurologic examinations show no abnormalities. His serum sodium level is 120 mEq/L. An x-ray film of the chest shows a right hilar mass. Which of the following is the most appropriate next step in treatment?

A) Bisphosphonate therapy

B) Calcitonin therapy

C) Calcium therapy

D) Dexamethasone therapy

E) 5% Dextrose in 0.225% saline therapy

F) 5% Dextrose in 0.45% saline therapy

G) 5% Dextrose in water therapy

H) Fluid restriction

I) Hydrocortisone therapy

J) Lactated Ringer's solution

K) Mannitol therapy

L) Potassium therapy

M) 0.9% Saline therapy

N) 3% Saline therapy

O) Sodium bicarbonate therapy

elitoki
Forum Guru
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Topics: 54
Posts: 508

07/23/07 - 08:07 PM

H. fluid restriction.
this pt is asymptomatic, and probably has SIADH due small cell Carcinoma localed as right hiliar mass.
usually we use the follow datas as fluid req in hyponatremia:
mild - serum Na+ 120-130 - fluid restriction
moderate - serum Na+ 110-120 - loops with normal saline oir demeclocycline
severe - serum Na+ below 110 or symptomatic - hypertonic saline

patpelletier
Forum Junior

Topics: 12
Posts: 32

07/23/07 - 08:21 PM

Goljan says the only ones we don't restrict water is the ones with pulmonary scc because it is unfair.

robin082006
Forum Hero
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Topics: 471
Posts: 5,123

07/23/07 - 08:34 PM

H

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dr in trouble
Forum Guru
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Topics: 62
Posts: 601

07/24/07 - 06:48 PM

I think the answer shud not be fluid restriction.

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Aashi
Forum Moderator
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Topics: 113
Posts: 1,061

07/24/07 - 06:54 PM

elitoki wrote:
H. fluid restriction.
this pt is asymptomatic, and probably has SIADH due small cell Carcinoma localed as right hiliar mass.
usually we use the follow datas as fluid req in hyponatremia:
mild - serum Na+ 120-130 - fluid restriction
moderate - serum Na+ 110-120 - loops with normal saline oir demeclocycline
severe - serum Na+ below 110 or symptomatic - hypertonic saline

Its fluid restriction coz of above said reasons..

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