Kamsi
Forum Guru
Topics: 103
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A 67-year-old man comes to the physician because of a2-month history of progressive shortness of breath. He has had a4.5-kg (10-lb) weight loss over the past 4 months. He has not had chestpain. He has congestive heart failure treated with furosemide,digoxin, and enalapril. He has smoked two packs of cigarettes daily for 30 years.He appears alert and is in no acute distress. His temperature is37.2 C (99 F), blood pressure is 140/85 mm Hg, pulse is 84/min, andrespirations are 18/min. Examination shows no jugular venous distention. Thereis dullness to percussion, and breath sounds are decreased at theleft base. Cardiac examination shows a laterally displaced point ofmaximal impulse, normal S1 and S2, and an S3 at the apex. There is 1+ edemaover the extremities. An x-ray film of the chest shows anenlarged cardiac silhouette, left hilar fullness, and a moderate-sized left pleuraleffusion. Thoracentesis yields straw-colored fluid. Laboratorystudies show:Serum Glucose 90 mg/dLProtein 7 g/dLLactate dehydrogenase 300 U/LPleural fluid pH 7.25Glucose 75 mg/dLProtein 4.5 g/dLLactate dehydrogenase 280 U/LLeukocyte count 2000/mm3Segmented neutrophils 15%Lymphocytes 85%A Gram's stain and acid-fast stains are negative forany organisms. Which of the following is the most likely cause ofthis patient's pleural effusion?A) Bacterial pneumoniaB) Collagen vascular diseaseC) Congestive heart failureD) MalignancyE) Pulmonary embolus with infarctionF) Viral pleuritis
27. A 43-year-old man comes to the emergencydepartment because of fever, chills, malaise, cough, and pleuritic chestpain for 3 days; the cough is productive of foul-smelling, purulent sputum.He has alcoholism. His temperature is 39.2 C (102.6 F),blood pressure is 110/70 mm Hg, pulse is 120/min, and respirations are 14/min. Hemoglobin level is 15 g/dL, and leukocyte count is 25,000/mm3. An ECGshows normal findings. An x-ray film of the chest shows a 4-cmcavity in the superior segment of the right lower lobe and an air-fluidlevel. While awaiting results of sputum culture, which of the following isthe most appropriate next step in management?A) ObservationB) Broad-spectrum antibiotic therapyC) Isoniazid therapyD) Intravenous amphotericin B therapyE) Tube thoracostomy
A 42-year-old woman comes for a follow-up examination.Two weeks ago, her blood pressure was 152/94 mm Hg during a routinevisit. Her blood pressure today is 150/94 mm Hg, pulse is 76/min, andrespirations are 14/min. Examination shows no other abnormalities. Serum studies show:Na+ 142 mEq/LCl– 105 mEq/LK+ 4 mEq/LHCO3– 26 mEq/LUrea nitrogen (BUN) 12 mg/dLGlucose 101 mg/dLCreatinine 0.8 mg/dLAn ECG shows no abnormalities. Which of the followingis the most appropriate next step in management?A) Measurement of plasma renin activityB) Serum lipid studiesC) 24-Hour urine collection for measurement ofmetanephrine levelD) EchocardiographyE) Captopril renal scan
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| kpmle2
Forum Elite
Topics: 29
Posts: 290
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1) D) Malignancy
2) B) Broad-spectrum antibiotic therapy
3) A) Measurement of plasma renin activity
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| donjuan
Forum Junior
Topics: 9
Posts: 68
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Why not?
D
E
E
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| dr confused
Forum Senior
Topics: 66
Posts: 107
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D
B lung abcess so antibiotics
no abdominal bruit so not E
and why A?
his Na and K are good
i go for B
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| kpmle2
Forum Elite
Topics: 29
Posts: 290
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yes the last Q should be B) Serum lipid studies
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| donjuan
Forum Junior
Topics: 9
Posts: 68
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i previously said E but she has no abdominal bruit so it has to be serum lipids
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| tamerbashir
Forum Elite
Topics: 20
Posts: 284
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D
B
A
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| usmle12
Forum Senior
Topics: 19
Posts: 194
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1> malifgnancy>>weight loss high ldh
2>brod spectrum antibiotics
3>captopril renogram>>cz most coomon cause of secondary htn and almost 50%have not abdominal bruit..plus noraml labs
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