NEXT BEST STEP
A 67-year-old smoker with unilateral calf swelling and a high Wells score. Ultrasound unavailable.
Start therapeutic anticoagulation with heparin.
Fever, sore throat, posterior cervical LAD, splenomegaly, atypical lymphocytes.
Infectious mononucleosis (EBV).
Microcytic anemia, low ferritin, high TIBC, low transferrin saturation.
Iron-deficiency anemia.
Stable atrial fibrillation with RVR and normal EF.
Rate control with beta-blocker or diltiazem.
25-year-old woman with abdominal pain, CMT, mucopurulent discharge. Stable for outpatient treatment of PID.
Ceftriaxone + doxycycline
Proximal muscle weakness, elevated CK, heliotrope rash.
Dermatomyositis.
Anion gap 24 acidosis + calcium oxalate crystals in urine.
Ethylene glycol poisoning.
Therapy that reduces mortality in COPD with chronic hypoxemia.
Long-term oxygen therapy.
58-year-old man with inferior STEMI, hypotension, JVD, clear lungs
Give IV fluids to increase preload.
Refractory hypertension, metabolic alkalosis, spontaneous hypokalemia.
Primary hyperaldosteronism.
Low serum osmolality, high urine osmolality, urine Na > 40.
SIADH.
Preeclampsia with severe features at 34 weeks.
Give magnesium sulfate + deliver the baby.
72-year-old diabetic with fever, hypotension, gas in renal parenchyma on CT.
Emergent nephrectomy + broad IV antibiotics (emphysematous pyelonephritis).
Forgetfulness, urinary incontinence, magnetic gait.
Normal pressure hydrocephalus.
Fever and flank pain 6 hours after transfusion; acute hemoglobin drop.
Acute hemolytic transfusion reaction.
COPD exacerbation with hypercapnic acidosis (pH 7.26, CO₂ 65).
Start BiPAP.
HIV patient (CD4 48) with dyspnea, ground-glass opacities, sulfa allergy.
IV pentamidine.
Psychosis, seizures, autonomic instability, ovarian mass.
Anti-NMDA receptor encephalitis.
Patient on amphotericin B develops hypokalemia + hypomagnesemia.
Renal tubular toxicity → Type 1 RTA.
Severe alcohol withdrawal in a patient with liver failure.
Use lorazepam or oxazepam