Shock!
76yo F presenting with rigors, abdominal pain and altered mental status. Patient's vitals are the following:
Temp: 101F, HR 104, RR 2, spO2 95%, BP 80/60
She is given 3L of normal saline, BP afterwards is 81/65. What would you expect SVR and cardiac output to be?
SVR to be decreased
Cardiac output is normal or increased
25 y/o M brought to ER 15 min after being found lying on street. Neighbor reports that patient was jogging before falling to the ground. Patient is wearing a medic alert bracelet indicating that he has type 1 DM. No other history can be obtained. No evidence of trauma, does not respond to verbal stimuli but moans and thrashes in response to painful stimuli. Temperature 37, pulse 90, respiration 12, BP 112/70. Exam shows no other abnormalities. Next best step?
A. MRI of the brain
B. 50% dextrose in water
C. 1L Normal saline
D. Urine toxicology
B
Duke's criteria for endocarditis
Major: + blood culture, evidence of endocardial involvement
Minor: fever >38, risk factor for infectious endocarditis, vascular phenomenon (emboli), immunologic phenomenon (GN, roth spots), microbiologic evidence that does not meet major criteria
Name that shock:
Cardiac output decreased
SVR increased
PCWP increased
Cardiogenic shock
19yo M found with type 1 DM was brought in by family because he was acting strangely. Blood sugar in the ED was 300. Parents notified you that patient had not been taking his insulin for the last week. You accurately diagnose the patient and start insulin and normal saline. After 4 hours, what would you expect his potassium, bicarbonate, pH of blood and blood pCO2 to be compared to his labs on admission?
Potassium would decrease
Bicarbonate would increase
blood pH would increase
blood pCO2 would increase towards normal
3 most common infectious causes of fever of unknown origin?
Occult abscess
TB (extra-pulmonary)
Endocarditis (coxiella and bartonella which are not as easily identified as HACEK)
26yo M is brought to the ED 30 minutes after being shot in the leg. He is unconscious and appears markedly pale. His pulse is 120/min, respiratory rate 16/min, and blood pressure is 80/60 mm Hg. Compared with a healthy adult, what would you expect the patient's SVR, PVR and net systemic capillary fluid transfer to be?
Increase in SVR
Increase in PVR
net absorption into capillaries
72yo F presents to the ED because of a 3-day history of progressive confusion and lethargy. She underwent bilateral hip replacement 6 years ago. She takes no medications except for aspirin as needed for osteoarthritis. She is unable to answer questions. Her temperature is 36.2°C (97.2°F), pulse is 110/min and regular, respirations are 20/min, and blood pressure is 110/70 mm Hg. Examination shows a supple neck. The lungs are clear to auscultation. Cardiac examination shows no murmurs or gallops. The abdomen is soft with no guarding; bowel sounds are present but hypoactive. Deep tendon reflexes are 1+ bilaterally. Babinski sign is absent. Serum studies show
Na+ 135 mEq/L
Cl− 100 mEq/L
K+ 4.2 mEq/L
HCO3− 22 mEq/L
Urea nitrogen 52 mg/dL
Glucose 602 mg/dL
Creatinine 2.4 mg/dL
What is the likely diagnosis?
Nonketotic hyperosmolar state
3 most common inflammatory(autoimmune) causes of fever of unknown origin
Adult still disease
SLE
in adults >50years, giant cell arteritis
76 year old man falls at home and is diagnosed with an acute anterior MI. BP is 80, he is clammy. You hear crackles and heart tones are muffled, you hear an S3. What is the cause of the hypotension?
Decreased cardiac contractility from cardiogenic shock
What are the diabetes diagnostic criteria?
Fasting blood glucose >126mg/dL
Random blood glucose >200mg/dL + symptoms
A1c >6.5
Blood sugar >200 following 2h OGTT (glucose load 75g)
A 22 y/o woman comes to the physician for a follow-up examination. One year ago, she was diagnosed with a pulmonary embolism. Two years ago, she delivered a female stillborn at 23 weeks' gestation. Physical examination today shows no abnormalities. Lab studies show a normal platelet count, normal prothrombin time, and increased partial thromboplastin time. The findings in this patient are most consistent with which of the following conditions?
A. Factor V Leiden
B. Antiphospholipid syndrome
C.Protein C deficiency
D. Increased factor VIII
B. Antiphospholipid syndrome
After falling from a 10foot ladder, a patient is brought to the emergency department. The patient is alert, reports back pain, and difficulty moving the lower extremities. Which additional observation is an indication the patient may be experiencing neurogenic shock?
A. Cool, pale, clammy
B. Bradycardia
C. Poor skin turgor
D. Increased blood pressure
B. Bradycardia
Screening criteria for diabetes in adults
Anyone with blood pressure >135/80
All adults over age 45; every 3 years
Adults with BMI >25 with additional risk factors (physical inactivity, first degree relative with diabetes, high risk race/ethnicity, women who delivered babies >9lbs, HTN, HDL <35 with triglycerides >250)
A 21-year-old woman is evaluated for a 2-week history of worsening rash and arthritis as well as intermittent low-grade fever. She has a 5-year history of systemic lupus erythematosus (SLE). She has been doing well without active disease for the past 3 years and has been compliant with hydroxychloroquine.
On physical examination, temperature is 37.8 °C (100.0 °F), and blood pressure is 150/86 mm Hg; other vital signs are normal. A malar rash is present. Diffuse tenderness and swelling of multiple small joints of the hands are present. New dependent edema is present.
Laboratory studies show low C3 and C4 complement levels, a serum creatinine level of 1.8 mg/dL (159.1 µmol/L), a urine protein-creatinine ratio of 3200 mg/g, and active urine sediment on microscopic examination.
Which of the following test should be performed?
A. anti-Ro/SSA and La/SSB
B. anti-double stranded DNA
C. ANA
D. Anti-U1-ribonucleoprotein antibodies
B. anti-double stranded DNA