A 26-year-old woman with no prior medical history presents to the emergency department (ED) with progressively worsening dyspnea for 1 week. Her symptoms are preceded by 3 days of fever, rigors, and nasal congestion. She is afebrile with HR of 116 beats/min and BP of 92/70 mmHg. Physical examination reveals bilateral rales, elevated jugular venous pressure, 2/6 systolic murmur at the left lower sternal border, cool extremities, and 2+ bilateral lower extremity edema. Echocardiogram reveals LVEF of 20%, nondilated LV (LV end-diastolic diameter of 3.4 cm), global hypokinesis, mild mitral regurgitation, and a normal right ventricular function. Labs are significant for creatinine of 1.6 mg/dL, aspartate aminotransferase (AST) of 385 U/L, alanine aminotransferase (ALT) of 413 U/L, troponin I of 4.8 ng/mL, and serum lactic acid of 2.8 mmol/L. Intravenous diuretics and dobutamine are initiated. Within 24 hours of admission, the patient develops hypotension and worsening heart failure refractory to inotropes and vasopressors. Urine output is 125 cc in the last 6 hours.  Which of the following is the best next step in her management to stabilize her?

A 45-year-old male with morbid obesity (BMI 55) presents to the ED at 6 AM with right leg pain, and cellulitis that has kept him awake all night. He is admitted to the ward and his fevers and skin examination are improved with antibiotics during the first 16 hours of hospitalization. At 2 AM you are called to evaluate the patient for ICU admission because of somnolence and hypoxemia (SpO2 falling to high 70s on 2LNC). The rapid response team had difficulty waking the patient and ABG was performed before your arrival in the patient’s room: 7.29/74/52. Following arterial puncture, the patient woke up and by your arrival he is able to converse but remains sleepy with eyes closed, denying dyspnea, with SpO2 now 92% on 2LNC, and normal work of breathing. Medication history was reviewed, and no opiates have been administered. The ward team is requesting ICU transfer because of acute hypercarbic respiratory failure and initiation of BiPAP. You review recent laboratory test results and note that serum bicarbonate has been 38 to 40 over the last 6 months.Which of the following statements is true?

A patient presents with a new onset of chest pain, diaphoresis, ST segment depression in two contiguous leads, and a troponin I level of 0.5.  Of the following, the most likely diagnosis is:

A 38-year-old, 155 cm, 50 kg, previously health female presents to the ICU with altered mental status, tachycardia, hypotension, and high fever. She is intubated for airway protection. Her laboratory test results reveal a markedly elevated T3 and T4 level with a decrease in thyroid-stimulating hormone level consistent with thyroid storm. Her arterial blood gas shows a pH of 7.24, PaO2 of 80, PaCO2 of 52, and HCO3 of 22. Her ventilator settings are volume control, tidal volume of 350 mL, respiratory rate of 14, positive end expiratory pressure (PEEP) of 5, FiO2 of 50%. Which of the following is the next appropriate step in management?

46. Which food should be avoided during pregnancy due to listeria risk?  

A 56-year-old male with 30-pack year smoking history, CAD, and advanced liver disease due to alcoholic cirrhosis is being evaluated for a liver transplantation. He complains of worsening shortness of breath. His heart rate is 110/min, blood pressure is 97/64 mm Hg, respiratory rate is 32/min, and saturation 90% on 5 L/min nasal cannula. When asked to sit up in bed, the patient states that he “usually breathes better” when lying supine.  Which of the following is the MOST likely pathophysiology behind the diagnosis?

Which of the following subatomic particles adds negligibly to the total mass of an atom?

What anatomical landmark(s) will help you determine medial orientation in a transverse view of the carotid system?

Do you agree to the Academic Dishonesty Policy within the syllabus for this course, confirming you will submit all work with academic integrity as your own intellectual property and acknowledging the consequences of a failing grade?

Acknowledge your understanding of this course being “hybrid”.