JJ is a 73-year-old male with acute myelogenous leukemia. He attends the infusion clinic where he receives chemotherapy treatment.  Following his chemotherapy treatment this time he experiences a significant rise in his serum uric acid to 22 mg/dL (this is high). Which of the following is true regarding the best management of his tumor lysis syndrome (TLS)?

LO is a 39yo M receiving his chemotherapy on the oncology unit at the hospital.  The nurse calls you to tell you that the patient has had a fever of 103.4°F for the last 4 hours.  You quickly recognize the patient should be started on antibiotics and contact the MD.  Prior to initiating therapy, the oncologist orders the following labs, cultures, and tests.  CMP- normal,  ANC =100 PE:  Unremarkable, except PICC line insertion site is erythematous, swollen, warm, and there is pus present Microbiology:  Blood Cx x 2, pending Wound culture (PICC insertion site):   G+ cocci in clusters Urine Culture:  no growth to date Urinalysis:   leukocyte esterase (-), Squamous epithelial cells (-), WBC (-) Chest x-ray:  no infiltrates or effusions Patient is currently on Cefepime monotherapy Based on the information you have above, you decide to modify the patient’s therapy.  Which of the following is the best answer? 

TB is a 19-year-old healthy female seeking oral contraception (OC).  She has no history of thromboembolism, cerebrovascular disease or cancer.  After completing an appropriate and normal physical exam with her primary care provider, you recommend she begin the following type of contraceptive therapy: 

PM is a 43-year-old non-obese female newly diagnosed with rheumatoid arthritis with poor prognosis. She has been experiencing symptoms for the past 4 months of joint pain in her first metacarpals. The only notable lab abnormalities are elevated liver function tests (AST/ALT) which are 3 times the upper limit of normal. Vitals are WNL. PMH: Past (10 years prior) alcohol abuse, cirrhosis, and hypertension Home medications: Amlodipine 5 mg PO daily Which of the following is the most appropriate initial therapy for PM?

What medication is contraindicated in patients with G6PD deficiency?

RM is a 54 year old Caucasian woman who presents for follow-up for blood pressure management.  She has concerns about osteoporosis because her mother had a history of it, including multiple fractures.  She did have her bone density tested recently at the local health fair.  She smokes 1 ppd x 30 years, rides her bike 2 miles on 3 days per week and does swim when it’s too icy to ride her bike.  Her medications include HCTZ 25mg once daily, Lisinopril 10mg once daily, Levothyroxine 150mcg once daily, Centrum Vitamin once daily, Calcium carbonate 600mg with Vitamin D twice daily. What non-pharmacologic recommendations would you make to RM at this time?   

AQ is a 52-year-old woman who presents to clinic for follow-up with her PCP to discuss worsening, severe hot flushes.  She explains that she has to get up in the night and change the bedding, is unable to work a full day at her job at least once per week.  In addition, she feels “moody and down in the dumps” most days of the week, for a couple of months now.  Her health history includes hypertension, hyperlipidemia, Crohn’s disease, recurrent DVT and PE, and she did have a hysterectomy after her last daughter was born 21 years ago, due to complications.  She reports that she is at a “point of desperation to feel like myself again”.  Recognizing your expertise in the area of Women’s Health, AQ’s physician calls on you for a treatment recommendation.  What do you recommend? 

What is the goal urine output in patient’s administered IV fluids for TLS prevention?

TT, a 25-year-old comes to clinic today for her annual well woman exam.  She has a history of migraine headaches x6 years and would like to discuss contraception today.  She reports that her migraines have been much better in the past year since she switched from topiramate to Aimovig.  She feels this is because she “hates taking pills and forgets to take them a lot – so much easier to do a shot once a month”.  She is married to her husband for 2 years and admits they are tired of using condoms.  She works full time as a high school science teacher and enjoys her job but looks forward to having kids in the next 3-5 years and staying home with them. Today’s vital signs are: BP 122/72 HR 70 O2 94% RR 18.  She is 5’ 4” tall and weighs 217#.  Which form of contraception would best meet TT’s needs today?

TG is a 59-year-old male who has recently been diagnosed with mantle cell lymphoma. He is receiving the NORDIC regimen (alternating regimens with regimen 1: rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone and regimen 2: rituximab and high-dose cytarabine). He comes into the oncology clinic and you notice he has an unbalanced gait, nystagmus, and a prolonged separation of syllables. You think he might be having cerebellar neurotoxicity due to his chemotherapy. Which medication in his regimen is most likely contributing to his symptoms?