DF is a 32-year-old female (100 kg) who is brought into the emergency department after slipping on her icy driveway and hitting her head.  She is currently confused, only answering “yes” or “no” to questions and complaining of a severe headache.  She is known to be dialysis-dependent and has a mechanical valve for which she is on warfarin.  Her INR on admit is 2.5, and her blood pressure is 216/128 mmHg.  Her pregnancy test is currently pending.  A head CT shows a large subdural hematoma and a smaller subarachnoid hemorrhage, with brain swelling.  A peripheral line is placed for medication administration.    Use Case 2 for questions 37-47

Which of the following appropriately describes a primary analysis conclusion from the Steroids in Septic Shock, Patient Level Meta-Analysis regarding the use of steroids for treatment of sepsis/septic shock?

PJ is a 53-year-old male (92 kg, BMI 32) with a history of Duchenne muscular dystrophy, diabetes mellitus, and hypertension who resides in a skilled nursing facility.  He is brought to the hospital with confusion, shortness of breath, cough, and increased sputum production consistent with pneumonia.  One month prior to presentation he received a 10 day course of ciprofloxacin for a suspected urinary tract infection.  Vitals/labs on arrival include BP 71/48 (MAP 58), HR 127 beats/min, SCr 4.9 (baseline ~0.6), estimated CrCl = 21 ml/min, urine output 78 ml in last 4 hours, K = 5 (normal range = 3.5-5.1), RR 32 breaths/min, PaO2 = 54 on Room Air (PaO2/FiO2 ratio = 257), Glasgow Coma Scale (GCS) = 9, T 39.0 C, WBC 13.8 (normal range = 3.8-10.5), plt 350 (normal range = 160-370), ALT = 182 (normal range = 13-59), AST = 121 (normal range = 0-40), bilirubin = 1.4 (normal range = 0-1.4).    Use Case 1 for questions 1-36

What lab(s) should be drawn to diagnose septic shock? 

Show your work for this problem on your paper. You must show that you are using the requested method in the solution of this problem. A correct answer alone or computed by another method are not acceptable.Use the Egyptian technique to compute 54×130. Write your work using Hindu-Arabic numerals. Question:My response to this question has been recorded with the written work I will submit at the end of this test.

Nephrology decides to start continuous renal replacement therapy.  Would you expect the following medications to be cleared by CRRT? (0.5 points each) –> A medication that is 98% protein bound

Should the patient’s sedation and pain management plan be changed now that paralytics are going to start?

The next day, nephrology is evaluating PJ for dialysis.  Which of the following are all correct reasons for dialysis?

Show your work for this problem on your paper. You must show that you are using the requested method in the solution of this problem. A correct answer alone or computed by another method are not acceptable.Use the Egyptian method of division to compute 52÷9. (Hint: fractional multiples of 9 included 23, 13, 19, and halves of those values, as needed). Write your work using Hindu-Arabic numerals and our representation of Egyptian fractions.Question:My response to this question has been recorded with the written work I will submit at the end of this test.

Which of the following statements regarding epinephrine use in septic shock is true?