is URS TGSEOBEWNRSR HGR, 22 y-twe as sng ote vamunste been uring an nceneeprometr ever nuts sce recovenng om her surgery Prior sees, her ony reactors were a multi and an Petal welgh-oss preparation. he appears uncomdotal. He tempers 5TRC (100.07, pulse 90/r and blend pressure a 118/78 en Ho. Exarination shows ld FR HSER (SiS: ita GEBNG SENG. tomas signs regs, The abdomen ssf and snows ase {eyes papa. Tere we re bomnapwospc mcs wi fo eens fre, Teangs te STs pant ha oueling fhe ight lower extersy and fxer wth no eres ping edema, or pun and Ham's Sian snegtbe However, er pretest probably of dep ven trombst (DVT usihg Wels cen for DVT 53 Gta Or pcre cancardagiass, major sugary mtn ¢ weeks, and te ene eg swolin),caingarmodeate probably ss ct pumorary anoarepry ‘Compresion lrasonegraphy she estf choc or lignosing deep vin dvomboss Given the patent’ hgh risk of YT (Was score 23) and cite leg seling with fever, DVT mut be fled oat “(© cones verograsy © vencomen therapy so) atten hepa wry A® eben se(H) 2 seo ood curesDyan bvTiey|.2-yearold man's rouge 1th emerge department for heaton of Dowel movement He was cagrosed with hypertension 2 yeas go and as started on hyoclrehazide He stopped {aking is ps1 wee ago because ot several episodes of eat acing an daziess a he aubutes (ois madison P86 63.7. ule 120 man, reprations ae [6m ne blo pes |r 139 9 mm Hs Care oxaminason| a era res ya EEMERIE 01-0 5 -2.2 meq Lactate dayaroganae 105 UL Cr anglogcapy is perormas ara tbe agnosis is cnt. Which o te folowing sme mostapstopite dine Ths poten has severe abdominal pan spropordonate Wo hs unrenarable abomial examinaten This fading along ‘th eutoytni, elevated acne an lanate dahyrogenate, tal Rian (regal agua heh) =r sete odrsion of symotoms are most consistent wh embolic ocuson of the meseneic ares ecate mesenteric ‘sone2=(@) Experts laparotomy 2o(B) Anvecagulaton wth hepa 15 @ colonoscopy (®) MR angiogrpty = © Pres : g BS tncestnal ischemia|A5-year-old man comes tothe psn for evalua of fever anda nonoreduene cough forthe past 2 weeks: During ‘is pana, ne has had ety beading ih swe, an BIBI Ore mon 2, he UREA EGE [EERE congrats storie perth score bypeenne, sth, ae "ype 2 diabetes melts. colonoscopy 2 yeas ago was normal. The patent has smoked ope pack of gees Gal or the past 40 year He has never ard i drape Curent medications inca pin, wat, nop metfomn, inhale albtero anda rulvtarn. The pte’ appears weck 2d thao. TGRRRUEISSPE TOR, puss ‘Ham sear oer the et stra borer ana reaaes to te nae steal borer. A poteaaph of is naht Inge trge Stour. Laboratory stuces show a ORBEA BURETSIDD ronan GOSH SEOMEMUEN TE “Tis pasen ha a recent orc valve replacement and now presents wih fever, dyapne, palpation, anew hast ‘urmar, ane spite Remsrnagee stella lshoqor al fwmch ae hgh suggentoe st prostacte vue 2a « 2 @) streptococcus gulehacis 2(@) sreptocoeus preomeriae Stapyfococcusopitrmissi lading caute of cay prone valve encocaal, when acute within 60 days ar eu Valve replacementsmelang & eptermisahe most kay cma rgensm. 8 2) seohvecceu suave =O) vee pcos 2 @ seepocces pyogenes © espe gneronwe‘elec Resp SIGCSE SRP meno ene lowing te mar sppoprate nex pn Inenagerere 9 Soa Zo ‘5 @) Or pena v= genamicn for weeks 5 @) ort efempin for 2 weeks (©) Imrevenaus ampictin = nlampin + ceftimone for? weeks (©) Or gmcamiin = cfranone for 4 weaks AB) or amon fore wasie 1 amp can be sea fora Suro vae replacement maybe equed. so(@) mesenous gentamicin + pantlin for2 eke 3G) mraenous vince 4 wks14.23-yearold man comes tothe emergency department because ofa S-day history of progressively worsening He has ha intermittent episodes of ERESEBA, wich nas 4/10 in Iensty and increased on inspiration He does tHathlons and has not been able to tra because ofthe discomfort He has had no fever orsyncopl episodes He had an Upper rexprtory tract infection 3 weeks ago. His father ed of heart disease at the age of $5 years. ls teperatre 36.8 (95.2°7, pulse 1s 113/min, and blood pressure 1s 100/70 mm Hg. Examination shows Jagulf venous Inspiratory BEM are heard throughout the thorax. Cardiac examination show an §§ gallop. Laboratory studies show k> Hemoglobin 14.8 gid Leukocyte count 9200/mm* Peet count 230,009) mm" ese. 441 mmyhe serum (Creatinine 1 mg/dL ‘cweese 32 mgidt, Troponin! 0.204 ng/mL N< 0.1 ng/ml) ‘an x-ray ofthe chest shows 2n and prominent vascular markings in both lung fields. An ECG shows ‘which of te following echocardiograpc Findings 1s most likely inthis patient? ee hear fallure, most likly secondary 10 myocarditiss2x@) Right ventricular cation and hypokinests , 8 ®) Localized hypokinesis - Bol erent erence te eet - ss @ stoic anterior motion ofthe mil valve - vo(©) increased left venicular wall hickness = = (F) Moat valve stenosis wth lft atria enlargement - Left ventricular dilation and (usually global) hypokinesis on echocardiography are diagnostic of dilated cardiomyopathy, inthis case most likely secondary to viral myocarditis. Myocarditis has @ broad range of clinical presentations, from subclinical (and often undiagnosed) 0 acute heart failure, as seen inthis patient. If myocarditis is suspected (e.g, previcusly young healthy patient has acute heart failure ar cardiac pain) an ECG, cardiac biomarkers (e.9., ropanin) and chest x-ray should be obtained, Echocardiography is indicated to confirm ventricular dysfunction..sa-yearold woman brought tothe amatgancy department Scans f HTN an mic HOMIES LRH ice she woke up cat morning. The pain WEN 08 SBaton, end She describes 38S cu of TOInmensy. (00, GST, ssp atione ae 20 ron, and led peers HO3PTAMERHG use exe on room st Shows a oxygen stration of 93%, The langs ae! to auscultation. Cardiac examination shows mo abnormal. There awe hele lite surgical rein on he esd ofthe chest Stra lower extern ate not swale ot {anda aboray sue show s norma complas blood coun restinne of -0 mg/d aTennine sarc of {1 mLimin (normal 95 = 20mm). Ai od gs ana on Yoom a Shows pe 7a Fear 28mmtp fon Somme eos 22muqit ‘an cray ofthe chest stows no abnonralites, which of he following she most anpropnate next step in management? 5 forne diagnosis that bee explains the Symptoms this women’s Seer hes pn end dysprea make a cago of (ee eee Sees airtime puerto ey anon fe rl mi rent fn ring uy Sony ar an avy ha vodafone amo gah aa Sig aig mbna a Senn oy or fag ety eseFour dye afer undergoing 2 eanotom anderen for a meningioma 2. sca-old may Tat Evers pal an lng betinant estar He ha type 7 betes malts enone Kidney seat, and ward on erode 2 ea {oe Proroaamision nis medtators were sul eaapl, toast a seve. Hs temperatures 383 (GOV), ple 10 min ara resur 120/60 mm hp exmnaon shows stellen arm an erytematt ‘he cession Feit ROBT CHUSS SETI INTHE MGHTCAH Te peripheral elses ae palpate ater toys count “The presence of pana Sweing of he oh a wih fev! anda Zostve Homa’ Sion (orien fee fot causing ‘min th eal iceatos dep am thrombotic push thigh ik of desleping pulmonary embolism. a ei elt ten roe ee een ‘Soka score beding), complains tom anicanulsun, of une hav faa arecaaguaton his pata neste + sect ora merngima 4 sas Secaane othe ak fr seconde hemarhage,aneccoglo 2‘horn tanh wes uo opal agora omnce She has ye caus aan | 7 SEs Gorse, pulses 104/min ana toed pesure 180/90 mm ro. lamination shows pak conunctvs and smal ee ae opp et areca ‘i-inr heard banat th thi neon spe an accented by leering formar Te plan Ustkoere count 350 mm secs 25-20/hot ‘an eenocarsograshy shows multiie EGER GAINS SOHHEGNE. SoS euires GW SzaMOHRIEU. Snes weaved wth fimotein and gentamein for? weeks ans her symptoms resolve. A repent eehorargograshy at 3 wet shows Mis sore “heck ess and naa finding ane dsb he mao and int Bake aia fora tne agnoc of (psrealry i nascar na cearca canara bach wel etabishe. cee, ktm ule water Spades ‘pure tne ceagy of caret msugnaes er cancegues fhe esse oenarcopy i acted na pest ih 1S butapreas om is etre BoweAciraraténoran met menaneo apumat or neonate shesetvestant (EI 2 a Hemogiobin 63 moja Urea vagen 130 mara Which of th flowing ithe nex best step in management? “This patent, who has a story of chronic key sas, presents with Becks ad hypotension, dstant hea sounds, nd jour venous deteon which nda cuciac tamponade ‘Miges whe ne tht mens tay euers hor Cronts peel efron Ses tare hresahermnas ae