A 26-year-old man presents with a 2-day history of worsening right lower leg pain. He states that he believes his right leg is swollen when compared to his left leg. Past medical history is significant for generalized anxiety disorder, managed effectively with psychotherapy. He smokes a pack of cigarettes daily but denies alcohol and illicit drug use. His father died of a pulmonary embolism at the age of 43. His vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, respiratory rate 14/min. On physical examination, the right lower leg is warmer than the left, and dorsiflexion of the right foot produces pain. Which of the following conditions is most likely responsible for this patient’s presentation?
AVitamin K deficiency
BHemophilia A
Cvon Willebrand disease
DFactor V Leiden
EFactor XI deficiency
A 70-year-old man with a recent above-the-knee amputation of the left lower extremity, due to wet gangrene secondary to refractory peripheral artery disease, presents with weakness and dizziness. He says that the symptoms began acutely 24 hours after surgery and have not improved. The amputation was complicated by substantial blood loss. He was placed on empiric antibiotic therapy with ciprofloxacin and clindamycin before the procedure, and blood and wound culture results are still pending. The medical history is significant for type 2 diabetes mellitus and hypertension. Current medications are metformin and lisinopril. The family history is significant for type 2 diabetes mellitus in both parents. Review of symptoms is significant for palpitations and a mild headache for the past 24 hours. His temperature is 38.2°C (100.8°F); blood pressure, 120/70 mm Hg (supine); pulse, 102/min; respiratory rate, 16/min; and oxygen saturation, 99% on room air. When standing, the blood pressure is 90/65 mm Hg and the pulse is 115/min. On physical examination, the patient appears pale and listless. The surgical amputation site does not show any signs of ongoing blood loss or infection. Laboratory tests and an ECG are pending. Which of the following is the next best step in management?
AAdminister IV fluids
BAdminister oral fludrocortisone
CAdminister IV norepinephrine
DAdminister oral midodrine
EAdminister IV fluids and withhold lisinopril
An 8-year-old boy and his 26-year-old babysitter are brought into the emergency department with severe injuries caused by a motor vehicle accident. The child is wheeled to the pediatric intensive care unit with a severe injury to his right arm, as well as other external and internal injuries. He is hemorrhaging and found to be hemodynamically unstable. He subsequently requires transfusion and surgery, and he is currently unconscious. The pediatric trauma surgeon evaluates the child’s arm and realizes it will need to be amputated at the elbow. Which of the following is the most appropriate course of action to take with regards to the amputation?
AObtain an emergency court order from a judge to obtain consent to amputate the child’s arm
BFind the child’s parents to obtain consent to amputate the child’s arm
CAmputate the child’s arm at the elbow joint
DWait for the child’s babysitter to recover from her injuries to obtain her consent to amputate the child’s arm
EWait for the child to gain consciousness to obtain his consent to amputate his arm
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