A 61-year-old female with congestive heart failure and type 2 diabetes is brought to the emergency room by her husband because of an altered mental status. He states he normally helps her be compliant with her medications, but he had been away for several days. On physical exam, her temperature is 37.2 C, BP 85/55, and HR 130. Serum glucose is 500 mg/dL. Which of the following is the first step in the management of this patient?
AIV ½ NS
BIV insulin
CSubcutaneous insulin injection
DIV NS
EIV D5W
A 7-year-old girl is brought to the physician because of a 1-month history of worsening fatigue, loss of appetite, and decreased energy. More recently, she has also had intermittent abdominal pain and nausea. She is at the 50th percentile for height and 15th percentile for weight. Her pulse is 119/min and blood pressure is 85/46 mm Hg. Physical examination shows darkened skin and bluish-black gums. The abdomen is soft and nontender. Serum studies show: Sodium 133 mEq/L Potassium 5.3 mEq/L Bicarbonate 20 mEq/L Urea nitrogen 16 mg/dL Creatinine 0.8 mg/dL Glucose 72 mg/dL Which of the following is the most appropriate pharmacotherapy?
ASuccimer
BDeferoxamine
CNorepinephrine
DIsoniazid + rifampin + pyrazinamide + ethambutol
EGlucocorticoids
A 7-year-old boy is brought to the emergency room because of severe, acute diarrhea. He is drowsy with a dull, lethargic appearance. He has sunken eyes, poor skin turgor, and dry oral mucous membranes and tongue. He has a rapid, thready pulse with a systolic blood pressure of 60 mm Hg and his respirations are 33/min. His capillary refill time is 6 sec. He has had no urine output for the past 24 hours. Which of the following is the most appropriate next step in treatment?
AStart IV fluid resuscitation by administering colloid solutions
BProvide oral rehydration therapy to correct dehydration
CGive initial IV bolus of 2 L of Ringer’s lactate, followed by packed red cells, fresh frozen plasma, and platelets in a ratio of 1:1:1
DStart IV fluid resuscitation with normal saline or Ringer’s lactate, along with monitoring of vitals and urine output
EGive antidiarrheal drugs
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