A 19-year-old man with a history of type 1 diabetes presents to the emergency department for the evaluation of a blood glucose level of 492 mg/dL. Laboratory examination revealed a serum bicarbonate level of 13 mEq/L, serum sodium level of 122 mEq/L, and ketonuria. Arterial blood gas demonstrated a pH of 6.9. He is admitted to the hospital and given bicarbonate and then started on an insulin drip and intravenous fluid. Seven hours later when his nurse is making rounds, he is confused and complaining of a severe headache. Repeat sodium levels are unchanged, although his glucose level has improved. His vital signs include a temperature of 36.6°C (98.0°F), pulse 50/min, respiratory rate 13/min and irregular, and blood pressure 177/95 mm Hg. What other examination findings would be expected in this patient?
AHypoglycemia
BPupillary constriction
CPapilledema
DPancreatitis
EPeripheral edema
A 26-year-old man is undergoing a bone marrow transplantation for treatment of a non-Hodgkin lymphoma that has been refractory to several rounds of chemotherapy and radiation over the past 2 years. He has been undergoing a regimen of cyclophosphamide and total body irradiation for the past several weeks in anticipation of his future transplant. This morning, he reports developing a productive cough and is concerned because he noted some blood in his sputum this morning. The patient also reports pain with inspiration. His temperature is 101°F (38.3°C), blood pressure is 115/74 mmHg, pulse is 120/min, respirations are 19/min, and oxygen saturation is 98% on room air. A chest radiograph and CT are obtained and shown in Figures A and B respectively. Which of the following is the most likely diagnosis?
AStreptococcus pneumoniae
BAspergillus fumigatus
CPneumocystis jiroveci pneumonia
DStaphylococcus aureus
EMycoplasma pneumonia
A young woman from the Ohio River Valley in the United States currently on corticosteroid therapy for ulcerative colitis presented to a clinic complaining of fever, sweat, headache, nonproductive cough, malaise, and general weakness. A chest radiograph revealed patchy pneumonia in the lower lung fields, together with enlarged mediastinal and hilar lymph nodes. Skin changes suggestive of erythema nodosum (i.e. an acute erythematous eruption) were noted. Because the patient was from a region endemic for fungal infections associated with her symptoms and the patient was in close contact with a person presenting similar symptoms, the attending physician suspected that systemic fungal infection might be responsible for this woman’s illness. Which of the following laboratory tests can the physician use to ensure early detection of the disease, and also effectively monitor the treatment response?
ASkin tests
BFungal staining
CAntigen detection
DCulture method
EAntibody testing
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