A 19-year-old man presents to the emergency department after a motor vehicle accident. The patient reports left shoulder pain that worsens with deep inspiration. Medical history is significant for a recent diagnosis of infectious mononucleosis. His temperature is 99°F (37.2°C), blood pressure is 80/55 mmHg, pulse is 115/min, and respiratory rate is 22/min. On physical exam, there is abdominal guarding, abdominal tenderness in the left upper quadrant, and rebound tenderness. The patient’s mucous membranes are dry and skin turgor is reduced. Which of the following most likely represents the acute changes in renal plasma flow (RPF) and glomerular filtration rate (GFR) in this patient?
ANo change in RPF and decreased GFR
BDecreased RPF and decreased GFR
CNo change in RPF and increased GFR
DDecreased RPF and no change in GFR
ENo change in RPF and GFR
A 65-year-old man is brought to the emergency department by ambulance after falling during a hiking trip. He was hiking with friends when he fell off a 3 story ledge and was not able to be rescued until 6 hours after the accident. On arrival, he is found to have multiple lacerations as well as a pelvic fracture. His past medical history is significant for diabetes and benign prostatic hyperplasia, for which he takes metformin and prazosin respectively. Furthermore, he has a family history of autoimmune diseases. Selected lab results are shown below: Serum: Na+: 135 mEq/L Creatinine: 1.5 mg/dL Blood urea nitrogen: 37 mg/dL Urine: Na+: 13.5 mEq/L Creatinine: 18 mg/dL Osmolality: 580 mOsm/kg Which of the following is the most likely cause of this patient's increased creatinine level?
AAutoimmune disease
BCompression of urethra by prostate
CBlood loss
DDiabetic nephropathy
ERhabdomyolysis
A 79-year-old man with a history of prostate cancer is brought to the emergency department because of lower abdominal pain for 1 hour. He has not urinated for 24 hours. Abdominal examination shows a palpable bladder that is tender to palpation. A pelvic ultrasound performed by the emergency department resident confirms the diagnosis of acute urinary retention. An attempt to perform transurethral catheterization is unsuccessful. A urology consultation is ordered and the urologist plans to attempt suprapubic catheterization. As the urologist is called to see a different emergency patient, she asks the emergency department resident to obtain informed consent for the procedure. The resident recalls a lecture about the different modes of catheterization, but he has never seen or performed a suprapubic catheterization himself. Which of the following statements by the emergency department resident is the most appropriate?
A“I would prefer that you obtain informed consent when you become available again.”
B“Suprapubic catheterization is not the treatment of choice for this patient.”
C“I would be happy to obtain informed consent on your behalf, but I'm not legally allowed to do so during my residency.”
D“I will make sure the patient reads and signs the informed consent form.”
E“I will ask the patient to waive informed consent because this is an urgent procedure.”
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