1. 1. A 53-year-old man, with a history of rheumatic heart disease, presents with acute shortness of breath and fever. His wife notes that he was in his usual state of good health until recently and, other than a routine dental cleaning, he has not changed his routine. His vital signs show a temperature of 40 °C, a blood pressure of 97/44 mmHg, a pulse of 88 beats/min, a respiratory rate of 24 respirations/min, and a pulse oxygenation saturation of 84% on room air. On exam, he is cold, has poor capillary refill, he has bilateral crackles over his lungs, and a decrescendo systolic ejection murmur at the apex. He has prominent jugular venous distension with a marked “v” wave. Which one of the following is the definitive treatment for this patient?
2. A 24-year-old man, with a new diagnosis of acute lymphoblastic leukemia, presents with palpitations and lethargy after starting cytotoxic chemotherapy for his leukemia. His 12-lead EKG shows peaked t-waves. His laboratories show acute renal failure, hyperkalemia, hyperuricemia, and hyperphosphatemia. His uric acid level remains significantly elevated despite therapy with rasburicase and IV fluids—and the patient becomes anuric. Which one of the following therapies is the most appropriate in the care of this patient?
3. A 43-year-old man, with a past medical history of cirrhosis, presents with confusion and abdominal pain. His daughter notes that he has become very confused and combative over the past 3 days and had been complaining of worsening abdominal pain. On presentation, his vital signs have a temperature of 39.7 °C, a blood pressure of 88/52 mmHg, a pulse rate of 125 beats per minute, a respiratory rate of 20 respirations per minute, and a normal oxygen saturation. His exam is notable for a distended abdomen with a fluid shift and mild tenderness to palpation. He also has asterixis. A paracentesis is done and shows a neutrophils count of 680 cells/mm³, a total protein of 2 g/dl, a glucose of 40 mg/dl, and an LDH of 800 mg/dl. His fluid culture is showing 3 separate organisms. Which one of the following tests should be done next?
5. A 48-year-old man, with a history of hypertension and diabetes mellitus, presents with the “worst headache of his life” which started like a “thunderclap.” He also has a significant amount of neck stiffness. Prior to this acute onset of symptoms, he had been feeling great and had been very active. While talking to him, his mental status deteriorates; he becomes unconscious and needs to be intubated. An emergent noncontrast head-CT scan is done which does not show any abnormalities. A lumbar puncture is done and is positive for xanthochromia. A cerebral arteriography is done and shows an aneurysm but no signs of active bleeding. Which one of the following statements is true regarding the patient’s condition?
6. A young adult female arrests in the hospital lobby for unknown reasons. A group of medical students are present at the scene; they find her pulseless and begin resuscitation. When you arrive to assist, the patient is lying unresponsive on the ground. CPR is in progress. According to the most recent 2010 ACLS guidelines, which one of the following interventions by the students is correct?