An 18-year-old girl is brought in to the hospital by her parents because of an asthma attack. She normally takes inhaled fluticasone and albuterol; however, she is not currently responding to the albuterol. On examination, she appears anxious and is moderately short of breath. There are loud bilateral wheezes on examination, with a prolonged inspiratory and expiratory phase and use of accessory muscles of respiration. Her temperature is 37.6°C, blood pressure is 118/78 mmHg, heart rate is 106 beats per minute, respiratory rate is 26 breaths per minute, and oxygen saturation is 93% on room air. She is placed on supplemental oxygen and bronchodilators and an arterial blood gas is drawn. Arterial Blood GaspH 7.40PaO2 60 mmHgPaCO2 40 mmHg Which of the following is the most appropriate next step in management?  Ask StudybuddyGroup of answer choicesIntubationIncrease supplemental oxygen flow rateAzithromycinIV corticosteroids

A 32-year-old man comes to the physician complaining of fever, shortness of breath, and a productive cough that has developed slowly over the past week. He has no other medical history and does not take any medications. His temperature is 38.5°C, blood pressure is 122/78 mmHg, heart rate is 68 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 98% on room air. There are decreased breath sounds and dullness to percussion over the right lung base. The rest of the physical examination, including cardiac auscultation, is normal. A chest x-ray confirms consolidation of the right lower lobe. What is the most appropriate course of action for this patient?

A 49-year-old man presents to the Emergency Department complaining of fever and a productive cough for several weeks. He also endorses night sweats and perceived weight loss. The patient is homeless and is a known alcoholic. On examination, the patient's temperature is 38.3°C, blood pressure is 144/90 mmHg, heart rate is 94 beats per minute, and respiratory rate is 20 breaths per minute. He appears weak and disheveled with poor dentition. There are bronchial and amphoric breath sounds at the right lung base. His laboratory values are significant for a hemoglobin of 11.8 g/dL and a leukocyte count of 13,500/mm3. Blood and sputum cultures are collected and sent to the laboratory.What should be done next in the management of this patient?

A 38-year-old woman presents with progressive shortness of breath and a chronic dry cough. Initially, she presented to her primary care provider and had a chest x-ray performed which showed prominent reticular markings in the lung fields. She has no relevant medical history and does not take any medications. She denies any fevers, weight loss, or chest pain. There is a family history of hypertension and dyslipidemia, but no lung or heart disease. She works as a receptionist and has never smoked. On physical examination, there are dry rales throughout both lung fields with scattered wheezes. There is no focal dullness to percussion. Initial laboratory tests are ordered and show a normal hemoglobin and leukocyte count, as well as normal electrolytes and liver enzymes. HIV testing is performed and is negative. Which of the following should be done next in the workup of this patient?Ask StudybuddyGroup of answer choicesBronchoscopyHigh-resolution computed tomographyLung tissue biopsyChest x-ray

A 19-year-old athlete comes to the office with a week of fever, malaise, headache, and cough that disrupts her sleep.  She was unable to do her gymnastics training this past week due to fatigue and exertional dyspnea.  The patient has no chronic medical problems and takes no medications.  Temperature is 37.2 C (99 F), blood pressure is 110/60 mm Hg, pulse is 84/min, and respirations are 18/min.  The neck is supple, and there is no pharyngeal erythema or cervical lymphadenopathy.  Cardiopulmonary examination reveals normal S1 and S2 and scattered wheezes.  Neurologic examination shows preserved muscle strength in all extremities and 2+ deep tendon reflexes.  Laboratory results are as follows:Complete blood countHemoglobin 12.2 g/dLReticulocytes 2.2%Platelets 240,000/mm3Leukocytes 8,000/mm3Chest x-ray shows diffuse reticulonodular opacities.  Which of the following is likely to be the most effective treatment for this patient? A.Amoxicillin B.Azithromycin C.Ceftriaxone D.Clindamycin E.Trimethoprim-sulfamethoxazoleProceed To Next Item

A 51-year-old woman comes to the office because of fatigue and progressive exertional dyspnea during the past several months. She has not had fever, cough, chest pain, palpitations, or weight loss. She has a history of type 2 diabetes mellitus and hyperlipidemia and takes glyburide and simvastatin. Screening colonoscopy 1 year ago showed no abnormalities. The patient does not smoke cigarettes, drink alcohol, or use illicit drugs. BMI is 32 kg/m2. Her temperature is 37.0°C (98.6°F), pulse is 92/min, respirations are 12/min, and blood pressure is 115/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Physical examination shows mucosal and conjunctival pallor. The lungs are clear to auscultation. Cardiac examination discloses no murmurs. The abdomen is nontender to palpation. No peripheral edema is noted. Laboratory studies show:Hemoglobin 8.8 g/dLMean corpuscular volume 79 μm3Leukocyte count 6,300/mm3Platelet count 210,000/mm3Reticulocyte count 0.4%Hemoglobin A1c 7.8%Serum   Sodium 140 mEq/L   Potassium 4.3 mEq/L   Creatinine 0.9 mg/dL   Thyroid-stimulating hormone 1.2 μU/mLTest of the stool for occult blood is negative. Chest x-ray shows no abnormalities. Which of the following is the most likely underlying pathophysiology causing anemia in this patient?A. Acquired inhibition of aminolevulinic acid synthaseB. Immune-mediated hemolysisC. Increased erythrocyte recycling by macrophagesD. Intermittent nocturnal hypoxemiaE. Release of inflammatory cytokines