A 45-year-old female is brought to the ED complaining of fatigue. The patient has been feeling extremely weak over the past few days. Today she stood up and almost fainted, prompting her visit. She has had cough, rhinorrhea, and nasal congestion for the past week. Today she also began having nausea, vomiting, and severe abdominal pain. Past medical history is significant for hypertension, CKD, and SLE. Home medications are lisinopril, hydroxychloroquine, and prednisone 20 mg daily. Vitals: Temperature 38.5°C, BP 85/55 mm Hg, HR 126. In general, she appears weak and lethargic. Her heart sounds are tachycardic, regular, without murmurs. Her lungs have occasional rhonchi but no wheezing. Her abdomen is diffusely tender throughout without rebound tenderness. Labs: Na 124 mEq/L, K 5.3 mEq/L, Cr 3.0 mg/dL (baseline 1.8). Hgb is 11.1 g/dL. The patient is diagnosed with Influenza A and started on IV fluids. After 2 L of crystalloid fluids her blood pressure is 90/60 mm Hg. What is the most appropriate next step?Ask StudybuddyGroup of answer choicesMRI pituitaryCT adrenal glandsCortisol levelCosyntropin stimulation testIV hydrocortisone

A 17-year-old female is referred to the ED by her primary physician; she presents with a 3-day history of fevers, dysuria, and vomiting. She has not had vaginal discharge, abdominal pain, or diarrhea. She is sexually active with her partner. Vital signs are as follows: Temperature 103°F, RR 20, BP 98/65, pulse 100. She appears ill and is unable to tolerate liquids, but she is alert and oriented. Her examination is positive for suprapubic as well as costovertebral angle tenderness bilaterally. Urinalysis reveals numerous WBCs and bacteria, and it is positive for WBC casts and leukocyte esterase. Other laboratory study results are within normal limits, including a negative urine pregnancy test. What is the likely diagnosis?Ask StudybuddyGroup of answer choicesNephrolithiasisPyelonephritisAppendicitisAcute interstitial nephritisEctopic pregnancy

A 26-year-old man presents to his primary care physician with fatigue, headache, and a sore throat for the past week. There is also nausea and diarrhea, but no weight loss, productive cough, or difficulty breathing. He has no known past medical history, does not take any medications, and has no recent sick contacts. He is sexually active and uses condoms inconsistently; he drinks alcohol heavily on the weekends and has had previous IV drug use. On examination, his temperature is 39°C and the rest of his vital signs are normal. He has nontender cervical and axillary lymphadenopathy, tonsillar exudates, and mild splenomegaly. There are also several painful, well-demarcated ulcers within his mouth and a mild maculopapular rash over his chest and arms. A rapid Strep test and a monospot (heterophile antibody) test are negative; further screening for chlamydia, gonorrhea, syphilis, and HIV antibody is negative. What is the likely diagnosis?Ask StudybuddyGroup of answer choicesUpper respiratory infectionSecondary syphilisHodgkin lymphomaAcute retroviral syndromeInfectious mononucleosis

A 45-year-old man comes to the emergency department due to a 1-day history of constant upper abdominal pain, nausea, and several episodes of vomiting.  The pain is partially relieved by sitting up or bending forward.  He has also had mild shortness of breath.  The patient's other medical history includes hyperlipidemia and hypertension.  He uses tobacco and alcohol.  There is a family history of coronary artery disease and hypertension.  Temperature is 38.1 C (100.6 F), blood pressure is 110/70 mm Hg, pulse is 114/min, and respirations are 22/min.  There is dullness to percussion and decreased breath sounds at the left lung base.  Abdominal examination shows epigastric tenderness.  Laboratory results are as follows:Hematocrit 44%Leukocytes 16,000/mm3Calcium 7.8 mg/dLGlucose 250 mg/dLWhich of the following plays a principal role in initial management of this patient's current condition? A.Antiplatelet agents B.Broad-spectrum antibiotics C.Calcium gluconate D.Exploratory laparotomy E.Insulin infusion F.Isotonic crystalloids G.Proton pump inhibitors

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

An 83-year-old man is transferred to the hospital from his nursing home due to hypotension and confusion. He was previously well until yesterday morning, when the nursing staff observed that he seemed lethargic and spent the day in bed. Later that night, the staff tried to communicate with him but he was not oriented to place or time. His medical history is significant for hypertension, COPD, paroxysmal atrial fibrillation, and urinary incontinence requiring a urethral catheter. He is compliant with medications, has no recent medication changes, and has no sick contacts. On examination, his temperature is 35.4°C, his blood pressure is 68/44 mmHg, his heart rate is 88 beats per minute, and his respiratory rate is 18 breaths per minute. He is lethargic with flat neck veins; his cardiac examination is normal. His lungs are clear to auscultation, and there is no significant abdominal tenderness. His neurologic examination is normal, and his extremities are warm and well perfused. His laboratory values are significant for a leukocyte count of 13,500/mm3 and a serum lactate of 3.9 mmol/L (normal range 0.6 to 2.3 mmol/L). A urinalysis shows significant pyuria. A chest x-ray shows hyperinflated lungs but no focal opacities. Which of the following is the most appropriate next step in management?