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A patient with CAD and systolic heart failure is taking captopril, spironolactone, aspirin, carvedilol, clopidogrel and simvastatin. He presents to the ED with syncope and is found to have hyperkalemia and peaked T waves on EKG. What is the recommended initial therapy for the hyperkalemia to prevent further arrhythmia?
A 55-year-old male presents with hyperkalemia to the ED, he has been given calcium chloride, albuterol treatments, D50 + Insulin and remains hyperkalemic and despite treatment continues to have ventricular tachycardia. What is definitive treatment for the hyperkalemia?
A calcium channel blocker is preferable to a thiazide diuretic in the treatment of hypertension in a patient who has which of the following diseases?
The cremasteric reflex will be absent in which of the following conditions?
Which of the following is not a high anion gap acidosis cause?
A 56-year-old male presents with a complaint of fever, arthralgias and a rash for 2 days. He recently started taking naproxen for a back injury, but has no other significant past medical history. On examination he is mildly hypertensive, and there is a generalized maculopapular rash. His BUN and Creatinine are moderately elevated. Microscopic analysis of the urine reveals eosinohils, white blood cell casts and red blood cells. Which of the following is the most likely diagnosis?
The vitamin required for adequate intestinal absorption of calcium is:
A 24-year-old male presents with a history of abdominal pain that has been progressing over several weeks. She now has developed gross hematuria. On examination she is mildly hypertensive and her kidneys are enlarged bilaterally. A renal ultrasound is performed and multiple cysts are noted on each kidney. Which of the following organs is also likely to be affected by cysts?
An 8-year-old male presents with a complaint of edema of the face and extremities that has gradually come on over the past several days. He was previously well and has no significant past medical history. On examination he is normotensive but has periorbital edema and edema of the extremities. Urinalysis is positive for protein only. A 24 hour urine protein collection is done and the results are 4.5 grams of protein over 24 hours. Which of the following is the most likely diagnosis?
A 9-year-old female is brought in for evaluation of brown urine. She feels fine, but noticed the color change in her urine this morning. She denies any urgency, frequency, or dysuria. She was treated for impetigo approximately 3 weeks ago with cephalexin, but has no other significant medical history. On examination she is mildly hypertensive, but her exam is otherwise normal. Urinalysis is positive for blood and protein. Microscopic evaluation of the urine shows red blood cell casts. Which of the following laboratory results would be expected in this patient?
A 33-year-old female presents with fever, back and flank pain and hematuria. A CT scan confirms the presence of a large staghorn calculus in the right kidney. Which of the following bacteria is most likely the cause of her infection?
Which of the following is a risk factor for bladder cancer?
A 45-year-old female presents with microscopic hematuria that was an incidental finding during an employment physical. She is asymptomatic and was not menstruating at the time. Physical examination is normal. Repeat urinalysis confirms that microscopic hematuria is present. Which of the following diagnostic studies should be completed first?
A 34-year-old female who is status post a parathyroidectomy complains of profound weakness and fatigue. There is twitching at the corner of the mouth when the examiner taps the facial nerve just in front of the ear. Which of the following is the most likely electrolyte abnormality?
A 74-year-old male with a history of squamous cell carcinoma of the lung is brought to the emergency room with altered mental status. His family reports that he had been feeling very fatigued in the past few days. On examination he is lethargic, and there is generalized hyporeflexia. An ECG shows prolongation of the PR interval and a widened QRS complex. Which of the following electrolyte abnormalities is most likely present in this patient?
Which of the following represents the acid base disturbance seen with salicylate intoxication?
An unresponsive 2-year-old male is brought to the emergency room with a suspected ingestion of antifreeze. He experienced a seizure and has been unresponsive since the seizure. Which of the following acid base abnormalities would most likely be seen in this patient?
ECG findings in patients with hyperkalemia include:
A 74-year-old female nursing home resident is being evaluated for decreased urine output. She has only made 300ml of urine in the past 24 hours. On examination her BP is 90/62 and her heart rate is 118 beats per minute. Her oxygen saturation is 94% on room air. Her neck veins are flat and her oral mucosa is dry. Capillary refill is increased at 4 seconds. The remainder of the examination is normal. Her BUN and creatinine are elevated. Which of the following is the most likely diagnosis?
A 25-year-old female presents to the emergency room with a complaint of severe muscle aches and brown urine. She has just completed a marathon the previous day. Dipstick urinalysis is positive for blood; however, no red blood cells are seen on the microscopic examination. Which of the following is the most likely diagnosis?
A 28-year-old female presents for a routine physical. She has no complaints but is found to have a blood pressure of 160/90. On examination there are bruits heard over the renal arteries bilaterally. Her examination is otherwise normal. Which of the following is the most likely diagnosis?
A 42-year-old female presents with a complaint of urinary urgency. She reports that she will suddenly have a strong urge to urinate, and often is unable to make it to the toilet in time. Her physical examination is normal. She has tried oxybutinin but found the side effects of dry mouth and constipation intolerable. Which of the following medications would be appropriate to use in this patient?
A 44-year-old female with a history of type 1 diabetes mellitus since age 6 presents with a complaint of urinary leakage. She reports that she has intermittent leakage of urine, and “constant” wetness. She often has a sensation of bladder fullness, but will have to strain very hard to void. Which of the following is the most likely diagnosis?
A 23-year-old female presents with a three day history of dysuria, back and flank pain and fever. She denies nausea or vomiting. On examination she has a temperature of 102.3o and a heart rate of 104 beats per minute. There is mild suprapubic tenderness, and marked costovertebral angle tenderness to percussion. Which of the following would be the most appropriate treatment for this patient?
A 3-year-old female has a history of recurrent upper urinary tract infections that have required hospitalizations. Which of the following tests would be most appropriate to evaluate for the presence of renal scarring?
A 26-year-old male presents with a painless mass on his left testicle. On examination there is a 1 cm firm nodule on the superior aspect of the left testis. Which of the following is the most appropriate imaging study to evaluate this mass?
A 64-year-old male presents with a complaint of gross hematuria and flank pain. CT scan shows a solid mass on the left kidney. The right kidney is normal, and there is no evidence of metastatic disease. Renal cell carcinoma is confirmed by biopsy. Which of the following is the most appropriate treatment for this patient?
A 15-year-old male presents to the emergency room with a complaint of dysuria and urethral discharge. He has recently become sexually active. On examination there is copious mucoprurulent discharge coming from the urethral meatus. The penis is otherwise normal. Gram stain of the discharge shows gram negative diplococci. Which of the following is the most likely organism causing his symptoms?
Which of the following lab results may indicate an etiology for erectile dysfunction?
A 76-year-old, Caucasian woman arrives at the emergency department with altered mental status, no orthostasis or edema, serum BUN of 10, serum creatinine of 1.0, plasma osmolality of 285 mOsm/kg, and serum Na+ of 126 mEq/L. The most likely diagnosis is: