55-year-old man comes to the emergency department due to 2 days of fever, chills, and productive cough Over the past 4 months


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55-year-old man comes to the emergency department due to 2 days of fever, chills, and productive cough Over the past 4 months,

he has had 2 episodes of pneumonia, both of which resolved completely with antibiotics. He smoked a pack of cigarettes per day for

30 years but quit following the second bout of pneumonia. The patient’s only other medical problem is hypertension. Temperature is

38.9 C (102 F}, blood pressure is 130/86 mm Hg, pulse is 98/min, and respirations are 18/min. Oxygen saturation is 94% on room

air. Crackles and increased breath sounds are present over the right lower lung field. Leukocyte count is 14,200/mm3 and blood urea

nitrogen is 12 mg/dl Chest x-ray reveals right lower lobe consolidation. Antibiotics are administered. On follow-up 5 days later, the

patient describes improvement in his cough and fever. Crackles are still present at the right lung base. Review of chest x -rays

obtained during the previous episodes of pneumonia reveals a consolidation in the right lower lung segment, same as found in the

current episode Which of the following is the most appropriate next step in management of this patient?

  • 0 A Barium swallow study
  • Q B. Bronchoscopy
  • 0 C. CT scan of the chest
  • 0 D. Repeat chest x -ray in 6 weeks
  • Q E. Serum quantitative immunoglobulin assessment

0 voters

23-year-old woman, gravida 2 para 1, at 30 weeks gestation comes to the emergency department after she noticed a sudden gush

of clear fluid from her vagina The patient has no pain or bleeding, and the baby is moving She has a history of vaginal delivery at

term, and the current pregnancy has been uncomplicated Temperature is 37.2 C (99 F} and blood pressure is 110/70 mm Hg The

fundus is nontender. Sterile speculum examination shows a closed cervix and vaginal pooling of nitrazine-positive clear fluid.

Ultrasound reveals a fetal weight consistent with gestational age and breech presentation The fetal heart rate tracing is normal.

Tocometry shows no contractions. Which of the following is the most appropriate next step in management of this patient?

  • QA Cerclage
  • 0 B. Cesarean delivery
  • 0 C. External cephalic version
  • 0 D. Induction of labor
  • 0 E. Intramuscular betamethasone
  • 0 F. Vaginal progesterone

0 voters