56-year-old previously healthy man comes to the office with progressive difficulty walking due to imbalance for the past 3 months

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56-year-old previously healthy man comes to the office with progressive difficulty walking due to imbalance for the past 3 months. On several

occasions, the patient has lost balance and almost fallen while taking a shower. He also reports episodes of transient, sharp, stabbing pain in his

back and lower limbs, as well as involuntary dribbling of urine. He has no history of back injury. The patient has smoked half a pack of cigarettes

daily for 30 years and drinks 1 or 2 glasses of wine per day. Physical examination shows that bilateral knee and ankle reflexes are 1 + and

vibratory and position sensation is impaired in both feet. His gait is broad based. Bilateral pupils are small, irregular, and constrict poorly to light

but constrict normally when he is instructed to look at a finger placed near the tip of his nose. Which of the following is most likely to improve this

patient’s symptoms?

  • QA Intramuscular vitamin 812
  • 0 B. Intravenous acyclovir
  • 0 C. Intravenous alteplase
  • 0 D. Intravenous immunoglobulin
  • 0 E. Intravenous penicillin
  • 0 F Intravenous thiamine
  • 0 G. Spinal decompression surgery

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69-year-old man comes to the emergency department due to severe shortness of breath for the past 12 hours. He has used his

albuterol inhaler many times without relief. He reports one day of low-grade fever that resolved with acetaminophen The patient quit

smoking 2 years ago but has a 40-pack-year history His temperature is 37.2 C (99 F), blood pressure is 150/90 mm Hg, pulse is

110/min, and respirations are 22/min. The patient is using accessory muscles of respiration Lung examination shows prolonged

expiration with end-expiratory wheezing bilaterally Results of arterial blood gas testing performed on room air are as follows

pH 7.34

pO2 64 mm Hg

pC02 57 mm Hg

HCO3 32 mEq/L

Noninvasive positive-pressure ventilation is initiated. Which of the following additional therapies is most likely to benefit this patient?

  • QA Acetylcysteine
  • 0 B. Aminophylline
  • 0 C. Cromolyn sodium
  • 0 D. Fluticasone inhaler
  • 0 E. Methylprednisolone
  • 0 F Oral furosemide
  • 0 G. Salmeterol
  • 0 H. Zafirlukast

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