This patient presents with symptoms and signs of heart failure,

◦ Choices A and B describe decreased sympathetic tone, which is incorrect

in heart failure due to activation of the renin-angiotensin-aldosterone
Choices A, B, and D describe increased urine sodium concentration. The
neurohormonal effect of angiotensin and aldosterone leads to decreased urine
sodium concentration as the kidney attempts to reclaim solute and solvent when
faced with low effective circulating
Choices B and E describe increased renal blood flow. Heart failure typically results in
decreased renal blood flow due to decreased cardiac
This pattern of increased urine protein when upright (afternoon sample) but normal or minimal protein
in the morning (supine sample) is characteristic of orthostatic (postural) proteinuria. This is considered
a benign clinical finding and does not require further investigation in asymptomatic individuals with no
other clinical concerns.
*Antibiotic prophylaxis for infective
endocarditis is indicated for patients at the
highest risk for severe complications from
bacterial endocarditis (e.g., prosthetic valves,
prior endocarditis, unrepaired cyanotic
congenital heart disease).
*Empyema, a complication of bacterial pneumonia, is diagnosed by
pleural fluid analysis showing low pH (<7.2), low glucose (<40 mg/
dL), high protein (exudative, >85% of serum protein), and high LDH.
The patient's pleural fluid results fit these criteria.
*Drain cleaners contain caustic alkalis that cause burns and ulcerations of the
upper GI tract. An esophagoscopy (upper endoscopy) is crucial to evaluate the
extent of visceral injury and guide management.
*Activated charcoal and ipecac are contraindicated in alkali ingestions
*Recurrent acute pancreatitis often requires
investigation into underlying causes beyond
gallstones or alcohol. Hypertriglyceridemia is a
significant cause of acute pancreatitis, and
should be assessed if other common etiologies
are ruled out
 Parental consent is not required for the
treatment of life-threatening medical
conditions in minors (under 18 years old). A
court order is necessary to override
parental preferences when parents refuse
life-saving treatmen
ALS is characterized by a combination of upper motor
neuron (UMN) signs (e.g., hyperreflexia, Babinski sign) and
lower motor neuron (LMN) signs (e.g., muscle atrophy,
fasciculations), often in an asymmetric distribution. Sensory
symptoms are typically not present
* A positive PPD test is determined by induration, not
erythema. For a healthy individual in the general
population, induration must be 15 mm or greater to be
considered positive. Since her induration is 8 mm, it is a
negative PPD test. Annual screening is appropriate for
healthcare workers
*Entamoeba histolytica can cause amebic
dysentery (diarrhea with stool leukocytes) and *Extracolonic invasion refers to
extracolonic invasion, often leading to hepatic the spread of a tumor from its
amebic abscesses (cystic liver masses). Travel to original location into nearby
endemic areas (like Mexico) is a key risk factor. tissues or organs that are outside
the colon or rectum.
*Acute abdominopelvic pain in a sexually active female of
childbearing age, especially with irregular menses and
inconsistent contraception, necessitates ruling out serious
gynecologic conditions like ectopic pregnancy or pelvic
inflammatory disease.
*The patient's symptoms are consistent with menopause. While
estrogen therapy can relieve menopausal symptoms like hot
flashes, it must be combined with progesterone in women with an
intact uterus to counteract the increased risk of of endometrial
hyperplasia and cancer associated with unopposed estrogen.
The patient's somnolence, bradypnea, and respiratory acidosis
(high PCO2, low pH) indicate drug-induced hypoventilation,
most likely due to the opioid (morphine) and sedative
(temazepam). Naloxone is the specific antidote for opioid-
induced respiratory depression.
 *leukocyt
osis

*thrompocytopenia

* The combination of pancytopenia (anemia,

thrombocytopenia), leukocytosis with blast cells,
ecchymoses, splenomegaly, and an osteolytic lesion is
highly suggestive of acute lymphocytic leukemia (ALL), the
most common childhood malignancy. Bone marrow biopsy
is essential for confirming the diagnosis.
 * barium swallow shows
a dilated esophagus
with a distal taper

*These clinical and radiologic findings

(progressive dysphagia for solids and liquids,
"bird-beak" or distal taper on barium swallow) are
classic for achalasia, an esophageal motility
disorder caused by impaired relaxation of the
lower esophageal sphincter (LES)
* Mild idiopathic scoliosis with a Cobb angle less than 30
degrees (like her 15-degree curve) has a low chance of
progression or subsequent symptom development. Her
current back pain is likely related to the lifting injury, not the
mild scoliosis
*A sudden onset of hypotension and tachycardia following
a blood transfusion is highly suggestive of a transfusion
reaction. Anaphylactic transfusion reactions, often due to
IgA deficiency and anti-IgA antibodies, are life-threatening
and require immediate cessation of the transfusion and
treatment with epinephrine
*In patients with cancer and painful bone
metastases (lytic lesions) that are not
adequately controlled by analgesics,
radiation therapy is the most appropriate
next step for localized pain relief and to
prevent pathological fractures.
*This patient has multiple risk factors for endometrial
cancer, including age (>45), nulliparity (nulligravid),
obesity (BMI >30), and diabetes. Obesity leads to
increased estrogen production, which, when unopposed
by progesterone, significantly raises the risk of
endometrial cancer.
*NPH insulin typically has its peak action 4-12 hours after
administration. Since his hypoglycemia occurs in the afternoon,
the morning dose of NPH insulin is the most likely cause and
should be adjusted by decreasing it.
*The classic presentation of rickets, caused by
dietary vitamin D deficiency, includes growth
delay, widened and tender wrists, and widening of
the epiphyseal plates (knees on X-ray). Breastfed
infants in cold climates are at risk for vitamin D
deficiency
*The rapid progression of infection (fever,
systemic signs of sepsis, rapidly
enlarging erythema and tenderness)
following a puncture wound, especially in
a diabetic patient, is highly suspicious for
necrotizing soft tissue infection
(necrotizing fasciitis). Prompt surgical
exploration and aggressive debridement
are critical for treatment.
*Adjustment disorder is diagnosed when an emotional or
behavioral disturbance develops within 3 months of an
identifiable stressor (e.g., divorce) and causes significant
distress or impairment, but does not meet the full criteria
for other mental disorders like major depressive disorder
(which typically requires a longer duration of symptoms
*Ascites is a condition that
happens when fluid collects in *hyponatremia
spaces in abdomen.
*developed
acute kidney
injury with a
* normal creatinine 0.6–1.2 mg/dL rise in
creatinine

*The patient's presentation suggests pre-renal

acute kidney injury (AKI), possibly hepatorenal
syndrome, in the context of cirrhosis. Initial
management of pre-renal AKI involves fluid
resuscitation with 0.9% saline to improve renal
perfusion
*The patient has a strangulated inguinal hernia with signs of bowel
obstruction and potential bowel ischemia/necrosis. Preoperative
antibiotics should be broad-spectrum, covering both gram-positive
and gram-negative organisms. Cefoxitin, a second-generation
cephalosporin, provides this broad coverage.
*The patient's presentation with acute pulmonary edema and
severe, poorly controlled hypertension despite multiple
medications, along with a rising creatinine, is highly suggestive of
renovascular hypertension, typically due to renal artery stenosis.
Renal duplex ultrasonography is the diagnostic study of choice to
evaluate for renal artery stenosis.
*The constellation of paroxysmal coughing
episodes (often severe, causing post-tussive
emesis, and awakening from sleep), along with
lymphocytosis, is characteristic of pertussis
“whooping cough”)
 *A history of cryptorchidism
(undescended testis) significantly
increases the risk of developing testicular
cancer, even after corrective surgery
(orchiopexy). Seminoma is the most
common testicular malignancy associated
with cryptorchidism
 *The clinical picture of fever, altered mental status, nuchal rigidity,
and a purpuric rash is classic for acute meningococcal meningitis,
caused by Neisseria meningitidis. Meningococcal vaccination is
routinely recommended for adolescents to prevent this disease.
*The patient's symptoms are characteristic of diverticulitis, a
common cause of left lower quadrant pain. For uncomplicated
diverticulitis, antibiotic therapy (e.g., amoxicillin-clavulanate)
covering enteric flora along with bowel rest is appropriate
management.
*For uncontrolled hypertension despite
an ACE inhibitor, adding a calcium
channel blocker like amlodipine is a
recommended next step. Thiazide
diuretics (like hydrochlorothiazide) are
also first-line but are less ideal in
patients with gout due to their potential
to increase serum uric acid
*Pre-existing hypertension is a major risk factor for
developing preeclampsia during pregnancy.
Preeclampsia is a serious complication characterized
by new-onset hypertension and proteinuria after 20
weeks of gestation
*Although rare, stimulant therapy for ADHD has
been associated with sudden cardiac death. An
ECG should be considered for patients with risk
factors for sudden cardiac death, such as a family
history, before initiating stimulant medication
*Clostridium sordellii is a gram-positive,
anaerobic bacterium that has been
increasingly associated with severe
infections, particularly in the context of
medical abortion. It can cause toxic
shock syndrome with rapid onset of
fever, abdominal pain, and shock.
*the rapid onset of fever, severe pain, and
a well-demarcated, bright red erythema,
particularly in an area with impaired
lymphatic drainage (post-
lymphadenectomy), is characteristic of
erysipelas. The most common causative
organism of erysipelas is Group A
Streptococcus (Streptococcus pyogenes).
Given her history of recurrent Chlamydia infection,
inconsistent condom use, and recent unprotected
exposure, there is a high risk of reinfection. Immediate
re-treatment with appropriate antibiotics (e.g.,
azithromycin) is necessary to prevent complications
like pelvic inflammatory disease, even if her partner
was tested.
In cases of suspected pancreatic adenocarcinoma
(painless jaundice, pancreatic mass, dilated bile
ducts) where an initial fine-needle aspiration biopsy is
negative, endoscopy-guided ultrasonography (EUS)
with biopsy is the most accurate method to obtain a
tissue sample for definitive diagnosis. This is due to
the potential for false-negative results with
percutaneous biopsies
After brain death is confirmed, a representative
from the organ procurement organization (OPO)
is the most appropriate person to discuss organ
donation with the patient's family. OPOs are
third-party organizations that relieve clinicians
from potential conflicts of interest and maintain
public trus
* Exam Information: Patients on chronic corticosteroids (like prednisone) are
at risk for acute adrenal crisis when exposed to physiologic stress (e.g.,
surgery, trauma) because chronic steroid use suppresses the hypothalamic-
pituitary-adrenal axis. Acute adrenal crisis presents with hemodynamic
collapse (tachycardia, hypotension). Immediate intravenous administration of
corticosteroids (e.g., hydrocortisone) is crucial.
*The initial workup for a painless, growing thyroid nodule involves
ultrasonography of the thyroid gland to characterize the mass and
assess for suspicious features (e.g., microcalcifications, irregular
margins) before considering fine-needle aspiration biopsy.
*A mid-systolic murmur, an S4 heart sound, and a history of sudden cardiac death
in a young family member (as mentioned in a similar problem, not explicitly here
but implied by the context of HOCM) are highly suggestive of hypertrophic
obstructive cardiomyopathy (HOCM), which is characterized by hypertrophy of the
left ventricle.
*Newly diagnosed HIV patients should undergo
routine serum chemistry testing to evaluate hepatic
and renal function and also be screened for
common coinfections, including tuberculosis, viral
hepatitis (Hepatitis B and C), and other sexually
transmitted infections. Hepatitis B surface antigen
assay is part of this initial workup.
* Pleuritic chest pain (worsening with movement/swallowing), diffuse ST-
segment elevation on ECG, and a recent viral illness are classic for pericarditis.
Echocardiography is indicated to assess for pericardial effusion and cardiac
dysfunction.
 spinal cord compression.

*In suspected or confirmed malignant spinal cord compression, immediate administration of high-dose
intravenous corticosteroids (e.g., dexamethasone) is crucial to reduce peritumoral edema and preserve
neurological function. This buys time for definitive treatment like surgery or radiation.
*Confounding is a common problem in research. To decrease confounding by a
specific variable like age, matching participants by that variable in case-control
studies is an effective statistical method.
• Statistical feature most supportive of recommending lifestyle management: β Level (5%).
• Exam Information: A low β (beta) level (e.g., 5%) means the study has a high statistical power (1-β =
95%) to detect a true difference if one exists. In this context, a low β level for a study comparing
lifestyle management to PCI would increase confidence in recommending lifestyle changes if the study
found no significant difference or a favorable outcome for lifestyle. A low beta level indicates a low risk
of a type II error (failing to reject a false null hypothesis).
 (orthostatic syncope

*The classic triad of symptoms for aortic stenosis includes syncope (especially exertional or orthostatic),
angina, and dyspnea. Physical examination findings typically include a harsh, late-peaking systolic
ejection murmur heard at the upper right sternal border, diminished and delayed carotid upstrokes (pulsus
parvus et tardus), and a soft or absent S2 heart sound.
*In children with signs of malnutrition or growth delay and social risk factors,
directly inquiring about food insecurity is the most appropriate initial step. This
approach builds trust and helps identify specific needs to connect the family with
resources and appropriate referrals.
*Patients initiating hydroxychloroquine therapy require a baseline ophthalmologic
examination due to the risk of retinal toxicity and permanent vision loss. Regular follow-
up ophthalmologic examinations are also recommended to monitor for adverse effect
*A fixed, widely split S2 heart sound is a classic clinical finding characteristic of an atrial septal
defect (ASD). This occurs due to increased blood flow through the pulmonic valve and
delayed closure of the pulmonic valve.
*Brain death is defined as the permanent loss of all brain stem functions. The most appropriate next step
to determine brain death is a neurologic examination focusing on the assessment of brain stem reflexes
(e.g., pupillary response, corneal reflex, oculocephalic reflex, gag reflex) and an apnea test.
*In randomized controlled trials, using a placebo as a control group is medically
unethical when an accepted standard of care treatment already exists for the condition
being studied (e.g., current effective treatments for stomach and duodenal ulcers). New
treatments should be compared to the current standard of care.
*In the third trimester, a variation of up to 3 weeks between estimated gestational age and fetal
measurements is considered normal. Therefore, reassurance is the appropriate next step, as
further testing is unnecessary and could increase maternal anxiety.
*Iritis (anterior uveitis) is an inflammatory disorder characterized by sudden eye pain, redness,
severe photophobia, and the presence of inflammatory cells (haze/flare) in the anterior
chamber. Asymmetric pupils can also be present.
*Hemolytic Uremic Syndrome (HUS), characterized by acute
kidney injury, thrombocytopenia, and hemolytic anemia,
typically follows an infection with Shiga toxin-producing
Escherichia coli (STEC), most commonly O157:H7. This
infection is usually acquired through the ingestion of
contaminated food or water, so appropriate food preparation is
key to prevention.
*For patients with stable exertional chest pain (angina pectoris) and risk factors for
coronary artery disease, with a normal resting ECG, an exercise stress test is the
appropriate initial diagnostic test to evaluate for inducible myocardial ischemia.
*Acute interstitial nephritis (AIN) is an acute
kidney injury caused by a hypersensitivity
reaction to medications (e.g., antibiotics,
NSAIDs) or autoimmune disorders. It is
characterized by acute kidney injury and often
by the presence of eosinophils in the urine.
*Children with developmental disabilities, such as cerebral palsy, are entitled to education in
the least restrictive environment. This means they should be taught in a regular classroom
with appropriate accommodations whenever possible.
*Traveler's diarrhea, characterized by acute, diffuse, crampy abdominal
pain and bloating, with watery, non-bloody diarrhea after travel to
developing countries, is most commonly caused by Enterotoxigenic
Escherichia coli (ETEC).
*Immunocompromised individuals with HIV, especially those with a CD4+ T-
lymphocyte count less than 200/mm³, cannot receive live virus vaccines. If
such a patient is susceptible to varicella-zoster virus and is exposed, varicella-
zoster immune globulin (VZIG) is indicated for post-exposure prophylaxis.
 microcytic anemia

*In a patient with microcytic anemia and a history of

heavy menses, iron deficiency anemia (IDA) is the most
likely diagnosis due to chronic blood loss. Oral ferrous
sulfate therapy is the first-line treatment for IDA.
*Primary amenorrhea is defined as the absence of menarche by age 15. A
14-year-old girl with secondary sexual characteristics (Tanner stage 3
breast and pubic hair development) and continued growth is likely
experiencing a normal, albeit later, onset of menarche, and reassurance is
appropriate.
*Recurrent and severe mucocutaneous candidiasis (oral thrush, recurrent vaginal candidiasis,
onychomycosis), even in the presence of risk factors like diabetes, strongly suggests an
underlying defect in cell-mediated immunity.
*Hallucinogen-persisting perception disorder (HPPD), characterized by persistent visual
disturbances (e.g., images, colored lines, flashbacks) occurring long after drug cessation,
is most commonly associated with LSD use.
*Crohn disease is characterized by transmural inflammation that can affect any part of the
gastrointestinal tract, often with skip lesions. Classic symptoms include chronic abdominal pain,
diarrhea, weight loss, and fatigue. Perianal disease (fissures, fistulas, abscesses) and inflammatory
changes in the terminal ileum are strong indicators.
 *consistent with
seborrheic keratoses

*Seborrheic keratoses are common, benign skin lesions that typically do

not require active treatment unless they are symptomatic or suspicious for
malignancy. Reassurance and annual follow-up are usually sufficient.
*The combination of severe intracranial injury (bulging fontanelle),
acute neurological deficit (respiratory arrest, limpness,
unresponsiveness), and bilateral retinal hemorrhages in an infant,
especially with an inconsistent history, is highly suggestive of
nonaccidental trauma (shaken baby syndrome).
 *mass in the right
parietal lobe

*In a patient with a new-onset seizure and a brain mass, particularly with a
history of cancer (suggesting metastasis), urgent administration of
corticosteroids (dexamethasone) is critical to reduce cerebral edema associated
with the tumor and prevent further neurological complications.
*Obsessive-compulsive disorder (OCD), characterized by
obsessions (unwanted thoughts) and compulsions (repetitive
behaviors) causing significant distress, is primarily treated with
selective serotonin reuptake inhibitors (SSRIs) such as sertraline.:
*Restricting a meta-analysis to only published studies can lead to publication
bias, where studies with statistically significant or positive results are more
likely to be published. This can lead to an overestimation of treatment effects.
*In trauma patients receiving large-volume resuscitation with intravenous
crystalloids and packed red blood cells, dilutional thrombocytopenia (low
platelet count due to dilution of blood components) is a common cause of
coagulopathy and bleeding.
 In cases of suspected elder abuse or neglect, particularly when there are
repeated injuries, unexplained trauma, or a defensive caregiver,
physicians are legally mandated to report the suspicion to adult protective
services. This is crucial to ensure the patient's safety.
 *coagulopathy

*For patients with cirrhosis and signs of gastrointestinal bleeding, often due to esophageal
or gastric varices, an emergent esophagogastroduodenoscopy (EGD) is essential to
localize and treat the source of bleeding. Coagulopathy should also be corrected.
*For lower extremity ulcers, especially those that are painful, non-healing, progressive,
or when the diagnosis is unclear (e.g., suspected vasculitis, malignancy, or unusual
infections), a punch biopsy is useful to identify the underlying cause and guide
appropriate treatment.
*In a patient presenting with hypercalcemia, the most appropriate next step to confirm the
diagnosis and differentiate causes (e.g., primary hyperparathyroidism, malignancy) is to measure
serum intact parathyroid hormone (PTH) concentration.
*The patient's ABG shows a low pH (acidosis). A low
HCO3- (12 mEq/L) indicates metabolic acidosis. A
PCO2 of 36 mm Hg, given the severe metabolic
acidosis, is not an appropriate respiratory
compensation (which would be lower), and in a
patient with COPD and severe respiratory distress, it
suggests an element of respiratory acidosis.
Therefore, it's a mixed metabolic acidosis with a
concomitant respiratory acidosis.
*Opioid medications are well-known to cause constipation due to their effects on gastrointestinal motility. This
patient's history of oxycodone use after trauma, along with decreased bowel sounds and constipation, strongly
suggests drug-induced constipation.
*Persistent respiratory congestion, recurrent pneumonia, and coughing/choking
during feedings with liquids in an infant are highly suggestive of
tracheoesophageal fistula (TEF) or esophageal atresia. A barium swallow is the
initial diagnostic step to visualize the anatomy and confirm a TEF.
*This patient's history (sandblaster) and symptoms (progressive dyspnea, leg swelling, abdominal
girth, prominent P2, enlarged liver) are suggestive of silicosis with associated pulmonary
hypertension and cor pulmonale, leading to hypoxemia. The most appropriate immediate step for
hypoxemia is oxygen administration.
*In prepubertal girls, foul-smelling or blood-tinged vaginal discharge, especially without inguinal
lymphadenopathy, often suggests a foreign body in the vagina. If a foreign body is detected, it
should be removed, and vaginal irrigation can help decrease the purulent material in the canal.
*The presence of conjugated (direct) hyperbilirubinemia in a newborn is always
pathologic and requires investigation. It suggests biliary atresia or other
cholestatic conditions. Ultrasonography of the abdomen is the initial imaging
study to assess for biliary tract abnormalities.
Patients with chronic kidney disease, especially those with congenital urinary tract
abnormalities, often develop hypertension due to activation of the renin-angiotensin-
aldosterone system (RAAS), which results in increased renin and angiotensin concentrations.
This patient's symptoms (early-onset emphysema, chronic obstructive pulmonary disease) and lung findings are
consistent with alpha-1 antitrypsin deficiency. This inherited disorder not only leads to early-onset emphysema but
also significantly increases the risk for chronic liver inflammation and cirrhosis due to the accumulation of
misfolded alpha-1 antitrypsin polymers in hepatocytes.
Twin gestations, especially dichorionic-diamniotic twins, are
associated with an increased risk for preterm delivery. Maternal
smoking further increases the risk of complications like preterm
delivery.
*Venous insufficiency is a common cause of non-healing ulcers
on the lower extremities, known as stasis ulcers. These ulcers
typically present with leg swelling, heaviness, and varicose
veins, and are often associated with brownish discoloration,
induration, and dilated superficial veins. The presence of
palpable pulses makes ischemic ulcer less likely.
(primary amenorrhea, short stature, delayed
pubarche with breast development but no
axillary/pubic hair, and no menarche by 15) is
highly suggestive of Turner syndrome (45,XO)
or other forms of ovarian dysgenesis, which
typically involve short stature and delayed/
absent puberty. Prior to growth hormone
replacement therapy, a skeletal survey to
assess epiphyseal fusion is necessary to
determine growth potential.
 Metabolic syndrome is a common disorder associated with an increased risk for
developing type 2 diabetes mellitus and nonalcoholic fatty liver disease. It is
characterized by a cluster of conditions, including hypertension, abdominal obesity (high
BMI), insulin resistance/hyperglycemia (elevated random glucose), increased serum
triglyceride concentrations, and decreased HDL-cholesterol. This patient presents with
multiple of these features.
Vulvovaginitis, characterized by vaginal itching, redness,
and discharge, commonly presents as vulvovaginal
candidiasis (yeast infection). Diabetes is a risk factor.
Terconazole is an antifungal agent used for topical
treatment of vulvovaginal candidiasis.
Patients with anorexia nervosa who engage in
purging behaviors (vomiting, laxative/diuretic
misuse) often develop hypokalemia (low
potassium), hypochloremia (low chloride), and
metabolic alkalosis (elevated bicarbonate) due
to gastric acid loss. U waves on ECG are a
sign of hypokalemia.
In palliative care, opioid medications
are commonly used for both pain
and dyspnea at the end of life. They
can effectively alleviate severe pain
and reduce the sensation of
shortness of breath, improving
quality of life for the patient.
This patient's symptoms are consistent with bulimia nervosa with
purging behavior. Bupropion is contraindicated in patients with bulimia
nervosa due to an increased risk of seizures, which can be precipitated
by electrolyte disturbances (common in purging behaviors).
In a patient with persistent hoarseness,
especially with a significant smoking history,
laryngeal carcinoma must be ruled out. Direct
visualization of the larynx, typically by flexible
laryngoscopy, is the most appropriate initial
diagnostic step.
The triad of symptoms (dementia, gait instability,
and urinary incontinence) in an elderly patient,
along with brain imaging showing widely dilated
ventricles, is characteristic of normal pressure
hydrocephalus (NPH).
For healthy women with frequent UTIs, especially in situations with limited healthcare access (like deployment), providing a prescription for antibiotics
(e.g., nitrofurantoin) and instructions for self-treatment of uncomplicated UTIs is an appropriate management strategy.
Osteoarthritis (OA) is a common noninflammatory arthropathy. First-line treatment for OA
pain is acetaminophen. Given that he is still getting some pain relief and is interested in
potential treatment options, continuing acetaminophen while considering other low-
impact exercises or weight loss is appropriate. Further options include NSAIDs or intra-
articular injections if symptoms persist.
The symptoms (fever, cough, night sweats, lower lobe infiltrates, bloody
diarrhea) in a patient from the Southwestern United States with Crohn's
disease (immunocompromised state) are highly suggestive of
coccidioidomycosis, a fungal infection endemic to that region. Fluconazole is
an appropriate antifungal agent for treating Coccidioides infections.
Surgical guidelines recommend administering prophylactic
antibiotics within 1 hour prior to the first surgical incision.
Cefazolin, a first-generation cephalosporin, has a half-life of
approximately 2 hours. If the time from administration to
incision exceeds this window, an additional dose of antibiotic
is required to maintain adequate tissue concentrations during
the prolonged procedure.
*in hemodynamically unstable patients with penetrating abdominal trauma
(e.g., gunshot wound) and signs of severe intra-abdominal injury (diffuse
tenderness, hypotension, tachycardia), exploratory laparotomy is immediately
required to control hemorrhage and repair injuries. CT scan and
ultrasonography are useful for stable patients but should not delay urgent
surgical intervention in unstable cases.
normal 0.4–4.0 μU/mL
Female: <25 ng/mL