A 16-year-old man presents to the ED complaining of three da…

A 16-year-old man presents to the ED complaining of three days of nasal rhinorrhea, cough, myalgias, and generalized malaise. After a coughing episode yesterday, he developed pleuritic chest pain radiating to the left neck. His vital signs are BP 130/70 mm Hg, HR 76, RR 16, T 36.6°C and pulse oximetry 98% on room air. You obtain the chest radiograph seen above. Which of the following is the most appropriate next step in management?

A 59-year-old Chinese immigrant presents with a new, diffuse…

A 59-year-old Chinese immigrant presents with a new, diffuse skin rash and facial swelling. The patient was discharged three weeks ago after suffering a myocardial infarction. His hospitalization was complicated by an episode of gout. On exam, he has significant facial edema without throat swelling or difficulty breathing. He also has a morbilliform rash with scattered bullae. His home medications include aspirin, metoprolol, lisinopril, clopidogrel, atorvastatin, allopurinol, and esomeprazole. His laboratory results are as follows: WBC 11,900/uL, neutrophils 63%, lymphocytes 17%, eosinophils 14%, BUN 48 mg/dL, creatinine 2.4 mg/dL, AST 28 U/L, ALT 102 U/L, alkaline phosphatase 98 U/L. Which medication is the likely etiology of his symptoms?

A 33-year-old man presents to the ED with a 2-day history of…

A 33-year-old man presents to the ED with a 2-day history of a cough with rust-colored sputum, fever, and chills. He has no past medical history and has had no recent illnesses or hospitalizations. In the ED, his vital signs are BP 120/76, HR 102, RR 22, oxygen saturation 97% on room air, and temperature 102.2°F. A chest X-ray shows a right lower lobe consolidation. The patient is diagnosed with pneumonia. What is the most likely pathogen?

A 30-year-old man presents to the ED with three weeks of dia…

A 30-year-old man presents to the ED with three weeks of diarrhea. He reports colicky abdominal pain associated with frequent episodes of pale, loose, foul-smelling stools. He returned from a camping trip in New Hampshire one month prior. His vital signs are temperature 37.1°C, heart rate 85, blood pressure 125/80 mm Hg. Which of the following is the most appropriate treatment for this condition?

An 83-year-old man with a history of diabetes and hypertensi…

An 83-year-old man with a history of diabetes and hypertension complains of numbness and severe pain in his left thigh. The pain began yesterday as a dull ache, but has rapidly increased in intensity and is now 10/10. Vital signs are BP 102/48 mm Hg, RR 24, HR 112, oxygen saturation 98% on room air, and a T of 40.3°C. Physical exam reveals tender, edematous, erythematous purpuric patches, and scattered bullae filled with serosanguineous watery fluid on his left thigh. Complete blood count reveals WBC of 15.8/µL with 31% bands, hemoglobin of 10.6 g/dL, a hematocrit of 31.8%, and platelets of 98/µL. Metabolic panel is significant for calcium of 8.4 mg/dl. Which of the following is the most appropriate next step in management?

An 82-year-old nursing-home resident is sent to the emergenc…

An 82-year-old nursing-home resident is sent to the emergency department with lower abdominal pain and bloody diarrhea. He has a history of vascular dementia, hypertension, and hyperlipidemia. On examination he is afebrile, and a nasogastric aspirate is negative for evidence of bleeding. Which of the following is the most likely cause of this patient’s bleeding?