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A patient with a history of small cell lung cancer is admitted with progressive shortness of breath and dry cough. The patient was discharged post thoracentesis 2 weeks ago for similar presentation. Upon assessment, the patient is awake, alert, oriented, and tachypneic, with a respiratory rate of 28 and dyspneic with speaking. Oxygen saturation is 89% on 2 L on oxygen. A recurrent large pleural effusion is noted on chest x-ray.  What is best treatment for this patient?

Name the artifact indicated on the image below.

A 70 year old man presents with peritonitis from a ruptured diverticulum and has an urgent partial colectomy. Postoperatively, he requires vasopressors and multiple liters of IV fluid.His medical history includes stage 4 CKD from HTN. His usual medications include lisinopril 20 mg QD, amlodipine 10 mg QD, and furosemide 80 mg BID.On POD 1, his temp is 101°F, HR 90, and BP 120/60 mmHg. His urine output declines to 5 mL/h despite continued IV fluids and repeat doses of IV furosemide boluses. His abdomen is mildly distended, quiet, and tender to palpation. He has pitting edema of the hands and lower legs. Bladder pressure is 10 cm H2O. His labs showed the following:Na 125, K 6.4, Cl 100BUN 50, CO2 18, Cr 4.5His urine sediment shows granular casts and cellular debris.An ECG shows tall T waves in precordial leads and a shortened QT interval.In addition to intravenous calcium, insulin, and dextrose, which the following is the next MOST appropriate treatment?

 Provide a clear plan for a multi-step synthesis to prepare explaining how the reactions will proceed.

A 57 year old female with history of breast cancer treated with L. mastectomy and chemotherapy and radiation presents with a 1-week history of headaches, gait instability, progressive confusion, and a new onset seizure. On physical examination she is somnolent and only opens her eyes in response to voice. She is only oriented to person (knows her own name) but is not oriented to place or date. She does not follow commands but does withdraw from painful stimuli. Emergent noncontrast head CT is performed, which reveals multiple masses with surrounding edema and no evidence of blood. The patient’s Glasgow Coma Score is 11.What is the MOST appropriate intervention for this patient at this time?

A 55 year old male presents to the emergency department with agitation. The ED physician orders haloperidol for agitation before learning that patient is taking high-dose methadone for back pain and has a history of substance abuse and dependence. His ECG strip on telemetry is shown below. He converts to normal sinus rhythm after receiving 2 g of magnesium. 10 minutes later the arrhythmia recurs. He is alert and talking comfortably. BP is 110/68 and SpO2 is 94% on 2 L NC. EKG What should be the next immediate step?

Which of the following statements is MOST likely to be true of continuous renal replacement therapy (CRRT) in comparison to intermittent hemodialysis (IHD):

A 69 year old male with history of HTN, T2DM, and COPD with a previous 30 pack-year smoking history presents to his PCP for his yearly physical exam. He has no current complaints.Which diagnostic test should be ordered for preventive lung caner screening?

Which statement regarding finished medicinal products is correct: All new finished medicinal products for human use in the European Union must…? (2 correct answers)

Which type of muscle is attached to bones and can be contracted and relaxed by a person at will?