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A 26-year-old woman with no prior medical history presents to the emergency department (ED) with progressively worsening dyspnea for 1 week. Her symptoms are preceded by 3 days of fever, rigors, and nasal congestion. She is afebrile with HR of 116 beats/min and BP of 92/70 mmHg. Physical examination reveals bilateral rales, elevated jugular venous pressure, 2/6 systolic murmur at the left lower sternal border, cool extremities, and 2+ bilateral lower extremity edema. Echocardiogram reveals LVEF of 20%, nondilated LV (LV end-diastolic diameter of 3.4 cm), global hypokinesis, mild mitral regurgitation, and a normal right ventricular function. Labs are significant for creatinine of 1.6 mg/dL, aspartate aminotransferase (AST) of 385 U/L, alanine aminotransferase (ALT) of 413 U/L, troponin I of 4.8 ng/mL, and serum lactic acid of 2.8 mmol/L. Intravenous diuretics and dobutamine are initiated. Within 24 hours of admission, the patient develops hypotension and worsening heart failure refractory to inotropes and vasopressors. Urine output is 125 cc in the last 6 hours.  Which of the following is the best next step in her management to stabilize her?

A 60-year-old male with a history of nonischemic dilated cardiomyopathy is admitted to the intensive care unit after presenting to the emergency department with several days of progressive dyspnea and lower-extremity swelling. He is found to be hypotensive and tachycardic and on examination is noted to be confused with edematous, cool extremities. A 12-lead ECG shows rapid atrial fibrillation with nonspecific ST-segment changes. His last transthoracic echocardiogram performed 1 year ago showed a severely dilated LV cavity with a left ventricular ejection fraction of 28%, severe mitral regurgitation, moderate aortic insufficiency, and severe tricuspid regurgitation.  In this patient, which of the following represents a contraindication to the use of an intra-aortic balloon pump (IABP)?

The PTA is seeing a patient with the diagnosis of tibial plateau fracture. The POC calls for TE , TA, and gait training. The patient is NWB and wears a knee immobilizer during gait, MMT is generally 3+/5 flexion and 3-/5 extension. Please choose the most appropriate interventions from the following: 

The PTA is seeing a patient for back pain and tenderness and muscle spasm in the rhomboids and traps. What would be the most appropriate treatment to use to decrease the muscle spasms?

A 61-year-old male with history of ischemic cardiomyopathy and prior myocardial infarction is admitted to the ICU with symptoms of worsening shortness of breath and lower extremity edema. He has had cardiac resynchronization therapy with an implantable cardiac defibrillator (CRT-ICD) implanted 1 year ago. His home medications include carvedilol 12.5 mg twice a day, lisinopril 5 mg daily, aspirin 81 mg daily, spironolactone 25 mg daily, furosemide 40 mg daily, and atorvastatin 40 mg daily. On examination, he is afebrile, his heart rate (HR) is 60 beats/min, his blood pressure (BP) is 110/59 mmHg, his jugular venous pressure is elevated, his lungs are clear, he has a 3/6 holosystolic murmur with S3, and his lower extremities are cool with +2 pitting edema. Laboratory testing reveals sodium of 124 mmol/L, potassium of 4.6 mmol/L, blood urea nitrogen (BUN) of 51 mg/dL, and creatinine of 1.8 mg/dL. An ECG shows 100% atrioventricular paced rhythm.  Which of the following statements is FALSE with respect to this patient’s management?

A 76-year-old female undergoes uncomplicated coronary angiography via the right femoral artery for evaluation of a newly diagnosed cardiomyopathy. She is found to be without obstructive coronary artery disease. The patient is admitted to the intensive care unit for further monitoring. Her femoral angiogram is shown in the figure that follows. Angio2.jpg Two days following admission, the patient begins to cough. Shortly thereafter, she is observed to have sudden and rapid expansion of her right lower quadrant, with associated hypotension. Which of the following is the most appropriate next step?

ECG12.gif Based on the findings of this electrocardiogram, identify which coronary artery is affected:

A 69-year-old male patient presents with severe dyspnea, respiratory rate 32, SaO2 84%, heart rate 112, a blood pressure of 82/50, cold extremities, and confusion. After examining the patient, he begins to cough pink-tinged sputum. This scenario reflects:

All of the following conditions can cause secondary hypertension except:

You are being emergently called to the bedside of a 52-year-old otherwise healthy female who underwent a thoracotomy for left lower lobectomy for non-small-cell lung cancer one day ago. According to the nurse, the patient received a 2mg IV hydromorphone bolus 30 minutes ago. You find a somnolent patient, with a respiratory rate of 12/min, stable oxygen saturation of 97% on room air. The patient’s heart rate is 167 beats/min and irregular, blood pressure 73/34 mmHg. An ECG confirms the new diagnosis of atrial fibrillation (AF). The nurse states that the tachycardia started about 5 minutes ago.  Which would be the MOST appropriate next step?