23. A 27-year-old man presents to the emergency department complaining of muscle pain, weakness, and reddish-brown urine. He states that while moving furniture yesterday he got pinned under a dresser. He has large areas of bruising over his bilateral thighs. Which additional finding would confirm the suspected diagnosis?

22. When treating myasthenia gravis, what major side effect can excessive use of anticholinesterase medication cause that results in paradoxical weakness?

66. Ms. T.G. is an 80 y/o female initially admitted to the ICU for septic shock due to UTI. She developed acute respiratory failure and was intubated for airway protection. After 2 weeks on the ventilator she became febrile, tachycardic and tachypneic; Lactate was 3.1. You would prescribe 

92. A patient is intubated, quickly regains his baseline level of alertness, and is extubated 4 hours later. He is alarmed by his need for mechanical ventilation and before discharge he asks you about his life expectancy. Which of the following is the best predictor of survival in COPD.

26. What is the first-line and most effective drug for the symptomatic treatment of the above neurologic disorder (#25)?

57. J.T. is a 57-year-old male status post MVA, currently post op day 7 and on high levels of positive pressure ventilation. He is now febrile with worsening leukocytosis. CXR shows increased bilateral diffuse opacifications, increased peak/plateau inspiratory pressures, and increased 02 requirements. This is related to which of the following and what is the most appropriate treatment?

27. A 70-year-old woman presents to your clinic for routine follow-up after an urgent care visit for an abscess on her buttock. After incision and drainage, she was prescribed clindamycin. Now, five days later, the surgical site is well appearing, but the patient has developed low-grade fevers, fatigue, and profuse, watery diarrhea about 12 times per day that is associated with sharp, crampy abdominal pain. Based on her history, you suspect C. difficile colitis. What is the first step in the treatment while awaiting culture results?

95. Which of the following is the correct order for highest to lowest priority of surrogate decision makers for an incompetent adult patient?

79. A patient who has been in the intensive care unit for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care nurse practitioner’s initial treatment 

100. A 39-year-old patient presents to the ED with a one-day history of right upper quadrant pain, nausea and one episode of vomiting. The pt has no prior medical history. A right upper quadrant ultrasound is indicative of cholecystitis.  Labs are the following WBC 11, Bun 40, Cre 1.1  ALT 189  AST 275.  The pt undergoes an ERCP.  Overnight the patient developed a low grade 100.9 and complains of increased epigastric pain that is now band like in nature. What is the most appropriate lab to obtain for this patient?