A 75-year-old woman is brought to the emergency department by her daughter because of a 2-day history of malaise and new-onset confusion. The patient has been hemiplegic and bedridden following an ischemic stroke 4 months ago. She has type 2diabetes mellitus and hypertension. Current medications include metformin, lisinopril, atorvastatin, and aspirin. She is oriented to person but not to place or time. Her temperature is 37.6°C (99.7°F), pulse is 102/min, respirations are 31/min, and blood pressure is 88/59 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Examination of the sacrum reveals an ulcer with exposed subcutaneous tissue and necrotic areas. The skin is warm and well-perfused. Arterial blood gas analysis shows a pH of 7.25, pCO2 of 30 mm Hg, and HCO3- of 14 mEq/L. Which of the following is the most appropriate next step in management?

Five days after being admitted to the intensive care burn unit for partial-thickness burns involving 36% of the total body surface area, a 32 year old woman develops decreased urine output. She sustained the burns after spilling boiling water on herself while cooking. She was admitted for fluid resuscitation, nutritional support, pain management and wound care. She had been improving until today. She is receiving total parenteral nutrition via a central venous catheter. She has no other medical conditions. She is only oriented to person. Vitals include: Temp 96.5*F, Pulse 120 beats/min, Respirations 24 breathes/min, BP 96/60 mmHg, Pulse Ox 93% on 5L oxygen via face mask.  Examination shows extensive partial-thickness burns across her lower abdomen and legs, as well as some full-thickness burns. The burns are tender and have edematous borders. The skin around the central venous catheter appears normal.  Labs include: Leukocyte count 18,000/mm3 Which of the following is the most likely underlying cause of this patient’s worsening symptoms?

A 58-year-old man with diabetes presents with scrotal pain and fever. He appears confused, and his vital signs are notable for tachycardia and hypotension. Which finding would most strongly support a diagnosis of Fournier gangrene?

A 22 year old women presents with a 4 day history of swelling and pain in her right inguinal area. She has no past medical history. She states there has been increased swelling and tenderness a few days after noticing an ingrown hair in the area. She has no history of skin infections. Her temperature is 99.2*F and she appears well. Along the right inguinal crease there is a 5 cm x 3 cm area of induration with central fluctuance. The area is tender to palpation, especially toward the central portion. There is no erythema, streaking or crepitus. The rest of her examination is unrevealing. Which of the following next steps is most appropriate to manage this patient’s skin lesion?

A 63 year old patient with diabetes mellitus presents with a 36 hour history of progressive right lower extremity pain and swelling that began after stepping barefoot on a rusty nail. Initial urgent care prescribed cephalexin for presumed cellulitis, but the patient returns with worsening symptoms.  Vitals include: BP 102/60 mmHg, HR 114, RR 24, Temp 101.4*F.  He appears confused. Physical examination shows an area of erythema on the right foot with purple discoloration, several tense bullae, and crepitus extending up the ankle. Laboratory studies, including blood cultures, are drawn. What is the most appropriate next step in management?

Assume that the economy starts out with potential and current real GDP being the same.  If the government increases spending, then in order to ensure an inflationary gap doesn’t exist, the FED must .  The effect of ONLY the change in the money supply will investments into physical capital, and cause .  

Once you are done, please scan/save ALL your FULL-WORK in one pdf file (with 3 or more pages). Then check that file BEFORE you submit. Then check your submitted file AFTER submission to make sure I receive the file you intend to send. The Proctorio part is due by 6.00pm. You have until 6.15pm to fully upload and submit your full work for Final (part 1). You can start part 2 of this final at 6.15pm. Good luck!

Suppose that there is currently a recessionary gap, then the FED should the money supply by US securities or the required reserve ratio.    

================= For this Proctorio part, please enter the final answers for parts (a) and (b). You will need to type using Equation Editor (“three dots” then “” sign). Remember, you still need submit your full work in “Final (part 1) upload” as PAGE 1.  

If the economic stability in the US increases, then the equilibrium exchange rate will and as a result imports will , and the United States real GDP will .