A 47-year-old woman with known Graves disease presents to th…
A 47-year-old woman with known Graves disease presents to the emergency department with acute agitation, vomiting, profuse diarrhea, and fever. Vital signs reveal a temperature of 105.8°F (41°C), heart rate 156 bpm, blood pressure 82/46 mmHg, and oxygen saturation 93% on room air. She is confused and diaphoretic. ECG shows atrial fibrillation with rapid ventricular response.Which feature most strongly supports thyroid storm rather than uncomplicated hyperthyroidism?
Read DetailsA 29-year-old woman presents with palpitations, heat intoler…
A 29-year-old woman presents with palpitations, heat intolerance, unintentional weight loss, and increased bowel movements. She denies taking thyroid medication. Physical examination reveals warm, moist skin and a diffusely enlarged, nontender thyroid. Laboratory testing shows a suppressed TSH and elevated free T4.Which diagnosis best explains this patient’s condition?
Read DetailsA 65-year-old male is post-traumatic brain injury (TBI) and…
A 65-year-old male is post-traumatic brain injury (TBI) and intubated in the ICU. Over the past 12 hours, he has developed high urine output (>300 mL/hr), rising serum sodium, and signs of dehydration despite adequate IV fluid resuscitation.Laboratory results:Serum sodium: 154 mEq/LSerum osmolality: 315 mOsm/kgUrine osmolality: 110 mOsm/kgUrine specific gravity: 1.001Which of the following is the most appropriate next step in management?
Read Details58-year-old male with a history of alcohol use disorder pres…
58-year-old male with a history of alcohol use disorder presents with altered mental status, jaundice, and abdominal distention. Vitals: BP 92/56, HR 112, RR 22, SpO₂ 95% on room air. Labs show:AST 134 U/L, ALT 98 U/LINR 2.4, Platelets 78,000/mm³Total bilirubin 6.2 mg/dLAmmonia 88 µmol/LCreatinine 2.1 mg/dL (baseline 0.9)Based on these findings, what is the most appropriate initial management priority?
Read DetailsA patient with known decompensated cirrhosis presents with f…
A patient with known decompensated cirrhosis presents with fever, worsening abdominal pain, and altered mental status. Diagnostic paracentesis reveals an ascitic fluid polymorphonuclear (PMN) count of 420 cells/mm³. Blood pressure is stable, and renal function is pending.What is the most appropriate immediate management step?
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