A 68 year old male presents to the emergency department with sudden shortness of breath and pleuritic chest pain. He reports he has been on a 2 day road trip to visit family in a different state. His history includes hypertension, type II diabetes, tobacco use, and obesity (BMI 34).  Vitals: BP 159/90 mmHg, HR 121 bpm, RR 28 breaths/min, and oxygen saturation 91% on room air. Electrocardiogram (ECG): Shows sinus tachycardia with no specific signs of acute strain.  Chest X-ray: No obvious abnormalities Labs:  Hemoglobin: 14.2 g/dL Hematocrit: 42% White blood cell count: 8,500/mm³ Platelets: 210,000/mm³ INR: 1.1 PTT: 28 seconds  Creatinine: 0.9 mg/dL D-dimer: 8.5 µg/mL Which of the following is the most appropriate next step in the diagnostic work-up?

An 82-year-old woman with limited mobility is admitted to the hospital from a nursing home. During the skin assessment, the nursing staff identify a pressure injury on her sacrum. The wound shows full-thickness tissue loss, but the base of the wound is completely covered by thick, black, dry eschar that is firmly adherent to the underlying tissue. There is no erythema, fluctuance, or drainage present. The AGACNP is unable to visualize the wound bed due to the eschar coverage. How should this pressure injury be classified?

A 74-year-old female with a history of severe COPD is being intubated in the ICU for acute hypercapnic respiratory failure secondary to pneumonia. The AGACNP is preparing to set the initial ventilator parameters. Patient demographics: Height: 5’5″ (165 cm) Body weight: 150 lbs (68 kg) Gender: Female What is the appropriate tidal volume range for this patient?

A 52-year-old male with a history of hypertension, hyperlipidemia, and type II diabetes presents to the emergency room with a 2-day history of right lower leg pain, redness, and swelling. He reports the symptoms began suddenly and have progressively worsened. He denies any recent trauma but mentions he had a small scratch on his leg from gardening about 5 days ago. He denies any recent long care rides or recent sedentary activity.  Vital signs: temperature 38.3°C (101°F), blood pressure 128/82 mmHg, heart rate 92 bpm, and respiratory rate 16/min on room air. Physical examination reveals a poorly demarcated area of erythema and edema on the right lower leg that is warm and tender to palpation. There is no streaking erythema. The left lower leg appears normal. The affected area is not exquisitely tender, and there is no crepitus or bullae formation. (Tintinalli’s Emergency Medicine) What is the most likely diagnosis?

A 64-year-old man is admitted to the medical floor with acute-on-chronic dyspnea and productive cough with dark sputum for the past week. He reports progressively worsening shortness of breath over the past 5 years. His occupational history includes 38 years working in coal mining in West Virginia. He has a 20 pack-year smoking history but quit 10 years ago. Vital signs: BP 142/86, HR 102, RR 26, temperature 38.3°C (101°F), SpO2 88% on room air. Physical examination reveals use of accessory muscles, decreased breath sounds throughout with coarse crackles in the upper lung fields bilaterally, and dullness to percussion at the right base. Laboratory Results: Test Value Reference Range Complete Blood Count WBC 14,500/μL 4,500-11,000/μL Hemoglobin 16.8 g/dL 13.5-17.5 g/dL Hematocrit 52% 38.5-50% Platelets 285,000/μL 150,000-400,000/μL Basic Metabolic Panel Sodium 138 mEq/L 136-145 mEq/L Potassium 4.2 mEq/L 3.5-5.0 mEq/L Chloride 100 mEq/L 98-106 mEq/L Bicarbonate 32 mEq/L 22-28 mEq/L BUN 22 mg/dL 7-20 mg/dL Creatinine 1.1 mg/dL 0.6-1.2 mg/dL Arterial Blood Gas (Room Air) pH 7.38 7.35-7.45 PaCO2 48 mmHg 35-45 mmHg PaO2 56 mmHg 80-100 mmHg HCO3 28 mEq/L 22-26 mEq/L Additional Labs Procalcitonin 2.8 ng/mL

Which of the following pulmonary manifestations is characteristic of systemic lupus erythematosus?

Which of the following are surgical indications for the management of chronic venous insufficiency ulcers? Select all that apply. 

A 34-year-old factory worker splashes hydrofluoric acid onto two fingers. Initially there is minimal erythema, but 2 hours later he reports severe, escalating pain. After immediate copious water irrigation, what is the best next step?

A 45-year-old man presents to the clinic with a 5-day history of fever (temperature 38.9°C/102°F), diffuse pruritic rash, and facial edema. He started taking carbamazepine 4 weeks ago for newly diagnosed trigeminal neuralgia. He reports that the rash initially began on his trunk and has progressively spread to his extremities. On examination, he has a generalized morbilliform eruption with areas of confluence on the trunk, along with periorbital edema and bilateral cervical lymphadenopathy. Laboratory studies show: WBC: 13,500/μL with 18% eosinophils Atypical lymphocytes: 12% Hemoglobin: 14.2 g/dL Platelets: 140,000/μL AST: 285 U/L (normal: 10-40) ALT: 320 U/L (normal: 10-40) Alkaline phosphatase: 95 U/L (normal: 30-120) Total bilirubin: 1.8 mg/dL (normal: 0.1-1.2) Creatinine: 1.8 mg/dL (baseline: 0.9 mg/dL) Sodium: 138 mEq/L Potassium: 4.2 mEq/L Which of the following features are characteristic of DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome? Select all that apply.

A 28-year-old man with asthma is brought to the emergency department with severe respiratory distress. He has received three back-to-back albuterol nebulizer treatments and ipratropium without significant improvement. He can only speak single words, is using accessory muscles, and appears tired, but remains alert and oriented. Lung examination reveals wheezing bilaterally.  Vital signs: HR 132, RR 38, SpO2 86% on 4L nasal cannula. ABG: pH 7.32, PaCO2 52 mmHg, PaO2 58 mmHg. He has been placed on continuous albuterol nebulization and has just received IV methylprednisolone 125 mg. Which additional intervention should be administered immediately?