Based on the metagenomic analysis in Olm et al. (2022), genes related to utilization of what compound were seen more in non-industrialized children?  (Your answer should be three letters).

In nursing and medical fields, inductive reasoning helps professionals identify patterns that may indicate underlying problems.

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?

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?

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?

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?

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?

A 58-year-old man presents to the emergency department with melena and epigastric pain. He is tachycardic on arrival but becomes hemodynamically stable after intravenous fluid resuscitation. Laboratory studies are pending. Upper gastrointestinal bleeding from a peptic ulcer is strongly suspected, and endoscopic evaluation is planned.Which intervention should be initiated prior to endoscopy to optimize visualization and diagnostic accuracy while avoiding unnecessary delays in care?

A patient with persistent polyuria and hypernatremia undergoes a desmopressin (DDAVP) challenge. Following administration, urine osmolality increases significantly.Which conclusion can be drawn from this response?

A 58-year-old man with known cirrhosis and ascites is admitted for worsening lower extremity edema. He is afebrile and denies abdominal pain, nausea, or confusion. As part of routine evaluation, diagnostic paracentesis is performed. Ascitic fluid analysis reveals a polymorphonuclear (PMN) count of 320 cells/mm³. Ascitic fluid cultures are pending.What is the most appropriate management?