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?
Read DetailsA 58-year-old man presents to the emergency department with…
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?
Read Details