93. A 70-year-old male with past medical history of mild-moderate mitral regurgitation and moderate-severe tricuspid regurgitation, COPD, and secondary pulmonary hypertension presents to the Emergency Department with a fever and new cough. Vitals on presentation are notable for a blood pressure of 80/43, temperature of 38.7°C, and oxygen saturation of 80% on room air, which improves modestly with 6 L oxygen by nasal cannula. Chest radiograph shows multifocal airspace opacities suggestive of pneumonia, but not pulmonary edema. He is transferred to the ICU for intubation. Examination is also notable for cool extremities with +1 symmetric lower extremity edema. In determining whether to administer fluids to this patient to augment his mean arterial pressure, which of the following techniques would be LEAST helpful?

23. A 27-year-old man presents to the emergency department complaining of muscle pain, weakness, and reddish-brown urine. He states that while moving furniture yesterday he got pinned under a dresser. He has large areas of bruising over his bilateral thighs. Which additional finding would confirm the suspected diagnosis?

22. When treating myasthenia gravis, what major side effect can excessive use of anticholinesterase medication cause that results in paradoxical weakness?

66. Ms. T.G. is an 80 y/o female initially admitted to the ICU for septic shock due to UTI. She developed acute respiratory failure and was intubated for airway protection. After 2 weeks on the ventilator she became febrile, tachycardic and tachypneic; Lactate was 3.1. You would prescribe 

92. A patient is intubated, quickly regains his baseline level of alertness, and is extubated 4 hours later. He is alarmed by his need for mechanical ventilation and before discharge he asks you about his life expectancy. Which of the following is the best predictor of survival in COPD.

26. What is the first-line and most effective drug for the symptomatic treatment of the above neurologic disorder (#25)?

57. J.T. is a 57-year-old male status post MVA, currently post op day 7 and on high levels of positive pressure ventilation. He is now febrile with worsening leukocytosis. CXR shows increased bilateral diffuse opacifications, increased peak/plateau inspiratory pressures, and increased 02 requirements. This is related to which of the following and what is the most appropriate treatment?

27. A 70-year-old woman presents to your clinic for routine follow-up after an urgent care visit for an abscess on her buttock. After incision and drainage, she was prescribed clindamycin. Now, five days later, the surgical site is well appearing, but the patient has developed low-grade fevers, fatigue, and profuse, watery diarrhea about 12 times per day that is associated with sharp, crampy abdominal pain. Based on her history, you suspect C. difficile colitis. What is the first step in the treatment while awaiting culture results?

95. Which of the following is the correct order for highest to lowest priority of surrogate decision makers for an incompetent adult patient?

79. A patient who has been in the intensive care unit for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care nurse practitioner’s initial treatment