A 54-year-old female with PMH significant for alcoholic cirrhosis and recurrent esophageal varices, who recently underwent transjugular intrahepatic portosystemic shunt (TIPS) placement, is brought to the emergency room by her daughter due to somnolence. Starting this morning, the patient has appeared sleepy, difficult to arouse, and slow to respond to questions. On physical exam, temperature is 98.6º F, BP 98/56 mmHg, pulse is 72/min, and respirations are 14/min. She repeatedly falls asleep during examination. With arms outstretched and wrists dorsiflexed, flapping of the hands is observed. Which of the following is the most appropriate treatment for this patient?

Bonus Question: A 72-year-old male has a past medical history that is significant for severe and uncontrolled hypertension; he is brought into the emergency room by his family due to a 30-minute history of change of mental status. The patient had just climbed stairs when he first developed a headache that has become progressive; it is associated with nausea, non-bilious vomiting, and unilateral upper and lower extremity numbness. His physical exam reveals an alert patient who is not oriented to time, place, or person. He is afebrile, with a blood pressure of 185/108 mm Hg, and there is nuchal rigidity present. His neurological exam notes contralateral sensory loss, contralateral hemiparesis, gaze paresis, homonymous hemianopia, and miosis. A CT scan without contrast was performed, and it is shown in the image below.  Your preceptor asks you to calculate the patient’s current mean arterial pressure (MAP).  MAP = [(2 x diastolic BP) + systolic BP] / 3

A 68-year-old male with a past medical history of hypertension, diabetes mellitus type II, and hyperlipidemia, as well as a 30-pack-year smoking history presents to the Emergency Department with aphasia and right-sided hemiparesis. His wife reports that he was completely normal three hours ago at dinner. Vital signs are T 37C, HR 90, BP 142/91 mmHg, RR14, O2 99% on room air. On physical examination, he is unable to repeat a sentence. He is unable to express himself although he is able to follow commands. His right upper extremity and lower extremity are both weak but the weakness is more pronounced in his right arm than right leg. On examination of the head and neck, you note bilateral carotid bruits. Head CT is obtained (see image below). Which of the following statements regarding the management of this patient is TRUE? 

A 32-year-old female presents to the Emergency Department for evaluation of sudden painful vision loss in the left eye. The symptoms started suddenly this evening and have never happened before. She is followed by a primary care provider and is not currently receiving any medications. The patient reports “a few episodes of weakness or numbness in the past that resolved on their own.” Vital signs: BP: 120/74, HR: 88/min, T: 98.2F, RR: 12/min O2sat (RA): 98% On exam, the patient is noted to have decreased sensation over the dorsal aspect of the left foot and vision loss in the left eye. The patient reports pain in the left eye on exam. Which of the following clinical findings would also likely be present in this patient given her probable diagnosis?

What culture is known for their BCE architectural works (sculpture, columns, and buildings)?

True or False:  Alfred Stieglitz is the first U.S. photographer to be recognized in the 20th century for his individuality and artistic worth.

What is the only remaining ancient wonder of the world?  At one time, there were seven of them.

Who invented the modern day camera?

Directions: Calculate the following dosage. Order: Cardura 8 mg p.o. dailyAvailable: How many whole tablets will the nurse administer?

Directions: Determine the infusion time for the following IV.  When will the IV infusion be complete if 1,000 mL D5W infusing at 100 mL/hr is started at 3:00 AM?  Give answer in military time of hours.