1.A 57-year-old woman with known Addison disease, maintained on fludrocortisone 0.1 mg/day and dexamethasone 0.5 mg/day, attends the Emergency Room after having experienced five days of nausea, weakness and lethargy. She is found to have a blood pressure of 105/65 and a pulse of 110. Serum sodium is 123 and potassium 5.9. Which of the following would be the most appropriate treatment?
Hypertonic IV saline at 250 cc/hr, fludrocortisone po 0.1mg day, dexamethasone 0.5 mg/day
Normal saline IV at 100 cc/hr, cosyntropin 0.25 mg iv q 24h
Normal saline IVat 250cc/hr, hydrocortisone 100 mg iv q six hours for 24 hours
Five percent glucose in normal saline at 100 cc/hr, cosyntropin 0.25 mg iv q 24h
Normal saline IV at 250 cc/hour, fludrocortisone to 0.1 mg bid po, dexamethasone 0.5 mg po bid
A 60-year-old man presents to the Emergency Department with recent onset of light-headedness. He reports no chest pain and has no past history of cardiac disease. His blood pressure is 90/65 mm Hg, and his heart rate is 120/minute. Which one of the following is the most important first step in managing this patient?
Administer vasopressors
Order serum electrolytes
Monitor urine output
Insert a central line to monitor central pressure
Administer intravenous fluids
3.A 25-year-old woman is 12 weeks’ pregnant. She comes to see you as she is anxious that she may have a baby with trisomy 21. Her sister has spina bifida. Which one of the following antenatal screening tests should you offer?
Chorionic villus sampling.
Maternal chromosomes.
Fetal blood sampling.
Maternal serum screening (triple screen).
Amniocentesis.
4.You are a physician who stops at a serious motor vehicle collision. There is an elderly gentleman who is in severe respiratory distress from a flail chest, and hemorrhagic shock. You should provide medical care:
under all circumstances whether or not you have medical skills in first aid.
if the circumstances of providing treatment are within your skills and capability.
if you know that you will have liability coverage to protect against any future claims of medical negligence.
as an obligation of service to society whether or not the scene is safe.
only if the patient is competent and provides you consent to provide treatment.