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* Question from USMLE Sample questions?
  aricept123 - 10/11/18 13:34
  A 35-year-old man is brought to the emergency department because of altered mental status. He is disoriented and reports problems with his vision. You have been his physician for the past 3 years. He has type 1 diabetes mellitus and a known history of intravenous drug use. You last saw him 2 weeks ago; at that visit his serum glucose concentration was 150 mg/dL 3 hours after eating. Today, vital signs are temperature 38.1°C (100.5°F), pulse 110/min, and blood pressure 190/70 mm Hg. On physical examination pupils are constricted; funduscopic examination of the left eye following dilation is shown. Which of the following is the most appropriate test at this time?

(A) Blood cultures (B) Chest x-ray (C) Hemoglobin A1c level (D) HIV antibody titer (E) Plasma renin activity
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* Re:Question from USMLE Sample questions?
  cardio69 - 10/11/18 19:01
  Pat DM1 & known "IVDU"^ (There is no reliable marker available to exclude serious illness in the febrile IV drug user) -> YOU obtain specimens for Blood culture & adm* pat 4 observation while culture/results are awaited… even if your pat “clinically well” pat for whom follow up can be ensured/outpat evaluation is reasonable ALA appropriate culture specimen are obtained.

Pat^ here clearly painted with infection (most probably related to IVDU history) standard care-> blood cultures must be obtained in case pat didn’t respond to the antibiotic in order-> *for pat adm with septic or possible meningitis ...

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* Re:Question from USMLE Sample questions?
  cetamool - 10/11/18 20:39
  Will, this guy clearly had cocaine, the pulse pressure is very high! I would go with cxr to rule out widening of the mediastinum.  
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* Re:Question from USMLE Sample questions?
  cardio69 - 10/11/18 22:19
  Let's review step 1@cetamool

On pat who took sympathetic NS agonist or amphetamine/coca/LSD -> Q4 you, Do you see Bilateral constricted pupils???:) on your PE...
("On PE pupils are constricted") ask yourself :) can cocaine cause that?
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