NBME1-------A little confusing - gainer84 - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: NBME1-------A little confusing - gainer84 (/showthread.php?tid=517467) |
NBME1-------A little confusing - gainer84 - ArchivalUser - 07-07-2010 1. A previously healthy 52-year-old man comes to the emergency department because of hiccups for 1 week. He has smoked two packs of cigarettes daily for 30 years. He does not drink alcohol. He is alert and oriented. His temperature is 37 C (98.6 F), blood pressure is 150/95 mm Hg, pulse is 70/min, and respirations are 12/min. Physical and neurologic examinations show no abnormalities. His serum sodium level is 120 mEq/L. An x-ray film of the chest shows a right hilar mass. Which of the following is the most appropriate next step in treatment? A ) Bisphosphonate therapy B ) Calcitonin therapy C ) Calcium therapy D ) Dexamethasone therapy E ) 5% Dextrose in 0.225% saline therapy F ) 5% Dextrose in 0.45% saline therapy G ) 5% Dextrose in water therapy H ) Fluid restriction I ) Hydrocortisone therapy J ) Lactated Ringer's solution K ) Mannitol therapy L ) Potassium therapy M ) 0.9% Saline therapy N ) 3% Saline therapy O ) Sodium bicarbonate therapy 0 - ArchivalUser - 07-16-2010 M. since na is low, and pt probably has small cell ca secreting ADH. 0 - ArchivalUser - 07-16-2010 H. I am thinking for fluid restriction. Pt has no sym like confusion.. apart from hiccup, Na is 120 that is borderline. I will start fluid restriction. 0 - ArchivalUser - 07-16-2010 Mild hypona Na > 120, no change in mental.... Fluid restriction n correct underlying cause moderate No 110 - 120, altered mental status......... NS + diuretics severe Na < 110, coma n seizure .................. hypertonic saline |