NBME1-------A little confusing - gainer84

[ArchivalUser]

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

[ArchivalUser]

M. since na is low, and pt probably has small cell ca secreting ADH.

[ArchivalUser]

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.

[ArchivalUser]

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