Items 519 through 520

A 24-year-old woman presents with lethargy, anorexia, tachypnea, and weakness. Laboratory studies reveal a BUN of 150 mg/dL, serum creatinine of 16 mg/dL, and potassium of 6.2 meq/L. Chest x-ray shows increased pulmonary vascu-larity and a dilated heart.

5-19. Management of this patient includes a. Emergency kidney transplantation b. Creation and immediate use of a forearm arteriovenous fistula c. Sodium polystyrene sulfonate (Kayexalate) enemas d. A 100-g protein diet e. Cardiac biopsy via femoral vein catheterization

5-20. In the course of 3 mo of treatment, the patient's congestive heart failure resolves, her lethargy and weakness diminish markedly, and she is able to return to work part time. Family immune profile studies reveal that her mother and father are haplotype identical with regard to HLAs and that her sister is a six-antigen match. At this time, the patient should be urged to a. Continue hemodialysis three times a week b. Undergo cadaveric renal transplantation c. Accept a kidney transplant from her sister d. Accept a kidney transplant from her father e. Accept a kidney transplant from her mother

5-21. A 31-year-old man presents to the emergency room 3 days after undergoing a hernia repair operation. He is febrile and hypotensive. The symptoms began with the sudden onset of a diffuse maculopapu-lar rash that was pruritic and erythematous. On cutaneous examination, the erythroderma involves the palms and soles and is beginning to desquamate. The patient has no other illnesses and takes no medications. Which of the following is the most likely diagnosis?

a. Toxic epidermal necrolysis b. Toxic shock syndrome c. Necrotizing fasciitis d. Scarlet fever e. Cellulitis

5-22. A 74-year-old man presents with the abrupt onset of pain in the left lower abdomen. The pain has been progressively worsening over the last 2 days. The patient states that the pain is unremitting. He has some diarrhea but no nausea or vomiting. He has no dysuria or hematuria. His temperature is 102 °F. Bowel sounds are decreased. The patient exhibits involuntary guarding. There is tenderness and rebound tenderness when the left lower quadrant is palpated. The referred rebound test is positive. A fixed sausagelike mass is palpable in the area of tenderness. There is no CVA tenderness. Rectal examination reveals brown stool, which is FOBT positive. Bloodwork demonstrates a leukocytosis. Which of the following is the most likely diagnosis?

a. Colon cancer b. Diverticulitis c. Pancreatitis d. Pyelonephritis e. Appendicitis

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