Internal Medicine

Question 1

. What is your immediate action about this patient with these laboratory results after consuming a lot of metformin and some other drugs?
PH:7
HCO3:14

1.Bicarbonate
2.hemodialysis

Answer 1

2.hemodialysis

Question 2

A person who have hyperkalemia 5.6 and has hypernatremia 148 and has a troponin about 160 and has calcium about 3.2. After iv Fluid resuscitation what should we to next?

Resonium
Pamidronate

Answer 2

Resonium, also known as sodium polystyrene sulfonate or Kayexalate, is often used to treat hyperkalemia. It works by binding excess potassium in the intestines and thus reducing overall body potassium levels.

Question 3

A young female who doesn’t have any disease before, comes with symptoms like spontaneous pneumothorax just after smoking. Patient is stable and It was not mentioned anything in the CXR and how much percent is pneumothorax. What should we do next?
(I think options was like these, but I’m not sure.)

Observe
Needle aspiration
Chest tub
Discharge

Answer 3

Observe

Management of pneumothorax depends on its size, the patient’s symptoms, and whether it is a first-time event or recurrence. If the patient is stable and the pneumothorax is small, often defined as less than 15-20% of the lung volume or 2cm or less of space at the level of the hilum on CXR, observation with or without supplemental oxygen may be appropriate.

When the pneumothorax is larger, or if the patient is in distress with symptoms such as shortness of breath, then intervention is needed, often in the form of needle aspiration or placement of a chest tube to allow the air to escape from the pleural space, and hence re-expand the lung.

In the scenario you have described, where the patient is stable and the size of the pneumothorax is not clear, observation may be a reasonable next step, followed by repeat imaging to ensure that the pneumothorax is not enlarging.