,1. A patient reports to the emergency department where you are working at 10 pm. They
report that earlier in the day beginning at approximately 9 am they began to experience tingling
in their right arm. They decided to ignore it thinking it was probably a result of all the gardening
they did the day before. As the day went on, the tingling sensation got worse, and they started to
have difficulty speaking.The patient's spouse reported that they were slurring their words. Past
medical history includes a diagnosis of diabetes and hypercho- lesteremia. By the time they are
evaluated, their symptoms start to subside. The tingling disappears and their speech returns to
normal. What do you suspect this patient has experienced? What evidence is there to support that
diagnosis?: This patient has experienced a TIA. They have experienced symptoms consistent
with oxygen deprivation to the brain, however their symptoms subsided within 24 hours of
their onset.
2. A 75-year-old male is brought to the emergency department by their
spouse at 8 pm. The spouse reports that they were cleaning up after dinner at approximately 6:30
pm, and she noticed that her husband's speech was very unclear. When she asked him what was
going on, he said that he didn't know and that the entire right side of his face felt numb. She
reports that he is very active, but he has a past medical history of atrial fibrillation. Based upon
these symptoms and past medical history, what do you suspect this patient is experiencing? How
would you confirm this diagnosis? What treatment should be administered? Explain why you chose
that treatment.: This patient is more than likely experiencing an ischemic stroke. A CT scan
and MRI would be needed to determine if a clot was blocking blood flow to the brain tissue
and to rule out a hemorrhagic stroke. If a clot is found, this patient should receive tPA drugs
as they are within the 3-4.5 hour treatment window.
3. You are seeing a patient in your office with a primary complaint of ex-
cessive daytime sleepiness. Their spouse reports that they snore loudly and often wake up gasping
for air.What type of sleep disorder do you suspect they are experiencing (be specific)? What type of
diagnostic work up needs to be done? Name one treatment option to address this patient's
symptoms.: This pt is experiencing Moderate/ borderline severe Obstructive Sleep apnea, we
need to see if he has any of the potential risk factors like large neck girth, obseity, male, etc.
the pt needs to go under extensive sleep studies to confirm their OSA diagnosis. depending on
the severity, life style changes can help with this apnea but a NCPAP machine or a mouth peice
can be given to open the airways and help them not to collapse during the pts sleep.
,4. A patient with chronic kidney disease must undergo dialysis treatments as they wait for
transplantation. Give 1 reason peritoneal dialysis would
be preferable to the patient over hemodialysis and 1 concern in choosing peritoneal dialysis over
hemodialysis.: Peritoneal dialysis can be done in the patient's home as opposed to going to a
dialysis clinic multiple times per week. A major concern of the utilization of peritoneal dialysis
the risk for infection at the catheter site.
5. A patient presents to the emergency department with complaints of sharp pain that comes in
waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been
experiencing nausea and vomiting all day long. They have a history of UTIs. Urinalysis reveals that
the pH of their urine is 7.8. A CT scan is ordered, and it reveals a stone 4 mm in diameter. What
type of renal calculi do you suspect? What treatment is needed? Explain your
, reasoning for both answers.: since the urine is alkalidic, i suspect a magnesium ammonium
phosphate renal calculi. The stone is not large enough to have any surgical intervention, it
can pass on it own. pain management would be given as well as antibiotics to treat any
current or future UTIs. I chose this answer because If the stone is between 1-5 mm then it can
pass on its own, the urine is alkilidic which points to the MAP renal calculi, as well as you
have to treat and even pretreat the UTI so the pt is not at risk for an even worst infection
due to the renal calculi.
6. A patient presents in the emergency department with severe dehydration secondary to
vomiting. The following are the results of their blood work: pH
= 8.2, PCO2 = 39 mm, and HCO3- = 33 mEq/L. Based upon these results, what type of acid-base
disorder are they experiencing? Is compensation occurring? Describe a treatment intervention for
this disorder. Normal values are as follows: pH = 7.35-7.45, PCO2 = 35-45 mm, HCO3- = 22-26 mEq/L.:
The patient is in metabolic alkalosis. The respiratory system is not compensating as PCO2
compensation falls within normal limits. Fluids are replaced with normal saline solution.
7. A patient is in the ICU following open heart surgery. The patient was feeling well earlier in
the day, but suddenly began to demonstrate signs of confusion and disorientation. Blood results
reveal Na+ = 100 mEq/L. Based upon these symptoms and results of blood work, what electrolyte
imbalance is this patient experiencing? What treatment is indicated for this imbalance?-
: This patient is experiencing euvolemic hypotonic hyponatremia. The administration of
intravenous saline solution would be indicated to correct the sodium deficiency.
report that earlier in the day beginning at approximately 9 am they began to experience tingling
in their right arm. They decided to ignore it thinking it was probably a result of all the gardening
they did the day before. As the day went on, the tingling sensation got worse, and they started to
have difficulty speaking.The patient's spouse reported that they were slurring their words. Past
medical history includes a diagnosis of diabetes and hypercho- lesteremia. By the time they are
evaluated, their symptoms start to subside. The tingling disappears and their speech returns to
normal. What do you suspect this patient has experienced? What evidence is there to support that
diagnosis?: This patient has experienced a TIA. They have experienced symptoms consistent
with oxygen deprivation to the brain, however their symptoms subsided within 24 hours of
their onset.
2. A 75-year-old male is brought to the emergency department by their
spouse at 8 pm. The spouse reports that they were cleaning up after dinner at approximately 6:30
pm, and she noticed that her husband's speech was very unclear. When she asked him what was
going on, he said that he didn't know and that the entire right side of his face felt numb. She
reports that he is very active, but he has a past medical history of atrial fibrillation. Based upon
these symptoms and past medical history, what do you suspect this patient is experiencing? How
would you confirm this diagnosis? What treatment should be administered? Explain why you chose
that treatment.: This patient is more than likely experiencing an ischemic stroke. A CT scan
and MRI would be needed to determine if a clot was blocking blood flow to the brain tissue
and to rule out a hemorrhagic stroke. If a clot is found, this patient should receive tPA drugs
as they are within the 3-4.5 hour treatment window.
3. You are seeing a patient in your office with a primary complaint of ex-
cessive daytime sleepiness. Their spouse reports that they snore loudly and often wake up gasping
for air.What type of sleep disorder do you suspect they are experiencing (be specific)? What type of
diagnostic work up needs to be done? Name one treatment option to address this patient's
symptoms.: This pt is experiencing Moderate/ borderline severe Obstructive Sleep apnea, we
need to see if he has any of the potential risk factors like large neck girth, obseity, male, etc.
the pt needs to go under extensive sleep studies to confirm their OSA diagnosis. depending on
the severity, life style changes can help with this apnea but a NCPAP machine or a mouth peice
can be given to open the airways and help them not to collapse during the pts sleep.
,4. A patient with chronic kidney disease must undergo dialysis treatments as they wait for
transplantation. Give 1 reason peritoneal dialysis would
be preferable to the patient over hemodialysis and 1 concern in choosing peritoneal dialysis over
hemodialysis.: Peritoneal dialysis can be done in the patient's home as opposed to going to a
dialysis clinic multiple times per week. A major concern of the utilization of peritoneal dialysis
the risk for infection at the catheter site.
5. A patient presents to the emergency department with complaints of sharp pain that comes in
waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been
experiencing nausea and vomiting all day long. They have a history of UTIs. Urinalysis reveals that
the pH of their urine is 7.8. A CT scan is ordered, and it reveals a stone 4 mm in diameter. What
type of renal calculi do you suspect? What treatment is needed? Explain your
, reasoning for both answers.: since the urine is alkalidic, i suspect a magnesium ammonium
phosphate renal calculi. The stone is not large enough to have any surgical intervention, it
can pass on it own. pain management would be given as well as antibiotics to treat any
current or future UTIs. I chose this answer because If the stone is between 1-5 mm then it can
pass on its own, the urine is alkilidic which points to the MAP renal calculi, as well as you
have to treat and even pretreat the UTI so the pt is not at risk for an even worst infection
due to the renal calculi.
6. A patient presents in the emergency department with severe dehydration secondary to
vomiting. The following are the results of their blood work: pH
= 8.2, PCO2 = 39 mm, and HCO3- = 33 mEq/L. Based upon these results, what type of acid-base
disorder are they experiencing? Is compensation occurring? Describe a treatment intervention for
this disorder. Normal values are as follows: pH = 7.35-7.45, PCO2 = 35-45 mm, HCO3- = 22-26 mEq/L.:
The patient is in metabolic alkalosis. The respiratory system is not compensating as PCO2
compensation falls within normal limits. Fluids are replaced with normal saline solution.
7. A patient is in the ICU following open heart surgery. The patient was feeling well earlier in
the day, but suddenly began to demonstrate signs of confusion and disorientation. Blood results
reveal Na+ = 100 mEq/L. Based upon these symptoms and results of blood work, what electrolyte
imbalance is this patient experiencing? What treatment is indicated for this imbalance?-
: This patient is experiencing euvolemic hypotonic hyponatremia. The administration of
intravenous saline solution would be indicated to correct the sodium deficiency.
