Online Course for NAPLEX / Clinical portion of CPJE

Case:

RN, a 56-year-old male patient, presents to the ER with progressively worsening shortness of breath when walking more than 20 feet, fatigue, and bilateral pitting edema of his legs for the last few months.

Past Medical History:
DM type 2
Long-standing hypertension

Current Medications:
Metformin 1000 mg PO BID
Pioglitazone 30 mg PO once daily
Hydrochlorothiazide 25 mg PO once daily
Lisinopril 40 mg PO once daily
Amlodipine 10 mg PO once daily

Vitals: BP: 110/63 mmHg P: 110, Resp Rate: 22 Temp: 97.8

Labs:
BUN ................................ 19 mg/dL (6-20)
Serum Creatinine ............. 1.1 mg/dL (0.6-1.2)
Potassium ....................... 3.1 mEq/L (3.5-5.2)
BNP ................................ 960 (10-300)
Troponins ....................... Negative

Imaging Studies:
Chest x-ray: Enlarged cardiac silhouette, mild pulmonary edema
Echocardiogram: Ejection Fraction: 30%

Question:

Which of his medications may be worsening his pulmonary edema and leg edema symptoms? Select ALL that apply.

Answer:

A Metformin B Poiglitazone C Hydrochlorothiazide D Lisinopril E Amlodipine

Case:

MK is a 49-year-old male with history of liver cirrhosis. He is brought to ER by family members with a chief complaint of confusion and altered mental status for the last 24 hours.

On exam, MK is difficult to arouse; he is not oriented to time, person or place.

Vitals: BP: 110/67 mmHg P: 80 RR: 14 Temp 98.6

Labs:

Comprehensive Metabolic Panel:

	Normal Range	Results
Sodium	135 – 145 mEq/L	138
Potassium	3.5 – 5.2 mEq/L	4.2
Chloride	97 – 108 mEq/L	100
HCO3	23 – 29 mEq/L	25
Calcium	8.5 – 10.2 mg/dL	9.2
BUN	6 – 20 mg/dL	15
Creatinine	0.6 – 1.3 mg/dL	1.0
Glucose	70 – 100 mg/dL	85
ALT	< 35 U/L	52
AST	< 35 U/L	55
Albumin	3.4 – 5.4 g/dL	2.0
Bilirubin	0.3 – 1.9 mg/dL	4.0
Ammonia	15 – 45 mcg/dL	110

INR …………………. 2.1

Urine analysis & Lumbar puncture results are normal.

Question:

Which of the following treatment measures do you recommend? Select ALL that apply.

Answer:

A Volume resuscitation with Normal Saline IV infusion B Ceftriaxone empiric therapy to treat meningitis C PO Lactulose D Xifaxan E Sodium bicarbonate to alkalinize the urine

Question:

Which of the following medications are used to treat hyperphosphotemia of ESRD? Select ALL that apply.

Answer:

A Calcium acetate B Renagel C Renvela D Sodium polystyrene E Lokelma

Question:

DB is a 67-year-old male with ESRD on dialysis who has been on Epogen 3000 units SC three times a week for anemia of chronic renal failure. His recent labs are as follows:

Hgb …………………. 12.6 g/dL (13.5 – 16.5 g/dL for males)
Hct …………………… 38.6 % (40% – 52%)
MCV …………………. 86 fL
WBC ………………… 4.0 thous/microL
Platelets …………….. 185 thous/microL

With regards to his Epogen dosing, what would be the most appropriate course of action?

Answer:

A Continue with the same dose B Increase dose to 3600 units SQ three times a week. C Reduce dose to 2400 units SQ three times a week. D Discontinue for a few weeks and when HgB <10 g/dL, restart Epogen at a lower dose.

Question:

Which of the following is NOT a suspending agent?

Answer:

A Silica Gel B Tragacanth C Hydroxyethylcellulose D Guar Gum E Methylparaben

Your score:

You correctly answered out of questions.

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