NEJM Knowledge+

A 45-year-old woman presents in the emergency department for evaluation of weakness, fatigue, and inability to concentrate.....What is the most likely cause of this patient's hyponatremia?
►Cerebral salt wasting
►Low-solute diet
►Diabetes insipidus
►Syndrome of inappropriate antidiuretic hormone
►Reset osmostat
A 52-year-old woman with a history of hypertension, type 2 diabetes, stage 3 chronic kidney disease, and coronary artery disease reports one hour of retrosternal chest pain.....Which one of the following diagnoses is most likely in this case? (July 13, 2021)
►Coronary artery plaque rupture
►Coronary artery plaque erosion
►Coronary artery dissection
►Stent thrombosis
►In-stent restenosis

A 50-year-old man with a history of inflammatory bowel disease has a follow-up appointment to discuss his anemia, which is from ongoing gastrointestinal blood loss related to his inflammatory bowel disease.....Which one of the following treatments is most appropriate for treating this patient's anemia? (July 6, 2021)
►Oral iron and vitamin C
►Intravenous iron
►Packed red-cell transfusion
►Increased dose of oral iron
►Intramuscular iron dextran

A 72-year-old woman with a history of frequent urinary tract infections, who has a chronic suprapubic catheter to manage a neurogenic bladder associated with multiple sclerosis, presents for follow-up.....Which one of the following management approaches is most appropriate for this patient? (June 29, 2021)
►Nitrofurantoin for 7 days
►Amoxicillin for 7 days
►Trimethoprim–sulfamethoxazole for 14 days
►Ciprofloxacin for 3 days
►No treatment

A 46-year-old woman with a recent diagnosis of HIV infection and a CD4 count of 55 cells per mm3 is hospitalized with a 2-week history of fever and shortness of breath that began shortly after she began antiretroviral therapy......Which one of the following treatment approaches is most appropriate for this patient? (June 22, 2021)
►Begin treatment for tuberculosis and continue antiretroviral therapy
►Stop antiretroviral therapy and start prednisone
►Discontinue antiretroviral therapy and begin treatment for tuberculosis
►Continue antiretroviral therapy alone until the CD4 count exceeds 200 cells per mm3; then begin treatment for tuberculosis
►Continue antiretroviral therapy and start prednisone

A 6-year-old girl is evaluated 2 months after her father was killed in a motor vehicle crash.....Which one of the following responses is most appropriate in this situation? (June 15, 2021)
►Support the mother and reassure her that her daughter is exhibiting developmentally appropriate bereavement
►Encourage the mother to avoid confrontation with her daughter and limit discussion about the father’s death
►Recommend referral to a child psychiatrist for maladaptive grief reaction
►Encourage the mother to reinforce positive behaviors and manage the negative behaviors with time-outs
►Encourage the mother to communicate the finality of death to her daughter

A 63-year-old man with a history of hypertension, type 2 diabetes, chronic obstructive pulmonary disease, chronic low back pain, and chronic hepatitis C virus infection with decompensated cirrhosis presents to the emergency department with weakness, low-grade fevers, and fatigue for the past week......In addition to continuing albumin, which one of the following next steps is most appropriate for managing this patient’s acute kidney injury? (June 8, 2021)
►Initiate treatment with intravenous furosemide
►Refer for renal biopsy
►Initiate treatment with midodrine and octreotide
►Refer for renal replacement therapy
►Perform large-volume paracentesis 

A 63-year-old woman with hypertension, hyperlipidemia, and gastroesophageal reflux disease presents for preoperative evaluation before surgical repair of a torn right rotator cuff.....In addition to continuing the beta-blocker and statin, which one of the following approaches is most appropriate for this patient's preoperative management? (June 1, 2021)
►Perform cardiac catheterization and percutaneous coronary intervention for any significant lesions
►Perform an echocardiogram
►Perform a nuclear stress test
►Perform an exercise treadmill test without imaging
►No further evaluation is required; proceed to surgery

A 55-year-old man is brought to the emergency department after a witnessed tonic–clonic seizure.....What is the most appropriate initial management option in this patient? (May 25, 2021)
►Start a continuous infusion of phenytoin
►Obtain repeat CT of the brain
►Start a continuous infusion of midazolam
►Transfer to the intensive care unit, and initiate sedation
►Obtain electroencephalography

A 53-year-old man with a history of hypertension reports 3 months of weekly intermittent episodes of a racing heartbeat.....In addition to checking serum electrolytes and thyroid function, which one of the following next steps is most appropriate in managing this patient’s palpitations? (May 18, 2021)
►Exercise tolerance test
►Cardiac event monitor
►Counseling to reduce caffeine and alcohol intake
►24-hour Holter monitor

A 47-year-old man with cirrhosis attributed to alcohol use disorder presents to the emergency department with abdominal tenderness, increased abdominal girth, lower-extremity edema, and fatigue.......Which one of the following tests should be done initially for this patient? (May 11, 2021)
►Renal ultrasound
►Noncontrast abdominal CT scan
►Measurement of serum alpha-fetoprotein
►Upper endoscopy
►Diagnostic paracentesis

A 32-year-old previously healthy man reports a 3-day history of diarrhea that began one day after he returned from a trip to Mexico......Which one of the following bacterial pathogens is the most likely cause of this patient's diarrhea? (Apr. 27, 2021)
►Enterotoxigenic Escherichia coli
►Staphylococcus aureus enterotoxin
►Shiga-toxin–producing Escherichia coli
►Salmonella typhi
►Shigella flexneri

A 19-year-old male college student reports low back pain that started about 4 months ago.....Which one of the following medications is most appropriate for initial management of this patient? (May 4, 2021)
►Naproxen and physical therapy
►Scheduled oxycodone


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Oral iron and vitamin C

Intravenous iron
Packed red-cell transfusion
Increased dose of oral iron
Intramuscular iron dextran