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16936 Medicine

A 47-year-old HIV-positive man is brought to the emergency room because of weakness. The patient has HIV nephropathy and adrenal insufficiency. He takes trimethoprim-sulfamethoxazole for PCP prophylaxis and is on triple-agent antiretroviral treatment. He was recently started on spironolactone for ascites due to alcoholic liver disease. Physical examination reveals normal vital signs, but his muscles are diffusely weak. Frequent extrasystoles are noted. He has mild ascites and 1+ peripheral edema. Laboratory studies show a serum creatinine of 2.5 with a potassium value of 7.3 mEq/L. ECG shows peaking of the T-waves and QRS widening to 0.14. What is the most important immediate treatment?

ASodium polystyrene sulfonate (Kayexalate)
BAcute hemodialysis
CIV normal saline
DIV calcium gluconate
Medicine
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16937 Medicine

A 20-year-old woman presents with bilateral conductive deafness, palpable purpura on the legs and hemoptysis. Radiograph of the chest shows a thin-walled cavity in left lower zone. Investigations reveal total leukocyte count 12,000/mm red cell casts in the urine and 12,000/mm serum creatinine 3 ing/dL. What is the most probable diagnosis ?

AHenoch-Schonlein purpura
BPolyarteritis nodosa
CWegener's granulomatosis
DDisseminated tuberculosis
Medicine
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