07-02-2007, 12:35 PM
7 year old man is bought to the emergency department by his wife cause of 3 days of progressive sleepinies. Ovrt yhr past year he has had intermittent night sweats and a 9 kg weight with no change in appetite he ahsw 2yr history of non productive cough treated with inhaled corticosteroid thrapy He has smoked 2 packs everydat for 40 years and he does nto smoke alcohol He is somlonene tbut oriented to person but not time nad place Temp 98.8 pulse 96 resp 16 bp is 120/85 Examination shows supple neck with fullness in the left supraclavicular fossa dullness to percussion onleft base of lung oxygen saturation 90% no neurologic abnormality calcim is 14 urine sodium less then 5 fractional excretion less than 1 % x ray shows left pleural effusion
what is most appropriate next step
a iv bisphosphanated
b iv dextrose and salinw
c iv dextrose and water
d iv saline only
e oral loop diuretic
what is most appropriate next step
a iv bisphosphanated
b iv dextrose and salinw
c iv dextrose and water
d iv saline only
e oral loop diuretic