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Difficulty: MediumGeneral Internal Medicine

Match each clinical presentation to the most appropriate initial therapeutic intervention.

  • A 68-year-old man with chronic kidney disease presents with generalized weakness; ECG shows peaked T waves and QRS widening.Administer intravenous calcium gluconate
  • A 54-year-old man with a history of heavy alcohol use develops severe agitation, diaphoresis, and visual hallucinations 72 hours after hospital admission.Administer intravenous lorazepam
  • A 45-year-old woman with cirrhosis presents with abdominal pain and fever; ascitic fluid analysis shows 400 neutrophils/mm³.Administer intravenous cefotaxime
  • A 72-year-old woman with heart failure presents with worsening dyspnea, orthopnea, jugular venous distention, and bilateral crackles on lung auscultation.Administer intravenous furosemide

Answer

Hyperkalemia with ECG changes requires calcium gluconate; delirium tremens requires lorazepam; spontaneous bacterial peritonitis requires cefotaxime; acute decompensated heart failure requires furosemide.
Each clinical presentation describes a classic acute medical emergency requiring a specific, immediate intervention. Hyperkalemia with QRS widening necessitates immediate cardiac membrane stabilization with calcium gluconate. Delirium tremens requires prompt symptom control with intravenous benzodiazepines like lorazepam. Spontaneous bacterial peritonitis, diagnosed by an ascitic neutrophil count greater than 250/mm³, requires urgent empiric antibiotics such as cefotaxime. Acute decompensated heart failure with signs of fluid overload is initially managed with an intravenous loop diuretic like furosemide to provide rapid symptom relief.

Step-by-Step Solution

1
Analyze each clinical vignette to establish the most likely acute primary diagnosis.
The diagnoses are severe hyperkalemia, delirium tremens, spontaneous bacterial peritonitis, and acute decompensated heart failure.
Establishing the correct diagnosis is required to select the targeted initial therapeutic intervention.
2
Determine the most appropriate immediate management for each confirmed diagnosis.
Hyperkalemia with ECG changes requires calcium gluconate; delirium tremens requires benzodiazepines; SBP requires a third-generation cephalosporin; acute decompensated heart failure requires a loop diuretic.
These represent the standard-of-care initial treatments according to current clinical guidelines.
3
Match the clinical presentations with their corresponding therapeutic interventions.
The correct pairs are formed based on the established diagnoses and their respective evidence-based treatments.
This completes the requirement of the matching task.

Key Concept

Initial management of acute internal medicine emergencies
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Topics

General Internal Medicine

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