Match each patient's clinical scenario with the most appropriate next step in management.
- A 67-year-old man with advanced chronic obstructive pulmonary disease presents with three days of increased cough, newly purulent sputum, and worsening shortness of breath. He is hemodynamically stable without signs of impending respiratory failure.Prescribe a short course of oral corticosteroids, an oral antibiotic, and scheduled bronchodilators.
- A 60-year-old man recently started on high-dose furosemide for decompensated heart failure presents with severe muscle cramps. Laboratory testing reveals a pH of 7.54, bicarbonate of 34 mEq/L, and potassium of 2.8 mEq/L.Administer intravenous isotonic saline and replete potassium deficits.
- A 78-year-old man with a chronic indwelling urinary catheter is found to have >100,000 CFU/mL of Pseudomonas aeruginosa on a routine screening urine culture. He is completely asymptomatic, afebrile, and has a normal leukocyte count.Discontinue the urinary device and observe without administering antimicrobial therapy.
- A 32-year-old woman with generalized fatigue is found to have a serum TSH of 14.5 mIU/L (normal: 0.5-5.0 mIU/L) with a normal free T4 concentration on two separate occasions.Initiate daily levothyroxine replacement and repeat thyroid laboratory testing in 6 weeks.
Answer
The correct matching aligns the COPD exacerbation with systemic steroids and antibiotics, the diuretic-induced metabolic alkalosis with isotonic saline and potassium, the asymptomatic bacteriuria with catheter removal (no antibiotics), and the severe subclinical hypothyroidism with levothyroxine replacement.
Each clinical vignette maps directly to a definitive first-line intervention in general internal medicine. The COPD exacerbation meets criteria for triple therapy (steroids, bronchodilators, antibiotics). The volume-contracted metabolic alkalosis resolves with isotonic saline and potassium. The asymptomatic bacteriuria requires strict antibiotic avoidance and catheter discontinuation. The subclinical hypothyroidism with TSH >10 mIU/L requires thyroid hormone supplementation.
Step-by-Step Solution
Key Concept
Application of targeted, evidence-based management pathways across varied internal medicine presentations, emphasizing antibiotic stewardship and proper endocrine laboratory interpretation.