.A 55-year-old male presents to the ICU with severe acute respiratory failure. His blood gases reveal the following: pH: 7.28 PaCO2: 60 mmHg PaO2: 60 mmHg HCO3-: 26 mEq/L Which of the following best describes the primary cause of his acid-base disturbance?

. Which of the following is the most common cause of shock in a patient with a history of acute myocardial infarction (MI)?

Which of the following is the most appropriate management for a patient with status epilepticus who has failed initial benzodiazepine therapy?

In a patient with diabetic ketoacidosis (DKA), which of the following is the most important initial step in treatment

Which of the following changes in a patient's blood gas would suggest a mixed respiratory and metabolic acidosis?

Which of the following is a contraindication to the use of nitroprusside in an ICU setting?

**A 70-year-old female with COPD presents to the ICU with acute respiratory failure. Her blood gases are as follows: pH: 7.32 PaCO2: 60 mmHg PaO2: 50 mmHg HCO3-: 28 mEq/L What is the most likely cause of her hypoxemia?**

A 45-year-old male with a history of alcohol use disorder develops acute liver failure. His lab results reveal an INR of 3.5, total bilirubin of 12 mg/dL, and an albumin level of 2.0 g/dL. Which of the following is the most likely underlying cause of his acute liver failure?

Which of the following is the most important factor to monitor during the administration of intravenous sodium bicarbonate for metabolic acidosis?

A 56-year-old man with sepsis is being treated with norepinephrine to maintain adequate blood pressure. His MAP is now 70 mmHg, but his urine output is still low despite adequate fluid resuscitation. Which of the following is the most likely cause of his oliguria?

A 34-year-old woman with a history of systemic lupus erythematosus (SLE) develops acute kidney injury (AKI) with the following laboratory results: Serum creatinine: 4.0 mg/dL Urine protein: 3+ (significant proteinuria) Urine sediment: Dysmorphic red blood cells What is the most likely cause of her AKI?**

A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with a tidal volume of 6 mL/kg and a positive end-expiratory pressure (PEEP) of 10 cm H2O. His PaO2/FiO2 ratio is 150. What is the most appropriate next step in management?

A 72-year-old man presents to the ICU after undergoing emergency surgery for a ruptured abdominal aortic aneurysm. He has a history of hypertension, coronary artery disease, and chronic kidney disease. His serum creatinine is 2.0 mg/dL (baseline 1.3 mg/dL), and his urine output is 25 mL/hr. What is the most likely cause of his oliguria?

A 64-year-old male with chronic heart failure develops sudden onset of dyspnea and orthopnea. On examination, he has bibasal crackles, jugular venous distention, and an S3 gallop. His BNP is elevated, and his chest X-ray shows cardiomegaly with pulmonary congestion. What is the most likely cause of his acute symptoms?

Which of the following is the most likely cause of hyponatremia in a patient receiving large volumes of intravenous normal saline for fluid resuscitation?

A patient with acute respiratory failure due to chronic obstructive pulmonary disease (COPD) exacerbation is started on non-invasive positive pressure ventilation (NIPPV). After 30 minutes, the patient’s condition worsens with increasing respiratory rate, decreased oxygen saturation, and confusion. What is the most likely cause of his deterioration?

Which of the following is the most common cause of hospital-acquired pneumonia (HAP) in mechanically ventilated patients?

Which of the following interventions is most likely to improve the prognosis of a patient with severe sepsis?

A 48-year-old woman presents with severe abdominal pain and signs of peritonitis. She is found to have acute pancreatitis, and her serum lipase is 8 times the normal level. What is the most likely cause of her acute pancreatitis?

A 65-year-old male with a history of chronic atrial fibrillation presents to the ICU with sudden-onset hemiparesis and dysphasia. A CT scan of the head confirms an ischemic stroke. Which of the following is the most appropriate next step in management?

A 63-year-old man with a history of hypertension and coronary artery disease presents to the ICU with acute onset chest pain and shortness of breath. His ECG shows ST-segment elevation in leads II, III, and aVF. His troponin I level is elevated. What is the most appropriate initial management for this patient?

A 25-year-old woman presents to the ICU after a motor vehicle accident with a large pelvic fracture and hypovolemic shock. Her blood pressure is 80/40 mmHg, heart rate is 120 bpm, and she is receiving large volumes of intravenous fluids. Which of the following is the most appropriate next step in management?

**A 72-year-old man with advanced chronic obstructive pulmonary disease (COPD) presents to the ICU with worsening respiratory distress and confusion. His blood gases show the following: pH: 7.28 PaCO2: 75 mmHg PaO2: 45 mmHg HCO3-: 28 mEq/L What is the most appropriate treatment for this patient?**

A 70-year-old male with a history of diabetes and hypertension is admitted to the ICU with acute respiratory distress and a PaO2/FiO2 ratio of 150. His chest X-ray shows bilateral infiltrates. He has a fever, and his white blood cell count is elevated. Which of the following is the most likely cause of his acute respiratory distress syndrome (ARDS)?

Which of the following is the most appropriate management for a patient with severe sepsis who is persistently hypotensive despite adequate fluid resuscitation and is now requiring vasopressor therapy to maintain a mean arterial pressure (MAP) of 65 mmHg?

A 50-year-old woman with a history of heart failure and diabetes mellitus is admitted to the ICU with shortness of breath, orthopnea, and lower extremity edema. Her echocardiogram shows a left ventricular ejection fraction (LVEF) of 35%. What is the most appropriate pharmacologic therapy to improve her symptoms?

A 40-year-old man presents with fever, chills, and severe back pain. He is febrile (39°C), and his white blood cell count is elevated. A CT scan of the abdomen reveals a large retroperitoneal collection. What is the most likely diagnosis?

A 52-year-old male with cirrhosis and ascites presents to the ICU with confusion and asterixis. His ammonia level is elevated. What is the most likely diagnosis?

A 68-year-old woman with a history of hypertension and atrial fibrillation presents with sudden-onset severe leg pain, pallor, and a cold, pulseless limb. Doppler ultrasound confirms the absence of blood flow to the affected leg. What is the most likely cause of her condition?

A 30-year-old woman with a history of systemic lupus erythematosus (SLE) presents with pleuritic chest pain, dyspnea, and a positive D-dimer. Her chest X-ray is normal. What is the most likely diagnosis?

A 58-year-old woman with a history of diabetes mellitus and chronic kidney disease presents to the ICU with confusion, lethargy, and a serum sodium level of 125 mEq/L. Her urine sodium is 40 mEq/L. What is the most likely cause of her hyponatremia?

A 45-year-old male with chronic alcoholism presents with confusion, ataxia, and nystagmus. He is found to have an elevated serum lactate level, and his MRI shows bilateral thalamic lesions. What is the most likely diagnosis?

A 68-year-old woman presents with acute-onset shortness of breath, jugular venous distention, and bilateral lower extremity edema. Her echocardiogram reveals a left ventricular ejection fraction of 20%. What is the most appropriate treatment for her condition?

A 72-year-old male with a history of atrial fibrillation presents with a sudden onset of right-sided weakness and slurred speech. His CT scan of the head shows no hemorrhage. What is the most likely diagnosis, and what is the most appropriate management?

A 56-year-old male with a history of hypertension and diabetes presents to the ICU with chest pain, dyspnea, and diaphoresis. His ECG shows ST-segment elevation in leads V1- V4. What is the most appropriate next step in management?

A 48-year-old male presents with severe back pain, fever, and night sweats. He has a history of intravenous drug use. His physical exam reveals spinal tenderness, and his MRI shows vertebral disc space narrowing with a paraspinal abscess. What is the most likely diagnosis?

A 68-year-old woman with chronic kidney disease and diabetes presents with nausea, vomiting, and confusion. Her laboratory results reveal a serum sodium of 126 mEq/L, and her urine sodium is 8 mEq/L. What is the most likely diagnosis?

A 70-year-old man with a history of hypertension and smoking presents to the ICU with acute shortness of breath, pleuritic chest pain, and a widened mediastinum on chest Xray. His blood pressure is 90/60 mmHg. What is the most likely diagnosis?

A 45-year-old woman with systemic lupus erythematosus (SLE) presents with malaise, low-grade fever, and arthralgias. Her laboratory findings show a positive anti-dsDNA antibody and low C3 levels. What is the most likely diagnosis?

A 62-year-old male with a history of coronary artery disease presents with sudden-onset severe chest pain and a blood pressure of 80/50 mmHg. His ECG shows no ST-segment elevation. What is the most likely diagnosis?

A 60-year-old male with a history of hypertension and type 2 diabetes presents to the ICU with confusion, blurred vision, and nausea. His serum glucose is 950 mg/dL, and his serum osmolality is 330 mOsm/kg. What is the most likely diagnosis?

A 55-year-old male presents with sudden-onset severe abdominal pain, nausea, and vomiting. He has a history of chronic alcohol use and cirrhosis. On examination, he has a distended abdomen and signs of peritonitis. His serum amylase is elevated. What is the most likely diagnosis?

A 40-year-old female with a history of systemic lupus erythematosus (SLE) presents with new-onset hematuria, edema, and elevated blood pressure. Urinalysis shows 3+ protein and numerous red blood cell casts. What is the most likely cause of her symptoms?

A 72-year-old man presents with acute-onset right-sided weakness, dysphagia, and facial droop. His CT scan of the head reveals a hypodense area in the left middle cerebral artery (MCA) territory. What is the most appropriate next step in management?

A 60-year-old woman with a history of atrial fibrillation presents to the ICU with acute shortness of breath, pleuritic chest pain, and tachycardia. Her ECG shows no ST-segment elevation, but a CT pulmonary angiogram confirms the diagnosis of a pulmonary embolism. What is the first-line treatment for this condition?

A 35-year-old woman presents with a fever, malaise, and painful joints. She has a history of systemic lupus erythematosus (SLE) and a recent upper respiratory tract infection. On examination, she has a butterfly-shaped rash on her face and oral ulcers. What is the most likely diagnosis?

A 72-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with increased shortness of breath, cough, and sputum production. His chest X-ray reveals hyperinflation and flattened diaphragms. What is the most likely diagnosis?

A 52-year-old man presents with severe chest pain radiating to his back, diaphoresis, and a blood pressure of 90/50 mmHg. His ECG shows no ST-segment elevation. What is the most likely diagnosis?

A 70-year-old man with a history of heart failure presents with worsening dyspnea, orthopnea, and bilateral lower extremity edema. His echocardiogram shows a left ventricular ejection fraction of 30%. What is the most appropriate next step in management?

A 68-year-old woman presents with sudden-onset headache, nausea, vomiting, and altered mental status. Her CT scan of the head reveals a subarachnoid hemorrhage. What is the most important next step in management?