Q) A 32-year-old woman presents with fatigue and kidney stones. Labs show:
- Serum calcium: 11.6 mg/dL (elevated)
- PTH: inappropriately elevated
- Serum prolactin: normal
- Fasting glucose: elevated, HbA1c: 7.2%
Her brother had a gastrinoma and hyperparathyroidism in his 30s.
A MEN1 mutation is detected on genetic testing.
Which of the following is the most appropriate next step in her evaluation?
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Q: A 60-year-old man with cirrhosis presents with refractory ascites requiring frequent large-volume paracentesis. He is evaluated for TIPS placement. Which of the following findings would be the strongest contraindication to proceeding with the procedure?
A) Serum bilirubin of 3.5 mg/dL
B) MELD score of 18
C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg
D) History of prior hepatic encephalopathy controlled on lactulose
Q ) During fluid resuscitation in a burns patient using Parkland’s formula, volume of fluid given in first 8 hours is ? A. 50% B. 25 % C. 75 % D. 100 %
TBSA% burn × weight (kg) × 4 = volume in mL
The first half is given in 8 hours and the second over 16 hours to complete the 24-hour resuscitation time frame.
Developed by Dr. Charles Baxter in the 1960s at the Parkland Memorial Hospital in Texas, this formula serves as a cornerstone in determining the initial fluid requirements to stabilize burn victims during the crucial early hours following injury.
Although the Parkland Formula offers a valuable framework for fluid resuscitation, it's important to note that individual patient variability, coexisting injuries, and evolving clinical conditions necessitate close monitoring and adjustment of the resuscitation plan. Over-resuscitation can lead to complications such as pulmonary edema, while under-resuscitation can result in inadequate tissue perfusion and organ failure.