Welcome to your Review Board III
59 year old M with initial presentation of follicular lymphoma s/p treatment with relapse and now diffuse large B cell lymphoma. Patient with prior deep vein thrombosis. Patient with large 10 cm right flank mass currently receiving local radiation therapy only and no chemotherapy treatment,continues to receive weekly port flushes. Patient on pregabalin 25 mg po qHS for bilateral lower extremity neuropathic pain with acute on chronic thrombocytopenia. Which is next step?
58 year old with metastatic Renal Cell Carcinoma diagnosed 5 years ago presents with progressive weakness in his bilateral lower extremities. He is very fatigued and his legs hurt at the end of the day. He denies bowel/bladder incontinence. Anal sphincter tone is adequate on exam. Recently his methadone was increased to 40 mg PO TID. He is also on atorvastatin, Lisinopril, HCTZ and oxycodone 15-20 mg every 4 hours as needed. What is the next best step in management?
Appropriate step chosen for patient in question #6. Which is next best step in treatment?
69 yo M with chronic back pain taking MSIR 15mg po q4h as outpatient admitted for right total hip arthroplasty develops acute on chronic renal failure postop and is placed on fentanyl 25 mcg patch with fentanyl 25 mcg IV every 2 hours prn without relief. Which of the following would be next best step?
After choosing appropriate step in question #11, patient more comfortable. On POD#3, no longer using breakthrough. Primary team would like to prepare pt for discharge within the next 48 hours,acute on chronic renal failure is improving but not resolved. Which is most appropriate?
Patient with delirium for 12 hours with history of prostate cancer, CHF, COPD with acute onset severe agitation and fever for the last 48 hours. Which is most likely cause?
88 year old African American Female with metastatic breast cancer,minimal symptoms except for diminished PO intake with gradual decline. Patient with PPS of 20. Which would be best intervention?