and does well post-operatively for 48 hours. He then develops atrial fibrillation with chest |
pain, hypotension, and depressed consciousness. He is cardioverted out of atrial fibrillation |
and his mental status improves. Two hours later is he found slumped over in his bed and is |
difficult to arouse. He is tachypnic and diaphoretic. His pulse is 110 (and regular), blood pressure 160/90mm/Hg, temperature 101.2° (earlobe). Pulse oximetry reveals an oxygen saturation of 89% on 4 Liter/minute nasal canula O2. He cannot move his left hand and the |
left side of his mouth. Chest exam reveals right lower lobe "wet" crackles. An arterial |
blood gas on 4 Liter/minute nasal canula returns with a pO2 of 58mm, pCO2 24mm, pH 7.49. |
A chest radiograph shows a new right lower lobe consolidation which was not present on |
the previous hospital day. An ECG shows sinus tachycardia, mild PR depression throughout, |
diffuse non-specific ST/T wave abnormalities, and an old incomplete right bundle branch |
block. Renal function is stable and urine output is good. |
A. Post-CABG cerebral embolism (stroke) followed by aspiration
B. Cerebral embolism (stroke) due to immobility followed by aspiration
C. Aspiration pneumonia precipitating atrial fibrillation, leading to stroke
D. Metabolic alkalosis precipitating atrial fibrillation, stroke, and aspiration
E. Dressler's Syndrome precipitating atrial fibrillation, stroke and aspiration
A. Pure respiratory alkalosis
B. Pure metabolic alkalosis
C. Respiratory alkalosis with metabolic compensation
D. Metabolic acidosis with respiratory compensation
E. Metabolic alkalosis and repiratory alkalosis
pneumonia is [3]: |
and he is on no inotropic agents. On 50% FiO2 non-rebreathing mask, the arterial blood gas shows a pO2 of 90mm, pCO2 32mm, pH 7.32. The most likely explanation for the current |
condition of this patients is [4]: |
A. The patient could not have moderately severe carbon monoxide poisoning
B. The pulse oximeter reading is accurate
C. An arterial blood gas would show mixed respiratory alkalosis and metabolic acidosis
D. Nausea and vomiting are common symptoms of carbon monoxide poisoning
E. Fetal hemoglobin has a higher affinity for carbon monoxide than adult hemoglobin
A. Administer 50% oxygen by face mask and admit patient to critical care unit
B. Administer 100% oxygen by non-rebreathing face mask and monitor the patient closely for signs of airway edema
C. Administer lidocaine, 2µg/kg/min intravenously and monitor the patient closely for signs of airway edema
D. Administer 100% oxygen by non-rebreathing mask, contact a hyperbaric oxygen unit, andmonitor the patient closely for signs of airway edema
E. Emergently intubate the patient and administer 100% oxygen
A. ACE Inhibitor induced syncope
B. Progressive cardiac conduction system disease with bradycardia
C. Cebrovascular accident
D. Uremic induced bradycardia
E. Digitalis (digoxin) poisoning with bradycardia
A. Shock or Cardiac Arrest or Ventricular Tachycardia
B. AV Block or Sinus Bradycardia unresponsive to atropine
C. Digoxin Level >10ng/mL or ingestion of >10mg digoxin
D. Hyperkalemia with any other signs of digoxin toxicity
E. Severe nausea and vomiting
A. Hyperventilation
B. Acetazolamide (Diamox®): blocks excretion of bicarbonate (HCO3-)
C. Nitroprusside
D. Maintenance of normal or hypothermic temperature (ie. treat fevers)
E. Glucocorticoids
TOPIC CARD REFERENCES |