Answer and Explanation 7

7.  Choice A is the correct answer.  Idiopathic Pulmonary Fibrosis IPF is a restrictive airway disease characterized by diffuse airway inflammation and scarring.  It causes reduced airway compliance and decreased diffusion across the alveolar capillary membrane.  Alpha 1 anti-trypsin deficiency is a genetic problem that can lead to emphysema which is an obstructive disease.  Chronic bronchitis and bronchiectasis are conditions that cause air trapping and lead to increased airway compliance and thus an obstructive disease.

Question 7

7.  Which of the following is not characterized as a obstructive airway disease?

A. Idiopathic pulmonary fibrosis

B. Alpha 1 antitrypsin lung disease

C. Chronic Bronchitis

D. Bronchiectasis

Answer and Explanation 6

6.  Choice C is correct.  Dysphonia after closed space inhalation injuries should be taken seriously.  Airway inflammation and swelling develops quickly and can lead to problems getting an airway.  It is advised to be performed by an experienced provider or at least have them available for back up.  While racemic epinephrine aerosol would improve the patient initially, the patient could rebound and get much worse.  If there truly is an inhalation injury, the airway swelling will develop quickly and racemic epinephrine will not be effective.  Choice A is incorrect.  In these instances, there is a lot of emotion and often the patients want to be discharged to be with there family.  His Sp02 is 100% but he could have some significant carbon monoxide exposure.  Remember he has a headache and carbon monoxide can cause falsely high Sp02 and a carboxyhemoglobin needs to be done

Question 6

6.  Your patient is a 34 year old male that was involved in a house fire after rescuing his three kids that were also inside of the home.  He is only complaining of headache and a hoarse voice.  He is awake and talking to you.  His vitals are as follows:  BP- 112/67, Pulse-76, RR-20, SpO2 is 100%.  His lungs are clear.  Which of the following is the best management option?

A.  Discharge the patient.  His vitals are fine.  He needs to be with his family

B.  Give the patient a racemic epinephrine treatment and admit the patient for observation.

C.  Consider intubating the patient and transferring him to a burn center and ventilate him on 100 FiO2.

D.  Put the patient in heated aerosolized oxygen mask.  That will help his hoarse voice and reduce swelling.

Answer and Explanation 5

5.   Choice B.  This patient is presenting with a clinical picture consistent with Diabetic Ketoacidosis (DKA).  Patients with DKA undergo an osmotic diuresis and present profoundly dehydrated.  Standard protocol dictates giving 2 liters of fluid to begin if they can tolerate it and starting the patient on an insulin drip.  The patients ABG’s demonstrate a metabolic acidosis.  Choice A is incorrect because the bicarb will correct itself when the acidosis resolves.  It is not advised in this situation.  Choice C is incorrect.  Hypertonic saline should almost never be given.  Correcting a “true” hypernatremia too quickly can result in pontine myelinolysis.  Choice D is simply not aggressive enough of management.  Patients with DKA need to be fluid rescuicitated more aggressively and need to have an insulin drip.

Question 5

5.  Your patient is a 64 year old that presents with shortness of breath, nausea and vomiting.  Initial vital signs and labs are as follows:  HR 111, BP 102/75, Sat-98% on RA.  WBC 12.9, Hgb 12.5. Hct 36.5, Platelets 230,000.  Na-124, K-3.3, CO2-16, Glucose 394, BUN-30 Creatine 1.1.  ABG- pH-7.1, PaCO2-24, HCO3 16, PaO-96 on Room Air. Based upon this clinical data, which on the following represents the best management plan.

A.   Order 3 amps of Bicarb to correct the patients acidosis and give the patient Zofran 4 mg IV.

B.   Give the patient 2 liters of normal saline, 4 units of Zofran, and place the patient on an insulin drip.

C.  Start the patient on hypertonic saline, patients with low Na for prolonged periods of time can cause seizures

D.  Gently hydrate the patient at NS 50 mL/Hr, order 4 mg of Zofran, give 10 units of insulin subcutaneously, and admit the patient to the hospital.