Answer and Explanation 4

4.  Choice B is the correct answer.  This patient has a left sided hemopneumothorax.  It is over 15% which is generally considered the threshold for putting a chest tube in  or not.  Choice A is incorrect for a couple reasons.  First the patients problem is on the left not the right.  In addition, needle decompression is done in the mid clavicular line.  It would simply not be effective for draining blood or air.  Choice C may buy some time if the patient is unstable and it is under tension but would not provide definitive treatment.  Choice D would be correct if the patient had a pleural effusion on the left.

Question 4

4.  Take a look at the chest x ray on the below.  What is the best therapeutic intervention based on your interpretation?

A.   Needle decompression at the anterior auxillary line  at the second or third on the right side with a 16 guage needle

B.  Insert a 36 french chest tube at the forth or fifth interspace anterior auxiliary line on the left side

C.  Insert a 16 gauge needle at the second or third interspace in the midclavicular line on the left

D.  Send the patient for a thoracocentesis on the left.

Answer and Explanation 3

3.  The correct answer is D.  Decadron or parenteral glucocorticoids are one of the mainstays of severe acute asthma attacks, It will help potentiate beta agonists and help reduce airway inflammation.  Giving singulair the leukotriene inhibitor will not be beneficial.  It is a maintenance medication.  The long acting beta agonist, would not be beneficial in an acute attack.  it take about 30 minute to even begin working let alone peak.  It to should be thought of as a maintenance medication.  Fluticsone or inhaled glucocorticoids she be thought of as a maintenance medication.

Question 3

3.  Your patient is a 23 year old female that presents via EMS with status asthamticus,  she has received albuterol aerosols via squad.  She is still short of breath and her vitals signs are as follows HR-93, RR-28, BP 134/56, Temp-98.0, and Sp02 of 91% on 6 LPM nasal cannula.  Her lung exam reveals diffuse wheezes throughout.  What is the next best management option?

A.   Give the patient singulair 10 mg PO stat.
B.  Give the patient salmeterol 2 puffs stat
C.  Give the patient fluticsone 2 puffs stat
D.  Give the patient Decadron 10 mg IV

Answer and Explanation 2

2.  The answer is C.  This patients clinical picture is concerning for a pulmonary embolus.  He is tachycardic and hypoxic with a normal chest x ray and lung exam.  While tachycardic arrhythmia’s  can cause dyspnea, they usually do not cause hypoxia.  Choice A is not the best answer.  While it is true a small percentage of patients with bronchospasm can present with a normal lung exam, the patients tachycardia could be exacerbated by giving a patient a Beta 2 agonist Albuterol.  It would be unusual for the patient to have that significant of hypoxia and bronchospasm with normal lung sounds and chest x ray.  Choice B giving the patient metoprolol is not a good idea because the patients tachycardia is being caused by the patients hypoxemia.  It is possible to actually induce bronchospasm giving the patient beta blockers.  Choice D giving the patient cardizem would slow the patient’s heart rate down and not really be beneficial.

Question 2

2. Your patient is a 88 year old male that comes in with shortness of breath that started suddenly his lung exam reveals clear breath sounds throughout. He is quite dyspneic with a SpO2 of 85% on room air. His heart rate is 135 and EKG reveals a sinus tachycardia. His portable chest x ray is normal showing no evidence of heart failure, pneumonia, or pneumothorax. His CBC and Chem 7 are normal. Which of the following is the best next management options?      

A. Apply Oxygen, order an Albuterol Nebulizer, and give the patient Solumedrol 125 mg IV.  

 B. Apply Oxygen, Give Metoprolol 50 mg PO, and admit to the hospital

C. Apply Oxygen, order a CTA of the Chest, and admit to the hospital.

D. Apply Oxygen, Give Cardizem 20 mg IV, and admit to the hospital

Answer and Explanation 1

1. Answer is B. Hyperresonance is not consistent with a patient with a right lower lobe pneumonia. It is expected in areas of hyperareation such as a pneumothorax. Tactile fremitus, rales, and A to E egophony would be consistent with a patient with a right lower lobe pneumonia. Dullness to percussion in the right lower lobe would be the expected physical finding on a patient with a right lower lobe pneumonia.

Question 1

1. Which of the following physical findings is not consistent with a patient with a right lower lobe pneumonia?

 A. Rales in the right lower lobe

 B, Hyperresonance to percussion the right lower lobe

 C. A to E Egophany to the right lower lobe

 D. Tactile Fremitus to the right lower lobe