5. Choice B is the correct answer. This patient has a left sided pneumothorax. 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.
Friday, February 22, 2013
Question 5
5. Take a look at the chest x ray above and 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 4
4. A is the correct answer. This patient has RDS (Respiratory Distress Syndrome). This patient needs immediate administration of Survanta. Surfactant replacement is essential to decrease mortality and morbidity. Administering oxygen would be appropriate for transient tachypnea of the newborn (TTN). This is not likely in this age group. Also high FiO2 for a prolonged period of time can cause Retinopathy of Prematurity (ROP). Getting a CBG alone is not agressive enoug in this situation. Nasal CPAP may be beneficial in an older term infant but this baby really needs surfactant.
Question 4
4. Your patient is a 29 week gestation male born to a group B negative mother that you are seeing in the delivery room. He has no fever but has signs of respiratory distress. His RR is 80 and Sats are 88%. Which of the following is the best management option?
A. Intubate the patient and administer Survanta
B. Administer oxygen at a 100% and if the patients Sats improve to 100% leave the patient on that so they can recover.
C. Get a capillary blood gas and observe the patient
D. Place the patient on nasal CPAP
Answer and Explanation 3
3. D is the correct answer. An empyema (pleural space abscess) is not likely to cause hemopytsis. Wegner's Granulamatosis is a vasculitis that can cause pulmonary hemorrhage and needs immunosuppression. Active TB can cause hemoptysis but is usually accompanied with night sweats. Pulmonary embolus can cause hemoptysis also.
Question 3
3. Which of the following is not in the differential diagnosis in a patient with hemoptysis?
A. Wegner’s Granulamatosis
B. Tuberculosis
C. Pulmonary Embolus
D. Empyema
Answer and Explanation 2
2. 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.
Subscribe to:
Posts (Atom)