EMQs in Clinical Medicine.pdf - Peshawar Medical College

34 Respiratory medicine
17 Emergency management: respiratory distress
A
B
C
D
E
F
G
H
intubation
left-sided decompression
chest radiograph
nasal intermittent positive
pressure ventilation
28 per cent O 2 , nebulized salbutamol,
oral prednisolone
emergency tracheostomy
28 per cent O 2 , nebulized salbutamol,
intramuscular adrenaline
right-sided decompression
I
J
K
L
M
28 per cent O 2 , nebulized
salbutamol, intravenous
hydrocortisone
chest drain
100 per cent O 2 , intramuscular
adrenaline, nebulized salbutamol
intravenous hydrocortisone
100 per cent O 2 , nebulized
salbutamol, intravenous
hydrocortisone
For each clinical scenario below, suggest the most appropriate intervention. Each
option may be used only once.
1 A 65-year-old man with long-standing COPD presents with severe shortness of
breath. He has been treated with oxygen and nebulized bronchodilators. An hour
later: PaO 2 6.0 kPa (on max. O 2 ), PaCO 2 16.0 kPa, pH 7.2.
2 A 17-year-old woman presents with wheeze and marked perioral swelling: PaO 2
7.0 kPa (on 28 per cent O 2 ), PaCO 2 4.1 kPa.
3 A 14 year old with asthma presents with an acute severe asthma attack. PaO 2
10.0 kPa (on 28 per cent O 2 ), PaCO 2 8.0 kPa.
4 A 28-year-old man involved in a road traffic accident presents with severe
respiratory distress. Examination reveals decreased expansion on the right side of
the chest with mediastinal shift to the left.
5 A young man presents with an acute onset shortness of breath. Examination
reveals decreased expansion on the right: SaO 2 95 per cent.
Answers: see page 44.