Question

S. METABOLIC ACIDOSIS T. METABOLIC ALKALOSIS A. CHRONIC BRONCHITIS B. EMPHYSEMA C. PULMONARY EMBOLUS D. PULMONARY EDEMA E. TUBERCULOSIS F. THIN: SKIN PINK G. OXYGENATED H. FROM BLOWING OFF CO2 I. LUNGS FILLED WITH MUCUS J. DIFFICULTY WITH EXPIRATION K. SKIN BLUE-ISH & PUFFY L. RR 26/MIN; RETRACTIONS PRESENT M. RR 18/MIN; STRIDOR HEARD N. RESPIRATORY ALKALOSIS o. DIFFICULTY WITH INSPIRATION P. RESPIRATORY ACIDOSIS Q. DIFFICULTY BREATHING THROUGH FLUID-FILLED ALVEOLI R. STIFF LUNGS WITH BLEBS Eor questions 13-19, choose one of A-T from box above to answer questions about the scenario below. Don't re-use a letter. Choose BEST FIT from the choices (a-d) you are given. Ihe scenario: A 50 year old male is evaluated in the emergency room (ER) for a complaint of dyspnea. The dyspnea has become worse over many years but today is especially bad. He reports a history of smoking. His breath sounds are clear but greatly diminished throughout his lungs. ABGS, peak flow test (PF), VQ scan and chest x-ray (CXR) are completed. Results are below. ABGS: pH Z48, PCO2: 30, HCO3: 24, PO2 80, S02 94%. PF: 50 % of predicted norm (ie, "low PF). V/Q scan Q.8 CXR shows hyperinflated aveoli and air trapping. (Remember, you are supposed to know pH range, SO2 range, & RR range) Normal ABG ranges: PO2: 80-100 mmHg PCO2: 35-45 mmHg HCO3: 22-26 mEq/L Putting together all information given, what is the most likely diagnosis on this patient? 13. D a. b. B C c. d. A Using the "patient picture" scenario & correct answer from # 13, what is the expected breathing rate & pattern of this patient? 14 L a b. M C. d. What do you expect his general appearance to be like? 15. a. b. C. K d. The low PF in this scenario indicates 16. Q a. b M C C. d. o d

Answer 1

13.b:B emphysema

The scenario states that X-ray shows hyper inflated alveoli and air trapping .the patient has hyperventilation which is classical sign of emphysema which is causing a lower co2 and low po2 patient also has alkalosis.patient also gives a history of smoking .which is a risk factor for emphysema .patient also stars that he has chronic dyspnea people with emphysema has shortness of breath

14 c : O difficulty in inspiration patients with emphysema uses a. Pursed lip breathing during inspiration due to shortness of breath they have to use accessory muscles to breathe.

15 c : K skin appears bluish and puffy due to shortness of breath there is no enough oxygen reaching the peripheries which makes the skin look pale and bluish

16 d : J difficulty in expiration peak flow test calculates the amount of air expired out in one minute in liters during emphysema the patient has difficulty in expiration which leads to air trapping and low peak flow meter.

17 c :N Respiratory Alkalosis because the pH is 7.48 which is alkalotic and patient has normal bicarbonate level which excludes metabolic conditions

18 b : G to keep the body oxygenated die to emphysema there is shortness of breath and just to keep the oxygenation level due to hyper inflation of alveoli which reduces the pco2 which in turn increases the ratio of bicarbonate to pco2 which is the pH value  

19 d : R stiff lungs with blebs due to hyper inflation of alveoli it leads to air trapping and the lung looses it's elasticity and looks like a hard surface .