EMQs in Respiratory Medicine 3 Flashcards
A 65 year old man with long-standing COPD presents with severe shortness of breath. Has been treated with oxygen, nebulised bronchodilators and oral prednisilone. An hour later, his arterial blood gas reveals PaO2 7.0 kPa on max O2, PaCO2 9.0 kPa, pH 7.25, standard bicarbonate 34 mmol/L.
Most appropriate intervention:
Intermittent Positive Pressure Ventilation (BiPap)
A 17 year old woman presents with wheeze and marked perioral swelling: PaO2 7.0 on 28 per cent O2, PaCO2 4.1 kPa.
100 per cent O2, intramuscular adrenaline salbutamol intravenous hydrocortisone
A 14 year old with asthma presents with an acute severe asthma attack. PaO2 10 kPa, on 28 per cent O2, and PaCO2 8.0 pKa.
100 per cent O2, nebulised salbutamol and ipratropium bromide, intravenous hydrocortisone. Contact the intensive care team urgently.
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.
Right-sided chest-decompression.
A young man presents with an acute onset shortness of breath. Examination reveals decreased expansion on the right: SaO2 95 per cent.
Chest X Ray
A previously healthy 65 year old smoker with early COPD complains of shortness of breath on exertion.
Inhaled Salbutamol
A 65 year old woman with long standing COPD presents with shortness of breath and cough productive of coloured sputum.
28 per cent O2, nebulised salbutamol & ipratroprium, oral prednisilone, oral amoxicillin.
A 70 year old man admitted with acute severe exacerbation of COPD does not respond to oxygen, nebulised bronchodilators and oral steroids. After treatment his arterial blood gas on 28 per cent oxygen reveals a pH of 7.28, PO2 8, and PCO2 9.4.
Non-invasive positive pressure ventilation BiPap
A 65 year old patient with advanced COPD treated with bronchodilators and steroids still feels breathless. His baseline PaO2 is around 6.5kPa.
Long term 02 therapy
A 55 year old patient with COPD requires regular add-on therapy after bronchodilators do not control symptoms.
Oral Aminophylline - bronchodilator theophylline
Standard therapy for community-acquired pneumococcal pneumonia not requiring hospital admission.
Oral Amoxicillin
A 35 year old patient on the ward admitted to hospital 10 days ago develops a severe pneumonia.
Intravenous Tazocin (Piperacillin-tazobactam)
A 40 year old builder presents with a severe community-acquired pneumonia. Atypical pathogens suspected.
Intravenous benzylpenicillin and clarithromycin.
A 22 year old HIV-positive individual on anti-retroviral therapy presents with Pneumocystis jiroveci pneumonia.
Intravenous Co-trimoxazole
A 19 year old man contracts pneumonia with symptoms of headache, fever and dry cough. Serology shows evidence of chlamydia infection.
Oral Tetracycline.
