Intermediate skills modules (MCQ) Flashcards
(4 cards)
A 72 year old chronic smoker was admitted for 2 days of fever, productive cough and progressive shortness of breath. He was treated with Augmentin and bronchodilators. You were called to assess him for worsening of shortness of breath. He appears anxious and sweaty. His blood pressure is 90/35 mmHg, heart rate 100 beats/minute. His SpO2 is 80% on 6 L/min oxygen via Hudson mask and his respiratory rate is 25 breaths/minute. You noticed that he has noisy inspiration. There is also lip swelling and a generalized rash over the neck and trunk. You immediately stop the Augmentin. What should be the next step of your management?
Select one:
1. 15/L minute oxygen via reservoir face mask
2. Adrenaline 0.5mg intravenously
3. Bag mask ventilation with 15L/min oxygen
4. Given hydrocortisone 100mg intravenously
5. Adrenaline 0.5mg intramuscularly
A
Important considerations: Does he need resuscitation? What is his biggest problem, hypoxia or hypotension? Is he breathing?
You are asked to see a 65 year old man with sudden loss of consciousness 1 hour ago. The patient has a history of hypertension and hyperlipidaemia. On examination his airway is patent, respiratory rate 15/min, SpO2 97% on air and he is haemodynamically stable. Extensor response to pain bilaterally, incomprehensible sounds and eyes open to pain. Pupils 2 mm reactive, absent dolls eyes and corneal reflexes. Gag reflex present, tendon reflexes depressed, bilateral upgoing plantar reflexes. Your management at this stage should include (select one or more):
Select one or more:
1. Hyperventilate with bag-valve-mask resuscitator
2. Consult ICU/anaesthesia for intubation
3. Urgent CT brain
4. IV mannitol 0.5g/kg
5. Recovery position
BCE
A 72 year old chronic smoker was admitted for shortness of breath, which has been progressive over 2 days. He is becoming progressively more drowsy although he is responsive to voice. His blood pressure is 160/100mmHg, heart rate was 100 beats/minute. His SpO2 is 94% on 10 L/min via reservoir face mask and his respiratory rate is 25 breaths/minute. His blood gas shows pH 7.25, pCO2 13.0, pO2 9.0, HCO3 30, BE 4. High dose inhaled salbutamol and ipratropium with iv hydrocortisone have been initiated two hours ago. What should be the next step of your management?
Select one:
1. Consult ICU for intubation and mechanical ventilation
2. Bag mask ventilation with 15L/minute oxygen
3. Initiate non-invasive ventilation support
4. Insert an oropharyngeal airway + continue reservoir facemask
5. Further increase dose of salbutamol and ipratropium
C
(Hypercarbic respiratory failure, likely due to COPD, likely to protect and maintain his airway, breathing)
