An MS Patient with a respiratory problem - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-15-2011
USMLE Forums Addict
 
Steps History: 1 + CS
Posts: 160
Threads: 52
Thanked 70 Times in 31 Posts
Reputation: 80
Lungs An MS Patient with a respiratory problem

A 45 yr old woman with MS is brought to the ER with one hour history of increased confusion; she is now stupurous. She has been in remission for two years. Temp is 37.2, pulse 72, RR 8/min and bp 116/66.
Percussion of chest reveals low lung volumes. The lungs are clear to auscultation and the breath sounds appear distant. There is a poor gag reflex. When aroused she is mildly combative and moves all four limbs then drifts back into unconsciousness..
ABG-
PH 7.12
PCO2 76 mm hg
PO2 50 mm hg
What is the cause of her condition?
1. ARDS
2. Aspiration pneumonia
3. Opioid overdose
4. Pulmonary Embolism
5. Upper airways obstruction
Reply With Quote Quick reply to this message
The above post was thanked by:
dr-ahmed (05-15-2011), gokulramani (10-13-2015), heights (05-15-2011), m82_ghasemi (10-08-2011), prataptetali (05-16-2011)



  #2  
Old 05-15-2011
Banned
 
Steps History: 1 + CK
Posts: 751
Threads: 133
Thanked 304 Times in 192 Posts
Reputation: 314
Default

good question.....

Last edited by add1; 05-15-2011 at 07:43 AM.
Reply With Quote Quick reply to this message
  #3  
Old 05-15-2011
Hope2Pass's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,685
Threads: 213
Thanked 1,569 Times in 657 Posts
Reputation: 1579
Default

I would go with A) ARDS.

Im not quite sure but her other problems can be related to the fact that she has a demylenating disorder and a respiratory acidosis. Her respirations are really low so may be its because of ARDS.
Reply With Quote Quick reply to this message
  #4  
Old 05-15-2011
USMLE Forums Newbie
 
Steps History: CS Only
Posts: 2
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default

Opiod overdose
Reply With Quote Quick reply to this message
  #5  
Old 05-15-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,185
Threads: 38
Thanked 844 Times in 477 Posts
Reputation: 854
Default

Quote:
Originally Posted by Hope2Pass View Post
I would go with A) ARDS.

Im not quite sure but her other problems can be related to the fact that she has a demylenating disorder and a respiratory acidosis. Her respirations are really low so may be its because of ARDS.

Yep, I agree with this!
Reply With Quote Quick reply to this message
  #6  
Old 05-15-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 88
Threads: 25
Thanked 17 Times in 10 Posts
Reputation: 27
Default

i think its aspiration pneumonia....
Reply With Quote Quick reply to this message
  #7  
Old 05-15-2011
heights's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 561
Threads: 69
Thanked 1,029 Times in 351 Posts
Reputation: 1049
Default

The answer is opiod overdose.
- One hour confusion, she's now stuporous and has decreased gag reflex, and is combative when awakened. Classic opioid overdose, eg high dose heroin.
Opioid overdose causes respiratory depression and coma. Because of her low RR, she is not breathing off her CO2--> respiratory acidosis.

Ps. don't get tripped up by the fact that she has MS- she has been in remission for two years so for her to suddenly develop ARDS as a result of MS is highly unlikely. Patient's with MS get respiratory problems as a chronic sequelae because of respiratory muscle weakness.
Aspiration pneumonia occurs when someone is passed out and aspirate gastric contents. This is not the case here- this woman presented with confusion, i.e. she was awake so she wouldn't have aspirated. Hint- usually the case with aspiration pneumonia is the alcoholic or homeless man found unconscious.

Last edited by heights; 05-15-2011 at 03:55 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
adithi (10-14-2015), donofitaly (05-15-2011), Dr.Sam vishad (10-13-2015), gokulramani (10-13-2015), Hope2Pass (05-15-2011), Kelvin (05-28-2011), Lena (05-21-2011), montre (05-15-2011), noothan (05-15-2011), patelMD (05-15-2011), prataptetali (05-16-2011), tamartato (10-26-2015), usluipek (05-15-2011), vaibhavmanu (05-17-2011)
  #8  
Old 05-15-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 88
Threads: 25
Thanked 17 Times in 10 Posts
Reputation: 27
Default

yes,bcz only opiods cause respiratory depression...none other....
Reply With Quote Quick reply to this message
The above post was thanked by:
bebix (05-15-2011)
  #9  
Old 05-15-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,185
Threads: 38
Thanked 844 Times in 477 Posts
Reputation: 854
Default

Quote:
Originally Posted by sana akbar View Post
yes,bcz only opiods cause respiratory depression...none other....
OD on barbiturates also causes Respi Depression.

(Not in this case)
Reply With Quote Quick reply to this message
  #10  
Old 05-15-2011
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 272
Threads: 9
Thanked 334 Times in 126 Posts
Reputation: 344
Default

Opiods, its the only one that makes sense.
Reply With Quote Quick reply to this message
  #11  
Old 10-11-2015
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 1
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default Opiods...its all about the RR

Quote:
Originally Posted by sana akbar View Post
yes,bcz only opiods cause respiratory depression...none other....
Opiod OD is correct. It is all about the respiratory rate and I missed it! Every other condition would cause tachypmia, NOT Bradypnia. Respiratory acidosis in the presence of decreasing resp rate is one of two things. Something depressing the RR (oipiods) or verging on total respiratory failure which she obviously is not since she wakes enough to be combative.
The ONE piece of info in this question that is the differentiator is the RR and its easy to miss! I did and picked Aspiration thinking of the MS as well. They do love their distractors!!!!
Reply With Quote Quick reply to this message
  #12  
Old 10-11-2015
USMLE Forums Addict
 
Steps History: Not yet
Posts: 129
Threads: 12
Thanked 20 Times in 19 Posts
Reputation: 30
Default

Quote:
Originally Posted by meka View Post
A 45 yr old woman with MS is brought to the ER with one hour history of increased confusion; she is now stupurous. She has been in remission for two years. Temp is 37.2, pulse 72, RR 8/min and bp 116/66.
Percussion of chest reveals low lung volumes. The lungs are clear to auscultation and the breath sounds appear distant. There is a poor gag reflex. When aroused she is mildly combative and moves all four limbs then drifts back into unconsciousness..
ABG-
PH 7.12
PCO2 76 mm hg
PO2 50 mm hg
What is the cause of her condition?
1. ARDS
2. Aspiration pneumonia
3. Opioid overdose
4. Pulmonary Embolism
5. Upper airways obstruction

So what's the answer?
Reply With Quote Quick reply to this message
  #13  
Old 10-13-2015
USMLE Forums Scout
 
Steps History: Not yet
Posts: 12
Threads: 1
Thanked 1 Time in 1 Post
Reputation: 11
Send a message via Skype™ to Dr.Sam vishad
Default

Quote:
Originally Posted by ucheeee View Post
So what's the answer?
opioid overdose
Reply With Quote Quick reply to this message
  #14  
Old 10-16-2015
USMLE Forums Scout
 
Steps History: Not yet
Posts: 61
Threads: 8
Thanked 13 Times in 6 Posts
Reputation: 23
Default ill go wid C

reasons .. its not A because ARDS causes bilateral pulmonary edema and that has findings on ausculatation of chest and has V-Q mismatch rather than respiratory acidosis ...
not B because aspiration pneumonia has more involvement of right side and no ausculations findings and no features of pneumonia

not D because PE is acute ,. and has tachypnea and this pt has low RR ....

not E .. upper airway obstruction has stridor ..


low gag can cause aspiration pneumonia again and again and this pt has low lung volume so that fits but aspiration pneumonia would have tachypnea as a response
Reply With Quote Quick reply to this message



Reply

Tags
Pathology-, Respiratory-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
What is your diagnosis? (Respiratory) aktorque USMLE Step 1 Forum 11 05-30-2011 02:43 PM
Function of respiratory Clara cells! Gulara USMLE Step 1 Forum 7 05-02-2011 01:13 PM
Respiratory Physical Exam Question good_boy_1234 USMLE Step 2 CK Forum 6 03-17-2011 03:59 PM
Why respiratory depression in increased ICP? Rawalian USMLE Step 1 Forum 3 03-13-2011 04:39 PM
respiratory pathology ecgram USMLE Step 1 Forum 3 05-22-2010 12:21 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2016 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)