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  #1  
Old 09-01-2012
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Lungs Pulmonology Questions

A 60 year old male with a history of HTN,diabetes,coronary artery disease ,asthma,and cigarette smoking undergoes emergent laparotomy for a perforated peptic ulcer.He receives 4 liters of intravenous normal saline intraoperatively.Following the procedure he is extubated without complication but subsequently develops respiratory distress.Immediate arterial blood gas analysis on room air shows
PaO2 60
pH 7.46
PaCO2 37
HCO3 22

His temp 37.2(98.9F) and bloob pressure is 126/76 mmHg.Lung auscultation reveals bilatera; rales.His arterial blood gas fails to improve with administration of 100% Oxygen.What is the most likely cause of his respiratory distress?

A. Excessive anesthesia
B. Pulmonary edema
C. Pulmonary Emblosim
D. Aspiration pneumonia
E. Exacerbation of bronchial asthma

Please add reasoning
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pulm edema ans B as his po2 didn't improve upon administration of o2. also the bilateral rales. his pmh can also predispose him to edema, b/c of probable ventricular weakness.
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pul edema....hypoxia,respi alkalosis,previous CAD,B/L rales
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Try Try Everyone !
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Quote:
Originally Posted by step_enhancer View Post
A 60 year old male with a history of HTN,diabetes,coronary artery disease ,asthma,and cigarette smoking undergoes emergent laparotomy for a perforated peptic ulcer.He receives 4 liters of intravenous normal saline intraoperatively.Following the procedure he is extubated without complication but subsequently develops respiratory distress.Immediate arterial blood gas analysis on room air shows
PaO2 60
pH 7.46
PaCO2 37
HCO3 22

His temp 37.2(98.9F) and bloob pressure is 126/76 mmHg.Lung auscultation reveals bilatera; rales.His arterial blood gas fails to improve with administration of 100% Oxygen.What is the most likely cause of his respiratory distress?

A. Excessive anesthesia
B. Pulmonary edema
C. Pulmonary Emblosim
D. Aspiration pneumonia
E. Exacerbation of bronchial asthma

Please add reasoning

Pulmonary embolism my answer.
Hypoxia without hypercarbia... due to ventillation perfusion mismatch....
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Old 09-03-2012
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Quote:
Originally Posted by step_enhancer View Post
A 60 year old male with a history of HTN,diabetes,coronary artery disease ,asthma,and cigarette smoking undergoes emergent laparotomy for a perforated peptic ulcer.He receives 4 liters of intravenous normal saline intraoperatively.Following the procedure he is extubated without complication but subsequently develops respiratory distress.Immediate arterial blood gas analysis on room air shows
PaO2 60
pH 7.46
PaCO2 37
HCO3 22

His temp 37.2(98.9F) and bloob pressure is 126/76 mmHg.Lung auscultation reveals bilatera; rales.His arterial blood gas fails to improve with administration of 100% Oxygen.What is the most likely cause of his respiratory distress?

A. Excessive anesthesia
B. Pulmonary edema
C. Pulmonary Emblosim
D. Aspiration pneumonia
E. Exacerbation of bronchial asthma

Please add reasoning
pulmonary edema: bilateral rales, previous CAD, but pulmonary edma can lead to hypocarbia??

A.) excessive anesthesia: hypoventilation
C.) pulmonary embolism: hyperventilation
D.) aspiration pneumonia: hypoventilation or hyperventilation
E.) exacerbation of asthma: first hypervntilation then hypoventilation

please correct me, thank you!
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Quote:
Originally Posted by step_enhancer View Post
A 60 year old male with a history of HTN,diabetes,coronary artery disease ,asthma,and cigarette smoking undergoes emergent laparotomy for a perforated peptic ulcer.He receives 4 liters of intravenous normal saline intraoperatively.Following the procedure he is extubated without complication but subsequently develops respiratory distress.Immediate arterial blood gas analysis on room air shows
PaO2 60
pH 7.46
PaCO2 37
HCO3 22

His temp 37.2(98.9F) and bloob pressure is 126/76 mmHg.Lung auscultation reveals bilateral rales.His arterial blood gas fails to improve with administration of 100% Oxygen.What is the most likely cause of his respiratory distress?

A. Excessive anesthesia
B. Pulmonary edema
C. Pulmonary Emblosim
D. Aspiration pneumonia
E. Exacerbation of bronchial asthma

Please add reasoning

B. Pulmonary edema

He has increased A-a gradient as well as rales with hypoxemia.

Unlikely to be:

A. Excessive anesthesia >>>>Hypoventilation, so he should have raised CO2.

C. Pulmonary Embolism >>>>> should have improved with 100% O2

D. Aspiration pneumonia >>>>>>No fever

E. Exacerbation of bronchial asthma >>>>>>Co2 should be higher and PO2 should improve with 100% O2
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Old 09-04-2012
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Answer B. Pulmonary Edema
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