Chapter·CCS CasesTime Management

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1

A 42-year-old woman presents to the emergency department with abdominal pain. Her pain started last night during dinner and has persisted. This morning, the patient felt very ill and her husband called emergency medical services. The patient has a past medical history of obesity, diabetes, and depression. Her temperature is 104°F (40°C), blood pressure is 90/65 mmHg, pulse is 160/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a very ill appearing woman. Her skin is mildly yellow, and she is in an antalgic position on the stretcher. Laboratory values are ordered as seen below. Hemoglobin: 13 g/dL Hematocrit: 38% Leukocyte count: 14,500 cells/mm^3 with normal differential Platelet count: 257,000/mm^3 Alkaline phosphatase: 227 U/L Bilirubin, total: 11.3 mg/dL Bilirubin, direct: 9.8 mg/dL AST: 42 U/L ALT: 31 U/L The patient is started on antibiotics and IV fluids. Which of the following is the best next step in management?

ANasogastric tube and NPO

BSupportive therapy followed by elective cholecystectomy

CFAST exam

DEmergency cholecystectomy

EEndoscopic retrograde cholangiopancreatography

2

A 30-year-old patient presents to clinic for pulmonary function testing. With body plethysmography, the patient's functional residual capacity is 3 L, tidal volume is 650 mL, expiratory reserve volume is 1.5 L, total lung capacity is 8 L, and dead space is 150 mL. Respiratory rate is 15 breaths per minute. What is the alveolar ventilation?

A7.5 L/min

B7 L/min

C8.5 L/min

D8 L/min

E6.5 L/min

3

A 68-year-old woman was recently diagnosed with pancreatic cancer. At what point should her physician initiate a discussion with her regarding advance directive planning?

AOnce she enters hospice

BNow that she is ill, speaking about advance directives is no longer an option

COnly if her curative surgical and medical treatment fails

DOnly if she initiates the conversation

EAt this visit

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