A 63-year-old man presents to the clinic with fever accompanied by shortness of breath. The symptoms developed a week ago and have been progressively worsening over the last 2 days. He reports his cough is productive of thick, yellow sputum. He was diagnosed with chronic obstructive pulmonary disease 3 years ago and has been on treatment ever since. He quit smoking 10 years ago but occasionally experiences shortness of breath along with chest tightness that improves with the use of an inhaler. However, this time the symptoms seem to be more severe and unrelenting. His temperature is 38.6°C (101.4°F), the respirations are 21/min, the blood pressure is 100/60 mm Hg, and the pulse is 105/min. Auscultation reveals bilateral crackles and expiratory wheezes. His oxygen saturation is 95% on room air. According to this patient’s history, which of the following should be the next step in the management of this patient?
AChest X-ray
BArterial blood gases
CBronchoprovocation test
DBronchoscopy
ECT scan
A 21-year-old man presents to his physician because he has been feeling increasingly tired and short of breath at work. He has previously had these symptoms but cannot recall the diagnosis he was given. Chart review reveals the following results: Oxygen tension in inspired air = 150 mmHg Alveolar carbon dioxide tension = 50 mmHg Arterial oxygen tension = 71 mmHg Respiratory exchange ratio = 0.80 Diffusion studies reveal normal diffusion distance. The patient is administered 100% oxygen but the patient's blood oxygen concentration does not improve. Which of the following conditions would best explain this patient's findings?
ASeptal defect since birth
BUse of opioid medications
CPulmonary fibrosis
DPulmonary embolism
EVacation at the top of a mountain
An 8-year-old girl is brought to the emergency department by her parents with severe difficulty in breathing for an hour. She is struggling to breathe. She was playing outside with her friends, when she suddenly fell to the ground, out of breath. She was diagnosed with asthma one year before and has since been on treatment for it. At present, she is sitting leaning forward with severe retractions of the intercostal muscles. She is unable to lie down. Her parents mentioned that she has already taken several puffs of her inhaler since this episode began but without response. On physical examination, her lungs are hyperresonant to percussion and there is decreased air entry in both of her lungs. Her vital signs show: blood pressure 110/60 mm Hg, pulse 110/min, respirations 22/min, and a peak expiratory flow rate (PEFR) of 50%. She is having difficulty in communicating with the physician. Her blood is sent for evaluation and a chest X-ray is ordered. Her arterial blood gas reports are as follows: PaO2 50 mm Hg pH 7.38 PaCO2 47 mm Hg HCO3 27 mEq/L Which of the following is the most appropriate next step in management?
AIntravenous corticosteroid
BInhaled corticosteroid
CMechanical ventilation
DMethacholine challenge test
EInhaled β-agonist
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