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4781 Medicine

A 25 year old patient with asthma arrives at the emergency depament complaining of extreme shoness of breath. He has been compliant with his medications, which are metaproterenol and inhaled betamethasone. Over the past 6 hours, his wheezing and shoness of breath have become increasingly severe. At present, his blood pressure is 136/84 mm Hg and with deep inspiration falls to 116/56 mm Hg. His pulse is 126/min, and respirations are 32/min and labored. There is retraction of the sternocleidomastoid muscles with inspiration. There are soft wheezes and poor air movement diffusely throughout both lung fields. His peak expiratory flow rate is 60 L/min, and he is immediately staed on an albuterol nebulizer and given IV hydrocoisone. His aerial blood gas revealed a pH of 7.55, pCO2 of 21 mm Hg, and a pO2 of 60 mm Hg. Twenty minutes later, a repeat peak flow rate is still 60 L/min. A repeat aerial blood gas reveals that his pH is now 7.46, his pCO2 is now 34 mm Hg, and his pO2 is 64 mm Hg. Which of the following is the most appropriate next step in management?

AAdminister IV epinephrine
BAdminister 100% oxygen a tight fitting face mask
CAdminister subcutaneous epinephrine
DPrepare for intubation
Medicine
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4787 Medicine

A 67-year-old woman presents to the clinic complaining of increasing shortness of breath on exertion. She has no prior cardiac or pulmonary history, and reports no symptoms of chest discomfort, cough, sputum production, orthopnea or peripheral edema. Her physical examination including vital signs, cardiac and pulmonary examinations are completely normal. Her CXR, ECG, and CBC are also normal. She then undergoes pulmonary function tests to evaluate her symptoms of dyspnea. The most prominent finding is a reduction of the ratio of FEV1/FVC with no reversibility when given inhaled salbutamol. Which of the following is the most likely diagnosis?

ACOPD
Bankylosing spondylitis
CPickwickian syndrome
Dscleroderma of the chest wall
Medicine
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4788 Medicine

A 56-year-old man presents with shortness of breath, fatigue, and edema. He has also noticed weight gain, abdominal discomfort, and distension. He has a prior history of lung cancer treated with radiotherapy to the chest. There is no history of liver or cardiac disease in the past. On examination, he has an elevated JVP, prominent y descent of neck veins, and positive Kussmaul sign. The heart sounds are normal. The CXR shows a normal cardiac silhouette and the ECG has low voltages.For the above patient with shortness of breath and peripheral edema, select the most likely diagnosis.

Acardiac tamponade
Bconstrictive pericarditis
Crestrictive cardiomyopathy
Dright ventricle myocardial infarction (RVMI)
Medicine
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