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The scenario: A 50 year old male is evaluated in the emergency room (ER) for a complaint of dyspnea. The

dyspnea has become worse over many years but today is especially bad. He reports a history of smoking. His breath sounds are clear but greatly diminished throughout his lungs. ABGs, peak flow test (PF), VQ scan and chest x-ray (CXR) are completed. Results are below.


ABGs: pH 7.48, PCO2: 30, HCO3 : 24, PO2 80, SO2 94%.  PF: 50% of predicted norm (ie, "low" PF). V/Q scan 0.8. CXR shows hyperinflated aveoli and air trapping.

Normal ABG ranges:    PO2: 80-100 mmHg          (Remember, you are supposed to know

                               pCO2: 35-45 mmHg                pH range, SO2 range, & RR range)

                               HCO3: 22-26 mEq/L         





13.          Putting together all information given, what is the most likely diagnosis on this patient?

                 a.             D              

                 b.             B

                 c.            C

                 d.             A


14.          Using the "patient picture" scenario & correct answer from #13, what is the expected breathing rate & pattern of this patient?

                 a.             L

                 b.             M

c.             O

d.             Q


15.    What do you expect his general appearance to be like?  

                 a.             I

                 b.             F

                 c.             K

                 d.             O


16.          The low PF in this scenario indicates___________.

                 a.             Q

                 b.             M

                 c.             C

d.             J



17.         What acid base imbalance does this patient have?

                 a.             S

                 b.             T

                 c.             N

                 d.             P


18.          The acid/base imbalance above is part of a compensatory response to keep the body

                 a.             F

                 b.             G

                 c.             H

                 d.             K


 19.    If you could look at this patient's lungs directly, you would expect to see _____.  

                 a.             D

                 b.             E

                 c.             I

d.             R

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