Question of the Month

[جوري]

and the prize is>>>> just rep pts :hmm:
as usual think it over, do some research, but don't give me random guesses..chances are 20% in your favor.. so let me know your rational ..


A 72 year old diabetic man presents with fever,chills, burning micturition and altered mental status. He has a history of calcium oxalate renal stones and two previous episodes of lower urinary tract infections. He is being treated with Insulin for his diabetes. His pulse is 102/min BP 90/56 Temp 40c(104F) and RR 24. He is confused and disoriented. chest auscultation reveals diffuse bilateral crepitations. Chest radiography shows unilateral alveolar infiltration with prominent air brocheography. Labs show hematocrit of 35% WBC count of 15000/micrliter. platelet count of 100,000. Blood glucose of 110. Blood gas analysis shows shows ph of 7.4, pco2 of 28mmHG and paO2 of 49mmHG and PaO2 of 49mmHG. He is intubated and started on 100% O2 but his condition doesn't improve. He is suspected to be suffering ARDS (adults respiratory distress syndrome seondary to urosepsis. Which of the following suggests ARDS?

A- Normal pulmonary capillary wedge pressure
B-Increased lung compliance
C-Normal protein concentration and pulmonary edema
D-Normal pulmonary arterial pressure
E-Normal alveolar arterial PO2 gradient

good luck

 

[barney]

Normal Protein concentration. his urine looks ok, so he prolly hasnt got urosepsis.

(is he on any Antibiotics?)

 

[Khayal]

B-Increased lung compliance

(Just a guess..:-[)

​

 

[Umm Yoosuf]

Assalaamu Alaikum Wa Rahmatulaah,

Tough question there...

I'm thinking maybe this one but not so sure.

C-Normal protein concentration and pulmonary edema


hmmm....

 

[barney]

Yah, and the pulmonary odema points to the ARDS

 

[NoName55]

C
according what I could make out from my Wikipedia search (am I cheating)

 

[barney]

C
according what I could make out from my WIKIdpedia seach (am I cheatin')

Definatly!

 

[north_malaysian]

I'll choose

F: All of the above! eace:

 

[جوري]

lol..
Jazakoum Allah..I appreciate all the replies.. I thought this would sink to the bottom unread :smile:..I think I'll ask you all for your rational that led you to choose your answer..will have to rep all of you just for making such a wonderful honest effort..but when I get my 'repability back' :embarrass

I can't give out the correct answer, until I learn your reason why..might also give you the chance to re-think or re-affirm your choice..

 

[Jayda]

hola,

is he on any antibiotics?

gracias

 

[north_malaysian]

Erm.. does that mean that I have to give reasons too for choosing answer "F".?:uuh:

 

[جوري]

By the way I just want to add, that you may use all the resources you need, it isn't cheating, it will be an educated thought but I'll need your rational ..and north malaysian you can't have all the above-- there is only one correct answer :smile:

 

[NoName55]

Definatly!

Definitely not! LOL

that was my pathetic attempt at sarcasm,
I think I should stop my attempts at humor since no one gets it.

 

[جوري]

hola,

is he on any antibiotics?

gracias

Just Insulin and 100% oxygen.. a general rule with Q's the info given is all the info needed :shade:


peace

 

[barney]

Whoo Yay! i'm a gonna get Rep from PA!!!

Rationale:
The Pulomenary odema is rsetricting bronchiol capacity. (hey i'm speedtyping, so no gags about me english please), NAD in the MSU sample points to no UTI being present.
He's old so is at increased risk of COAD and ARDS his resp is raised > 10 above nominal, and one side of his lung is flooded.

Sit him up, Give him a Cup of tea...He will be fine. Failing that, drain the chest, stick him on antibio's (WCC is down), fill him with a Diuretic and adjust his Metformin accordingly. QDS BM's and monitor.

Im a psychiatric nurse, but thats my best shot!

 

[north_malaysian]

and north malaysian you can't have all the above-- there is only one correct answer :smile:

Hey... I'm just thinking outside the box... that's why answer "F" exists... :exhausted

At least my answer is 20% correct...

 

[barney]

Definitely not! LOL

that was my pathetic attempt at sarcasm,
I think I should stop my attempts at humor since no one gets it.

Yeah i got it. Your sarcasm is traditionally pretty good. Lets not start arguing! there is a Patient DYING out there!

 

[جوري]

Whoo Yay! i'm a gonna get Rep from PA!!!

Rationale:
The Pulomenary odema is rsetricting bronchiol capacity. (hey i'm speedtyping, so no gags about me english please), NAD in the MSU sample points to no UTI being present.
He's old so is at increased risk of COAD and ARDS his resp is raised > 10 above nominal, and one side of his lung is flooded.

Sit him up, Give him a Cup of tea...He will be fine. Failing that, drain the chest, stick him on antibio's (WCC is down), fill him with a Diuretic and adjust his Metformin accordingly. QDS BM's and monitor.

Im a psychiatric nurse, but thats my best shot!

ok.. BUT, how the do you distinguish between ARDS and cardiogenic pulmonary edema?


cheers!

 

[barney]

Without Googeling i dont really know!
I imagine a MRI scan would show up the Cardio Pully odey-thingy. yeah...stick Him in a MRI and check for that.

 

[Jayda]

Just Insulin and 100% oxygen.. a general rule with Q's the info given is all the info needed :shade:


peace

gracias!

i have never done one of these questionaires before i would say C, but i am not a doctor...

maybe it would be best to consult his PCP or the attending physician... i do not know what the laws are in your country but in the united states this might be a breach of ethics... not that i imply you are in trouble, it just seems questionable and you might want to double check...

que Dios te bendiga