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Saturday, August 11, 2012

MCAT question #44

I cannot reveal my source, but I once again am privy to esoteric wisdom. The following is a question I have obtained from the Medical College Admission Exam (MCAT):

44.  You have an end stage pulmonary fibrosis patient with marked dyspnea.  She smoked a pack and a half packs of cigarettes per day, although she admits to quitting 48 years ago.  Her current ABGs reveal the following on an FiO2 of 40% on 12 lpm venturi mask: 
  • pH 7.44
  • CO2 53
  • PO2 47
  • HCO3 36
  • SpO2 84%
  • BE 10.4
What would be the first best thing to have your respiratory therapist do at this time?
  • a.  Intubate
  • b.  Decrease oxygen to 35% venturi mask
  • c.  Decrease oxygen to a 4lpm nasal cannula and add a bubbler
  • d.  Increase oxygen to 50%, monitor the patient, and redraw the ABG in one hour
  • e.  Either b or c will suffice due to fears of knocking out her drive to breathe

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