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Saturday, June 8, 2013

MCAT question #52-54

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):


Your an ER doc and in comes a patient complaining of dysnpea. He has a fistula on his left arm and his right arm is in a sling.  The patient has 3lpm nasal cannula at home, and is presently hooked to a flowmeter at 3lpm.  The patient presents with the following vitals:
  • Blood Pressure 188/93
  • Heart Rate 101
  • Lung sounds: Crackles in bases, diminished
  • Spo2 is 88% on 3lpm
What is the first thing you do?
  • a)Call respiratory therapy STAT to do a Duoneb breathing treatment
  • b)Check to make sure the nasal cannula is working properly
  • c)Increase oxygen until you maintain an SpO2 of 92% in order to oxygenate the patient
  • d)Order Lasix

The  respiratory therapist arrives to give the patient described in question #45 above a breathing treatment.  The first thing he does is fix the nasal cannula so that it's no longer oxygenating the patient's cheek.  The SpO2 shoots up to 98%.  The respiratory therapists asks if the breathing treatment is still needed.  What do you say?
  • a) Of course I still want a breathing treatment, the patient is short of breath, isn't he?
  • b) No, the patient appears to be wet.  I'll order Lasix and monitor blood pressure
  • c) Order Q2 hour treatment you arrogant condescending son of a b)*&^tch trying to show me off will you???
  • d) Ignore the respiratory therapist because you already gave an order

Continuing on with our patient in question #45 above, there is one more series of procedures we can order to piss off the respiratory therapist.  Hint:  There's no easy access to arteries.
  • a) Sepsis order set (includes EKG and ABG)
  • b) Another breathing treatment
  • c) Another breathing treatment and EKG and ABG
  • d) Order Lasix

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