Assignment 11: Multiple Choice Questions

Assignment 11: Multiple Choice Questions

1)(Stem / Case)A 2-year old is admitted to the ICU newly diagnosed asthma in status asthmaticus. You are called to evaluate the patient for an acute drop in SpO2 to 70%. The nurse initiated bag-mask manual ventilation with 100% oxygen with minimal improvement. Physical examination shows no chest movement, and no audible breath sounds on the right. The left chest has good movement and wheezes and rhonchi are heard. The PMI is at the 5th intercostal space, left anterior axillary line. Vital signs are HR 180/minute, RR 46/minute, and BP 60/40 mm Hg. Chest X-ray is shown below

( Lead in) What is the most likely diagnosis?

(5 Options)

/ a)Tension pneumothorax
/ b)Atelectasis
/ c)Severe bronchospasm
/ d)Pulmonary Edema
e)Foreign body in Right mainsteam bronchus
2)(Stem/Case)A 2-month old is admitted to the PICU for respiratory distress. He was well until 2 days prior to admission when he started to feed poorly. On the day of admission the mother noticed that he was breathing rapidly, was pale and refused to feed. There is no history of fever, vomiting or diarrhea. Physical examination: HR 220/minute, RR 60/minute, BP 65/38 mmHg, T-35.5oC (rectal). He is breathing rapidly and grunting; there are no murmurs; breath sounds are clear; there is no organomegaly. Extremities are cool, with weak pulses. The12 lead EKG is shown below.
(Lead in )Which of the following is the most appropriate next step in the management of this patient?

Options
a)Rapid IV adenosine
b)NSS bolus at 20 cc/kg
c)IV propranolol
d)Ice pack to the face
e)Defribrillation at 2 joules/kg
3)(Stem /case) A 1-month old infant with RSV bronchiolitis was intubated with as size 3mm uncuffed endotracheal tube due to respiratory failure. Required constant suctioning due to copious thick secretions. On day # 3 develops cyanosis and a decrease in oxygen saturation to 60% despite supplemental oxygen. End tidal CO2 is 80 and there is increased resistance to manual ventilation.
(Lead in )Which of the following is the most likely explanation for these findings
Options
a)Developing pneumonia
b)Air leak around the ET tube
c)Obstruction of ET tube
d)Hyperreactive airway
e)Ventilator failure
4)(Stem/Case)A 6-year old girl presents to an outlying hospital with fever, hypotension and a non-blanching reddish-purple rash covering her trunk and extremities. She is lethargic but able to answer questions appropriately. IV access is established; blood cultures obtained. Ceftriaxone is administered, and a fluid bolus of 20 mL/kg is given. En route to your facility, the transport team administers an additional 80 mL/kg of 0.9% NaCl without significant improvement in blood pressure or perfusion. On arrival to your PICU, vital signs are: HR 150/minute, RR 40/minute, BP 60/30 mm Hg, T-39oC.
(Lead in )Which of the following is the next most appropriate treatment intervention?
Options
a)0.9% NaCl 20cc/kg
b)IV methylprednisolone 30 mg /kg IV
c)Dopamine drip at 10 ug/kg/min
d)PRBC transfusion at 15 cc/kg
e)Dobutamine at 5 ug/kg/min
5)(Stem/Case)An 11-year old female with known insulin-dependent diabetes mellitus presents to the ED with a 2-day history of high sugars, vomiting and weakness. She is assessed to have 10% dehydration. Laboratory data include: serum glucose of 920 mg/dL, serum sodium 127 mEq/L, potassium 5 mEq/L, CO2 content 3 and serum osmolality of 343 mOsm/kg. Arterial blood gases show pH 6.99, PCO2 14 mmHg, PO2 140 mmHg. Insulin 0.1 unit/kg IV was administered followed by a continuous insulin infusion of 0.15 unit/kg/hour. 2500 mL of 0.9% NaCl was given over 1 hour, following which, she complained of a severe headache and becomes obtunded. Her pupils are 6 mm, equal and sluggishly reactive to light.
(Lead in )Which of the following is the most appropriate next step in management of this patient?
Options
a)Increased Insulin drip at 0.2 u/kg/hr
b)Mannitol at 0.5 gm/kg IV
c)25% Dextrose IV bolus
d)0.9% NaCl 20 cc/kg bolus
e)Intubate and secure the airway
6)(Stem/Case)You are called to reevaluate a 13-year old male with asthma several hours after he is admitted. He has received corticosteroids, oxygen, and continuous albuterol nebulization. The physical examination shows vital signs: HR 140/minute, RR 45/minute, BP 90/60 mmHg, T 37oC. He remains dyspneic and significant intercostal and subcostal retractions, but has minimal wheezing. He is sitting upright and awakens to repeated painful stimulation, but is otherwise obtunded.
(Lead in )What is the most likely explanation for his present condition?
Options
a)Albuterol toxicity
b)Impending respiratory failure
c)Asssociated pneumonia
d)Hypovolemia
e)Spontaneous pneumothorax
7)(Stem /Case) 2 year old boy with no significant past medical history that was admitted with acute gastroenteritis, and developed 10-minute generalized tonic clonic seizures. Vital signs: HR 128/minute, RR 30/minute, BP 98/60 mmHg, and a temperature of 100.9oF (axillary). He is place on 100% oxygen. Pulse oximetry reading is 100%. Laboratory data are: sodium 120 mEq/L, potassium 5.1 mEq/L, glucose 72 mg/dL; total serum calcium 8.2 mg/dL (normal range 8.6-10.4) and bicarbonate of 14 mEq/L, BUN 25 mg/dL, and serum creatinine 1.6 mg/dL.
(Lead in )Which of the following is the most appropriate step in the management of this patient?
Options
a)Dilantin 20 mg/kg IV bolus
b)Ca Gluconate 200 mg/ kg IV bolus
c)3% NaCl 4-5 cc/ Kg IV
d)25% Dextrose IV
e) lorazepam 0.05 mg/kg IV
8)(Stem/case) 4-year old boy with a 2-week history of early morning vomiting and headache worsening over the past 4 days. MRI reveals a large posterior fossa tumor. He was admitted for observation and monitoring prior to neurosurgical intervention scheduled for the morning. Medications prescribed were morphine for headache and decardon IV. Overnight, the patient’s vital signs trends showed an increase in blood pressure from 100/58 mmHg to 150/100 mmHg, and a decrease in heart rate from 90’s/minute to 40’s/minute. His respiratory rate is 10/minute. On examination, the child is difficult to arouse and his pupils are 6 mm and sluggishly reactive to light.
(Lead in )Which of the following is the most likely cause of these changes?
Options
a)Morphine overdose
b)Anxiety Reaction
c)Obstructive Hydrocephalus
d)Inadequate Pain Management
e)Seizures
9)(Case/Stem)4-day old infant whose parents brought in due to increased fussiness, vomiting after feeds and becoming slightly off color during feeding. The vital signs are triage were: HR 195 beats/minutes, BP 63/30 mm Hg, SpO2 85%, RR 60-80/minutes, Temperature 37.8oC. Physical examination reveals a baby with jaundice and severe respiratory distress with mottled extremities, weak pulses in the lower extremities compared to the upper extremities, and a systolic murmur.
(Lead in)Which of the following is the most likely explanation of these findings?
Options
/ a)Closing of the ductus arteriosus
/ b)septic shock due to bacterial infection
/ c)Galactose-1-phosphate uridyl transferase deficiency
/ d)Hypovolemic shock due to dehydration
e)Surfactant deficiency
10)(Case/Stem)16-year old female is admitted to the ICU after she was found unresponsive following an argument with her parents regarding her falling grades. Past Medical history of depression and on cyclic antidepressant therapy. On physical examination, Glasgow Coma Score is 9, HR 120/minute in sinus rhythm with occasional PVC’s, RR 20/minute, BP 100/60 mm HG, T-39oC. She is obtunded and her skin is warm and flushed. Pupils are 6 mm, equal and briskly reactive to light. During evaluation, she develops brief tonic/clonic generalized seizures. (Lead in) After stabilization of her airway, which of the following is the most appropriate next step?
Options
a)Administer activated charcoal
b)Administer dextrose 50%
c)Administer dilantin
d)Administer sodium bicarbonate
e)Administer naloxone