102 A 15-year-old boy is brought to the physician for an examination prior to participating on his high school basketball team. He does not smoke cigarettes. He is 185 cm (6 ft 1 in) tall and weighs 78 kg (172 lb), BMI is 23 kg/m2. His respirations are 14/min. Physical examination shows no abnormalities. He agrees to participate in lung function testing as part of a study of high school athletes. Pulmonary function tests show: Expiratory reserve volume FVC Functional residual capacity Resting tidal volume Which of the following is the most likely estimated residual volume (in L) in this patient? A) 0.80 B) 1.20 C) 1.50 D) 1.80 E) 2.40 1.90 L 4.40 L 3.10 L 0.70 L
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- A 4-year-old boy is brought to the physician by his mother for a routine well-child examination. He has a 3-week history of mild shortness of breath with exertion. He has had three minor upper respiratory tract infections during the past year. He has been otherwise healthy. His temperature is 37.5oC (99.5oF), pulse is 91/min, respirations are 24/min, and blood pressure is 97/70 mm Hg left arm and 127/86 mm Hg in the right arm. Pulse oximetry on room air shows an oxygen saturation of 98%. Cardiac examination shows a normal S1 and S2; there are no clicks, rubs, or palpable thrills. A grade 1/6 systolic ejection murmur us hears along the left sternal boarder with radiation to the back; there is no diastolic murmur. Which of the following is most likely the diagnosis? a. aortic stenosis b. asd c. atrioventricular septal defect d. coarctation of aorta e. pda f. pulmonary stenosis g. tetralogy of fallot h. total anomalous pulmonary venous congestion i. transpostions j. tricuspid atresia…C.J a 49 year old construction worker is scheduled for a bronchoscopy for biopsy of a right lung session.He initially sought medical care for hemoptysis and increasing fatique.When the nurse asked him to sign the operative permit,he stated that he was not certain if he should go ahead with the procedure because he fears a diagnosis of cancer. Subjective Data Has never been hospitalized Has had no medical problems except mid obesity Has cigarette smoking history of 40 pack years Is married with two children,ages 6&8 both children have cystic fibrosis Is fearful that his wife not be able to manage without him Objective data Diagnosuic studies :chest x-ray revealed mass in upper lobe of right lung Hematrocrit:31% What factors in C.J. background or personal situation might influence his emotional response and physical reactions to this surgery? What should C.J. know if his consent for surgery is to be truly informed? Priority Decision: C.J. will be an outpatient for this…107 A 23-year-old woman comes to the physician because of a 3-hour history of sharp left chest wall pain when she breathes deeply or coughs. She also has an 8-day history of fever, headache, nasal congestion, and productive cough. Her temperature is 38°C (100 4°F), and respirations are 18/min Physical examination shows decreased breath sounds over the left posterior hemithorax. A chest x-ray shows left lower lobe pneumonia and a pleural effusion on the left. Sensory fibers in which of the following nerves most likely transmit the pain sensation from the chest wall when this patient coughs? A) Cardiac plexus B) Intercostal nerves C) Long thoracic nerve D) Thoracic splanchnic nerves E) Vagus nerve
- A 40yo male presents to the emergency department with the chief complaint of shortness of breath (SOB). His past medical history (MHx) is remarkable for hypertension (HTN) and diabetes mellitus II (DMII). On examination, his oxygen saturation on room air is 87%, blood pressure 160/100 mmHg, and pulse rate is 93/min. His arterial blood gas on room air shows pH 7.44, PCO2 35 mmHg, PO2 55 mmHg. Assume that the RQ is 0.8. Given arterial pO2 and alveolar pO2, the following disease states are plausible... Group of answer choices Hypoxic hypoxia Ischemic/Stagnant hypoxia Histotoxic hypoxia Normal ventilation/perfusionA 40yo male presents to the emergency department with the chief complaint of shortness of breath (SOB). His past medical history (MHx) is remarkable for hypertension (HTN) and diabetes mellitus II (DMII). On examination, his oxygen saturation on room air is 87%, blood pressure 160/100 mmHg, and pulse rate is 93/min. His arterial blood gas on room air shows pH 7.44, PCO2 35 mmHg, PO2 55 mmHg. Determine the alveolar gas pressure. Assume that the RQ is 0.8. A. 52 B. 22 C. 107 D. 200A 40yo male presents to the emergency department with the chief complaint of shortness of breath (SOB). His past medical history (MHx) is remarkable for hypertension (HTN) and diabetes mellitus II (DMII). On examination, his oxygen saturation on room air is 87%, blood pressure 160/100 mmHg, and pulse rate is 93/min. His arterial blood gas on room air shows pH 7.44, PCO2 35 mmHg, PO2 55 mmHg. Assume that the RQ is 0.8. Based on your calculations, what should the arterial blood gas be?
- Ben, 59 is an employee who works in a post office. He is 5ft. Tall and weighs 150 pounds. His vital signs are the following : T 36.3°C; HR 94;BP 135/85; pain level 0. At the clinic, he presents himself with a major complaint of "just not feeling well" How would you assess Ben for hypertensive risks?48. A 58-year-old woman comes to the office because of a 1-month history of fatigue, fever, shortness of breath, and joint pain; she also has had a 3.2-kg (7-lb) weight loss during this period. Her temperature is 37.6°C (99.7°F), and respirations are 34/min. Physical examination shows tenderness to palpation over the maxillary sinus, nasal ulcerations, and a bulging, red left tympanic membrane. Laboratory studies show: Erythrocyte sedimentation rate Serum C-reactive protein 65 mm/h 8.2 mg/L (N=0.08-3.1) 2+ 2+ Urine Blood Protein Histologic examination of a biopsy specimen of affected lung tissue shows granulomata and vasculitis. An autoantibody is most likely directly binding which of the following cell types in this patient? OA) Basophils B) Endothelial cells C) Fibroblasts D) Neutrophils E) Plasma cellsMr. JKL is a 69 yr old white male complaining of shortness of breath during activities and sometimes at rest. He does not report any myocardial ischemia symptoms and is treated for hypertension and prostate cancer (diagnosed 5 years prior). The patient quit smoking 3 years ago and smoked on average 2 packs per day for 51 years. He was admitted to the hospital 4 months ago due to respiratory symptoms. The patient is not on supplemental oxygen, his oxygen saturation is 95%, and he reports some shortness of breath with a dyspnea rating of 5 (1-7 scale). The patient is sedentary, rarely walks outside of his home, and does not engage in sports or recreational activities. Mr. JKL's preexercise medical exam results: BMI = 31.8 Resting heart rate = 85 Blood pressure = 144/98 Enlarged anteroposterior chest diameter and decreased breath sounds and prolonged exhalation Current medications: Atrovent inhaler 8 puffs twice per day Doxapram HCL, 50 mg 3 times daily Furosemide, 40 mg 4 times daily…
- Rashidah is a 55-year-old female who is experiencing acute chest pain and shortness of breath. She describes the pain as “pressure and squeezing.” When she becomes nauseous and light-headed, her son insists that he take her to the emergency room. Health History: She started smoking when she was 18, attempted to quit several times in her 40s, and had her last cigarette on her 50th birthday. She has been overweight for most of her adult life but has gained 20 pounds in the last few years, which increased her BMI to 34. The last time she had a physical exam was when she turned 50. Her vital signs and blood test results from that exam are listed below. BP: 178/90 HDL: 62 mg/dl LDL: 190 mg/dl Triglycerides: 174 mg/dl Total cholesterol: 252 mg/dl Fasting blood glucose: 128 mg/dl Given her last physical exam results, Rashidah’s physician believes she has likely had undiagnosed atherosclerosis for years. Briefly describe the pathophysiology of atherosclerosis.Rashidah is a 55-year-old female who is experiencing acute chest pain and shortness of breath. She describes the pain as “pressure and squeezing.” When she becomes nauseous and light-headed, her son insists that he take her to the emergency room. Health History: She started smoking when she was 18, attempted to quit several times in her 40s, and had her last cigarette on her 50th birthday. She has been overweight for most of her adult life but has gained 20 pounds in the last few years, which increased her BMI to 34. The last time she had a physical exam was when she turned 50. Her vital signs and blood test results from that exam are listed below. BP: 178/90 HDL: 62 mg/dl LDL: 190 mg/dl Triglycerides: 174 mg/dl Total cholesterol: 252 mg/dl Fasting blood glucose: 128 mg/dl Rashidah quit smoking 5 years ago but still suffered a myocardial infarction. She is tempted to start smoking again since quitting “obviously didn’t make me healthier.” What does research tell us about her future…Ms. Monstera Peru, 21 year, was brought to the hospital with chief complaint of difficulty of breathing, chest pain, fever and diarrhea. She was admitted with the diagnosis COVID-19 Confirmed. Upon assessment of the admitting nurse, Ms. Peru’s vital signs are as follows: BP = 130/90, PR = 110 bpm, RR = 25 cpm Temperature = 38.9 degrees Celsius. Ms. Peru is using accessory muscle for breathing, have flushed skin and is holding her chest as if massaging it. Ms. Peru, told the nurse that “nahihirapan akong huminga” and “mamatay na baa ko.”