BCEN BCEN Respiratory Emergencies 2 — Questions and Answers
Question 1: A patient on anticoagulation presents with dyspnea, tachycardia, and pleuritic chest pain after a long flight. What diagnosis must be ruled out?
- Aortic dissection
- Pulmonary embolism (Correct answer)
- Spontaneous pneumothorax
- Acute MI
Correct answer: Pulmonary embolism
Pulmonary embolism classically follows prolonged immobility and presents with dyspnea, tachycardia, and pleuritic chest pain.
Question 2: Which diagnostic test is the gold standard for confirming pulmonary embolism?
- D-dimer blood test
- Chest X-ray
- CT pulmonary angiography (CTPA) (Correct answer)
- VQ scan
Correct answer: CT pulmonary angiography (CTPA)
CT pulmonary angiography is the gold standard for diagnosing PE due to its high sensitivity, specificity, and wide availability.
Question 3: What does the CURB-65 score assess in pneumonia patients?
- Likelihood of bacterial vs. viral etiology
- Severity and need for hospitalization (Correct answer)
- Response to antibiotic therapy
- Risk of pleural effusion
Correct answer: Severity and need for hospitalization
CURB-65 evaluates confusion, urea, respiratory rate, blood pressure, and age ≥65 to determine pneumonia severity and disposition.
Question 4: A COPD patient presents with worsening dyspnea and a PaCO2 of 65 mmHg. What ventilatory support should be initiated first?
- Immediate intubation
- Non-invasive positive pressure ventilation (NIPPV/BiPAP) (Correct answer)
- Simple face mask at 15 L/min
- Nasal cannula at 2 L/min only
Correct answer: Non-invasive positive pressure ventilation (NIPPV/BiPAP)
BiPAP is the preferred initial ventilatory support for hypercapnic COPD exacerbations, reducing the need for intubation.
Question 5: Which intervention is contraindicated in a patient with epiglottitis suspected in the ED?
- IV antibiotics
- Humidified oxygen
- Direct visualization of the throat with a tongue blade (Correct answer)
- Airway readiness at bedside
Correct answer: Direct visualization of the throat with a tongue blade
Forcing visualization of the throat in epiglottitis can trigger complete airway obstruction and should be avoided unless in a controlled setting.
Question 6: What is the characteristic barking cough and inspiratory stridor in a child most likely caused by?
- Epiglottitis
- Foreign body aspiration
- Croup (laryngotracheobronchitis) (Correct answer)
- Pertussis
Correct answer: Croup (laryngotracheobronchitis)
Croup causes subglottic swelling producing the classic seal-like barking cough and inspiratory stridor, most commonly due to parainfluenza virus.
BCEN BCEN Respiratory Emergencies 2
A patient on anticoagulation presents with dyspnea, tachycardia, and pleuritic chest pain after a long flight.
What diagnosis must be ruled out?