BCEN BCEN Respiratory Emergencies 1 — Questions and Answers
Question 1: A patient presents with sudden pleuritic chest pain, dyspnea, and absent breath sounds on the left. What is the most likely diagnosis?
- Pulmonary embolism
- Pneumothorax (Correct answer)
- Hemothorax
- Pleural effusion
Correct answer: Pneumothorax
Absent breath sounds with acute pleuritic pain and dyspnea are classic signs of pneumothorax, especially spontaneous in tall young patients.
Question 2: What is the immediate treatment for a tension pneumothorax?
- Chest X-ray then chest tube
- Needle decompression at 2nd ICS midclavicular line (Correct answer)
- High-flow O2 and observation
- Intubation and mechanical ventilation
Correct answer: Needle decompression at 2nd ICS midclavicular line
Tension pneumothorax is a clinical emergency requiring immediate needle decompression without waiting for imaging.
Question 3: Which ABG pattern is most consistent with acute respiratory failure (Type 1)?
- pH 7.30, PaCO2 55, PaO2 80
- pH 7.48, PaCO2 30, PaO2 55 (Correct answer)
- pH 7.38, PaCO2 40, PaO2 58
- pH 7.32, PaCO2 50, PaO2 60
Correct answer: pH 7.48, PaCO2 30, PaO2 55
Type 1 (hypoxemic) respiratory failure is characterized by low PaO2 with normal or low PaCO2 due to ventilation-perfusion mismatch.
Question 4: A patient with a known history of asthma presents with severe wheezing, accessory muscle use, and SpO2 of 88%. What is the priority intervention?
- Chest X-ray
- IV corticosteroids only
- Nebulized albuterol and supplemental oxygen (Correct answer)
- Intubate immediately
Correct answer: Nebulized albuterol and supplemental oxygen
Short-acting beta-2 agonists like albuterol combined with supplemental oxygen are the first-line treatment for acute asthma exacerbations.
Question 5: Which sign indicates impending respiratory arrest in a patient with severe asthma exacerbation?
- Loud wheezing bilaterally
- Silent chest with markedly decreased air movement (Correct answer)
- Moderate tachycardia
- Mild accessory muscle use
Correct answer: Silent chest with markedly decreased air movement
A 'silent chest' indicates near-complete airway obstruction with no air movement, a pre-arrest finding requiring immediate intervention.
Question 6: What is the most common cause of community-acquired pneumonia in adults in the US?
- Haemophilus influenzae
- Streptococcus pneumoniae (Correct answer)
- Legionella pneumophila
- Mycoplasma pneumoniae
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae (pneumococcus) remains the most frequent bacterial cause of community-acquired pneumonia in US adults.
BCEN BCEN Respiratory Emergencies 1
A patient presents with sudden pleuritic chest pain, dyspnea, and absent breath sounds on the left.
What is the most likely diagnosis?