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Free Open Access Short Answer Questions for ED Fellowship Study

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Case: Chest xray

A 55 year old man is brought to your ED after his family called an ambulance due to fever and confusion. A review of his medical record reveals that he is HIV positive with a recent CD4 count of 170 cells/ΞΌL. He also has hypertension and T2DM.

His observations are:

  • RR 26 bpm
  • HR 115 bpm
  • SpO2 91% on 5L O2
  • BP 95/55 mmHg
  • Temp 38.9Β°C
  • GCS 12 (E3 V4 M5)

He is brought into the resuscitation room and the following CXR is obtained:

1. Describe (2) key abnormalities on the CXR 2 marks

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2. List (3) potential pathogens causing this presentation in this patient. 3 marks

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An ABG is obtained on an FiO2 of 0.4 :

  • pH 7.25
  • PaO2 60 mmHg
  • PaCO2 35 mmHg
  • Na+ 129 mmol/L
  • K+ 4.5 mmol/L
  • Cl- 100 mmol/L
  • Glu 23.0 mmol/L
  • Lactate 5.5 mmol/L
  • HCO3- 12 mmol/L

3. Interpret the blood gas for this patient. 4 marks

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4. State your antibiotic regimen for this patient. 3 marks

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