MCQs
26-year-old woman presents to the emergency department with progressive dyspnea after a soccer game the night before. Over the past few weeks, the patient admits to wheezing on a daily basis. She has increased the frequency of her inhaled albuterol and triamcinolone to two puffs every two to four hours, with minimal relief of her symptoms. She has never used systemic steroids or had to be intubated in the past. While in the emergency department, her peak flow increases from 150 to 180 L/min after three continuous, nebulized albuterol treatments. She appears distressed. She is sitting up in bed and reluctant to lie down. She is afebrile, with a pulse rate of 110/min and a blood pressure of 150/90 mm Hg. She is audibly wheezing. An arterial blood gas shows: pH 7.50, CO2 30 mm Hg, PaO2 76. What is the best treatment strategy?
(A) A long-acting -agonist
(B) Nebulized beta 2-agonist and intravenous corticosteroids
(C) beta 2-nebrulized agonist and oral theophylline
(D) beta 2 -Agonist metered dose inhaler and cromolyn sodium
(E) Epinephrine-based nebulizer and intubation
A 68-year-old male is brought to the emergency with complaints of confusion, chest pain and acute breathlessness. He is diagnosed with acute myocardial infarction resulting in cardiogenic shock. Physical examination reveals bilateral crackles, S3 gallop, distended jugular veins and 2 + edema of lower extremities. He is started on dobutamine, furosemide, nitroglycerin and captopril. Which of the following effects is most specific for dobutamine in this patient?
A. Increased urine output
B. Improved left ventricular function
C. Increased heart rate
D. Increased conduction velocity
E. Decreased peripheral vascular resistance