THE WRITTEN EMERGENCY MEDICINE FELLOWSHIP COURSE
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MODULE 6 short answer questions - ABG.
Below are the module SAQs. There are 10 questions this module (5 as an ABG and 5 as an ECG), so you have 60 minutes. Good luck!
Take me to the ECG SAQ
Module 6 saQS - ABG
SAQ 1.
A 50 year old female presents to your department after a heroin overdose. Her vital signs are:
HR 76 /min
BP 90/62 mmHg
RR 3 /min
O2 sats 2L 96% 2L via prongs
T 37.2 oC
An arterial blood gas is shown below.
FiO2 28%
pH 7.20
pO2 87 mmHg
PCO2 105 mmHg
HCO3- 30 mmol/L
BE +8
Question 1. What are the major acid base disturbances? (3 marks)
Question 1. What are the major acid base disturbances? (3 marks)
*
Question 2. What is the primary acid-base disturbance? (1 mark)
Question 2. What is the primary acid-base disturbance? (1 mark)
*
Question 3. What HCO
3
-
levels would you expect as acute and chronic compensation for the primary disturbance? (2 marks)
Question 3. What HCO3- levels would you expect as acute and chronic compensation for the primary disturbance? (2 marks)
*
Question 4. Is there a V/Q mismatch, or is the primary problem hypoventilation? Why? (4 marks)
Question 4. Is there a V/Q mismatch, or is the primary problem hypoventilation? Why? (4 marks)
*
SAQ 2.
A 21 year old man with a history of insulin dependent diabetes presents to the emergency department with an altered level of consciousness.
His vital signs are:
HR 115 /min
BP 105/73 mmHg
RR 30 /min
O2 sats 2L 99% RA
T 37.3 oC
An arterial blood gas is shown below.
FiO2 21%
pH 7.15
pO2 114 mmHg
PCO2 20 mmHg
HCO3- 8 mmol/L
BE -16
Na+ 140 mmol/L
K+ 6.0 mmol/L
Cl- 110 mmol/L
Question 1. What are the major acid base disturbances? (3 marks)
Question 1. What are the major acid base disturbances? (3 marks)
*
Question 2. What is the primary disturbance? (1 mark)
Question 2. What is the primary disturbance? (1 mark)
*
Question 3. What CO
2
level would you expect as compensation for the primary acid-base disturbance? (1 mark)
Question 3. What CO2 level would you expect as compensation for the primary acid-base disturbance? (1 mark)
*
Question 4. What is the anion gap? (1 mark)
Question 4. What is the anion gap? (1 mark)
*
Question 5. Give 4 acids that are causes of a raised anion gap? (4 marks)
Question 5. Give 4 acids that are causes of a raised anion gap? (4 marks)
*
SAQ 3
A 21 year old girl presents complaining of severe chest pain and shaking in the hands. She is acutely distressed, and states that the pain came on after an argument with her boyfriend.
Her vital signs are:
HR 128 /min
BP 109/79 mmHg
RR 38 /min
O2 sats 2L 99% RA
T 37.0 oC
An arterial blood gas is taken by the intern.
FiO2 21%
pH 7.55
PO2 115 mmHg
PCO2 22 mmHg
HCO3- 20 mmol/L
BE +4
Question 1. What are the major acid base disturbances? (3 marks)
Question 1. What are the major acid base disturbances? (3 marks)
*
Question 2. What is the primary acid-base disturbance? (1 mark)
Question 2. What is the primary acid-base disturbance? (1 mark)
*
Question 3. What HCO
3
-
levels would you expect as acute and chronic compensation for the primary disturbance? (2 marks)
Question 3. What HCO3- levels would you expect as acute and chronic compensation for the primary disturbance? (2 marks)
*
Question 4. What is the Aa gradient? (2 marks)
Question 4. What is the Aa gradient? (2 marks)
*
Question 5. What is the likely diagnosis? (2 marks)
Question 5. What is the likely diagnosis? (2 marks)
*
SAQ 4
A 61 year old female presents to your department with a distended abdomen and copious vomiting which has worsened for the past 12 hours. She is complaining of extreme thirst, and has had three vomits since she arrived in your department 45 minutes previously. She has a history of bowel obstructions due to adhesions from previous surgery.
HR 116 /min
BP 115/74 mmHg
RR 8 /min
O2 sats 2L 99% RA
T 37.3 oC
An arterial blood gas is shown below.
FiO2 21%
pH 7.55
pO2 94 mmHg
PCO2 45 mmHg
HCO3- 32 mmol/L
BE +8
Question 1. What are the major acid base disturbances? Indicate the primary derangement.
(
4
marks)
Question 1. What are the major acid base disturbances? Indicate the primary derangement. (4 marks)
*
Question
2. What CO2 levels would you expect as compensation for the primary disturbance? (2 marks)
Question 2. What CO2 levels would you expect as compensation for the primary disturbance? (2 marks)
*
Question
3
.
Why does the patient have their acid base disturbance?(1 mark)
Question 3. Why does the patient have their acid base disturbance?(1 mark)
*
Question 4. What further investigations will you order?
Question 4. What further investigations will you order?
*
SAQ 5
A 52 year old smoker on home oxygen for COPD present feeling generally unwell. On further questioning he describes a fever and a cough for several days.
His vital signs are:
HR 123 /min
BP 98/71 mmHg
RR 42 /min
O2 sats 2L 89% 6L
T 39.6 oC
An arterial blood gas is taken.
FiO2 40%
pH 7.12
pO2 60 mmHg
PCO2 75 mmHg
HCO3- 16 mmol/L
BE -1
Na+ 145 mmol/L
Cl- 101 mmol/L
Lactate 5.4 mmol/L
Question 1. What are the major acid base disturbances?
(
4
marks)
Question 1. What are the major acid base disturbances? (4 marks)
*
Question
2
.
Which of these is the primary disturbance? (1 mark)
Question 2. Which of these is the primary disturbance? (1 mark)
*
Question 3. What is the anion gap? (1 mark)
Question 3. What is the anion gap? (1 mark)
*
Question 4. Is there a metabolic alkalosis present? Justify your answer.
Question 4. Is there a metabolic alkalosis present? Justify your answer.
*
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