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Category: Critical Care Medicine-Pulmonary Disorders--->Neoplasm
Page: 2

Question 6#Print Question

A 65-year-old female with 50 pack-year tobacco history presents to the ED after being involved in a motor vehicle accident. Her vitals on arrival were:

  • temperature of 98.6°F
  • heart rate 95
  • blood pressure 142/86 mm Hg
  • SpO2 of 91% on room air

She underwent a CT head, chest, abdomen, and pelvis. The CT chest demonstrated a 5 cm spiculated nodule in the right middle lobe. Thoracic surgery was consulted for possible lobectomy. Pulmonary function tests were performed which demonstrated a forced expiratory volume (FEV1) of 1.4 L (53% predicted), forced vital capacity (FVC) of 2.39 L (71% predicted), and a diffusing capacity of the lungs for carbon monoxide (DLCO) of 48% predicted.

What would be the next step in management?

A. Stair climbing assessment
B. Calculate perioperative lung function
C. Cardiopulmonary exercise testing
D. Proceed with surgery as the patient is low risk
E. Arterial PO2


Question 7#Print Question

A 75-year-old male with a history of tobacco use (50 pack year), chronic obstructive pulmonary disease (COPD), hypertension (HTN), and recent diagnosis of adenocarcinoma of the lung for which he has not started treatment presents to the ED with a 4-day history of increased dyspnea at rest and with exertion, productive cough, and subjective fevers at home. His initial vitals were notable for:

  • temperature of 101°F
  • heart rate of 105
  • blood pressure 120/80 mm Hg
  • saturation of 84% on room air with a respiratory rate of 26

He was placed initially on a nonrebreather and his saturations increased to 92%. He had a CXR performed which showed a dense consolidation in the right lower lobe. He was started on ceftriaxone and azithromycin for community-acquired pneumonia (CAP) and admitted to the ICU given his high oxygen requirements. Three days into his ICU course, his high flow requirements remained unchanged. He remained tachycardic in the low 100s and continued to have low-grade fevers.

What would be the next step in management?

A. Add vancomycin for greater antibiotic coverage
B. Add steroids for COPD exacerbation in the setting of pneumonia
C. Perform a CT-PE (pulmonary embolism)
D. Continue with current management




Category: Critical Care Medicine-Pulmonary Disorders--->Neoplasm
Page: 2 of 2