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    Statia Graduate is offline Junior Member 510 points
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    Hmmm, and another

    74 year-old white female with COPD, HTN, HLD, DM presents complaining of severe SOB and cough. She has had progressive SOB for 2 days, and a persistent cough with minimal white sputum. She denies any fevers or chills, or sick contacts. She uses 2 liters O2 at home.

    On exam, sshe is alert and oriented, she appears slightly diaphoretic, and in moderate distress. She is breathing through pursed lips.

    Vitals: 158/92, HR: 112, RR: 30, O2: 90% on 100% nonrebreather, Temp 98.1

    (system-specific)
    CV: Tachy, regular, no murmurs, rubs or gallops
    Lungs: Diffuse expiratory wheezes heard in all lung fields, prolonged espiratory phase

    Labs:
    WBC: 8.2
    Hg/HCT: 12.8/39.1
    Plt: 218

    Na: 138
    Cl: 108
    Bicarb: 28
    BUN: 12
    Cr: 0.7

    ABG:
    pH: 7.2, PCO2: 80, PO2 90 Bicarb on ABG: 29

    CXR shows hyperinflation, no evidence for infiltrate

    The patient's baseline PCO2 is 42. What should you do next?
    A. Bipap
    B. Cont nonrebreather, and give nebs
    C. Cont nonrebreather, give nebs and steroids
    D. Intubate
    E. Cont nonrebreather, give nebs, steroids, and treat for community acquired pneumonia
    Last edited by Statia Graduate; 05-09-2009 at 09:49 AM.

  2. #11
    Statia Graduate is offline Junior Member 510 points
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    Quote Originally Posted by RussianJoo View Post
    is ANCA and ASCA used to evaluate for UC as well? like isn't ANCA more associated with UC and ASCA more with Crohn's? so if you test for both and once is high and the other is low then you can pretty much say which it is but you still need a bipsy to make the official diagnosis.
    Now you sound like you are studying for the IM boards!

    You are correct, ANCA will be positive in 60-70% of UC pts, ASCA will be positive in 60-70% of Crohns pts. They can give you an idea of the diagnosis, but biopsy is the definitive answer. And crossover of the antibodies can occur.

  3. #12
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    RussianJoo is offline Ultimate Member
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    ok thanks a lot for your help.. now i got to get some reading done. i'll be back on tonight to answer other vignettes if you post them.


    thanks again these are great.. too bad others aren't involved with them but. not too many people are really that active on this forum. I guess I get all the benefits which is fine with me.

    take care.
    Hollywood Upstairs School of Medicology, Class of 2010
    Due to the high volume of private messages, I can only answer questions that are posted in a forum. Private messages will be ignored.
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