Help with question

[manleyjb]

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An 18 year old male is brought to the University of Utah Emergency Room after being found unconscious in his dorm room in a pool of his own vomit. He has a history of depression and recently expressed feelings of despondency to some of his friends. An empty pill bottle is found on the floor beside him. A blood gas obtained on room air at the start of his resuscitation is as follows: PaO2 44, PaCO2 60, pH 7.36, HCO3 24. Which one of the following diagnoses is most consistent with these values?

A. Aspiration of gastric contents from obvious vomiting
B. Pulmonary embolism from prolonged immobility
C. Hypoventilation from drug induced ventilatory suppression
D. Pneumonitis in response to drug overdose

The explanation says that the A-a gradient is normal. Assuming 760 torr and FiO2 of .21, I cannot get the A-a gradient to come out to a normal number, which is supposed to < 10 torr.

Anyone have an idea? I didn't have a hard time with the answer, but I do with the explanation. Thanks for the help.

 

[nabeya]

Answer C? Maybe respiratory depression causing acute respiratory acidosis from opiates possibly?

An 18 year old male is brought to the University of Utah Emergency Room after being found unconscious in his dorm room in a pool of his own vomit. He has a history of depression and recently expressed feelings of despondency to some of his friends. An empty pill bottle is found on the floor beside him. A blood gas obtained on room air at the start of his resuscitation is as follows: PaO2 44, PaCO2 60, pH 7.36, HCO3 24. Which one of the following diagnoses is most consistent with these values?

A. Aspiration of gastric contents from obvious vomiting
B. Pulmonary embolism from prolonged immobility
C. Hypoventilation from drug induced ventilatory suppression
D. Pneumonitis in response to drug overdose

The explanation says that the A-a gradient is normal. Assuming 760 torr and FiO2 of .21, I cannot get the A-a gradient to come out to a normal number, which is supposed to < 10 torr.

Anyone have an idea? I didn't have a hard time with the answer, but I do with the explanation. Thanks for the help.

 

[manleyjb]

Answer C? Maybe respiratory depression causing acute respiratory acidosis from opiates possibly?

I agree with you on answer C. What i do not understand is the explanation. It says the A-a gradient is normal, which would eliminate the other 3 answers. When I figure the gradient, I come up with a number that is far from normal, assuming normal is < 10 torr.

 

[nabeya]

Maybe the explanation is incorrect? Who wrote the question? Are you studying for the exam right now?

I agree with you on answer C. What i do not understand is the explanation. It says the A-a gradient is normal, which would eliminate the other 3 answers. When I figure the gradient, I come up with a number that is far from normal, assuming normal is < 10 torr.

 

[manleyjb]

Maybe the explanation is incorrect? Who wrote the question? Are you studying for the exam right now?

I take Step 1 next July. I am studying for it now however. Never can start too early right? The question came from, I believe, Q-bank. I am not 100% sure on that. I got this question from a 4th year and he used these like they were Gold. Anyway, You are right in that the explanation could be wrong and I should not dwell on it. Thanks for the help.