Multiprofessional Critical Care Review: Adult (2023)-Question and Answer Session 2B

Question and Answer Session 2B

Pdf Summary

In this document, there are multiple clinical scenarios presented, each with a question relating to appropriate management or diagnosis. Here is a summary of each scenario and their respective answers:<br /><br />1. An 82-year-old woman with atrial fibrillation and rapid ventricular rate develops right lower quadrant abdominal pain, guarding, rebound, and distention. CT shows pneumatosis of the right colon. The most appropriate next step is surgical consultation for intestinal resection.<br /><br />2. A 49-year-old man presents with acute-onset, severe epigastric pain, and diffuse guarding and rebound on examination. CT shows free air above the liver. The most appropriate next step is immediate exploratory laparotomy.<br /><br />3. A 21-year-old pregnant woman at 32 weeks gestation presents with uterine tenderness, malaise, and fever. The most appropriate next step is administration of IV antibiotics for suspected chorioamnionitis.<br /><br />4. A 65-year-old man with chronic lymphocytic leukemia develops flank pain, weakness, and nausea after starting fludarabine treatment. His laboratory results show elevated levels of creatinine, blood urea nitrogen, uric acid, and lactate dehydrogenase. The most appropriate next step is initiation of rasburicase for tumor lysis syndrome.<br /><br />5. A 45-year-old man, 10 days after hematopoietic stem cell transplantation, presents with dyspnea, nonproductive cough, high fever, and mucositis. Chest CT shows bilateral ground glass infiltrates. The most likely diagnosis is diffuse alveolar hemorrhage.<br /><br />6. A 66-year-old man presents with hematochezia and orthostatic changes. He has a systolic murmur and a diffusely tender abdomen. Tagged red blood cell scan shows lower gastrointestinal bleeding. The most appropriate next step is obtaining an angiogram.<br /><br />7. A 38-year-old woman presents with painless bright red blood per rectum. She has a positive flexible sigmoidoscopy to 35 cm but suboptimal visualization. The most appropriate next step is anoscopy examination.<br /><br />8. A 63-year-old man with nonvariceal upper gastrointestinal bleeding has multiple arteriovenous malformations, which are controlled with endoscopic clipping. The most appropriate pharmacologic management following endoscopic control of bleeding is high-dose proton pump inhibitor therapy.<br /><br />These summaries provide a brief overview of each scenario and the most appropriate next steps based on the information provided.

Keywords

clinical scenarios

appropriate management

diagnosis

atrial fibrillation

surgical consultation

exploratory laparotomy

IV antibiotics

tumor lysis syndrome

diffuse alveolar hemorrhage

high-dose proton pump inhibitor therapy

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