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* nbme19
 #346953  
  tabish60102 - 10/10/08 00:38
 
  19. A 4-year-old boy is brought to the emergency department 20 minutes after being involved in a motor vehicle collision. He was an unrestrained passenger. On arrival, his blood pressure is 110/70 mm Hg, pulse is 100/min, and respirations are 32/min with grunting and retractions. Examination shows multiple bruises over the chest. Arterial blood gas analysis while breathing 40% oxygen shows:

pH 7.38
PCO2 34 mm Hg
PO2 66 mm Hg

An x-ray film of the chest obtained 4 hours later shows diffuse infiltrates on the right side. Which of the following is the most likely diagnosis?

A
) Acute respiratory distress syndrome

B
) Aspiration pneumonia

C
) Fat embolism

D
) Hemothorax

E
) Pulmonary contusion
 
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* Re:nbme19
#1503410
  franklinsalam - 10/10/08 09:59
 
  cc?  
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* Re:nbme19
#1503450
  drkinjaldesai - 10/10/08 10:18
 
  could be ddddddddd or eeeeeeee most likely eeeeee  
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* Re:nbme19
#1503484
  tabish60102 - 10/10/08 10:33
 
  COULD IT BE C Vs E COMMENT  
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* Re:nbme19
#1503656
  snowpurple - 10/10/08 12:06
 
  EEE  
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* Re:nbme19
#1503671
  tabish60102 - 10/10/08 12:12
 
  I MEAN B Vs E  
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* Re:nbme19
#1503676
  tabish60102 - 10/10/08 12:15
 
  ASPIR PNEUM. WILL HAVE FEVER AND FEVER IS NOT MENTIONED. SO ANS IS E I GUESS  
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* Re:nbme19
#1503679
  halia - 10/10/08 12:16
 
  the answer is D  
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* Re:nbme19
#1503686
  tabish60102 - 10/10/08 12:18
 
  HEMOTHORAX LUNG FIELD OPAQUE ON CXR  
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* Re:nbme19
#1579712
  julia05 - 12/03/08 12:20
 
  I go with E -pulm cont develops unilaterally, in the first 24 h usually as opposed to ARDS-bilateral, 24-48 h.  
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* Re:nbme19
#1580646
  schenki - 12/04/08 02:02
 
  what about this one??? another NBME 1

a 40y/o man is brought to the ED 1 hr after a high speed motor vehiclecollision. On arrivel, he is awake and alert but has severe pain over the sternum. his systolic BP is 80, pulse 80, rep 10/min. ECG shows multifocal premature ventricular contractions but no ST segment changes. His PO2 is 100mmHg, after 1 lt of lactated ringer's solution is administered, his PO2 decreases to 60mmHg while breathing 4 L/min oxygen by nasal cannula. PCWP has increased from 14 mmHg to 24 mmHg (n1-10) which of the following is the most likely explanation for the patient's poor response to fluid resuscitation?
a) inadeq administ of fluids
b) myocardial contusion
c) MI
d) Pulmonary contusion
e) traumatic rupture of the aorta
 
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