Approach to dyspnea Quiz: Ace Your Exams

Get ready to dominate your medical and nursing exams by using our dynamic quizzes to elevate your knowledge and increase your confidence. Whether you're gearing up for the USMLE®, COMLEX®, or your next in-class assessment, Osmosis quizzes tackle key topics in pathology, diagnostics, and treatment approaches. By honing in on clinical readiness and decision-making, we make sure the knowledge you gain empowers you both in the classroom and in real-world practice. Jump in and supercharge your exam prep!

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A 24-year-old woman presents to the emergency department with three hours of severe shortness of breath. The patient has severe persistent asthma and has already been hospitalized twice this year due to exacerbations. The patient has never been intubated for mechanical ventilation. Her temperature is 37.0°C (98.6°F), pulse is 105/min, respirations are 28/min, blood pressure is 110/70 mmHg, and oxygen saturation is 93%. Diffuse wheezing is heard on pulmonary auscultation. Initial arterial blood gas shows pH of 7.49 and pCO₂ of 22 mmHg. The patient is given intravenous magnesium and methylprednisolone and is started on supplemental oxygen. Two hours later, the patient is re-evaluated and appears more fatigued, and she is no longer tachypneic. Minimal wheezing is noted on pulmonary auscultation. Repeat arterial blood gas shows pH 7.37 and pCO₂ of 47. Which of the following is the most appropriate next step in the management of this patient?

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Perform endotracheal intubation

Start continuous nebulized albuterol

Repeat arterial blood gas in 1 hour

Start oral acetazolamide

Consult pulmonology