A 26-year-old male presents to the ED with complaints of shortness of breath and right-sided chest pain that began after a 2-mile run. The symptoms have been persistent for the past 3 hours. Pain is increased with inspiration. He denies any constitutional symptoms of fever, cough, chills, or sick contacts. He is an avid runner on a daily basis, but does smoke ½-pack of cigarettes per day. On physical exam he is tachypneic, with respiratory rate 30, 94% saturation on room air. Breath sounds are decreased in the left lung fields, and there is hyperresonance to percussion. The AG-ACNP obtains the following chest x-ray: CXR1.jpg What is the diagnosis?

Match the following with the correct description/statement.

A patient with potential asthma was referred to the pulmonology clinic for further evaluation. To obtain the most information on her current respiratory status, you should order:

A 42-year-old obese female with OSA, diabetes mellitus, and hypertension is admitted for community-acquired pneumonia. After multiple attempts, she is emergently intubated with ET tube size 8.5. She has been intubated for 7 days and today she has tolerated the spontaneous breathing trial. What is the next step?

What is flow direction into the liver called?

Which view is best to visualize the  inferior vena cava extending from the right atrium?

An 80-year-old male patient presents to the hospital on supplemental oxygen with the following arterial blood gas: pH of 7.24, Paco2 of 70 mmHg, and Pao2 of 63 mmHg. He shows evidence of which of the following?

Which statement is true about veins?

A 56-year-old male with advanced idiopathic pulmonary fibrosis presents to the ICU in respiratory distress. He is put on high flow nasal cannula with 50 L flow, 80% FiO2. ABG obtained has a pH significant for 7.32, PaO2 of 80 mm Hg, PaCO2 of 20 mm Hg, HCO3 of 30. Given his underlying disease, what is the primary physiological aberration leading to the patient’s hypoxemia?

A 36-year-old man is admitted for alcohol withdrawal. The patient is initially treated with lorazepam injection as needed based on the Clinical Institute Withdrawal Assessment (CIWA) scale but develops respiratory depression, requiring transfer to the ICU and mechanical ventilation. To treat the symptoms of withdrawal, the patient was started on fentanyl infusion, midazolam infusion, and propofol infusion. Attempts to lower the sedation were met with extreme agitation and dyssynchrony with the ventilator. After 5 days, dexmedetomidine was introduced. A few hours later, the patient became bradycardic and hypotensive. A crystalloid bolus was started. The electrocardiogram (ECG) shows a second degree heart block. Laboratory analysis shows the following: Labs1.jpgAdditionally, his serum osmolality gap is elevated. Which is the responsible medication for the abnormal laboratory values?