Pulmonary Disorders II

has the highest quality of evidence for improving

patient outcomes?

inhaled antibiotics.

A 55-year-old woman with pulmonary artery hyper-

tension (PAH) is admitted to the ICU for severe

respiratory failure. She reports increased work of

breathing for the past 5 days and full adherence to

her PAH medication regimen, which includes maci-

tentan 10 mg daily and sildenafil 40 mg three times

daily. Her current vital signs are as follows: blood

pressure 76/60 mm Hg, heart rate 140 beats/minute,

respiratory rate 30 breaths/minute, and 85% Sao2

on 6 L of nasal cannula. Right heart catheterization

reveals the following: mean pulmonary artery pres-

sure (mPAP) 50 mm Hg, right atrial pressure 25 mm

Hg, cardiac index 1.9 L/minute/m2, and pulmonary

capillary wedge pressure (PCWP) 16 mm Hg. A

transthoracic echocardiogram reveals an ejection

fraction of 60% with severe right ventricular (RV)

dilatation. Which regimen would be most appropri-

ate for this patient?

Which best describes one of the primary treatment

goals for the management of PAH?

(FC) III or IV.

greater than 300 m.

sure less than 8 mm Hg).

(less than 200 ng/L).

A 42-year-old man presents to the emergency depart-

ment (ED) with anxiety and shortness of breath.

Auscultation reveals audible wheezing. He has dif-

ficulty speaking in full sentences. He has used his

albuterol metered dose inhaler (MDI) at home for

the past several hours without symptom resolution.

His forced expiratory volume in the first second of

expiration (FEV1) is 35% of predicted. Which best

classifies this patient’s asthma exacerbation?

A 55-year-old man presents to the ED with a 2-week

history of progressive shortness of breath, wheezing,

and dyspnea at rest. He is confused and speaking in

short phrases but can indicate that his inhaled bron-

chodilator has failed to improve his symptoms for

the past 2 days. He is afebrile with heart rate 116

beats/minute, respiratory rate 32 breaths/minute, and

Sao2 86% on room air. He is placed on supplemental

oxygen and administered albuterol nebulization and

methylprednisolone 125 mg intravenously × 1. One

hour later, his oxygenation has not improved. Which

adjunctive therapy would be best to add to his cur-

rent regimen?

acquired pathogens.

minutes.

dose; then obtain serum concentration in 30

minutes to guide further dosing.

hours.