Scenario
An 85 year old woman is in your emergency department awaiting a surgical ward bed for treatment of a bowel obstruction.
After becoming increasingly tired and breathless, the following investigations are performed.
Question
Describe and interpret the results of her investigations. (100%)
Answer
FACEM VAQ Exam 2007.1 – Question 3
- The overall pass rate for this question was 40/55 (72.7%).
- Clinical Chemistry showed a mixed acid–base abnormality (resp acidosis and low Chloride metabolic acidosis) plus evidence of hypoperfusion/dehydration (raised lactate and urea with N creatinine)
- This question was regarded as a good mid-level discriminator with a wide spread of marks allocated.
- Poor responses failed to show an understanding of mixed acid/base disturbances, the causes of metabolic alkalosis and compensatory responses to this condition.
- Better responses calculated secondary values for anion gap and A-a gradient plus discussed possible causes for the renal impairment and elevated lactate.
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