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2. Assume the oxygen capacity of blood is 20ml/100 ml of blood.If the oxygen consumption of the brain is 50 ml/min, the blood is100 % saturated in the carotid arteries carrying blood to the brainand 75% saturated in the jugular veins carrying venous blood fromthe brain, and that brain oxygen consumption is 50 ml/minute:

Calculate the volume of blood flowing through the brain =________ ml/mi

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Trinidad Tremblay
Trinidad TremblayLv2
28 Sep 2019

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Shock Case Study (15 pts)

HPI. Mrs. K is a 22 y/o college student, rushed to the ED 35 minutes after sustaining multiple stab wounds to the chest and abdomen by an unidentified assailant. A witness called 911. Paramedics arriving at the scene found the victim to be in severe acute distress.

Vital signs were as follows: HR 128 (baseline 80), BP 80/55 (baseline 115/80), RR 37 and labored. Chest auscultation revealed decreased breath sounds in the R lung consistent with basilar atelectasis (ie. collapsed R lung). Pupils were equal, round, reactive to light, and accommodation. Her LOC was reported as “awake, slightly confused, and complaining of severe chest and abdominal pain.” Pedal pulses were absent, radial pulses were weak, and carotid pulses were palpable. The patient was immediately started on IV Lactated Ringer’s solution at a rate of 150 mL/hr.

An ECG monitor placed at the scene of the attack revealed that the patient has developed sinus tachycardia. She was tachypneic, became short of breath with conversation and reported her heart was pounding out of her chest. She appeared to be very anxious and continued to c/o pain. Her skin was cool and nail beds were pale but not cyanotic. Skin turgor was poor. Peripheral pulses were absent with the exception of a thread, brachial pulse. Capillary refill time was 7-8 seconds. Doppler ultrasound had been required to obtain an accurate BP reading. The patient’s skin was cool and clammy. There was a significant amount of blood on her dress and on the pavement where she was lying.

Question 2. What is the pathophysiologic sequence of events for shock? (2pts)

Question 3. What type of shock does this patient seem to have? What is your rationale? (2 pts)

Question 4. Does this patient need a blood transfusion? Provide rationale for your answer. (2pts)

During transport to the hospital, vital signs were reassessed: HR 138, BP 75/50, RR 38 with confusion. Patient was diagnosed with hypovolemic shock and IV fluids were doubled. Oxygen was started at 3L/min by nasal cannula. ER physicians chose not to start a central venous line. An indwelling foley catheter was inserted with return of 180mL of amber colored urine. Urine output measured over the next hour was 14mL. Patient was taken to the OR for surgical correction of lacerations to the right lung, liver and pancreas. In total, patient received 1L of Lactated Ringers.

Table 1.

Class

Parameter

I

II

III

IV

Blood loss (ml)

<750

750–1500

1500–2000

>2000

Blood loss (%)

<15%

15–30%

30–40%

>40%

Pulse rate (beats/min)

<100

>100

>120

>140

Blood pressure

Normal

Decreased

Decreased

Decreased

Respiratory rate (breaths/min)

14–20

20–30

30–40

>35

Urine output (ml/hour)

>30

20–30

5–15

Negligible

CNS symptoms

Normal

Anxious

Confused

Lethargic

Please Help I keep getting 9/15 and the sytemwont let me know which is inncorect. I only have one moreattempt


QUESTION 1

You examine a young patient in the emergencyroom who is complaining of ankle pain following a soccer game. Thepatient demonstrates to you that an accident resulted in his footbeing forced into an excessively inverted position. Based on thisscenario, which of the following is the most likely injury?

A. fractured lateral malleolus

B. medial malleolar dislocation

C. fractured talus

D. fractured calcaneus

E. tibial dislocation

QUESTION 2

Which of the following is incorrect pertainingto human locomotion?

A. Theknee extensors contract during the first part of the stancephase.

B. Thestance phase of walking is longer than the swing phase.

C. Thestance phase of walking begins with �foot-flat� as the entireplantar surface of the foot contacts the ground.

D. Thepush-off phase of walking is associated with contraction of theplantar flexors.

E. During walking there is a period when both feet are in contact withthe ground.

QUESTION 3

Which of the following would conclusivelydemonstrate functionality of the deep fibular nerve?

A. inversion of the foot

B. response to pin prick on the foot at the level of the malleoli

C. response to pin prick on the anteromedial surface of the middle ofthe leg

D. eversion of the foot

E. response to pin prick on the foot between the first and secondtoes

QUESTION 4

Which of the following is not correct for thecribriform plate?

A. Itis part of the ethmoid bone.

B. Itis located posterior to the frontal crest.

C. Itis located in the middle cranial fossa.

D. Itlies adjacent to the crista galli.

E. Itpossesses numerous tiny foramina that transmit olfactorynerves.

QUESTION 5

During a difficult delivery an obstetricianuses forceps to extract the infant. Upon examining the baby younotice forceps impressions posteroinferior to the ear. You are mostconcerned that the:

A. styloid process and associated muscles may have been avulsed.

B. forceps may have penetrated a fontanelle.

C. middle ear cavity may have been crushed.

D. facial nerve may have been injured.

E. mastoid process may have been avulsed.

QUESTION 6

Which of the following is incorrect pertainingto the scalp?

A. Blood vessels and nerves enter the scalp inferiorly.

B. Thescalp muscles (e.g., occipitofrontalis) are attached to thepericranium.

C. Scalp injuries can result in �black eyes.�

D. Superficial wounds do not gape because the margins of the wound areheld together by the epicranial aponeurosis.

E. Scalp infections may spread to the brain via emissary veins thatpass through parietal foramina.

QUESTION 7

Which of the following associations pertainingto the dural venous sinuses is incorrect?

A. confluence of the sinuses�near internal occipital protuberance

B. arachnoid granulations�calcifications of arachnoid mater within thesinuses associated with arteriosclerosis

C. occipital sinus�metastases via internal vertebral venousplexuses

D. inferior sagittal sinus�located within the falx cerebri

E. sigmoid sinus�continues inferiorly as internal jugular vein

QUESTION 8

You examine a comatose patient in theemergency room. His wife relates that her husband was struckaccidentally in his �temple� by a baseball. After an initial periodof unconsciousness, he seemed to be okay but later became drowsyand comatose. You suspect that the patient is suffering from:

A. anextradural (epidural) hematoma caused by a laceration of thetransverse venous sinus.

B. anextradural (epidural) hematoma caused by a laceration of a branchof the middle meningeal artery.

C. asubdural hematoma caused by a laceration of a branch of the middlemeningeal artery.

D. asubarachnoid hemorrhage caused by a laceration of the internalcarotid artery.

E. asubdural hematoma caused by a laceration of a branch of thetransverse venous sinus.

QUESTION 9

Which of the following associations isincorrect pertaining to the blood supply of the brain?

A. anterior communication artery�connects anterior cerebralarteries

B. middle cerebral artery�supplies the lateral surface of thebrain

C. cerebral arterial circle (circle of Willis)�in most cases preventsdevelopment of neurological symptoms following acute ischemicstroke

D. cerebral arterial circle (circle of Willis)�an anastomosis betweenthe two vertebral and two internal carotid arteries

E. hemorrhagic stroke�severe headache and stiff neck

QUESTION 10

Which of the following is not correctpertaining to olfaction?

A. Theolfactory tract terminates in the medulla.

B. Theaxons of secondary olfactory neurons form the olfactory tract.

C. Thecentral processes of the right and left olfactory receptor neuronseach collectively form the right and left olfactory nerve.

D. Thecentral processes of the olfactory receptor neurons pass throughforamina in the cribriform plate.

E. Theolfactory nerves terminate in the olfactory bulb, which is incontact with the orbital surface of the frontal lobe of thebrain.

QUESTION 11

Upon neurological examination, you notice aslow pupillary light reflex in a patient's right eye. Which of thefollowing is consistent with this sign?

A. compression of the right facial nerve proximal to the geniculateganglion

B. compression of the right facial nerve distal to the geniculateganglion

C. compression of the right oculomotor nerve

D. lesion of the left long ciliary nerves

E. lesion of the right nasociliary nerve

QUESTION 12

Which of the following is not correct for thetrochlear nerve?

A. Itpasses through the superior orbital fissure.

B. Nerve injury is characterized by inability to focus on nearobjects.

C. Itinnervates the superior oblique.

D. Nerve injury is characterized by lack of coordination for the twoeyes when looking downwards.

E. Itemerges from the posterior aspect of the brainstem.

QUESTION 13

Which of the following is not correct for themotor fibers of the trigeminal nerve?

A. Theyinnervate the muscles of mastication.

B. Theypass through foramen ovale.

C. Theyare distributed entirely with the mandibular division.

D. Theyinnervate the tensor tympani muscle.

E. Theyoriginate in the trigeminal ganglion.

QUESTION 14

A lesion of the facial nerve may result in allof the following except:

A. lossof taste from the anterior two-thirds of the tongue.

B. increase in loudness of sound

C. partial sensory denervation of the auricle.

D. inability to open eye.

E. lossof tear production.

QUESTION 15

Which of the following is not correctpertaining to the VIIIth (vestibulorcochlear) cranial nerve?

A. Itcontains somatic motor fibers.

B. Itenters the internal acoustic meatus.

C. Alesion can result in vertigo.

D. Alesion can result in tinnitus.

E. Alesion can result in hearing loss.

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