A 68-year-old woman with HIV is admitted to the ICU with respiratory failure secondary to pneumocystis pneumonia, requiring intubation and mechanical ventilation. A chest CT scan was performed before intubation and demonstrated cystic changes throughout the lungs, thought to be a sequela of past pneumocystis infection, with superimposed diffuse ground glass opacities. Her ventilator is set on volume assist-control, TV 6 mL/kg, respiratory rate 16 breaths per minute, FiO2 0.8, and PEEP of 10 cm H2O. On day 2 of her critical illness, her ventilator suddenly alarms for elevated peak pressures. She is observed to be deeply sedated and breathing passively on the ventilator. The peak pressure has risen from 25 cm H2O several hours before 50 cm H2O. The patient has simultaneously experienced oxygen desaturation from 95% to 90%. She is otherwise hemodynamically stable. A chest radiograph is ordered. An inspiratory hold maneuver is performed and her plateau pressure is 20 cm H2O. Which of the following is the MOST LIKELY explanation for this acute event?

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?

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?

1. Which of the following nutrients provides the most energy per gram?

An 84-year-old male with severe chronic obstructive pulmonary disease (FEV1 20% predicted, on 4 L/min home O2) is admitted with severe hypoxemic respiratory failure due to a Streptococcus pneumoniae infection. He is intubated and placed on volume control-assist control ventilation with a set TV of 400 mL (6.5 mL/kg IBW), PEEP of 8 cm H2O and a respiratory rate of 30 breaths per minute. When the paralytic used for intubation wears off, the patient is noted to be triggering additional spontaneous breaths with a total respiratory rate of 36 breaths per minute, and his exhaled TVs vary from 100 to 800 mL. During an end-expiratory pause, his airway pressure is 18 cm H2O. Which of the following is the MOST accurate statement regarding his ventilator settings?

8. What is the function of vitamin B12?  

A 67-year-old-male with bullous emphysema is scheduled for a bullectomy to prevent air-leak syndrome. The AG-ACNP knows which of the following patients would not be suited for a bullectomy:

A 67-year-old female with a medical history of COPD has been experienced increasing dyspnea, which is now more prominent at rest. She has a slight increase in sputum production for the last 3 days at home. Sputum remains clear to white. She is short of breath, but able to speak in full sentences. The patient’s last hospitalization for COPD was 3 years ago. WBC is 8,800/mm3, sodium 142 mmol/L, BUN 16 mg/dL, creatinine 0.9 mg/dL. Nasal swab for MRSA is negative. Based on these findings, what is the best treatment?

46. Which food should be avoided during pregnancy due to listeria risk?  

36. Which food is high in monounsaturated fat?