A patient with chronic obstructive pulmonary disease (COPD) is admitted to the hospital with acute exacerbation and respiratory failure requiring mechanical ventilation. Which of the following ventilator settings is most appropriate for minimizing the risk of ventilator-induced lung injury (VILI) in this patient?

Correct Answer: A

Rationale: Patients with COPD are at increased risk for developing ventilator-induced lung injury (VILI) due to their underlying lung pathology. Using a low tidal volume strategy (6-8 ml/kg predicted body weight) has been shown to reduce the risk of VILI in these patients. Additionally, applying high positive end-expiratory pressure (PEEP) helps to recruit collapsed alveoli, improve oxygenation, and decrease the risk of barotrauma by keeping the alveoli open throughout the respiratory cycle. Therefore, the most appropriate ventilator settings to minimize the risk of VILI in a COPD patient with acute exacerbation and respiratory failure requiring mechanical ventilation would be low tidal volume and high PEEP.

Correct Answer: A

Rationale: Acute splenic sequestration crisis is a complication seen in patients with sickle cell disease characterized by the sudden pooling of sickled red blood cells in the spleen, leading to splenic enlargement, severe anemia, and hypovolemic shock. This pooling results in a rapid drop in hemoglobin levels, causing anemia. The spleen's sequestration of large numbers of red blood cells can cause a sudden rise in the number of immature red blood cells (reticulocytes) in the blood (reticulocytosis). The destruction of these trapped red blood cells in the spleen leads to hemolysis, evidenced by elevated indirect bilirubin levels and the presence of Howell-Jolly bodies (nuclear remnants of erythrocytes) on peripheral blood smear. Patients may present with severe abdominal pain, fever, jaundice, and signs of hemodynamic instability, which

Correct Answer: A

Rationale: The clinical presentation of fatigue, pallor, exertional dyspnea along with the laboratory findings of severe anemia, low serum iron, low transferrin saturation, and elevated TIBC are consistent with iron deficiency anemia. In iron deficiency anemia, there is inadequate iron available for erythropoiesis leading to microcytic hypochromic anemia. The low serum iron and transferrin saturation, along with the elevated TIBC, indicate decreased iron stores and increased iron-binding capacity as the body tries to compensate for the deficiency by increasing absorption and recycling of iron. Anemia of chronic disease typically presents with mild to moderate anemia, normal to low TIBC, and low transferrin saturation due to iron sequestration in macrophages. Sideroblastic anemia usually has elevated serum iron, high saturation, and normal to low TIBC. Thalassemia presents with microcytic hyp

Correct Answer: C

Rationale: Intracerebral hemorrhage occurs when there is bleeding directly into the brain tissue, often due to conditions such as hypertension or vascular malformations. The sudden-onset severe headache, altered mental status, and focal neurological deficits described in the patient are typical symptoms of an intracerebral hemorrhage. The location of the hemorrhagic lesion within the right basal ganglia corresponds to the clinical presentation. Ischemic stroke, subarachnoid hemorrhage, and transient ischemic attack (TIA) typically have different presentations and imaging findings compared to an intracerebral hemorrhage. Therefore, in this scenario, intracerebral hemorrhage is the most likely cause of the patient's symptoms.

Correct Answer: B

Rationale: The patient's presentation of sudden-onset weakness and sensory loss on one side of the body, along with difficulty speaking and understanding speech that partially resolved within one hour, is consistent with a transient ischemic attack (TIA). TIAs are caused by temporary disruption of blood flow to a part of the brain, leading to transient neurological symptoms. Unlike an ischemic stroke, which results in permanent damage to brain tissue due to prolonged interruption of blood flow, TIAs are transient and resolve within 24 hours. Hemorrhagic strokes and subarachnoid hemorrhages typically present with sudden, severe headaches, and may not improve or resolve quickly as seen in this case.