Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Cardiovascular Disorders--->Imaging (Ultrasound)
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Question 1#Print Question

A 34-year-old man with primary sclerosing cholangitis underwent orthotopic liver transplantation 6 hours ago. His other medical history includes obesity treated with sleeve gastrectomy 6 years ago, esophageal diverticulum, and peptic ulcer disease with remote gastrointestinal bleeding. He remains intubated and sedated in the ICU with current vital signs of:

  • T: 36.2°C
  • HR: 128 beats per minute
  • BP: 72/40 mm Hg
  • RR: 22 on the mechanical ventilator

He is currently receiving infusions of norepinephrine at 30 mcg/min and vasopressin at 0.04 units/min. He remains hypotensive despite rapid blood transfusion. An attempt at transthoracic cardiac ultrasound revealed no adequate windows. In deciding whether to perform a transesophageal echocardiogram (TEE) to work up his refractory shock, which of his medical problems would most likely be considered an absolute contraindication to TEE probe placement?

a. Esophageal varices
b. Prior gastric sleeve
c. History of bleeding peptic ulcer
d. Esophageal diverticulum

Question 2#Print Question

A 55-year-old man underwent bilateral lung transplantation for idiopathic pulmonary fibrosis with intraoperative central venoarterial ECMO support. After implantation of the second lung, the team is unable to wean the patient off the ECMO circuit despite dobutamine and norepinephrine infusions. TEE images of the midesophageal long axis view at end-diastole (A) and mid-systole (B) are shown in the figures below.

Based on the TEE findings, which of the following is the next best step in management?

a. Add epinephrine infusion
b. Insert an intra-aortic balloon pump
c. Discontinue dobutamine
d. Perform aortic valve replacement

Question 3#Print Question

A 42-year-old woman with Crohn’s disease is admitted to the ICU following laparotomy for small bowel obstruction. She is persistently hypotensive despite vasopressor and volume administration. She is breathing spontaneously on high-flow nasal cannula. Ultrasound imaging of her IVC reveals a 1.5 cm vessel diameter and >50% decrease in vessel diameter during inhalation. The critical care fellow concludes that these findings indicate the patient would increase her cardiac output with intravascular volume administration.

Which of the following, if present, would confound that conclusion?

a. Pneumothorax
b. Pericardial effusion
c. Abdominal compartment syndrome
d. Deep venous thrombosis of the right femoral vein

Question 4#Print Question

A 54-year-old man is admitted to the ICU following Impella placement for cardiogenic shock. Routine screening ultrasound for Impella position shows the following parasternal long axis image. The distance between the calipers is 2 cm

Which of the following is the best next step in management?

a. Advance the Impella 1.5 cm
b. Advance the Impella 3 cm
c. Remeasure from the end of the pigtail to the aortic annulus
d. Leave the Impella in its current position

Question 5#Print Question

Use of pulsed-wave Doppler in which of the following views allows for calculation of cardiac output?

a. Transesophageal mid-esophageal 4-chamber
b. Transthoracic apical 5-chamber
c. Transthoracic parasternal long axis
d. Transesophageal mid-esophageal long axis

Category: Critical Care Medicine-Cardiovascular Disorders--->Imaging (Ultrasound)
Page: 1 of 2