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Category: Critical Care Medicine-Pulmonary Disorders--->Hypoxemia and Oxygen Delivery
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Question 1#Print Question

A 56-year-old male with advanced idiopathic pulmonary fibrosis presents to the ICU in respiratory distress. He is put on high flow nasal cannula with 50 L flow, 80% FiO2 . ABG obtained has:

  • a pH significant for 7.32
  • PaO2 of 80 mm Hg
  • PaCO2 of 20 mm Hg
  • HCO3 of 30

Given his underlying disease, what is the primary physiological aberration leading to the patient’s hypoxemia?

a. Hypoventilation
b. Reduced inspired oxygen tension
c. Right to left shunt
d. Diffusion limitation


Question 2#Print Question

A 72-year-old male with past medical history significant for pulmonary hypertension and congestive heart failure presents to the ICU in cardiogenic shock with hypotension. Despite initiation of vasopressor therapy, the patient remains hemodynamically unstable and develops worsening hypoxemia. Bedside transthoracic echocardiography shows bowing of the intra-atrial septum toward the left atrium with positive Doppler color flow across the intraatrial septum and a hypokinetic right ventricle.

What is the most likely cause of the patient’s hypoxemia?

a. V/Q mismatch
b. Right to left shunt
c. Left to right shunt
d. Hypoxic pulmonary vasoconstriction


Question 3#Print Question

A 38-year-old, 155 cm, 50 kg, previously health female presents to the ICU with altered mental status, tachycardia, hypotension, and high fever. She is intubated for airway protection. Her laboratory test results reveal a markedly elevated T3 and T4 level with a decrease in thyroid-stimulating hormone level consistent with thyroid storm. Her arterial blood gas shows:

  • a pH of 7.24
  • PaO2 of 80
  • PaCO2 of 52
  • HCO3 of 22

Her ventilator settings are volume control, tidal volume of 350 mL, respiratory rate of 14, positive end expiratory pressure (PEEP) of 5, FiO2 of 50%.

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

a. Increase tidal volume to 500 mL
b. Change from volume control mode to pressure support mode of ventilation
c. Increase the PEEP from 5 to 8 mm Hg
d. Increase the respiratory rate from 14 to 18
e. Increase the FiO2 to 70%


Question 4#Print Question

A 63-year-old male presents to the hospital in acute respiratory distress, with high fevers and cough with purulent sputum. The patient has a history of adenocarcinoma of the lung and has underwent a right upper lobectomy 10 days ago. His vitals are:

  • heart rate 120 bpm
  • blood pressure 152/91 mm Hg
  • SpO2 91% on 5 L nasal cannula

Chest X-ray reveals a 3 cm pneumothorax in the right chest.

What is the next appropriate treatment option for this patient?

a. Initiate noninvasive positive pressure ventilation (NIPPV)
b. Apply high flow nasal cannula
c. Insert a chest tube
d. Draw blood cultures and start broad spectrum antibiotics
e. Perform a diagnostic bronchoscopy


Question 5#Print Question

A 68-year-old male with past medical history significant for COPD, HTN, and heart failure with preserved ejection fraction with newly discovered left upper lobe speculated mass presents from a nursing home facility with complaints of acute onset shortness of breath and chest pain. The patient had undergone an uneventful left upper lobe wedge resection 10 days ago. Chest X-ray obtained in unremarkable except for bibasilar atelectasis. The patient’s vital signs are:

  • heart rate of 101 bpm
  • blood pressure of 98/72 mm Hg
  • oxygen saturation of 90% on 50% FiO2 , on 50 L flow through high flow nasal cannula

Bedside point of care transthoracic ultrasound is showing normal function in the left ventricle, moderate tricuspid regurgitation, flattening of the intraventricular septum, and moderately depressed right ventricular function.

Which physiologic factor is not involved in this patient’s respiratory distress?

a. Increase in shunt fraction
b. Increase in dead space
c. Limitation in diffusion
d. Decreased cardiac output
e. Ventilation/perfusion mismatch




Category: Critical Care Medicine-Pulmonary Disorders--->Hypoxemia and Oxygen Delivery
Page: 1 of 2