Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Diseases of the Chest Wall
Page: 1

Question 1#Print Question

An 88-year-old male with a 55 pack-year smoking history and an additional past medical history of COPD, and stage IA non–small cell lung cancer was referred for bronchoscopy. Prior to the procedure the patient was alert and oriented, afebrile, with BP 130/70, RR 14, and O2 saturation of 99% while breathing room air. The patient received a total of 100 µg IV fentanyl and 4 mg IV midazolam in divided doses during the bronchoscopy. Following the airway survey the diagnostic bronchoscope was removed and the patient received an additional 100 µg of fentanyl and 1 mg of midazolam prior to insertion of the scope for endobronchial ultrasound. Two minutes after insertion of the endobronchial ultrasound bronchoscope the patient developed a clenched hand and jaw and hypertension to 225/135 mm Hg. Respiratory motion was no longer evident upon examination of his chest wall. Oxygen saturation dropped to 81%. In addition to securing the airway the next most appropriate step would be:

a. Rapidly obtain CT of the head
b. Administer antihypertensives with a goal of lowering SBP 10% to 20% over an hour
c. Administer naloxone 0.2 mg IV
d. Administer 2 mg benztropine

Question 2#Print Question

A 65-year-old female is scheduled for spinal surgery. Her pre-op CXR is shown below. She has a past medical history of CAD and HTN, atrial fibrillation. Which of the following is most helpful in predicting her risk of postoperative of respiratory failure?

a. Vital capacity
b. History of atrial fibrillation
c. Nature of the surgery (orthopedic)
d. Age

Question 3#Print Question

A 49-year-old female is admitted to the hospital with communityacquired pneumonia. On presentation to the emergency department she is complaining of shortness of breath:

  • temperature is 38.5
  • O2 sat is 95% on 2 L NC
  • RR is 14
  • BP 120/80
  • pulse is 98

CXR shows an RML lobar infiltrate. She is admitted to the general medical floor but that night complains of increased dyspnea that is worse when lying supine. She is noted to have a weak cough and difficulty clearing secretions. She is afebrile, with a pulse of 110 and BP 110/75. O2 sat remains >95% on 2 to 4 L/min NC. Exam is notable for a regular cardiac rhythm, with no murmurs, rubs, or gallops. There are bronchial breath sounds noted over the right mid-lung zone. Peripheral pulses are intact, strength is normal in the b/l upper and lower extremities and there are normal deep tendon reflexes. CXR is unchanged from admission.

Which will be most helpful in determining subsequent therapy and need for intubation?

a. Lumbar puncture and EMG
b. Measure vital capacity
c. Check BNP, obtain trans-throacic echocardiogram
d. Chest CT

Question 4#Print Question

A 77-year-old male presented to the emergency department after motor vehicle accident. On arrival, respirations were shallow and the right chest appeared to move inward with inspiration. O2 saturation was 85% while breathing room air and pulse was 122. Chest x-ray and chest CT are shown in the figure below.

What is the next most appropriate step in management?

a. Noninvasive positive pressure ventilation and IV morphine
b. Evaluation for surgical fixation of rib fracture
c. Intubation and adjustment of PEEP to improve oxygenation
d. Epidural catheter placement to decrease splinting

Question 5#Print Question

A 68-year-male is in the midst of a prolonged ICU stay for respiratory failure, ARDS, and gram-negative bacteremia. He initially presented with shock requiring high-dose vasopressors and stress-dose steroids as well as severe hypoxemia requiring mechanical ventilation and paralytics. By ICU day 10 he has repeatedly failed spontaneous breathing trials with low tidal volumes. His exam is notable for reduced strength in b/l upper and lower extremities without rigidity. Laboratory studies including creatine kinase are within normal limits. Head CT is normal and CSF studies are normal. Electrophysiologic testing is notable for significantly decreased sensory and motor nerve amplitudes in multiple nerves, prolonged compound muscle action potentials, and decreased motor amplitudes.

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

a. Dantrolene 2.5 mg/kg
b. Tracheostomy and physical therapy
c. Plasma exchange
d. IVIG (Intravenous Immunoglobulin)

Category: Critical Care Medicine-Pulmonary Disorders--->Diseases of the Chest Wall
Page: 1 of 1