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Category: Critical Care Medicine-Pulmonary Disorders--->Thromboembolic Disease and Hemoptysis
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Question 1#Print Question

A 55-year-old female with a history of renal cell carcinoma with metastases to the spine is scheduled for a spinal separation procedure to facilitate radiation therapy. The surgical procedure was uneventful. Following skin closure, there was a sudden drop in oxygen saturation to 86% with an increase in heart rate to 124/min and blood pressure of 85/41 mm Hg. The peak airway pressure was 25 cm H2O and the ETCO2 is 15 mm Hg. 100% oxygen was administered and the patient was started on an epinephrine infusion to support hemodynamics.

Which of the following statements is LEAST likely to be true if you are considering a diagnosis of pulmonary embolism in this patient? 

a. S1Q3T3 on ECG is seen in less than 20% of the patients
b. The VQ mismatch is due to an increase in dead space ventilation
c. Hemoptysis is an uncommon presenting symptom
d. Intravenous heparin infusion is the treatment of choice in this patient


Question 2#Print Question

Which of the following statements regarding monitoring modalities for venous air embolism (VAE) is MOST accurate?

a. Precordial Doppler is the most sensitive monitoring modality available for the detection of VAE
b. Changes in end tidal nitrogen occur earlier than changes in end tidal carbon dioxide
c. Pulmonary artery catheter is the most sensitive monitor for the detection of VAE
d. Mill-wheel murmur auscultated with an esophageal stethoscope is an early sign of VAE


Question 3#Print Question

A 40-year-old female is admitted to the intensive care unit with worsening shortness of breath. She states that she had a clot in her lung “a long time ago” for which she “took blood thinners for a few months.” Her initial transthoracic echocardiogram reveals enlarged right-sided chambers with severe tricuspid regurgitation and a large thrombus in the pulmonary artery with severe pulmonary hypertension.

This patient is MOST likely to belong to which of the groups of the World Health Organization clinical classification of pulmonary hypertension. 

a. Group 1
b. Group 2
c. Group 3
d. Group 4
e. Group 5


Question 4#Print Question

A 56-year-old male with 30-pack year smoking history, CAD, and advanced liver disease due to alcoholic cirrhosis is being evaluated for a liver transplantation. He complains of worsening shortness of breath. His heart rate is 110/min, blood pressure is 97/64 mm Hg, respiratory rate is 32/min, and saturation 90% on 5 L/min nasal cannula. When asked to sit up in bed, the patient states that he “usually breathes better” when lying supine.

Which of the following is the MOST likely pathophysiology behind the diagnosis?

 

a. Decreased FRC resulting in increasing closing capacity leading to atelectasis
b. Acute on chronic pulmonary thromboembolism
c. Increased production or decreased clearance of endogenous nitric oxide
d. Increased venous congestion leading to pulmonary edema


Question 5#Print Question

A 67-year-old female with a history of DVT/PE, hypertension, diabetes mellitus, and coronary artery disease undergoes a hemicolectomy with end ileostomy for colorectal carcinoma. On postoperative day 4, she aspirates following an episode of emesis. She is intubated and transferred to the ICU for further management. Ventilator settings are as follows:

  • Mode: Assist control—volume control
  • Tidal volume: 450 mL
  • Respiratory rate: 12/min
  • FiO2 : 100%
  • PEEP: 18 mm Hg
  • I:E ratio: 1:2

Her HR is 105 bpm; BP is 127/64 mm Hg, saturation 85%. Her most recent ABG reveals:

  • a pH 7.31
  • paCO2 48
  • paO2 59
  • Hgb 7.0

Which of the following interventions is MOST likely to improve the oxygen delivery in this patient?

a. Change the mode of ventilation to pressure control
b. Decrease the I:E ratio
c. Transfuse 1 unit of PRBC
d. Start norepinephrine infusion




Category: Critical Care Medicine-Pulmonary Disorders--->Thromboembolic Disease and Hemoptysis
Page: 1 of 2