Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Respiratory Diagnostic Modalities and Monitoring
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Question 1#Print Question

A 22-year-old man with a history of severe reactive airway disease and polysubstance abuse is brought to the emergency department following a motor vehicle collision. Endotracheal intubation is performed and placement confirmed by continuous capnography. Peak inspiratory pressure on the ventilator is 45 cm H2O.

Which of the following describes the MOST LIKELY appearance of his capnogram? 

a. Box shaped with a flat phase III
b. Biphasic with a rounded phase III
c. Shark finned with up-sloped phase III
d. Flat

Question 2#Print Question

A 72-year-old female (body mass index of 27 kg/m2 ), admitted for exacerbation of chronic obstructive pulmonary disease (COPD), is started on noninvasive ventilation on the floor. She is claustrophobic, and the intern orders lorazepam for mask tolerance. Soon after, the patient is found to be obtunded and a code is called. During laryngoscopy, particulate gastric contents are noted in the posterior pharynx. Her postintubation vitals are:

  • temperature 100.3°F
  • blood pressure 98/62 mm Hg
  • heart rate 108 beats/min
  • SpO2 88% on 100% FiO2
  • respiratory rate 14 breaths/min
  • peak end expiratory pressure of 8 cm H2O with tidal volume of 8 mL/kg ideal body weight

Despite adjustment of ventilatory parameters and maximal bronchodilator therapy, airway inspiratory pressures remain high.

Which of the following actions would be BEST next step in the management of this patient?

a. Surface ultrasound of the heart and lungs
b. Arterial blood gas
c. Chest x-ray
d. Bronchoscopy

Question 3#Print Question

A 68-year-old man in stable atrial fibrillation with rapid ventricular response undergoes transesophageal echocardiogram and successful synchronized cardioversion under conscious sedation in the medical intensive care unit (ICU). Topical 20% benzocaine spray is used for oropharyngeal anesthesia prior to transesophageal probe insertion. His starting SpO2 is 99% on 6 L/min oxygen via nasal cannula. Within a few minutes, the patient appears blue-gray and SpO2 decreases to 84%. His saturation fails to improve on 10 L/min oxygen via simple face mask. The rest of the vital signs remain stable.

Which of the following findings would be LEAST consistent with the patient’s clinical condition?

a. Carboxy-Hgb 18%
b. Normal SpO2 waveform
c. PaO2 265 mm Hg
d. PaCO2 55 mm Hg

Question 4#Print Question

An 88-year-old woman with an acute GI bleed undergoes endoscopic evaluation and subsequently remains intubated in the ICU in anticipation of further intervention the following day. She is 5′6″ and has her ideal body weight of 60 kg throughout her life. Her arterial blood gas (ABG) shows:

  • pH 7.30
  • PCO2 58
  • PaO2 68
  • HCO3 25 on assist control-volume control ventilation with tidal volume 320 mL
  • respiratory rate 14/min
  • PEEP 7 cm H2O
  • 50% FiO2

She is hemodynamically stable, and her airway pressures are low.

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

a. Increase FiO2
b. Increase tidal volume
c. Increase PEEP
d. Decrease FiO2

Question 5#Print Question

You are the sole intensivist at a rural hospital, and the overnight hospitalist asked you to evaluate a patient with a left-sided malignant pleural effusion who is experiencing dyspnea. You determine that the patient has a very large pleural effusion, and you decide that a thoracentesis will be needed. Under ultrasound guidance, you place a chest tube and begin to aspirate the pleural effusion.

At what point should you stop your thoracentesis to maximize your drainage and minimize complication(s)?

a. Stop after draining 1 L of pleural effusion
b. Stop after patient complains of chest discomfort
c. Stop after your pleural manometer goes below −20 cm H2O
d. Stop after patient coughs

Category: Critical Care Medicine-Pulmonary Disorders--->Respiratory Diagnostic Modalities and Monitoring
Page: 1 of 3