Your-Doctor
Multiple Choice Questions (MCQ)

Quiz Categories Click to expand

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Cardiothoracic and Vascular Surgery
Page: 1

Question 1#Print Question

A 70-year-old male is admitted to the ICU following esophagectomy for esophageal carcinoma via laparotomy and right thoracotomy. He has a history of former tobacco use (40 pack-years), hypertension, type 2 diabetes, non–obstructive coronary artery disease, and stage 3 chronic kidney disease.

A thoracic epidural was placed preoperatively and started during the surgery. Postoperatively, the epidural infusion consists of ropivacaine 0.1% with fentanyl 2 µg/mL at 6 mL/h. Initially, the patient complained of rightsided shoulder pain that was relieved with addition of scheduled acetaminophen. On postoperative day 1, the patient is comfortable at rest, but complains of a small area of distal abdominal incisional pain that is uncontrolled when he moves or coughs. He has minimal chest wall pain.

Which of the following is the most appropriate initial change to his pain regimen?

A. Add scheduled intravenous morphine and ketorolac
B. Change the epidural opioid from fentanyl to hydromorphone
C. Replace the epidural with a right-sided paravertebral catheter
D. Double the concentration of ropivacaine in the epidural solution and halve the rate of infusion


Question 2#Print Question

A 48-year-old female with no significant past medical history presents to the emergency department (ED) with 7 days of dyspnea, fatigue, and 2 days of coughing up frank blood. Chest CT shows a large right pulmonary arteriovenous malformation (PAVM) extending the width of the right middle lobe, which is thought to be the source of bleeding. The patient is admitted to the ICU for monitoring and while in the ICU she has an episode of large volume hemoptysis (more than 300 mL) associated with desaturation to 83%, which improves to 98% with deep suctioning and oxygen delivery via non-rebreather face mask. 

The patient is intubated using a 39F left-sided double lumen tube (DLT) and the endobronchial cuff is inflated to isolate her right lung and prevent blood from entering the left lung. Immediately after intubation her vital signs are:

  • HR 110
  • BP 125/68
  • SaO2 99% on 100% FiO2

After confirming appropriate tube position with bronchoscopy, leftsided one lung ventilation is initiated. Approximately 10 minutes after start of one lung ventilation, her vital signs are as follows:

  • HR 101 bpm
  • BP 100/62
  • SaO2 92% on 100% FiO

Which of the following factors correlates with increased risk of hypoxemia during one lung ventilation?

A. Right-sided one lung ventilation
B. Normal baseline spirometry
C. Normal PaO2 during two lung ventilation
D. Lateral position


Question 3#Print Question

A 76-year-old female who is a former smoker with a 30 pack-year history is admitted to the ICU with new productive cough, fevers, dyspnea, and hypoxia. She is started on high flow nasal cannula, steroids, and antibiotics with workup initiated for COPD exacerbation versus pneumonia. Her admission chest X-ray reveals a new focal lesion in the left upper lobe (LUL); follow-up CT shows a solitary tumor involving a portion of the LUL with PET scan finding no evidence of metastases. The patient’s recent pulmonary function testing demonstrates a forced expiratory volume in one second (FEV1) and diffusion capacity (DLCO) of 100%. She is being evaluated by your thoracic surgery team for possible left upper lobectomy. Using the lung segment model, what is her predicted postoperative (PPO) FEV1 and DLCO and what additional testing is necessary to further stratify her operative risk?

A. Her predicted postoperative (ppo)-FEV1 and ppo-DLCO are approximately 75%; no further testing is necessary as she is considered low risk for anatomic lung resection
B. Her ppo-FEV1 and ppo-DLCO are approximately 50%; no further testing is necessary as she is considered low risk for anatomic lung resection
C. Her ppo-FEV1 and ppo-DLCO are approximately 75%; low technology exercise testing is necessary (either stair climb or shuttle walk)
D. Her ppo-FEV1 and ppo-DLCO are approximately 50%; low technology exercise testing is necessary (either stair climb or shuttle walk)


Question 4#Print Question

A 67-year-old female with a 50 pack-year of smoking history, COPD, hypertension, and type II diabetes is admitted to the ICU following a right middle lobectomy for resection of non–small-cell adenocarcinoma. The patient has required positive pressure ventilation since her operation because of persistent hypoxemia and inadequate ventilation on pressure support. On postoperative day 5, she develops a new persistent air leak through her right-sided chest tube. Bronchoscopy confirms the presence of a bronchopleural fistula (BPF) on the right side. The ventilator repeatedly alarms for low minute ventilation (less than 0.8 L/min) despite increasing tidal volumes and RR. The latest ABG shows the following:

  • pH 7.15
  • PCO2 82
  • PO2 63
  • HCO3 27 on ventilator settings of VC
  • TV 520
  • RR 24
  • PEEP 6
  • FiO2 100%

Blood pressure and heart rate have remained stable.

Which of the following ventilation strategies is most appropriate until surgical repair of BPF can take place?

A. Pressure control ventilation
B. Single lung ventilation
C. High Frequency Oscillator ventilation
D. Synchronized Intermittent Mandatory Ventilation


Question 5#Print Question

A 54-year-old female with HTN, IDDM, obesity, and postintubation tracheal stenosis underwent a 4.3 cm tracheal resection with a pedicle flap. She is extubated after the surgery and maintained with head elevation, neck flexion, voice rest, and NPO. Routine bronchoscopy reveals a small anterior separation at the anastomosis site.

Which of the following is not a risk factor for tracheal anastomosis complications? 

A. Age less than 18
B. Diabetes
C. Obesity BMI >35 kg/m2
D. Length of tracheal resection
E. Reoperation




Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Cardiothoracic and Vascular Surgery
Page: 1 of 3