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Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Mechanical Ventilation
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Question 6#Print Question

A 54-year-old man with ischemic cardiomyopathy is admitted to ICU for respiratory failure due to decompensated heart failure and cardiogenic pulmonary edema. On the day of admission, he requires intubation and mechanical ventilation, and aggressive diuresis is initiated. On day 3 of his ICU stay, his ventilator is set on:

  • pressure support, with a driving pressure of 5 cm H2O
  • PEEP of 10 cm H2O
  • FiO2 of 0.3

He is fully awake and breathing comfortably. He is placed on a spontaneous breathing trial with pressure support settings of:

  • driving pressure of 5 cm H2O
  • PEEP of 0 cm H2O
  • FiO2 of 0.3

Within minutes, he experiences oxygen desaturation, tachypnea, and respiratory distress.

Which among the following in the MOST LIKELY cause for failure of his spontaneous breathing trial?

a. Atelectrauma from collapse of alveoli with tidal breathing
b. Mucous plugging from lower airway pressure
c. Increased preload and decreased afterload
d. Decreased preload and increased afterload
e. Increased preload and increased afterload


Question 7#Print Question

A 75-year-old woman has been intubated for 7 days for communityacquired pneumonia. She is placed on a spontaneous breathing trial on ventilator settings of:

  • pressure support of 5 cm H2O
  • PEEP of 0 cm H2O
  • FiO2 of 0.3

What is the most accurate explanation of how breaths are cycled (initiated or terminated) on this ventilator mode?

a. Breaths are initiated based on a set respiratory rate and inspiratory:expiratory ratio
b. Breaths are terminated when inspiratory flow decreases to a set percentage of peak inspiratory flow
c. Breaths are terminated when a target volume is reached
d. Breathes are initiated based on diaphragmatic inspiratory effort
e. Breaths are terminated when a peak inspiratory flow is reached


Question 8#Print Question

A 68-year-old woman with HIV is admitted to the ICU with respiratory failure secondary to pneumocystis pneumonia, requiring intubation and mechanical ventilation. A chest CT scan was performed before intubation and demonstrated cystic changes throughout the lungs, thought to be a sequela of past pneumocystis infection, with superimposed diffuse ground glass opacities. Her ventilator is set on:

  • volume assist-control
  • TV 6 mL/kg
  • respiratory rate 16 breaths per minute
  • FiO2 0.8
  • PEEP of 10 cm H2O

On day 2 of her critical illness, her ventilator suddenly alarms for elevated peak pressures. She is observed to be deeply sedated and breathing passively on the ventilator. The peak pressure has risen from 25 cm H2O several hours before 50 cm H2O. The patient has simultaneously experienced oxygen desaturation from 95% to 90%. She is otherwise hemodynamically stable. A chest radiograph is ordered. An inspiratory hold maneuver is performed and her plateau pressure is 20 cm H2O.

Which of the following is the MOST LIKELY explanation for this acute event?

 

a. Rupture of a cyst leading to pneumothorax and acute decrease in lung compliance
b. Mucous in the endotracheal tube leading to acute increase in airway resistance
c. Mainstem intubation from migration of the endotracheal tube
d. Biting on the endotracheal tube leading to acute increase in airway resistance
e. Mucous plugging leading to lobar collapse and acute decrease in lung compliance


Question 9#Print Question

A 68-year-old man with chronic obstructive pulmonary disease (FEV1 30% predicted, on 3 L home O2 ) presents to the emergency department with increased dyspnea for the past 3 days requiring a frequent albuterol-ipratropium nebulizer use at home. He is found to have labored breathing and his initial ABG shows pH 7.27 with a PCO2 90 mm Hg. His chest radiograph demonstrates no infiltrate but some increased interstitial markings consistent with volume overload. He is diagnosed with an acute exacerbation of chronic obstructive pulmonary disease and possible cardiogenic pulmonary edema and started on bronchodilators and given a dose of furosemide. On reevaluation, he is somnolent but arousable to sternal rub and is placed on bilevel positive airway pressure ventilation (BiPAP).

Which of the following is most true regarding use of BiPAP in this patient?

a. Treatment of patients like this with BiPAP is associated with increased mortality because it delays intubation
b. Treatment with BiPAP is associated with longer hospital length of stay
c. Coincident acute cardiogenic pulmonary edema is a relative contraindication to BiPAP
d. BiPAP is more likely to improve outcomes in patients with asthma than in this patient
e. His altered mental status is a relative contraindication to treatment with BiPAP


Question 10#Print Question

A 48-year-old man with no prior medical history is admitted with community-acquired pneumonia and severe acute respiratory distress syndrome (ARDS). On day 1 of his illness, he is admitted to your ICU on:

volume control-assist control ventilation with a VT of 4 mL/kg IBW

  • respiratory rate 32 breaths per minute
  • PEEP 14 cm H2O
  • FiO2 1.0

On those settings, he is found to be hypoxemic with a SaO2 of 86% with an ABG that demonstrates:

  • pH 7.28 PCO2 65 mm Hg
  • PaO2 55 mm Hg

Which of the following interventions is most likely to improve his survival?

a. Prone positioning for at least 16 hours a day until oxygenation improves
b. Initiation of extracorporeal membrane support (ECMO)
c. PEEP titration using esophageal balloon pressures
d. Initiation of high-frequency oscillatory ventilation
e. Inhaled pulmonary vasodilator therapy




Category: Critical Care Medicine-Pulmonary Disorders--->Mechanical Ventilation
Page: 2 of 3