Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Other Parenchymal Disease and pulmonary edema
Page: 2

Question 6# Print Question

A 74-year-old male patient weighing 80 kg with a history of essential hypertension and known subglottic laryngeal cancer is scheduled for elective surgery. He presents with dyspnea (respiratory rate of 45 breaths/min), hypoxemia (SpO2 80% in ambient air), and a highpitched stridor that can be easily localized to the neck. Respiratory sounds are barely heard bilaterally on lung auscultation. A fiberoptic examination shows no space for nasotracheal or orotracheal intubation, so an emergency percutaneous tracheostomy is performed. Invasive mechanical ventilation initiated with assist control volume control ventilation (tidal volume of 600 mL and a PEEP of 8 cm H2O). However, the patient remains hypoxemic with a PO2 of 69 mm Hg despite an FiO2 of 80%. An x-ray shows bilateral infiltrates.

What would be the MOST appropriate first intervention on this patient?

A. Switch to protective ventilation
B. Administer diuretics
C. Fiberoptic bronchoscopy of the bronchial tree
D. CT scan of chest

Question 7# Print Question

Which among the following medications is indicated for treatment of high-altitude pulmonary edema, in absence of oxygen while awaiting for descent?

A. Dexamethasone
B. Salmeterol
C. Nifedipine
D. Sildenafil

Question 8# Print Question

A 28-year-old female patient was brought to the emergency room with a complaint of dyspnea. She is awake, breathing 34 times per minute with a SpO2 of 93% in ambient air. She has a body temperature of 37.5°C and bilateral diffuse crackles on auscultation. The patient is a PhD student working in the same hospital where she is admitted, with symptoms starting just before leaving the lab to go back home. She regularly spends time in the animal facility as part of her PhD program. She denies allergies and admits to smoking 5 cigarettes per day. The chest x-ray is unremarkable.

What would be the next MOST appropriate next test for this patient?

A. Spirometry
B. RAST test
C. High resolution CT scan
D. ImmunoCAP assay

Question 9# Print Question

A 55-year-old female patient is intubated for severe respiratory failure. A CT scan is then performed which shows diffuse bilateral ground glass opacities. On arrival in the intensive care unit, the patient desaturates due to abundant hemorrhagic secretions in the endotracheal tube. A fiberoptic bronchoscopy with deep bronchoalveolar lavages is then performed, yielding a very high percentage (>50%) of hemosiderin-laden macrophages in all samples. 

Which among the following components in this patient’s medical history supports the diagnosis?

A. Acetylsalicylic acid prophylaxis for carotid artery disease
B. Three spontaneous abortions all happened during the first trimester
C. Polyarteritis nodosa treated with prednisone 60 mg daily
D. Chronic hepatitis B with persistence of circulating HBV DNA

Question 10# Print Question

A female 50-year-old patient is undergoing induction of general anesthesia for gastric bypass surgery. Which of the following intraoperative measures would have the MOST impact on preventing the development of postoperative pulmonary atelectasis?

A. Preoxygenation with a PEEP of 8 cm H2O
B. Induction and intubation using a FiO2 of less than 0.6
C. Setting an intraoperative PEEP of 10 cm H2O
D. Keeping the lowest possible FiO2 before extubation

Category: Critical Care Medicine-Pulmonary Disorders--->Other Parenchymal Disease and pulmonary edema
Page: 2 of 2