Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Respiratory Diagnostic Modalities and Monitoring
Page: 2

Question 6#Print Question

A 45-year-old man with a history of idiopathic pulmonary fibrosis is admitted to the ICU intubated and sedated after single lung transplantation. On postoperative day 1, the patient’s oxygen requirement increases. He remains afebrile, and his arterial blood gas shows PaO2 90 mm Hg on FiO2 50%. The respiratory therapist reports increased secretions from his endotracheal tube. The patient is on ceftazidime, vancomycin, voriconazole, inhaled amphotericin B, and valganciclovir.

Which of the following is the BEST next step in management?

A. Lighten the sedation and try to extubate him today
B. Perform a bronchoscopy and send the bronchial lavage from the native lung for culture and expand antibiotic coverage meropenem
C. Give the patient a pulse steroid therapy with methylprednisolone
D. Increase his FiO2 to 100%

Question 7#Print Question

A 52-year-old man with severe COPD underwent bilateral lung transplant 10 days ago. His postoperative course was unremarkable. He was extubated and transferred to the floor on postoperative day 5. Today, he starts to complain of shortness of breath. The physical examination is significant for chest wall subcutaneous emphysema. Images from a chest CT scan below:

What is the BEST next step in management?

A. Pulse dose of methylprednisolone
B. Flexible bronchoscopy
C. Open surgical exploration and repair
D. Observation and serial chest x-rays

Question 8#Print Question

A previously healthy 28-year-old man presents to the emergency department with severe respiratory distress, flu-like symptoms, and cough. The emergency physician intubates the patient for hypoxic respiratory failure. His postintubation chest x-ray shows diffuse, bilateral pulmonary infiltrations, and appropriate endotracheal tube position. The initial mechanical ventilation settings are FiO2 50%, PEEP 18 cm H2O, and tidal volume (TV) 6 mL/kg ideal body weight (IBW). The patient is transferred to the ICU, and 6 hours later you are informed that the patient is hypoxic on FiO2 100%, PEEP 24 cm H2O, and tidal volume (TV) 8 mL/kg ideal body weight (IBW). His plateau pressure is 42 cm H2O, and his ABG shows PaO2 of 54. You decided to place the patient on venovenous extracorporeal membrane oxygenation (V-V ECMO).

Which of the following mechanical ventilation settings are BEST after VV ECMO initiation?

A. Pressure controlled 25 cm H2O, rate 5, PEEP 15 cm H2O, FiO2 50%
B. Pressure controlled 30 cm H2O, rate 14, PEEP 10 cm H2O, FiO2 50%
C. Volume controlled, TV 5 mL/kg IBW, rate 14 PEEP 10 cm H2O, FiO2 50%
D. Volume controlled, TV 8 mL/kg IBW, rate 5, PEEP 10 cm H2O, FiO2 50%

Question 9#Print Question

A 5′7″ middle-aged man, with unknown medical history, has just arrived in the operating room for emergent exploratory laparotomy following intubation in the emergency department with appropriate hypnotic and 100 mg rocuronium. The initial ventilator settings are tidal volume 450 mL, rate 16 breaths/min, PEEP 5 cm H2O and FiO2 40%, and inspiratory:expiratory (I:E) ratio 1:2. The EtCO2 waveform follows.

Based on the EtCO2 waveform, what would be the BEST next course of action?

A. Give an additional dose of muscle relaxation
B. Increase minute ventilation to 600 mL
C. Continue current ventilator setting
D. Change the I:E ratio to 1:3

Question 10#Print Question

A 59-year-old male with history of COPD is admitted to the ICU for pneumonia and hypoxic respiratory failure. Four hours after admission, the patient continues to be in severe respiratory distress with O2 saturation of 85% on BiPAP (10 cm H2O IPAP, 5 cm H2O EPAP, and FiO2 100%). You decided to intubate the patient, and immediately after rapidsequence intubation, the patient oxygen saturation decreases to 78% with blood pressure 110/65 mm Hg and heart rate 95 bpm. Ventilator settings were tidal volume 6 mL/kg, respiratory rate 14 breaths/min, FiO2 100%, and PEEP 5 cm H2O. The ventilator is alarming for peak air pressure of 45 cm H2O with plateau pressure of 40 cm H2O. You next perform a point-of-care ultrasound of the lungs, and it shows an absence of pleural sliding on the left lung with positive A-lines and positive pulse sign on the left lung.

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

A. Perform left tube thoracostomy
B. Perform left needle thoracostomy
C. Start the patient on cisatracurium infusion
D. Adjust endotracheal tube

Category: Critical Care Medicine-Pulmonary Disorders--->Respiratory Diagnostic Modalities and Monitoring
Page: 2 of 3