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

Question 11#Print Question

An 89-year-old bedridden man with a history of dementia, non– insulin-dependent diabetes, hip fracture (treated conservatively), diastolic heart failure, and chronic kidney disease was admitted to the medicine service for confusion and possible UTI. The patient had a one week hospital admission for UTI one month ago. While he was waiting for bed assignment, he starts to desaturate in the emergency department. His vital signs are heart rate 115 beats/min, blood pressure 100/60 mm Hg, respiratory rate 26 breaths/min, SpO2 86% on room air. Lung auscultation was unrevealing. You were consulted by the medicine team to evaluate the patient for possible ICU admission for hypoxic repository failure. Portable x-ray was negative for any acute process per radiology official read. Your bedside lung ultrasound images show the following:

Besides placing the patient on oxygen, what would be the BEST next step in management?

A. Start the patient on antibiotics hospital acquire pneumonia
B. Order a STAT CT angiogram of the chest to rule out pulmonary embolism
C. Order furosemide to treat pulmonary edema
D. Place chest tube to treat pleural effusion


Question 12#Print Question

A 65-year-old female patient presents with acute respiratory failure to the ICU. She is intubated and placed on pressure support ventilation. The driving pressure is set at 10 cm H2O. The PEEP is set at 10 cm H2O. Esophageal balloon is placed, and a pressure of negative 12 cm H2O is obtained at end inspiration.

Given these measurements please estimate transpulmonary pressure. 

A. 22 cm H2O
B. 8 cm H2O
C. 32 cm H2O
D. 20 cm H2O


Question 13#Print Question

A 48-year-male patient with a BMI of 48 kg/m2 is undergoing a spontaneous breathing trial in anticipation of extubation.

What is the best position to optimize his respiratory mechanics?

A. Supine position
B. Trendelenburg
C. Beach chair position
D. Reversed Trendelenburg


Question 14#Print Question

A 47-year-old male patient (BMI 55 kg/m2 ) with methicillin-resistant Staphylococcus aureus pneumonia suffers an aspiration event. His oxygen saturation on a nonrebreather face mask is 72%. His previous endotracheal intubation was described as “straightforward.”

What is the best initial approach for airway management? 

A. Awake fiberoptic intubation
B. Rapid-sequence induction followed by intubation via direct laryngoscopy
C. Noninvasive ventilation
D. Rapid-sequence induction followed by intubation via video laryngoscopy


Question 15#Print Question

A 67-year-old patient (BMI 40 kg/m2 ) is admitted to the ICU in acute respiratory failure.

What is the best way to optimize the patient’s end expiratory lung volume?

A. PEEP setting guided by measurement of transpulmonary pressures
B. Recruitment maneuver followed by PEEP optimization guided by measurements of transpulmonary pressures
C. Zero PEEP
D. PEEP set by clinician preference




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