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Category: Critical Care Medicine-Cardiovascular Disorders--->Calculated Cardiovascular Parameters
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Question 1# Print Question

A 52-year-old female with a history of nonischemic cardiomyopathy and reduced ejection fraction undergoes emergent spine surgery after being involved in a motor vehicle collision. There is significant blood loss during the case requiring transfusion of blood products. The patient arrives to the ICU intubated, sedated, and requiring vasopressor support.

A pulmonary artery catheter is placed to guide management and the mixed venous oxygen saturation is noted to be low.

Which of the following is not a potential cause of decreased oxygen delivery in this patient?

A. Acute blood loss anemia
B. Low cardiac output (CO) state
C. Shivering due to hypothermia
D. Transfusion-related acute lung injury

Question 2# Print Question

A 56-year-old male with acute on chronic systolic heart failure and septic shock from pneumonia is admitted to the ICU. A recent transthoracic echo reveals moderate tricuspid regurgitation and an ASD with significant left to right shunting. A pulmonary artery catheter is placed to guide hemodynamic management.

Which of the following would most consistently underestimate CO if measured by thermodilution?

A. Left to right intra cardiac shunt
B. Right to left intra cardiac shunt
C. Right-sided valvular lesions
D. Injectate larger than programmed input volume
E. Injectate warmer than programmed input temperature

Question 3# Print Question

An 80-year-old female was admitted to the ICU from the emergency department with the diagnosis of septic shock secondary to urosepsis. She was noted to be in her usual state of good health 12 hours earlier, but was then found at home lying in bed with altered mental status by her daughter. In the emergency department she was found to be hypotensive with a mean arterial blood pressure (MAP) of 45, lethargic, and was mostly incoherent on physical examination. She was given 2 L of IV fluids with improvement in her BP and mental status. Blood cultures were obtained and a urinalysis revealed E. coli in her urine. She was started on broad-spectrum antibiotics and was admitted to the ICU for further management of her urosepsis.

The resident has seen the patient on admission and is concerned because she continues to require aggressive volume resuscitation to maintain her pressures and is now on a norepinephrine infusion at high doses. On physical examination she is cold to the touch, quite pale, and has a moderately distended abdomen. Your resident is concerned that her initial diagnosis may be incorrect, is worried about a retroperitoneal hemorrhage causing hypovolemic shock, and elects to place a pulmonary artery catheter to help further elucidate the etiology of her shock.

Which of the following hemodynamic parameters obtained from the pulmonary artery catheter would be most helpful in distinguishing hypovolemic shock from septic shock?

B. Central venous pressure
C. Pulmonary capillary wedge pressure
D. Systemic vascular resistance (SVR)

Question 4# Print Question

A 52-year-old female undergoes spine fusion surgery with 2 L of intraoperative blood loss. On POD#3 she develops new onset atrial fibrillation with plans to undergo transesophageal echocardiography (TEE) before cardioversion. After topicalization with 20% benzocaine spray, sedation with fentanyl and versed, the TEE rules out clot and confirms otherwise normal heart function. Electrical cardioversion is successful, but shortly afterward the patient becomes dyspneic and cyanotic. Despite adequate spontaneous ventilation with a non-rebreather mask, the patient remains cyanotic with a pulse oximetry saturation of 85%.

Which study would be most helpful in confirming the diagnosis?

B. Bedside Ultrasound
C. Chem Panel
D. Arterial Blood Gas with Co-oximetry

Question 5# Print Question

As part of a clinical study, you are measuring oxygen consumption using indirect calorimetry in a ventilated patient in the ICU and want to compare your measurements to a calculated value. Radial artery and pulmonary artery catheters are placed, and the following measurements are obtained:

  • Hb = 11.7 g/dL
  • SaO2 = 97%
  • SvO2 = 72%
  • CO (thermodilution): 5.1 L/min

Assuming minimal contribution from dissolved oxygen, what is the patient’s calculated oxygen consumption?

A. 0.2 L/min
B. 0.76 L/min
C. 1.3 L/min
D. D. 20 L/min

Category: Critical Care Medicine-Cardiovascular Disorders--->Calculated Cardiovascular Parameters
Page: 1 of 1