Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Pleural Disorders
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Question 1#Print Question

A 64-year-old female presents with a 5-day history of exertional dyspnea and orthopnea. Her medical history is significant for SLE and diastolic heart failure. Chest X-ray reveals significant bilateral pleural effusions. The decision is made to perform a thoracentesis.

Which laboratory value would indicate that the effusions are a result of her known diagnosis of SLE?

a. Pleural fluid to serum protein ratio less than 0.5
b. Pleural fluid LDH less than two-thirds the upper limit of normal serum LDH
c. Pleural fluid to serum LDH ratio greater than 0.6
d. Pleural fluid cholesterol less than 45 mg/dL

Question 2#Print Question

A 45-year-old male was admitted to the ICU after sustaining a gunshot wound to the chest. The resulting hemothorax was initially managed with a chest tube. On hospital day 4 he developed a fever, and leukocytosis and broad spectrum antibiotics were started. A CT of the chest revealed a multiloculated effusion that was concerning for empyema.

The next best step in management is:

a. Place a second chest tube
b. Continue systemic antibiotics and monitor for resolution
c. Flush the chest tube with 100 mL normal saline
d. Consult thoracic surgery for washout and debridement

Question 3#Print Question

A 72-year-old male with congestive heart failure is undergoing thoracentesis for a right pleural effusion. Shortly after draining 1.5 L of fluid, the patient develops dyspnea and hypoxia.

What measure, if taken, could reduce the risk of this complication?

a. Limit end-expiratory pleural pressures to less than (−) 20 cm H2O
b. Limit total volume removed to less than 0.5 L
c. Administer IV albumin in a 1:1 ratio for fluid removed
d. Increase the volume removed to 2 L

Question 4#Print Question

The proper position for chest tube placement in a patient with a pneumothorax is:

a. Second intercostal space mid-axillary line
b. Fifth intercostal space posterior axillary line
c. Third intercostal space mid-clavicular line
d. Fourth intercostal space anterior axillary line

Question 5#Print Question

A 90-year-old female with a history of atrial fibrillation on Eliquis presents with right rib pain and dyspnea after a mechanical fall from standing. She is hemodynamically stable, but her chest CT reveals right rib fractures 3 to 5 with associated hemothorax.

The next best step in management includes:

a. Placement of a large bore chest tube for hemothorax evacuation
b. Placement of an epidural for pain control and prevention of respiratory decompensation
c. Consult thoracic surgery for emergent VATS
d. Initation of broad spectrum antibiotics

Category: Critical Care Medicine-Pulmonary Disorders--->Pleural Disorders
Page: 1 of 1