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

A 45-year-old previously healthy woman presents to the emergency department with 3 days of fevers and progressive dyspnea and is admitted to the intensive care unit (ICU) for influenza infection complicated by severe hypoxemia. She is intubated, and chest radiograph following intubation demonstrates an appropriately placed endotracheal tube with bilateral patchy opacities and interstitial markings throughout all lung fields, without effusions. Her bedside echocardiogram reveals a left ventricular ejection fraction of 0.75 with otherwise normal findings. Her ventilator settings are:

  • volume control
  • tidal volume (VT) 500 mL
  • respiratory rate (RR) 14 breaths per minute
  • FiO2 1.0
  • positive endexpiratory pressure (PEEP) 5 cm H2O

An initial arterial blood gas (ABG) is:

  • pH 7.30
  • PCO2 45 mm Hg
  • PO2 80 mm Hg

Which of the following therapies has been best shown to improve the survival of patients such as this woman?

A. Diuresis to maintain a negative fluid balance
B. Ventilation at a TV of 6 mL/kg of ideal body weight (IBW)
C. Initiation of inhaled pulmonary vasodilator for severe hypoxemia
D. Bronchoscopy to rule out additional infections
E. Titration of PEEP with recruitment maneuver to optimize lung compliance


Question 2#Print Question

A 32-year-old man with severe asthma is admitted to the ICU with an acute asthma exacerbation. He is intubated, paralyzed, and mechanically ventilated. His ventilator settings are:

  • assist control/volume control
  • TV 400 mL
  • respiratory rate 20 breaths per minute
  • FiO2 0.5
  • PEEP 5 cm H2O

His ABG on these settings is:

  • pH 7.30
  • PCO2 55 mm Hg
  • PO2 150 mm Hg

On day 2 of his ICU stay, an end-expiratory hold maneuver is performed and his airway pressure is measured at 15 cm H2O. Several hours later, he is noted to have progressive tachycardia, and his blood pressure has decreased from 120/90 to 75/55 mm Hg. A chest radiograph demonstrates similar findings to the prior day, without evidence of new infiltrate or pneumothorax.

What is the best next step in management? 

A. Briefly disconnect the mechanical ventilator from the endotracheal tube
B. Perform a needle decompression at the second intercostal space
C. Perform an emergent bronchoscopy
D. Increase the respiratory rate on the ventilator
E. Decrease the set PEEP on the ventilator


Question 3#Print Question

A 68-year-old man with community-acquired pneumonia is intubated in the ICU with respiratory failure. Following induction of anesthesia, while paralyzed, his ventilator is set on:

  • volume assistcontrol
  • TV 450 mL
  • respiratory rate 14 breaths per minute
  • FiO2 0.8
  • PEEP 5 cm H2O

An inspiratory hold maneuver is performed and his peak inspiratory pressure is 25 cm H2O and plateau pressure is 15 cm H2O.

Which of the following is true regarding this patient’s respiratory mechanics?

A. The patient’s lung compliance is 45 mL/cm H2O
B. The patient’s chest wall compliance is 30 mL/cm H2O
C. The patient’s lung compliance is 10 mL/cm H2O
D. The patient’s respiratory system compliance is 45 mL/cm H2O


Question 4#Print Question

A 70-year-old woman is intubated in the ICU for respiratory failure following an episode of aspiration with resulting pneumonitis.

Which of the following practices is most likely to decrease her duration of mechanical ventilation?

A. Spontaneous breathing trial performed when supervised by the attending physician
B. Paired daily spontaneous breathing trial and spontaneous awakening trial
C. Decremental pressure support wean as directed by respiratory therapist
D. Early tracheostomy
E. Spontaneous breathing trial performed when directed by the bedside nurse


Question 5#Print Question

A 68-year-old woman is admitted to the hospital with an acute exacerbation of chronic obstructive lung disease. She is intubated for worsening hypercarbia and transferred to the medical ICU. On day 8 of her ICU stay, she is felt to be clinically improving and close to extubation readiness when she develops intermittent desaturation and increased tracheal secretions. A portable chest radiograph demonstrates a new right lower lobe infiltrate. A tracheal aspiration is obtained for culture.

Which of the following would be appropriate intravenous antibiotic regimen?

A. Metronidazole
B. Ceftriaxone and azithromycin
C. Vancomycin and cefepime
D. Cefepime and metronidazole
E. Ceftriaxone and metronidazole




Category: Critical Care Medicine-Pulmonary Disorders--->Mechanical Ventilation
Page: 1 of 3