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Category: Critical Care Medicine-Pulmonary Disorders--->Other Parenchymal Disease and pulmonary edema
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Question 1# Print Question

A 79-year-old male with a history of hypertension, dyslipidemia, and type-2 diabetes mellitus presents to the emergency department complaining of increasing shortness of breath, over the past 4 hours. Arterial blood gas (ABG) analysis at room air shows:

  • PaO2 54 mm Hg
  • PaCO2 28 mm Hg
  • pH 7.48
  • HCO3 − 22 mEq/L

Upon admission, the patient is administered oxygen via a face mask with oxygen reservoir at 15 L/min. The SpO2 raises from 87% to 99%. Thirty minutes later, the patient is still dyspneic (respiratory rate: 32 breaths/min). Noninvasive blood pressure is 180/85 mm Hg, heart rate is 100 bpm. ABG now shows:

  • PaO2 249 mm Hg
  • PaCO2 27 mm Hg

Chest auscultation reveals mild bilateral crackles at the bases of the lungs and mild wheezing.

  • Body temperature is 36.2°C
  • WBC 6500/mL
  • creatinine 1.8 mg/dL
  • lactate 1.4 mmol/L

What is the MOST likely diagnosis?

A. Pulmonary embolism
B. Acute pulmonary edema
C. Bilateral pneumonia
D. Exacerbation of COPD

Question 2# Print Question

A 70-year-old male patient with a history of pulmonary hypertension and smoking has been admitted to the neurocritical care unit because of a Hunt and Hess Grade 4 subarachnoid hemorrhage (SAH) caused by a ruptured aneurysm of the anterior communicating artery (ACA). Successful endovascular clot retrieval was performed on day 1. On day 4, his hypoxemia worsened, reaching a ratio of PaO2 to inspired oxygen (FiO2 ) of less than 200 mm Hg at a FiO2 of 0.6. The chest x-ray shows bilateral diffuse infiltrates suggestive of pulmonary edema.

Which among the following is the best test to identify the cause of pulmonary edema?

A. Transpulmonary thermodilution
B. CT scan
C. Lung ultrasound
D. Serum catecholamine concentration

Question 3# Print Question

A 20-year-old male patient with no medical history is admitted in the operating room for emergent decompressive craniotomy after a motorbike accident causing a posterior cranial fossa epidural hematoma (diagnosed on CT scan). The neurosurgeon accesses the posterior fossa and relieves an opening pressure of 40 cm H2O. Very quickly, the patient develops severe hypotension with a blood pressure of 50/30 mm Hg, for which high-dose norepinephrine is started. He also develops hypoxemia with an alveolar-arterial gradient of more than 100 mm Hg. In addition, the end-tidal CO2 concentration drops by 10 mm Hg. With a high-dose noradrenaline infusion, the BP returns to normal, but hypoxia remains.

Which among the following is most likely to be present in this patient?

A. Ischemic changes in electrocardiogram
B. Pink frothy sputum on tracheal aspiration
C. Low cardiac index on pulse contour analysis
D. Persistent reduction in end-tidal CO2 concentration

Question 4# Print Question

A 31-year-old primiparous female gave birth 10 hours ago after preterm labor. The delivery was vaginal and proceeded without complications under epidural analgesia. The baby is a 25-week gestational age female and weighs 1780 g. Terbutaline administration failed in delaying the delivery. The mother has a history of anaphylaxis triggered by NSAIDs, past history of deep venous thrombosis, hypertension, and hypothyroidism. She has had a dry cough with mild fever and malaise for the past 10 days treated with amoxicillin. The patient now develops acute onset dyspnea and cannot speak in full sentences. She denies pain. Vitals are:

  • respiratory rate is 32/min on non-rebreather face mask
  • blood pressure of 145/90 mm Hg
  • heart rate of 128/min

Bilateral rales and wheezing at the left base is heard on auscultation, cardiac sounds are normal, no jugular distension is observed, the skin is warm and well perfused. Blood gas analysis:

  • pH 7.40
  • pO2 52 mm Hg
  • pCO2 30 mm Hg
  • lactate 2.2 mmol/L

What is the MOST likely cause of the patient’s respiratory failure?

A. Pulmonary embolism
B. Pneumonia
C. Tocolytic pulmonary edema
D. Cardiac failure

Question 5# Print Question

A 5-year-old female patient has fallen from the balcony of her apartment located on a third floor. Impact on various branches of a tree before hitting the soil has dampened the velocity of the impact. Trauma burden includes two broken ribs on the right hemithorax, lung contusion, and a suspicion of spinal cord injury at the level of T1. She has to be sedated for a magnetic resonance imaging session.

Which strategy could BETTER diminish the incidence of postprocedure atelectasis?

A. Intubation, sedation with sevoflurane, PEEP of 5 cm H2O, a tidal volume of 10 mL/kg, and a FiO2 of 1.0
B. Spontaneous breathing, sedation with propofol, and 15 L/min of oxygen on a non-rebreathing O2 mask
C. Noninvasive ventilation, sedation with midazolam, and a FiO2 of 1.0
D. Any strategy with the lowest possible FiO2

Category: Critical Care Medicine-Pulmonary Disorders--->Other Parenchymal Disease and pulmonary edema
Page: 1 of 2