Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Acute Respiratory Distress Syndrome
Page: 2

Question 6# Print Question

A 65-year-old woman with a history of severe COPD and coronary artery disease is intubated for severe acute respiratory distress syndrome (ARDS) in the setting of pneumonia. Despite ventilation with 6 mL/kg tidal volumes and neuromuscular blockade, PaO2 :FiO2 remains 85 on FiO2 100%. PEEP is increased from 5 to 10 cm H2O, and mean arterial pressure subsequently decreases from 65 to 45.

In what setting is increased PEEP least likely to improve oxygenation and hemodynamics?

A. Right ventricular dysfunction
B. Left ventricular (LV) dysfunction
C. Severe ARDS
D. Obesity

Question 7# Print Question

A 67-year-old woman was intubated for ARDS in the setting of pneumonia with septic shock and received muscular paralysis with cisatracurium to improve ventilator synchrony over the first 24 hours of mechanical ventilation. Her mean arterial pressure remains >65 on norepinephrine 35 µg/min. Cisatracurium was discontinued 12 hours prior, and the ventilator has been weaned to pressure support mode. She receives a spontaneous breathing trial (SBT) for 30 minutes on CPAP 5 cm H2O and FiO2 0.4. At this setting she has an SpO2 92%, generates a tidal volume of 4 mL/kg, and respiratory rate 28 breaths/min, with no signs of respiratory distress.

What is the contraindication to extubation in the patient?

A. There are no contraindications to extubation
B. SBT <120 minutes
C. SBT on CPAP 5 cm H2O instead of 0 cm H2O
D. Ongoing vasopressor support

Question 8# Print Question

Two 24-year-old males are admitted to the ICU intubated after polytrauma status post motor vehicle collision. Over the first 24 hours of admission, Patient 1 develops hypoxemia with bilateral pulmonary opacities on chest radiograph and PaO2 :FiO2 110. Patient 2 remains intubated for persistent altered mental status, and then on hospital day 4, develops bilateral pulmonary infiltrates with PaO2 :FiO2 220. Compared to Patient 2, Patient 1’s clinical course likely includes:

A. Lower thoracic trauma burden
B. Higher mortality risk
C. More severe hypotension on admission
D. Increased likelihood of acute renal failure

Category: Critical Care Medicine-Pulmonary Disorders--->Acute Respiratory Distress Syndrome
Page: 2 of 2