Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Airway Diseases
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Question 6# Print Question

A 50-year-old female with a history of atopic dermatitis and coronary artery disease on beta blockade presents to the emergency department with shortness of breath and hives. She is on vacation and was staying at a horse farm. Along with her shortness of breath, she reports an itchy feeling in the back of her throat, sneezing, and swelling around her lips and eyes. On physical examination, she is noted to have a blood pressure of 90/55 mm Hg, an RR of 32, and a heart rate of 110 and is afebrile. Her oropharyngeal examination is notable for tongue and lip swelling and some pooling of secretions at the back of her mouth. Her cardiac examination is notable for sinus tachycardia, and her pulmonary examination is notable for bilateral wheezes. IM epinephrine is given on the mid-outer thigh. After 5 minutes, the patient demonstrates no improvement in her symptoms and she is intubated for airway protection. Repeat IM epinephrine is given. Her repeat vitals demonstrate a blood pressure of 80/50 mm Hg and a heart rate of 115. Normal saline is hung and started via a peripheral IV.

What next step could assist with the patient’s hypotension?

A. Administer diphendyramine 25 mg IV
B. Administer methylprednisolone 125 mg IV
C. Administer albuterol nebulizers via the endotracheal tube
D. Administer glucagon 5 mg IV

Question 7# Print Question

A 35-year-old male with a history of moderate persistent asthma presents to the emergency department with complaints of shortness of breath and increased wheezing. His initial vitals were notable for:

  • temperature of 100.4°F
  • blood pressure of 130/80 mm Hg
  • heart rate of 105
  • respiratory rate of 25
  • oxygen saturation of 88%

On examination, the patient was noted to be in moderate distress with increased respiratory muscle use. He did not have evidence of stridor; his pulmonary examination was notable for bilaterally wheezing and cardiac examinmation notable for sinus tachycardia. His chest x-ray demonstrated hyperinflation with flattening of the diaphragms bilaterally with no clear infiltrate. In the emergency department, he was started on IV steroids and continuous albuterol nebulizers and placed on 3 L/min of oxygen via nasal cannula. His initial basic metabolic panel was unremarkable with an anion gap of 10. An arterial blood gas showed:

  1. pH 7.41
  2. pCO2 34 mm Hg
  3. PaO2 90 mm Hg on supplemental oxygen

On arrival to the ICU, he continues to be in respiratory distress with accessory muscle use. A repeat basic metabolic panel is performed with labs notable for a creatinine of 0.80 and an anion gap of 24; lactate level was 8. A repeat arterial gas was performed and showed :

  • pH 7.26
  • PCO2 46 mm Hg
  • PaO2 80

What would be the next step in management?

A. Stop the albuterol nebulizers
B. Administer high-dose magnesium
C. Intubate the patient given persistent work of breathing
D. Provide patient with IV fluid bolus

Question 8# Print Question

A 50-year-old male with a history of obesity (BMI 35), type 2 diabetes, and GERD, who is status post right knee replacement 1 year prior, presented to the emergency room with complaints of right knee pain. His initial vitals are notable for:

  • temperature of 101.1°F
  • heart rate of 110
  • blood pressure of 90/50 mm Hg (baseline BP 140/80 mm Hg)

His labs were notable for an elevated white blood cell count of 16 000 and a lactate of 3.0. He had a chest x- ray with no cardiopulmonary process noted. On examination, his right knee was noted to be erythematous and he was unable to flex is knee or extend his knee and was taken to the OR for concern for joint infection. Upon LMA removal at the end of the case, he was noted to be in distress with a respiratory rate of 35 with accompanying loud upper airway sounds concerning for stridor. His oxygenation saturations decreased to 83%, and given his hypoxemia and increased respiratory effort, the decision was made to reintubate the patient. A chest x-ray was performed demonstrating bilateral perihilar infiltrates.

What was the most likely cause for the patient’s respiratory distress status post extubation?

A. Aspiration pneumonitis
B. Acute cardiogenic pulmonary edema
C. Anaphylaxis
D. Negative pressure pulmonary edema

Question 9# Print Question

A 40-year-old female presents to the ED via EMS after being rescued from a house fire. Upon presentation, the patient has:

  • a temperature of 99.4
  • blood pressure of 120/80 mm Hg
  • heart rate of 95
  • oxygen saturation of 97% on room air
  • respiratory rate of 22

The patient complains of a headache, pain on her face secondary to burn, and a hoarse voice. Her labs are notable for a carboxyhemoglobin level of 15%. On physical examination, she has a deep partial-thickness burn on the right side of her face extending from below her zygomatic arch to her jawline. She has soot in her nostrils bilaterally. She was placed on 100% oxygen.

What would be the next step in management?

A. Observe for 24 hours
B. Fiberoptic bronchoscopy to assess the upper airway
C. IV steroids
D. Hyperbarbic oxygen chamber

Question 10# Print Question

A 40-year-old male with history of obesity (BMI 40) and substance abuse disorder was brought into the ED status post cardiac arrest from opioid overdose. Return of spontaneous circulation was achieved after 3 rounds of CPR and epinephrine prior to arrival to the ED. He was intubated and transferred to the ICU for further management. One week into his ICU admission, his neurologic status remained poor, and after discussion with family, the decision was made to pursue tracheostomy and PEG tube placement. He was taken to the OR for the placement of a Shiley 8 tracheostomy tube and was sedated for the procedure. Twelve hours following the tracheostomy placement, he was switched from volume control ventilation to spontaneous ventilation with an inspiratory pressure of 8 and PEEP of 10. He was noted to have increased tachypnea, and his heart rate increased to 120. The ventilator started to alert high pressures with PIPs of 40 cm H2O with each respiratory effort.

What step could prevent the high pressures?

A. Suctioning within the tracheostomy tube
B. Decreasing the PEEP from 10 to 8
C. Replacing the tracheostomy tube with a Shiley XLT 8
D. Replacing the Shiley 8 tube with a T-piece

Category: Critical Care Medicine-Pulmonary Disorders--->Airway Diseases
Page: 2 of 2