Tải bản đầy đủ

MCQ of ICU

Critical Care MCQ

Critical Care

MCQ

Hemodynamics & Cardiology
Which arenot indications of temporary pacing in AMI?
a)
b)
c)
c

Mobitz type II.
Alternating right and left bundle branch block (BBB).
Mobitz type I + normal BP.

• ??????

Indication of permanent pacemaker in MI:
a) Sinus brabycardia.

b) Lt Ant. Hemiblock.
c) Persistent Mobitz type II with BBB. (or with
hemiblock)
d) Persistent Mobitz type II. ??????
c



Rt heart failure PCWP 18, treatment:
a) Fluids.
b) Lasix.
c) Dobutamine.
d) Dopamine.
c



Absolute contraindication to IABP:
a) Severe heart disease.
b) Unstable angina.
c) Acute mitral insufficiency.
d) Aortic insufficiency.
d

• Relative CI:
o Bilateral ilio-femoral peripheral artery disease.
o Aortic aneurysm.
o Iliac artery stent or prosthetic ilio-femoral graft
o Coagulopathy.
• Absolute CI: Aortic insufficiency , aortic dissection (risk to be inserted in in aneurysmal lumen),
PDA

1


Critical Care MCQ
• Confirm place of IABP by CXR (tip at carina)

Which have the most effect on flow of fluids in IV
catheters?
a)
b)
c)
d)

a

Diameter.
Length.
Viscosity of the fluid.
Site of insertion.

• Flow (Q) = k (ΔP/R)(L= Length, η = Viscosity, r = radius, P=pressure,R=Resistance)
• R= L.η/ r4
• k =Л / 8,
• Q = ΔP. Л.r4/ 8 L.η
• Radius (diameter is raised to the fourth power so small change → significant effect)

All increase risk of pulmonary embolism during
surgery except:
a) CRF (CKD).
b) Use of oral contraceptive pills (OCP).
c) Lupus (SLE).
d) Adenocarcinoma.
a

• Hypercoagulopathy: OCP, SLE(&APAS), malignancy
• CKD (platelet dysfunction

All are contraindication to CVC except:
a)
b)
c)
d)
a

Coagulation disorder.
Thrombocytopenia.
Scar at site of insertion.
Unconscious (or uncooperative) patient.

• ????? Marino 66

Test used to diagnose heart failure:
a)
b)
c)
d)

Troponin.
cK MB.
LDH.
B type Natriuretic Peptide (BNP).
2


Critical Care MCQ

d

• BNP >500 Pg/ml is diagnostic to HF &< 100 good negative value
• Not dependent test in RI or hemodialysis (false high)

All are indications of CVC replacement except:
a)
b)
c)
d)
e)
d

Purulent drainage from catheter site.
Percutaneously inserted is suspected to be a source
of systemic sepsis.
Catheter inserted emergently without strict aseptic
technique.
Subclavian catheter inserted >48 h.
Femoral catheter inserted >48 h.



Decompensated HF with (↑PCWP + ↓CO or CI + ↑BP);
TTT of choice is:
a)
b)
c)
d)
a

Vasodilators.
Dobutamine.
Dopamine.
Milrinone.

• Forrester classification

Decompensated HF with (↑PCWP + ↓CO or CI +
normal BP); TTT of choice is:
a)
b)
c)
d)
b

Milrinone.
Dobutamine.
Dopamine.
Norepinephrine.

• Forrester classification

RT HF with (PCWP 12 + ↓BP); TTT of choice is:
a)
b)

Dobutamine.
Dopamine.
3


Critical Care MCQ
c)
d)
d

Norepinephrine.
IV fluid

• Need to increase preload
• To give inotropes PCWP >15

Decompensated HF with (↑PCWP + ↓CO or CI +
normal BP) + patient on BB medication; TTT of choice
is:
a)
b)
c)
d)
a

Milrinone.
Dobutamine.
Dopamine.
Norepinephrine.

• ??????Milrinone. PDI 3 → inodilator(VD+ inotrope)not depend on B receptors
• Patients treated with beta blockersbefore admission and requiringconcomitant inotropic therapy
should bepreferably treated with a PDE III inhibitororlevosimendan rather than a betaadrenergic
agonist such as dobutamine

Subclavian CVC, most common complication is:
a)
b)
c)
d)

VTE.
Pneumothorax.
Hemothorax.
Rupture of free wall of the heart.

• Subclavian CVC, most common complication is Pneumothorax (nearly no risk difference between
b

jugular and Subclavian to Pneumothorax).

• Femoral catheter common complication VTE & infection.

Case: 72 years old exploratory laparotomy → remain
elective ventilation→ develops hypotension over
several hours (BP = 110/70) → develops manifestation
of septic shock require high dose vasopressors →
evidence of hypoperfusion (pH = 7.24 + PCO2 = 28 +
PO2 = 80 + O2sat=97% + Hb = 8 ) → PAC is inserted
giving this data (CVP = 10 + PCWP = 18 + CI= 1.5
L/min/m2+ mixed venous O2 saturation 54%). Which is
most likely to increase O2 delivery?
4


Critical Care MCQ
a)
b)
c)
c

2L normal saline.
Blood transfusion to increase Hb to 10.
Vasopressor + inotropes to increase CI to 3.

• DO2 = CO x CaO2 x 10 as CaO2 = (1.34 x Hb x SO2) + 0.003 x PO2)
• DO2 = CO x [(1.34 x Hb x SO2) + 0.003 x PO2)] x 10 → so effect of Hb change is more than CO change
• To increase DO2 →↑CO or ↑Hb (but indication of BL transf is Hb<7 unless IHD or SaO2 – SvO2 >50)
• So increase CO is better choise

Case: VF according ACLS you do:
a)
b)
c)
d)
d

DC 400 J.
DC does not exceed 630.
2nd DC is between 200-300.
Impedance increase with pressure on paddles.



Pulmonary artery catheter (PAC) in patient has no
cardiac nor respiratory disorders, measure SO2 = 91;
proposed cause is:
a)
b)
c)
c

FiO2 = 100%.
Distal end is at right ventricle.
Catheter tip is at top of pulmonary artery occlusion.



DVT prophylaxis for patient fall on his back &has
lumbar fracture is:
a)
b)
c)
b

SC heparin 5000 U / 12h.
SC enoxaparin 40 mg/24h.
SC enoxaparin 40 mg/12h.

• Spinal cord injury best 30 mg/12h.

For unfractionated heparin for DVT:
a)
b)

Can be used even with neurosurgery procedure.
No role in patient recovered from MI.
5


Critical Care MCQ
c)
d)

Not warranted in stroke in evolution.
Dose of prophylaxis is same as therapeutic for
thromboembolic state.

• Based on the current literature, the use of bothunfractionated and low-molecular-weight heparin
a
/
b

appearsto be safe when given at least 24 hours after the conclusionof surgery or admission for
traumatic closed head injury.
• Double-blinded prospective studies are needed to addressdefinitively the safety and efficacy of
unfractionatedand low-molecular-weight heparin for VTE prophylaxisin neurosurgical patients.

What is rate of the rate of performing chest
compression for victim of any age?
a) 2 ventilation + 15 compression at rate 80-100 / min.
a



Which of the following descries the way you can allow
the chest to recoil completely after each
compression?
• Take your weight off your hands and allow the chest to come back to its normal position.

When you don’t suspect cervical spine injury, what is
the best way you open an unconscious victim airway?


Patient with central line develops sepsis, what is the
organism?
a) Staph aureus.
a



Patient of Lt Heart failure on Lanoxin(serum level of
digoxin is subnormal) + Lasix patient develops
dyspnea; do what?
a) Atenolol.
b) ACEi.
6


Critical Care MCQ
c)
d)
b

Increase dose of lanoxin.
Increase dose of Lasix.

• Options for this case: ACEi

Prolonged QT is seen all except:
a) Hyponatremia
• Na is the only electrolye do not ECG changes
Prolonged OT interval (9-11 small squar or > 0.4 RR interval):

• ANTI [arrhythmic (Ia,Quinidine&III, amiodarone), psychotics (Haloperidol), depressant (TCA),
a

fungal (amphotericin), histaminic (terfenadine), biotic(erythromycin, quinolones), insects (OP
poisons)]
• Hypos [magnesimia, kalemia, calcemia]
• TTT of long QT syndrome:
o BB are drugs of choice (Propranolol, Nadolol, Metoprolol, Atenolol)
• Surgical TTT (Implantablecardioverter-defibrillators = ICD, pacemaker, Left
cervicothoracicstellectomy)

Case: 60 year-old ♂ + chronic renal insufficiency +
HTN + admitted POC: AAA repair initial hemodynamic
(CO = 3.2 L/min + PCWP = 12) + low UOP → 500 mL
colloid, which of the following dynamic change
indicates diastolic dysfunction?
CO
PCWP
A
3.4
14
B
4.2
14
C
3.8
18
Answer (c): Increase preload, little effect on CO (Pt is suspected to
have LDD: cause HTN)
Also diastolic dysfunction in: IHD, restrictive CM, tamponade,
myocardia fibrosis.

The best prophylaxis of DVT initially in the post-op
patient (safe and cost-effective):
a)
b)
c)
d)
a

LMWH
Warfarin
Aspirin
Unfractionated heparin



7


Critical Care MCQ

Aortic dissection:
a)
b)
a

BB is first line of TTT + Na nitoprusside for patient
with ongoing HTN.
CCB if BB is contraindicated.



Patient with sepsis develops chest pain; ECG change
in II,III, aVF; (CVP = 4 + PAOP = 18):
a)
a

Sepsis + cardiogenic shock.



Case: ♀ patient + menstrual period + fever + HR 132
+ RR31 + hypotension; do what?
a)
b)
c)

c

Intubation & MV
Start dopamine.
Start TTT of septic shock.

• Toxic shock syndrome

If CVP= (8)& intra-esophageal pressure (representing
intra-pleural pressure) = (-4), so RT atrial trans-mural
pressure is:
a)
b)
c)
d)
d

8
4
-4
12



8


Critical Care MCQ

Best anti HTN used in aortic aneurysm:
a)
b)
c)
c

Hydralazine. --------increase shearing
Nitropusside.
Nitropusside + BB.



Which is not a cause of pulsusparadoxus?
a)
b)
c)
d)
d

Tamponade.
BA.
Restrictive CM.
PE.



Case: DM +HTN +post op (aorto-femoral bypass) after
72 h develops hypotension; what is the cause?
a)
b)
c)
c

Bowel ischemia
Obstruction of graft
MI

•The most common causes of death after surgery are perioperative myocardial infarction
(MI) and stroke. Other causes of death include renal and respiratory failure

Case: pt with history of 3 vessel bypass + DCL →
Subclavian CVC inserted → 30 min patient develops
hypotension; all explain hypotension except:
a)
b)
c)
d)
a

Venous air embolism.
Pneumothorax.
Hemothorax.
Rupture of free wall of ventricle.

•?????

In PE; if V/Q is low probability +high clinical
suspicion; do what?
9


Critical Care MCQ
a)
b)
c)
d)
a

Start anticoagulation.
D dimer.
LL duplex.
Echo.

•?????
Forrester classification of acute heart failure (in MI)

Classification points
CI
PAOP
(L/min/m2)
(cm H2O)

class

Description

Findings

↓ < 18

I

Compensated

↑ > 18

II

Congestion

Warm
Dry
Warm
Wet

III

Hypovolemic shock
(Hypoperfusion)

Pul. edema
Cold
Dry

IV

Cardiogenic shock
(Congestion +
hypoperfusion)

N or ↑ CI >2.2

↓ < 18
↓ CI <2.2
↑ > 18

Risk level
High risk

Moderate risk

Risk Categories
Low risk
Moderate risk
High risk
Highest risk

Cold
Wet
Pul. edema

Thromboprophylaxis
Clinical Situation
Major trauma
Spinal cord injury
Hip or Knee arthroplasty
Benign disease
Gynecologic
surgery
Malignancy
Closed
procedures
Urologic
surgery

Open procedures

Mortality %

Therapy

3

Chronic HF therapy

9

Diuretic + v.dilator
(nitrate)

23

Fluid repletion

51

Norm. BP → v.dilator
↓BP → inotrope +
pressor

Recommended Prophylaxis
LMWH2 or leg compression (IPC)
LMWH2 plus leg compression
LMWH2
LDUH1
LDUH2 or LMWH2
Early mobilization only
LDUH1 or leg compression (IPC)

LDUH1 or LMWH1
High-risk medical illness
Leg compression (IPC)
Intracranial surgery
Thromboprophylaxis for General Surgery
Description
Prophylaxis
Surgery
Age
Other risk
Minor
<40
No
Early mobilization only
LDUH1 or LMWH1:
Major
<40
No
First dose 2 hr before surgery
LDUH2 or LMWH2:
Major
>40 or other risk
First dose 2 hr before surgery
LDUH2 or LMWH2 as above +
Major
>40
other risk
mechanical aid

Prophylaxis Regimens:
• UFH: variable sized particles (smaller →more effective) bind to Antithrombin III (AT III) →complex
→inactivating several coagulation factors (IIa [thrombin], IXa, Xa, XIa, and XIIa, (LDUH →only
antithrombineffect→inhibit thrombus formation),disadvantage: HIT
o LDUH1: Unfractionated heparin, 5,000 units SC every 12 hr

10


Critical Care MCQ
o LDUH2: Unfractionated heparin, 5,000 units SC every 8 hr
• LMWH:enzymatically produced smaller uniform size molecules of heparin (more potent),with renal failure, the
prophylactic dose of Enoxaparin, 40 mg SC once daily (No dose adjustment for dalteparin)

o LMWH1: Enoxaparin, 40 mg SC once daily, or dalteparin, 2,500 units SC once daily
o LMWH2: Enoxaparin, 30 mg SC every 12 hr, or dalteparin, 5,000 units SC once daily

• Mechanical aid:
o Graded compression stockings:pressure gradient acts as a driving force for venous outflow from the legs (18
mm Hg at ankles and 8 mm Hg at thigh)

o Intermittent pneumatic compression (IPC): inflatable bladders wrapped around leg (35 mm Hg at ankle and
20 mm Hg at the thigh)→inflating and deflating at regular intervals

• PE → 10% of postop mortality (incidence of PE increase 50% with major surgery or trauma)
• Determinant risk of PE in surgery: vascular injury (orthopedic) and hypercoagulable state caused by
thromboplastin release during surgery&Patient-specific factors.
• Minor surgery: performed under local or spinal anesthesia and lasts <30 min
• major surgery: performed under general anesthesia and lasts >30 min
• Other risk factors: cancer, obesity, history of thromboembolism, estrogen or other hypercoagulability.

SBP
DBP
Pulse P
MAP
CO
CI = CO/SA
Nail refill
Temp
SVRI
PVRI
CVP
PAOP
DO2
SvO2
Etiology

Other clinical S/S



Hemodynamic &Oxygen Transport Parametersmonitoring
Obstructiv
RVF
Hypovolemia
LVF
Tamponade
e
















N-↓




Distributive
Vasogenic

↓↓↓













N-↑


N






N






N




Cancer
(breast,
lung,
lymph)
RF, TB


N





N-↑


N-↓

N-↓
Pneumothx,
P.E, air &
amniotic
fluid
embolism
Dyspnea not
improving
wiyh O2
(mostly
clear lung)
Target CVP
in PE
therapy 2025 cm H2O


N
N-↓
N-↓

N-↑

Hge,
dehydration,
burn

MI, acute HF

Gallop,
Pul. edema

RVEDP=
PAP =
PAOP

Systolic Blood Pressure (SBP) = 90-140 (120) mm Hg

11

Secondary
to LVF,
Corpumon
ale

PAH,
congested
liver,
peripheral
edema

Septic, spinal,
anaphylaxis
Liver failure
Suspect cause
(infection,
S.C. injury,
anesthesia)
spinal shock:
Bradycardia +
BP+ within
hours from
injury


Critical Care MCQ




Diastolic Blood Pressure (DBP) = 60-90 (80) mm Hg
Pulse Pressure = SBP-DBP = 40 mm Hg
Mean Arterial Pressure (MAP) = DBP + 1/3(SBP-DBP) = 90 mm Hg (target in shock correction

>65)





Heart Rate (HR) = 60-100 (75)bpm
Cardiac Output (CO) = SV.HR = 4.0 - 8.0 (6) L/min








Body Surface Area (SA)= (Kg+Cm-60)/100 = m2
Cardiac Index (CI) = CO/SA= 2.4-4 L/min/m2

Stroke Volume (SV) = CO/HR =End-Diastolic Volume (EDV=120) - End-Systolic Volume (ESV=50) =
55-100 (70) mL

Stroke Index (SI) = CI/HR = 20–40 mL/m2

Systemic Vascular Resistance (SVR) = 80 ×(MAP – CVP)/CO = 800 –1200dynes•sec-1•cm-5
Pulmonary Vascular Resistance (PVR)=80 ×(Mean PAP – PAOP)/CO = <250dynes•sec-1•cm-5

Systemic Vascular Resistance Index (SVRI)=(MAP – CVP)/CI = 25-30 Wood
Pulmonary Vascular Resistance Index (PVRI)=(Mean PAP – PAOP)/CI = 1-2 Wood
vascular resistance is expressed in Wood units (mm Hg/L/min/m2), which can be multiplied by 80 to
obtain more conventional units of resistance (dynes•sec-1•cm-5/m2)→ so: SVRI =2000 -2400
dynes•sec-1•cm-5/m2& PVRI = 80-160 dynes•sec-1•cm-5/m2

Central Venous Pressure (CVP) = 0-5 mm Hg (8–15 cm H2Owhen measured from mid axillary
point as mmHg = 1.36 Cm H2O)
CVP = JVP + 5 (JVP is measured from angel of sternum which is perpendicularly higher than mid axillary
point by 5 Cm)

Pulmonary artery occlusion Pressure (PAOP) = Pulmonary Capillary Wedge Pressure(PCWP)= 6-12
mm Hg

Pulmonary Artery Pressure (PAP)= systolic 15–30 (25) mm Hg/ diastolic 5–15(15) mm Hg

Mean PAP =10- 20 mm Hg



Content of Arterial O2 (CaO2) = 1.3 × Hb × SaO2+ 0.003× PO2 = mL O2(0.003× PO2 is insignificant
as a content)

Delivery of O2 (DO2) = CI ×CaO2 = CI ×1.3 × Hb × SaO2 = 520-570 mL/min/m2
(CO may be used as alternative to CI in all oxygen parameters so the unit is mL/min)

O2 uptake = Oxygen consumption (VO2)= CI × CaO2 - CvO2 = CI × 1.3 × Hb × (SaO2 – SvO2)= 110160 mL/min/m2
(<100 → impaired aerobic metabolism)also Compensated Heart Failure (normal VO2) vs.
Cardiogenic Shock (low VO2)

Oxygen Extraction Ratio (O2ER)= VO2/DO2×(100)= 25 (±5)%



Mixed venous oxygen saturation (SvO2)= 70-75% (decreased by low CO as high oxygen
extraction)

Arterial oxygen saturation (SaO2)= 90-100%

Matching question: hemodynamics with diagnosis: (so
important)
a
b
c
d

CI
1.5
1.5
1.9
7.2

SV
20
25
40
102

CVP
2
16
19
6

PAOP
2
18
8
6

Diagnosis (choice)
Hypovolemia
Biventricular failure
Rt Ventricular failure
Hepatic failure

Case, matching:(so important)
66 year female + suspected biliary sepsis + hypotension in ER → aggressive fluid but still hypotensive
(78/40) → continued fluid therapy and inserted PAC giving 1st measures (shown below), match expected

12


Critical Care MCQ
dynamic change with administration of vasoactive drug:
a) Dopamine 8 mic/kg/min.
b) Dopamine 25mic/kg/min.
c) Dobutamine.
d) Norepinephrine.
e) Phenylephrine.
1st
Event 1
Event 2
measure
BP
88/42
99/48
120/65
MAP
57
65
83
HR
108
120
125
CVP
10
8
8
PAOP
18
15
15
CI
2.1
3
3.1
SVR
895
760
968
Choice
a
b
β1 dose:
α 1 dose:
•↑HR
•↑SVR
•↑BP
•↑BP

↑CI
•↑CI
Explanation
•↑HR
(β action is
still with
this dose)

13

Event 3

Event 4

120/65
83
80
12
20
1.8
1578
e
Phenylephrine
.
•↑SVR
•↑BP
•↓HR
(reflex
bradycardia, no
effect on CI)

130/70
90
100
10
16
2.5
1280
d
NE: (α > β)
•↑SVR
•↑BP
•↑HR (little)
•↑CI
(little)

Event 5
80/36
51
120
8
15
3.3
521
c
Dobutamine:
• ↓SVR (β2
initially)
• ↑CI
• ↑HR
Should be used
initially with
pressor


Critical Care MCQ

a
c
x
v
y

Atrial contraction
Carotid pulse (contraction of vent.→ tricuspid pulg in atrium )
Diastole
Venous return
Passive filling of vent (tricuspid open)

14


Critical Care MCQ

Ventilation & Pulmonology
Which would increase Ppeak not Pplat?
a)
b)
c)

c

Pneumothorax.
Pulmonary embolism.
Tube obstruction.

• Ppeak = PIP →represent dynamic compliance; Cdyn=Vt/(Ppeak - PEEP) affected by airway
• Pplat →represent static compliance; Cstat=Vt/(Pplat - PEEP) affected by alveoli & chest wall
• Causes of isolated high P peak: bronchospasm, AW obstruction (plug, kink, FB, ETT cuff herniation)
• Causes high peak & plat pr: pneumothx, atelectasis, Pul edema, pneumonia, bronchial intubation,
pl effusion, increasedabd pressure.

Heliox is indicated for use in:
a)
b)
c)
d)

ARDS.
Severe pneumonia.
Pulmonary embolism.
Upper airway obstruction.

•Heliox is mix 80% helium + 20% O2→ ↑laminar flow & ↓ resistance to turbulent flow&
better delivery nebulizers
•Uses: COPD, BA, FB aspiration, bronchiolitis, croup, vocal folds dusfunction.
d

The use of a helium-oxygen (heliox) mixture in patients with airway obstruction was used
as early as the 1930s. Although heliox does not resolve airway obstruction, it decreases
airway resistance providing time to allow other treatments to become therapeutic, and
thus, possibly preventing the need for intubation and mechanical ventilation. Despite new
and advanced treatment options in airway obstruction, heliox continues to be a choice for
treatment.

In life threatening conditions what is best way of
intubation?
a)
b)
c)
d)
d

Fiberoptic without anesthesia of post pharynx.
Nasal intubation under GA.
Tracheostomy.
Oral ETT by Direct laryngoscope.

• Time saving is life saving

15


Critical Care MCQ

What increase peak and plateau pressure…..
a)
a

Tension pneumothorax.

• See above also bronchospasm

Dead space ventilation is the relation of:
a)
b)
c)

Tidal volume to vital capacity.
Vital capacity to tidal volume.
Physiological dead space to vital capacity.

• Physiologic dead space (VD)= anatomical + alveolar (non-perfused normally 5% of alveoli)=2ml/kg
• Dead space = VD/ Vt = 2/6 = 30% in awake upright person
• Causes ofincreased VD:
c

Anatomical VD:GA, artificial airway, head extension jaw thrust, PPV(+ve airway pr), upright position
Perfusion of alveoli: PE, He, hypotension, lung surgery, PAH
Overventilation with decreased flow (emphysema), age

The Bohr equation is used to quantify the ratio of physiological dead space to the total tidal
volume, and gives an indication of the extent of wasted ventilation. It is stated as follows: [1]

Case: RTA + GCS 9/15 + tracheostomy done → on
weaning developed increase in Bp and agitation; do
what?
a)
b)
c)

a

Clonidine.
Sedate and MV.
Endotracheal intubation.

• Clonidine (Catapress®)α1 blocker →↓(stress, HR, BP) that it facilitates weaning from mechanical
ventilation
• Pt is already on tracheostomy with weaning failure

Which mode doesn’t contain mandatory ventilation?
a)
b)
c)
d)
a

PSV.
AC.
SIMV.
PCV.

• PSV: Pt trigger all breaths and vent support all breathes within pressure limit

16


Critical Care MCQ

Which is not a cause of weaning failure?
a)
b)
c)
d)
d

Heavy sedation.
Electrolyte imbalance.
Pneumonia.
Minimal secretions.

• Review criteria of weaning

Patient has aspiration pneumonia, admitted,
intubated, mech. vent. (R. failure)… suddenly his
SaO2 decreased….what is most correct initial
management…..
a)
b)
a

Suction of secretion. (Or disconnect vent & ventilate
by ambu).
Check ETT position.

• Suction &ambu (confirm gas delivery)

Radical O2 toxicity occurs in…..
a)
a

FiO2 (50- 60%) for 24 hrs.



Lt sided atelectasis….can be proved by:
a)
b)
c)
b

Rt recumbent position.
Crowding of Lt Ribs.
Shift of mediastinum to RT.

• Lt side atelectasis: patient prefer Lt recumbent (better Rthealthy lung inflation, but treatment
based on ling on healthy side to enhance drainage), shift mediastinum to Lt, crowding ribs &
vessels of Lt side (collapsed Lt lung)

ARDS…..the following is not criteria of ARDS:
a)

PO2 over fiO2 less than 300.
17


Critical Care MCQ

a

• Hypoxic index = PO2 /fiO2: ARDS <200, ALI 200-300, normally 800 to 100/0.2=400 to 500, as
criteria of weaning >200

Effect of autoPEEP is following except:
a)
b)
c)
d)
d

Increased work of breathing.
Risk factor to barotrauma.
Decreased venous return, hypotension.
It easily can be measured at end expiration.



Tobin index:
a)
a

Respiratory rate/ spontaneous tidal volume.

• Tobin index = RSBI = f/Vt rapid shallow breathing index

Which of the following increase peak pressure (PIP)?
a)
b)
a

Decrease of inspiratory time.
Decrease flow rate.

• ↓Ti→↑peak flow→↑PIP
• Decreased flow rate is a result of high airway pressure (not a cause)

Which is not an indication of isolated lung intubation?
a) Bronchial hemorrhage.
b) Broncho-pleural fistula.
c) Bronchial……..
d) PE.
d



Case: patient 70 kg + ARDS + FiO2 = 0.7 + PEEP = 8 +
Vt = 420 → develops hypoxia; do what?
a) ↑ FiO2 to 0.8
b) ↑ PEEP 10-12
18


Critical Care MCQ
c)
b

↑ Vt to 550



Ventilator graphs:
Spontaneous
ventilation
Spontaneous with
CPAP

BiPAP

Best to detect small pneumothorax in CXR; done in:
a)
b)
c)
d)
b

Upright position + during expiration.
Upright position + during inspiration.
Supine position + during expiration.
Supine position + during inspiration.

• Marino 72

Case: obstetric + ARDS:
a)
b)

NIPPV is treatment of choice.
Increase PEEP> 10 may cause pneumothorax.
19


Critical Care MCQ
c)
d)
b

Alveolar fluid has less protein.
Diuretics improve oxygenation.

• ??

Case: patient ventilated; PS = 12 → PIP = 50 + Pplat =
48 + tachypnea + desaturation despite FiO2 = 100%.
Probable cause is:
a)
b)
c)
c

Secretion in airway.
Massive P.E.
Pneumothorax.

• See above

Expansion of chest measure:
a)

TLC Volume of air in the lungs at the end of a
maximal inspiration.

a

Permissive hypercapnia is beneficial in:
a) ARDS, BA.
a

Diffusion capacity of the lungs measure transfer of
the gas from air in the lung to RBC in the lung blood
Vessels, increased in:
20


Critical Care MCQ
Lung conditions that increase Diffusion capacity

• Alveolar hemorrhage Goodpasture'ssyndrome,polycythemia, left to right intracardiac shunts, due
a

increase in volume of blood exposed to inspired gas.

• Asthma due to better perfusion of apices of lung. This is caused by increase in pulmonary arterial
pressure and/or due to more negative pleural pressure generated during inspiration due to
bronchial narrowing

Aspiration occurring in intubated patient with well
intact inflated cuff:
a)
b)
c)
a

Micro……
Macro…….
Chemical causing pneumonitis.

???? I think micro-aspiration

All are indication of NIPPV except:
a)
b)
c)
d)

BA exacerbation.
COPD exacerbation.
Acute respiratory acidosis.
An obtunded patient.

d

Lung volumes & capacities
TV
IRV
ERV

Tidal volume
Inspiratory
reserve volume
Expiratory
Reserve Volume

RV

Reserve Volume

FRC

Functional
Residual
Capacity

IC

Inspiratory
Capacity

VC

Vital Capacity

Lung volumes & capacities
volume of air moved in and out of the respiratory tract
(air moving with normal inspiration & expiration)
max amount of air inspired after a normal inspiration
(with max inspiration)
max amount of air expired after normal expiration
Volume remainin the lungs aftermaximal
expiration(after ERV)
RV = FRC - ERV
volume remain in the lungs is after normal
expiration(after a tidal volume)
FRC = ERV+RV
Max volume of air that can be inhaled following a
resting state.
IC = TV + IRV
Max amount of air expelled after max inhalation

21

500 mL
3100mL
1000mL
1200mL
2400mL
3600
mL
4800mL


Critical Care MCQ

TLC

Total lung
capacity

VC = IRV+TV+ERV
Volume of air in the lungs at the end of a maximal
inspiration.
TLC= IRV + TV + ERV + RV

22

5200
mL


Critical Care MCQ

Pulmonary function tests (PFTs)

23


Critical Care MCQ

Minute volume is the
Maximal breathing capacity
(maximal voluntary
ventilation)
Forced expiratory volume 1

• Volume of air exhaled per minute.
• Maximum volume of air that can be exhaled by voluntary effort in a 15 second
interval. This volume is multiplied by 4 and expressed as litres per minute

• Volume of air that is forcefully exhaled in one second.

(FEV1)
Forced vital capacity

• Volume of air that can be maximally forcefully exhaled.

(FVC)
Ratio of FEV1 to FVC
(FEV1/FVC)
Forced expiratory flow

• expressed as a percentage (Normal FEV/FVC ~ 80% )
• Restrictive (fibrosis) ratio normal or increased
• Obstructive (asthma, COPD) usually low
• Average forced expiratory flow during the mid (25 - 75%) portion of the FVC.

(FEF25 - 75)
Peak expiratory flow rate

• peak flow rate during expiration

(PEFR)

24


Critical Care MCQ

Sepsis& immunological response
In sepsis best to decrease mortality and morbidity is:
a) SpO2> 97%.
b) Keep CVP 10- 12.
c) Keep mean BP > 55.
d) ScvO2> 50.
• Targets in TTT of sepsis are: Keep CVP 10- 12 (8-12 in spont breathing, 12-15 in vent Pt), MAP> 65,
a

ScvO2 > 70, best result with precocious TTT & massive fluid challenge

• Mortality predictors in sepsis: male, bad APACHE & SOFA scores, positive fluid balance, need to
hemodialysis, need to steroid,leukopenia, lactatemia, BNP

Common cause of MOF:
a) Stroke.
b) Trauma.
c) Sepsis.
c



In study (??????????) 1996, mortality rate is:
a)
b)
c)
d)
d

SIRS 9%.
Sepsis 19%.
Severe sepsis.
Septic shock 90%.



25


Tài liệu bạn tìm kiếm đã sẵn sàng tải về

Tải bản đầy đủ ngay

×

×