Deck 28: Acute Respiratory Distress Syndrome

Question 1

Which of the following are causes of ARDS?
1) Liver failure
2) Drug abuse
3) Septicemia
4) Goodpasture's syndrome

A)1, 4
B)2, 3
C)2, 3, 4
D)1, 3, 4

Answer 1

2, 3, 4

Question 2

According to the Berlin definition of ARDS, what does a PaO₂/FIO₂ ratio of 150 mm Hg indicate for a patient on mechanical ventilation with a PEEP of 10 cm H₂O?

A) Normal lungs
B) Mild ARDS
C) Moderate ARDS
D) Severe ARDS

Answer 2

Moderate ARDS

Question 3

What is the most common cause of ARDS?

A) Sepsis
B) Fat embolism
C) Inhalation of irritants
D) Aspiration of gastric contents

Answer 3

Sepsis

Question 4

Which of the following clinical manifestations are associated with ARDS?
1) Increased pulmonary capillary wedge pressure (PCWP)
2) Increased CVP
3) Intercostal retractions
4) Cyanosis

A)1, 2
B)3, 4
C)2, 3, 4
D)1, 3, 4

Question 5

Which of the following are current ventilatory strategies in the treatment of ARDS?
1) Large tidal volume
2) Small tidal volume
3) Rapid respiratory rates
4) Slow respiratory rates

A)2
B)3
C)1, 4
D)2, 3

Question 6

Which of the following are recommended to treat alveolar consolidation and atelectasis associated with ARDS?
1) Aerosolized bronchodilator medications
2) Continuous positive airway pressure (CPAP)
3) Chest percussion and postural drainage
4) Positive end-expiratory pressure (PEEP)

A)4
B)1, 2
C)1, 3
D)2, 4

Question 7

The clinical manifestations associated with ARDS usually appear:

A) 2 to 4 hours following the inciting event.
B) 4 to 12 hours following the inciting event.
C) 6 to 72 hours following the inciting event.
D) 72 to 96 hours following the inciting event.

Question 8

Permissive hypercapnia is typically allowed to:

A) protect the lungs from high airway pressures.
B) protect the lungs from high PaO₂ levels.
C) protect the lungs from high tidal volumes.
D) protect the lungs from fluid accumulation.

Question 9

The chest radiograph finding indicative of severe ARDS is:

A) "ground-glass" appearance of the lungs.
B) pleural effusion.
C) bilateral hyperinflation of the lungs.
D) tracheal deviation.

Question 10

During permissive hypercapnia, at what pH level does the increasing PaCO₂ become a concern?

A) 7.2
B) 7.3
C) 7.5
D) 7.6

Question 11

Which of the following pulmonary changes are associated with ARDS?
1) Abnormal surfactant
2) Interstitial edema
3) Decreased shunt
4) Narrowing of the alveolar-capillary membrane

A)1, 2
B)3, 4
C)1, 3
D)1, 2, 3

Question 12

ARDS can result from the inhalation of all of:
1) FIO₂ >0.60 for prolonged exposure.
2) nitrogen dioxide.
3) very dry air.
4) chlorine gas.

A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Question 13

What is the reason for the elevated risk for developing ARDS associated with massive blood transfusions?

A) Shock (hypovolemia)
B) Receiving the wrong blood type
C) Fat emboli
D) Blockages in pulmonary blood vessels

Question 14

Which of the following materials will be found in the intraalveolar walls of a patient with ARDS?
1) Leukocytes
2) Cellular debris
3) Fibrin
4) Hyaline membrane

A)1, 4
B)2, 3
C)2, 3, 4
D)1, 2, 3

Question 15

What initial tidal volume setting on the ventilator would be recommended for a 70-kg adult male with ARDS?

A) 350 mL
B) 420 mL
C) 560 mL
D) 700 mL

Question 16

When would symptoms of ARDS associated with a fat embolism from a long bone fracture be most likely to develop?

A) 2 to 4 hours following the fracture
B) 4 to 12 hours following the fracture
C) 12 to 48 hours following the fracture
D) 48 to 96 hours following the fracture

Question 17

Breath sounds associated with ARDS include:
1) vesicular.
2) bronchovesicular.
3) crackles.
4) bronchial.

A)4
B)1, 2
C)3, 4
D)2, 3, 4

Question 18

A patient has a prolonged case of ARDS. What changes would be expected in the patient's alveolar cells?

A) Multiplication of the type I cells
B) Influx of macrophages
C) Hyperplasia and swelling of the type II cells
D) Development of emphysema

Question 19

Which of the following would be low tidal volume ventilation goals in a patient with ARDS?
1) Decrease barotrauma.
2) Maintain plateau pressure >30 cm H₂O.
3) Decrease high transpulmonary pressures.
4) Reduce overdistention of the lungs.

A)1
B)2, 3
C)2, 3, 4
D)1, 3, 4