Deck 29: Acute Respiratory Distress Syndrome

Question 1

Which of the following is another term for hydrostatic pulmonary edema?

A) ARDS-related pulmonary edema
B) Cardiogenic pulmonary edema
C) Exudative pulmonary edema
D) Fibroproliferative pulmonary edema

Answer 1

B
Explanation: Hydrostatic pulmonary edema is often also called cardiogenic pulmonary edema, due to its close association with abnormalities in intravascular hydrostatic pressures that cause edema.

Question 2

Which of the following is the likely cause of nonhydrostatic pulmonary edema?

A) Injury to the vascular endothelium and/or alveolar epithelium
B) Abnormalities in intravascular hydrostatic pressures
C) An influx of polymorphonuclear neutrophils
D) Medication overdose

Answer 2

A
Explanation: Nonhydrostatic pulmonary edema, also called noncardiogenic pulmonary edema, results from injury to the vascular endothelium and/or alveolar epithelium. This injury creates a loss of integrity in the barrier between the vascular and alveolar spaces.

Question 3

Which of the following parameters are important in the management of patients with ARDS?
1) Keep systolic blood pressure below 90 mm Hg.
2) Keep hemoglobin saturation above 90%.
3) Ensure adequate urine output.
4) Keep mean arterial pressure above 60 mm Hg.

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

Answer 3

C

Question 4

What mode of mechanical ventilation is designed to increase the mean airway pressure to allow recruitment of alveoli while allowing the patient to spontaneously breathe?

A) Inverse ratio ventilation
B) High-frequency ventilation
C) Intermittent mandatory ventilation
D) Airway pressure-release ventilation

Question 5

What is the maximal inspiratory pressure that should be targeted when using pressure-control ventilation in patients with ARDS?

A) 20 to 25 cm H₂O
B) 25 to 30 cm H₂O
C) 30 to 35 cm H₂O
D) 35 to 40 cm H₂O

Question 6

Which of the following mechanisms ultimately leads to ARDS regardless of the etiology?

A) Disruption of the endothelial and epithelial barriers
B) Alveolar flooding
C) Interstitial damage
D) Increased oncotic pressure

Question 7

What is recommended in terms of fluid management of patients with ARDS?

A) Conservative
B) Aggressive volume replacement
C) Increased dieresis
D) Only administer colloids

Question 8

What time does the exudative phase of ARDS typically presents?

A) Between days 1 and 7
B) After 1 week
C) After 3 weeks
D) After 1 month

Question 9

Which of the following risk factors for ARDS is classified as a nonpulmonary cause?

A) Toxic inhalation
B) Gastric aspiration
C) Near drowning
D) Sepsis

Question 10

Which of the following statements is true about prone positioning of patients with ARDS?

A) May be beneficial to patients with sustained severe ARDS (P/F ratio < 150 for more than 12 to 24 hr on stable ventilator settings).
B) It dramatically reduces the mortality of patients with ARDS.
C) It is easy to do and helps morbidity rates of patients with ARDS.
D) It does not improve gas exchange at all.

Question 11

Which of the following parameters is important in determining the optimal level of positive end expiratory pressure (PEEP) in a patient with ARDS?

A) PaO₂
B) SaO₂
C) DO₂
D) CaO₂

Question 12

Which of the following complications has been associated with the use of PEEP in patients with ARDS?

A) Lung infection
B) Reduced cardiac output
C) Hepatic failure
D) Myocardial infarction

Question 13

What range is now recommended for tidal volumes (V_T) in a patient with ARDS who is being mechanically ventilated?

A) 4 to 6 ml/kg
B) 6 to 10 ml/kg
C) 6 to 8 ml/kg
D) 10 to 12 ml/kg

Question 14

What mode of mechanical ventilation is designed to optimize ventilation by reducing alveolar collapse while using small tidal volumes in patients with ARDS?

A) Inverse ratio ventilation
B) High-frequency ventilation (HFV)
C) Intermittent mandatory ventilation
D) Airway pressure-release ventilation

Question 15

Which of the following factors are associated with a higher risk for ARDS?
1) Gastric aspiration
2) Multiple transfusions
3) Septic shock
4) Burn injury

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

Question 16

What is the name of the period that follows the exudative phase in ARDS?

A) Fibroproliferative
B) Transudative
C) Proliferative
D) Intraalveolar

Question 17

Which of the following is the primary system for removing filtered fluid and protein from the lungs?

A) Lymphatic
B) Renal
C) Circulatory
D) Respiratory

Question 18

Which of the following clinical features is often common to both ARDS and congestive heart failure (CHF)?

A) BALF is proteinaceous and inflammatory.
B) Diffuse alveolar and interstitial infiltrates in chest radiograph.
C) Pleural effusions on chest radiograph.
D) Recent history of trauma.

Question 19

Which of the following white blood cells is most commonly implicated in the inflammatory process of ARDS?

A) Eosinophils
B) Monocytes
C) Neutrophils
D) Lymphocytes

Question 20

What ventilatory strategy has been found to be useful for avoiding barotrauma in the treatment of patients with ARDS?

A) Prolonged expiratory time
B) Permissive hypercapnia
C) Inverse ratio ventilation
D) Intermittent mandatory ventilation

Question 21

Using which of the following medications carries the greatest risk of persistent memory and cognition problems in the survivors of ARDS?

A) Benzodiazepines
B) Beta-2 agonists
C) Exogenous surfactants
D) Corticosteroids

Question 22

How does the Berlin Criteria define the "mild" category of ARDS?

A) P/F ratio = 300 to 400
B) P/F ratio = 201 to 300
C) P/F = 101 to 200
D) P/F ?4= 100

Question 23

Which of the following are clinical features that favor congestive heart failure over ARDS?
1) Elevated PA catheter wedge pressure
2) Asymmetric, peripheral infiltrates on chest x-ray
3) Prompt (<12 to 24 hr) and lasting response to diuretics
4) Bronchoalveolar lavage fluid low protein and minimally increased cellularity

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

Question 24

Which of the following are common causes of volume overload in patients with hydrostatic pulmonary edema?
1) Renal failure
2) Hepatic failure
3) Hypoalbuminemia
4) Hyperkalemia

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

Question 25

In most ARDS patients, PEEP levels below __________ are generally preferred.

A) 10 cm H₂O
B) 15 cm H₂O
C) 20 cm H₂O
D) 25 cm H₂O

Question 26

When administering oxygen, which of the following should be considered regarding oxygen toxicity?
1) It is only a concern with premature infants.
2) The longer the exposure, the worse the injury.
3) The higher the FiO₂, the worse the injury.
4) The target SpO₂ is in the range of 88% to 95%.

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

Question 27

Which of the following are ways to prevent further lung injury in an ARDS patient?
1) Avoid barotrauma and volutrauma
2) Permissive hypercapnia
3) Keep plateau pressure between 30 and 40 cm H₂O
4) Tidal volume ideally between 6 and 8 ml/kg IBW

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

Question 28

What time does the fibroproliferative phase of ARDS typically present?

A) Between days 1 and 7
B) After 3 days to weeks
C) After 3 weeks
D) After 1 month

Question 29

Which of the following is an indirect injury that can cause ARDS?

A) Pneumonia
B) Lung contusion
C) High concentrations of oxygen
D) Transfusions

Question 30

Which of the following explains the basis for permissive hypercapnia as a ventilator strategy for ARDS?

A) Introduction of CO₂ into the breathing circuit to stimulate spontaneous breaths.
B) Use of lower tidal volumes and accepting a gradual rise in PCO₂ to avoid associated hazards of high P_aw.
C) Allow patients with ARDS to breathe spontaneously to build their respiratory muscular endurance.
D) To use exhaled CO₂ to increase residual volume and improve gas exchange.