Question 1

Which of the following clinical findings is most typical for ARDS patients?&#10;A)Wheezing,cough,fever&#10;B)Dyspnea,tachypnea,crackles&#10;C)Tachycardia,wheezing,prolonged expiratory time&#10;D)Deep and fast breathing with cyanosis

Accepted Answer

Dyspnea (shortness of breath), tachypnea (rapid breathing), and crackles (abnormal lung sounds) are the most typical clinical findings in patients with ARDS. Wheezing, fever, tachycardia, and cyanosis may also be present but are not as specific to ARDS. Deep and fast breathing with cyanosis may indicate respiratory distress, but it is not specific to ARDS.

Question 2

When ARDS was first recognized the mortality rate was about 90%.What is the mortality rate currently?&#10;A)It remains about 90%&#10;B)About 60-75%&#10;C)About 35-40%&#10;D)25%

Accepted Answer

The mortality rate for ARDS has decreased over time and is currently estimated to be about 35-40%, reflecting improvements in supportive care and management strategies.

Question 3

Which of the following measurements is obtainable only with a Swan-Ganz catheter? A)PCWP B)SaO₂ C)CVP D)None of the above (all are obtainable with a Swan-Ganz catheter)

Accepted Answer

Pulmonary capillary wedge pressure (PCWP) is obtained only through a Swan-Ganz catheter as it allows direct measurement of pressure within the pulmonary artery. Choice B is not a valid measurement. Choice C, central venous pressure (CVP), can also be obtained through other methods such as peripheral venous catheterization or a central venous line. Therefore, the correct answer is A.

Question 4

What is the primary reason patients with ARDS have refractory hypoxemia?&#10;A)Diffuse microatelectasis and shunting&#10;B)Diffuse edema and   mismatching&#10;C)Bronchospasm and   mismatching&#10;D)Pulmonary hypertension

Accepted Answer

Patients with ARDS have diffuse microatelectasis and shunting, which is the primary reason for refractory hypoxemia. This is because there is decreased gas exchange and ventilation-perfusion (V/Q) matching in the lungs. Other factors such as fluid accumulation in the alveoli and pulmonary hypertension may exacerbate the hypoxemia, but they are not the primary reason for it.

Question 5

Which of the values below for f/Vt ratio during spontaneous breathing is most indicative of success?&#10;A)>200&#10;B)<100&#10;C)<50&#10;D)< or = 300-350

Accepted Answer

The answer of Which of the values below for f/Vt...

Question 6

Which of the following is a common cause of acute lung injury?&#10;A)Sepsis&#10;B)Severe trauma&#10;C)Aspiration&#10;D)All the above

Accepted Answer

All of the above are common causes of acute lung injury. Sepsis can cause inflammation throughout the body and damage the lungs, severe trauma can directly damage the lungs or cause aspiration, and aspiration can introduce foreign material into the lungs and trigger an inflammatory response.

Question 7

All of the following are side effects of PEEP except:&#10;A)Decreased lung compliance from overdistended alveoli&#10;B)Barotrauma&#10;C)Increased cardiac output&#10;D)Increased PVR

Accepted Answer

PEEP (positive end-expiratory pressure) is a ventilation strategy used in critically ill patients to improve oxygenation. It involves applying a positive pressure at the end of expiration to open up collapsed alveoli and keep them open, preventing lung collapse. However, PEEP can also have several side effects, including decreased lung compliance and the risk of barotrauma (such as pneumothorax or air leak). Additionally, PEEP can affect hemodynamics, causing an increase in cardiac output due to improved oxygenation, but it typically leads to a decrease in pulmonary vascular resistance (PVR) due to recruitment of collapsed capillaries and veins. Therefore, the only option that is not a side effect of PEEP is C (increased cardiac output).

Question 8

Your patient presents with bilateral pulmonary edema as a consequence of acute lung injury.Which of the following is the least likely finding? A)Increased pulmonary wedge pressure B)Normal sized heart on x-ray C)PaO₂/FIO₂ ratio <200 D)Increased pulmonary capillary permeability

Accepted Answer

Increased pulmonary wedge pressure is more indicative of cardiogenic causes of pulmonary edema, such as heart failure, rather than acute lung injury, which typically involves normal pulmonary wedge pressure.

Question 9

What plateau pressure should you accept while mechanically ventilating an ARDS patient to avoid barotrauma?&#10;A)Below 20 cwp&#10;B)Below 30 cwp&#10;C)Below 40 cwp&#10;D)Below 50 cwp

Accepted Answer

The recommended plateau pressure to avoid barotrauma while mechanically ventilating an ARDS patient is below 30 cm H2O. This is based on lung-protective ventilation strategies aimed at minimizing ventilator-induced lung injury.

Question 10

All the following statements are true regarding the use of static compliance measurements in monitoring the ARDS patient except:&#10;A)Is indicative of lung stiffness only&#10;B)Is obtained with the following formula: Cst = Vt / (Pstat-PEEP)&#10;C)Is obtained using a short inspiratory hold after a volume-limited breath&#10;D)Plateau pressures of <30 cwp are usually indicative of acceptable static compliance in the adult

Accepted Answer

Static compliance measurements in ARDS patients provide information about the overall compliance of the respiratory system, which includes both lung and chest wall compliance, not just lung stiffness.

Question 11

Your ARDS patient is being mechanically ventilated with PEEP.The PEEP is increased from 10 cwp to 15 cwp.Subsequently,the mixed venous PO₂ drops from 40 mmHg to 32 mm Hg.What does this indicate? A)PaO₂ dropped B)Cardiac output dropped C)PEEP should be increased more D)The FIO₂should be increased

Accepted Answer

The answer of Your ARDS patient is being mechanically ventilated...

Question 12

What is the normal static compliance? A)60-100 cm H₂O/mL B)20-40 mL/cm H₂O C)20-40 cm H₂O/mL D)60-100 mL/cm H₂O

Accepted Answer

The answer of What is the normal static compliance?&#10;A)60-100 cm...

Question 13

All of the following are indicative of failure in an ARDS patient being weaned from a mechanical ventilator except: A)>20% change in blood pressure,heart rate,or respiratory rate B)Drop in SpO₂ C)Decrease in P(A-a)O₂ D)Decreased sensorium

Accepted Answer

The answer of All of the following are indicative of...

Question 14

Which of the following is NOT true regarding "permissive hypercapnia" in managing your ARDS patients? A)Volumes should be kept low,but pH kept >7.20 B)Use of volumes which keep plateau pressures <30 cm C)PaCO₂ can be allowed to be as high as 100 mmHg as long as pH is corrected with NaHCO₃- D)Pressure-limited ventilation is acceptable in some,but not all cases

Accepted Answer

The answer of Which of the following is NOT true...

Question 15

Initial ventilatory strategy includes all of the following except: A)Vt of 5-7 ml/kg B)Use of PEEP C)Paralysis in all patients,at least initially D)Plateau pressures <30 cm H₂O

Accepted Answer

The answer of Initial ventilatory strategy includes all of the...

Deck 11: Acute Respiratory Distress Syndrome