08.14 - ARDS (Muthiah) - Questions

Question 1

Berlin Criteria

Answer 1

(1) Acute Onset of Respiratory Failure; (2) Bilateral Infiltrates; (3) No evidence of Volume overload; (4) PaO2/FiO2 < 300

Question 2

Cells damaged in ARDS

Answer 2

Capilary Endothelial, Alveolar Epithelial

Question 3

Character of edema in ARDS

Answer 3

Protein-rich

Question 4

Surfactant in ARDS

Answer 4

Dysfunctional

Question 5

Most common direct cause of ARDS

Answer 5

Pneumonia

Question 6

Most common indirect cause of ARDS

Answer 6

Sepsis

Question 7

What is TRALI

Answer 7

Transfused blood has antibodies to white blood cells

Question 8

Stages of ARDS (no time)

Answer 8

(1) Exudative; (2) Proliferative; (3) Fibrotic; (4) Recovery

Question 9

4 predictors of worse outcome

Answer 9

(1) Chronic Liver Disease; (2) Non-pulmonary organ dysfunction; (3) Sepsis; (4) Advanced age

Question 10

Which is more susceptible to injury: Type 1 or 2 Pneumocyte

Answer 10

Type 1

Question 11

Which can proliferate: Type 1 or 2 Pneumocyte?

Answer 11

Type 2

Question 12

4 components of lung injury score

Answer 12

CXR; PaO2:FIO2; PEEP; Respiratory Compliance

Question 13

How do you improve oxygenation in a patient with ARDS?

Answer 13

Increase the PEEP

Question 14

T/F: Using a pulmonary vasoconstricting agent will improve oxygenation in a patient with ARDS?

Answer 14

FALSE

Question 15

T/F: Decreasing the peak inspiratory flow rate will improve oxygenation in a patient with ARDS?

Answer 15

FALSE

Question 16

What is FRC

Answer 16

Amount of air left in lungs after normal expiration

Question 17

Possible mechanism of improvement in oxygenation with application of PEEP in ARDS

Answer 17

Recruiting atelectatic alveoli and increasing FRC

Question 18

Bigger FRC = ___ oxygenation

Answer 18

better

Question 19

3 situations of Low FRC

Answer 19

Pregnancy, Large Ascites, Really Obese

Question 20

T/F: PEEP reduces lung water in ARDS

Answer 20

FALSE

Question 21

T/F: PEEP increases pulmonary vascular resistance and therefore improves oxygenation

Answer 21

FALSE

Question 22

Compliance in ARDS

Answer 22

Acute decrease in compliance due to edema

Question 23

Recommended tidal volume in ARDS

Answer 23

6 cc / kg

Question 24

T/F: Nitric Oxide administration in patients with refractory hypoxemia reduces mortality

Answer 24

False, but it does improve oxygenation

Question 25

The incidence of pneumothorax as a complication of ARDS is usually seen

Answer 25

After 2 weeks of ARDS onset

Question 26

Death in a patient with ARDS is usually due to

Answer 26

Multi-organ failure from raging inflammation

Question 27

T/F: Refractory Hypoxemia often causes death in ARDS

Answer 27

FALSE

Question 28

Acute onset dyspnea, left sided pleuritic chest pain, purulent sputum since last night

Answer 28

Pneumonia

Question 29

Most likely etiological agent of pneumonia

Answer 29

Strep Pneumoniae

Question 30

Doesn’t respond to supplemental O2

Answer 30

Shunt

Question 31

In ARDS, there is severe hypoxemia due to ___

Answer 31

Shunting

Question 32

Require mechanical ventilation with ___

Answer 32

PEEP

Question 33

Ventilatory defects in ARDS survivors

Answer 33

Mild to moderate restrictive defects, with mild reduction in DLCO; Improve over following year and may normalize