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Pulmonology > ARDS > Flashcards

ARDS Flashcards

1
Q

Trauma patients with an Acute Physiology and Chronic Health Evaluation (APACHE) II score ____(Chap. 300) have a 2.5-fold increased risk of developing ARDS.

A

≥16

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2
Q

Encompasses first 7 days of illness after exposure to a precipitating ARDS risk factor, with the patient experiencing the onset of respiratory symptoms.

A

Exudative phase

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3
Q

This phase of ARDS usually lasts from approximately day 7 to day 21.

A

Proliferative Phase

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4
Q

Historically, the first signs of resolution are often evident in this phase, with the initiation of lung repair, the organization of alveolar exudates.

A

Proliferative

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5
Q

There is a shift from neutrophil- to lymphocyte-predominant pulmonary infiltrates

A

Proliferative

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6
Q

There is marked disruption of acinar architecture leading to emphysema-like changes, with large bullae.

A

Fibrotic

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7
Q

The physiologic consequences include an increased risk of pneumothorax, reductions in lung compliance, and increased pulmonary dead space.

A

Fibrotic

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8
Q

Increased proinflammatory cytokines: interleukin-1, interleukin-8, tumor necrosis factor-α (TNF-α)

A

Exudative phase

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9
Q

Which of the following best describes the primary pathophysiologic process occurring during the exudative phase of ARDS?

A. Hypersecretion of mucus in the airways
B. Hypertrophy of alveolar epithelial cells
C. Injury to alveolar capillary endothelial cells and type I pneumocytes
D. Fibrosis of alveolar spaces

A

C

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10
Q

What characteristic feature of alveolar histology is commonly seen during the exudative phase of ARDS?

A. Smooth muscle hypertrophy
B. Hyaline membrane formation
C. Thickened alveolar walls with fibroblast proliferation
D. Accumulation of mucus plugs

A

B

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11
Q

Which of the following best explains why patients with ARDS experience hypoxemia during the exudative phase?

A. Increased airway resistance due to mucus plugging
B. Decreased surfactant synthesis causing airway collapse
C. Increased intrapulmonary shunting from alveolar collapse
D. Bronchospasm causing reduced airflow

A

C

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12
Q

Which of the following findings on chest radiograph is most characteristic of the exudative phase of ARDS?

A. Unilateral lung consolidation
B. Cardiomegaly with pleural effusions
C. Bilateral diffuse opacities without cardiomegaly
D. Clear lung fields with hyperinflation

A

C

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13
Q

Which pulmonary vascular complication commonly occurs during the exudative phase of ARDS?

A. Pulmonary embolism
B. Bronchial artery hypertrophy
C. Microvascular thrombosis
D. Aneurysm formation

A

C

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14
Q

Which of the following is a key early symptom of ARDS during the exudative phase?

A. Hemoptysis
B. Rapid shallow breathing and dyspnea
C. Chest pain radiating to the jaw
D. Productive cough with green sputum

A

B

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15
Q

Which imaging modality can best demonstrate heterogeneous lung involvement in ARDS?

A. Chest X-ray
B. Chest computed tomography (CT)
C. Pulmonary angiography
D. Ventilation-perfusion (V/Q) scan

A

B

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16
Q

Many patients recover rapidly and are liberated from mechanical ventilation during this phase.

A

Proliferative

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17
Q

Type II pneumocytes proliferate along the alveolar basement membranes as part of the reparative process.

A

Proliferative

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18
Q

3–4 Weeks After Initial Pulmonary Injury

A

Fibrotic

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19
Q

Which of the following processes best describes the histologic changes seen in the proliferative phase of ARDS?

A. Alveolar exudate organization and type II pneumocyte proliferation
B. Extensive alveolar duct fibrosis and bulla formation
C. Pulmonary vascular obliteration with intimal fibroproliferation
D. Recruitment of neutrophils into alveolar spaces

A

A

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20
Q

Which of the following pulmonary cells is critical for alveolar repair during the proliferative phase of ARDS?

A. Type I pneumocytes
B. Type II pneumocytes
C. Alveolar macrophages
D. Fibroblasts

A

B

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21
Q

During the proliferative phase of ARDS, which immune cell type predominates in the pulmonary infiltrate?

A. Neutrophils
B. Eosinophils
C. Lymphocytes
D. Basophils

A

C

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22
Q

What clinical finding most likely persists in patients during the proliferative phase of ARDS despite improvement?

A. Hemoptysis
B. Hypercapnia
C. Hypoxemia and tachypnea
D. Pleural effusions

A

C

23
Q

Which of the following best explains why pneumothorax is more common in the fibrotic phase of ARDS?

A. Pleural effusions accumulate in late ARDS.
B. Emphysema-like changes and bullae formation occur.
C. Persistent hypoxemia increases airway pressure.
D. Hypersecretion of mucus causes airway obstruction.

A

B

24
Q

Which of the following physiologic consequences is most likely to occur in the fibrotic phase of ARDS?

A. Increased lung compliance
B. Increased pulmonary dead space
C. Improved gas exchange
D. Reduced work of breathing

A

B

25
Q

Which of the following most strongly predicts a poor prognosis in a patient with ARDS?

A. Proliferative phase with lymphocyte-predominant infiltrates
B. Early use of mechanical ventilation
C. Lung biopsy showing evidence of pulmonary fibrosis
D. Persistent pleural effusions

A

C

26
Q

Use low-tidal-volume ventilation (___mL/kg predicted body weight) with plateau pressure ___ cm H₂O to reduce mortality.

A

6

≤30

27
Q

Prevents alveolar collapse, improves oxygenation, and reduces FiO₂ requirements.

A

PEEP

28
Q

Caused by alveolar overdistention from excessive tidal volume (Vt).

A

Volutrauma

29
Q

Which of the following best describes the primary goal of using low-tidal-volume ventilation (LTVV) in ARDS patients?

A. To improve airway clearance
B. To reduce barotrauma and volutrauma
C. To minimize atelectasis
D. To reduce oxygen consumption

A

B

30
Q

Which of the following best explains how positive end-expiratory pressure (PEEP) improves oxygenation in ARDS?

A. By increasing cardiac output
B. By reducing alveolar fluid accumulation
C. By maintaining alveolar patency at end-expiration
D. By enhancing diaphragmatic contractility

A

C

31
Q

In the ARDS Network Trial, what maximum plateau pressure was targeted in the low-tidal-volume group to reduce mortality in mechanically ventilated ARDS patients?

A. ≤20 cm H₂O
B. ≤25 cm H₂O
C. ≤30 cm H₂O
D. ≤50 cm H₂O

A

C

32
Q

Which of the following was a key finding of the 2013 trial on prone positioning in patients with severe ARDS (PaO₂/FiO₂ <150 mmHg)?

A. Improved oxygenation with no change in mortality
B. Reduced 28-day mortality from 32.8% to 16.0%
C. Reduced need for mechanical ventilation
D. Reduced risk of nosocomial infection

A

B

33
Q

Which of the following settings is most appropriate when using low-tidal-volume ventilation for a patient with ARDS?

A. Tidal volume of 10 mL/kg of predicted body weight
B. Tidal volume of 8 mL/kg of actual body weight
C. Tidal volume of 6 mL/kg of predicted body weight
D. Tidal volume of 6 mL/kg of actual body weight

A

C

34
Q

Which of the following clinical scenarios indicates optimal PEEP titration in a mechanically ventilated patient with ARDS?

A. Reduced FiO₂ requirement while maintaining adequate oxygenation
B. Improved cardiac output and reduced heart rate
C. Increased plateau pressure to ≥40 cm H₂O
D. Increased respiratory rate with reduced PaCO₂

A

A

35
Q

Maintaining a ____ minimizes pulmonary edema and prevents further decrements in arterial oxygenation and lung compliance; improves pulmonary mechanics; and shortens ICU stay and the duration of mechanical ventilation.

A

low left atrial filling pressure

36
Q

___ lung injury (Higher Mortality):
Nearly twice the risk of death compared to ____ causes.

A

Direct

indirect

36
Q

In a multicenter, randomized, placebo-controlled trial of early neuromuscular blockade (with _____) for 48 h, patients with severe ARDS had increased survival and ventilatorfree days without increasing ICU-acquired paresis. A

A

cisatracurium besylate

37
Q

What is the primary goal of fluid management in patients with ARDS?

A. To increase preload and improve cardiac output
B. To reduce left atrial filling pressure and minimize pulmonary edema
C. To maintain a high central venous pressure (CVP)
D. To promote diuresis regardless of organ perfusion

A

B

38
Q

Which of the following best guides fluid management in ARDS patients?

A. Maximizing central venous pressure (CVP)
B. Aggressive diuresis regardless of hemodynamic status
C. Fluid restriction and diuretics, limited by hypotension or hypoperfusion
D. Increasing FiO2 to improve lung compliance

A

C

39
Q

Which mechanism leads to fluid accumulation in the lungs in ARDS?

A. Increased hydrostatic pressure from left atrial pressure
B. Decreased pulmonary vascular permeability
C. Impaired alveolar surfactant production
D. Increased pulmonary vascular permeability

A

D

40
Q

Which neuromuscular blocking agent was used in a clinical trial that demonstrated improved survival and ventilator-free days in severe ARDS patients?

A. Vecuronium
B. Pancuronium
C. Cisatracurium besylate
D. Rocuronium

A

C

41
Q

Which of the following best summarizes the findings of a subsequent trial on early neuromuscular blockade (NMB) in moderate-to-severe ARDS?

A. It demonstrated improved survival in all ARDS patients.
B. It showed no mortality benefit but supported selective use in certain patients.
C. It recommended routine NMB use in ARDS for at least 72 hours.
D. It showed an increased risk of ICU-acquired paresis.

A
42
Q

Which of the following statements best reflects the recommendation on glucocorticoids in non-COVID-19 ARDS?

A. They are recommended as first-line therapy.
B. They should be used only in mild ARDS.
C. Their use is not routinely recommended.
D. They are indicated only after 10 days of mechanical ventilation.

A

C

43
Q

What is the initial step in the management of acute respiratory distress syndrome (ARDS) according to the algorithm?

A. Begin diuresis
B. Correct acidosis
C. Initiate volume/pressure-limited ventilation
D. Optimize mean arterial pressure (MAP)

A

C

44
Q

Which of the following is the recommended maximum tidal volume for ARDS patients, according to the algorithm?

A. ≤8 mL/kg PBW
B. ≤10 mL/kg PBW
C. ≤6 mL/kg PBW
D. ≤12 mL/kg PBW

A

C

45
Q

What is the target range for arterial oxygen saturation (SpO₂) in ARDS patients based on the algorithm?

A. 75–85%
B. 88–95%
C. 90–100%
D. 85–92%

A

B

46
Q

What is the recommended maximum fraction of inspired oxygen (FiO₂) for ARDS management?

A. ≤0.4
B. ≤0.5
C. ≤0.6
D. ≤0.7

A

C

47
Q

What is the target arterial pH for ARDS patients according to the algorithm?

A. ≥7.20
B. ≥7.25
C. ≥7.30
D. ≥7.35

A

C

48
Q

What is the recommended maximum respiratory rate (RR) for ARDS patients to ensure lung-protective ventilation?

A. ≤25 bpm
B. ≤30 bpm
C. ≤35 bpm
D. ≤40 bpm

A

C

49
Q

What is the target mean arterial pressure (MAP) for ARDS patients to ensure adequate tissue perfusion?

A. ≥50 mmHg
B. ≥55 mmHg
C. ≥60 mmHg
D. ≥65 mmHg

A

D

50
Q

Which of the following therapies has the strongest evidence (Grade A recommendation) for use in ARDS?

A. Recruitment maneuvers
B. Low tidal volume ventilation
C. High-frequency ventilation
D. Glucocorticoid treatment

A

B

51
Q

What are the grade B recommendation in ARDS management?

A

Minimize left atrial filling pressures
High PEEP or “open lung”
Prone Position
ECMO

52
Q
A

Pulmonology (11 decks)

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