CRITICAL CARE MEDICINE

Question 1

Give the type of respiratory failure.

• Result of atelectasis

• Perioperative respiratory failure

Answer 1

Type III

Question 2

In the presence if an increased A-a gradient, if the PaO2 is correctible with O₂ what is the possible cause? Give examples.

Answer 2

V/Q mismatch.

• airway disease (asthma, COPD)
• interstitial lung disease
• Alveolar disease (atelectasis, pneumonia, pulmonary edema)
• Pulmonary vascular disease

Question 3

Give the type of respiratory failure.

• Results from hypoperfusion of respiratory muscles in shock
• Intubation and mechanical ventilation allow redistribution of cardiac output away from respiratory muscles and back to other vital organs while shock is treated

Answer 3

Type IV

Question 4

DIAGNOSTIC CRITERIA FOR ARDS (BERLIN CRITERIA)

Answer 4

• Acute onset: within 1 week of known clinical insult
• CXR: Bilateral alveolar or interstitial infiltrates (NOT fully explained by effusion, consolidation or atelectasis)
• Absence of left atrial hypertension (PCWP < 18mmHg)

• Severity

o PaO 2 /FiO2 200-300 = mild

o PaO 2 /FiO2 100-200 = moderate

o PaO 2 /FiO2 <100 = severe

Question 5

What is the inotropic drug of choice in cardiogenic shock ?

Answer 5

Dobutamine

Question 6

Give the type of respiratory failure.

• Hypercarbic respiratory failure (PCO2 >45- 50mmHg)
• Diminished CNS drive to breathe: drug overdose, brainstem injury, sleep disorders, hypothyroidism
• Reduced neuromuscular strength: myasthenia gravis, GBS, ALS, phrenic nerve injury, myopathy, fatigue, electrolyte abnormalities
• Increased load to respiration: bronchospasm, alveolar edema, atelectasis, pneumothorax, pleural effusion, pulmonary embolism, sepsis

Answer 6

Type II

Question 7

Oxygenation is monitored by ____

Answer 7

O2 saturation and PaO2

Question 8

In the presence if an increased A-a gradient, if the PaO2 is NOT correctible with O2 what is the possible cause? Give examples.

Answer 8

Shunt (right-to-left)

• intracardiac shunt
• vascular shunt within lungs

Question 9

What is the most urgent step in cardiogenic shock?

Answer 9

Fluid resuscitation

Question 10

Acute CHF management:

Answer 10

LMNOP = Lasix (furosemide), Morphine, Nitrates, Oxygen, Position (sit upright)

Question 11

How will you increase increase oxygenation?

Answer 11

Increase FiO2 ­and PEEP

Question 12

How will you increase ventilation?

Answer 12

Increase Respiratory rate ­or Tidal volume

Question 13

Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality

Answer 13

Septic Shock

Question 14

Life-threatening organ dysfunction caused by a dysregulated host response to infection

Answer 14

SEPSIS

Question 15

What is the cause of an increased PCO2 in the presence of a normal A-a gradient?

Answer 15

Hypoventilation

• decrease inspiratory drive
• neuromuscular disease

Question 16

Ventilation is monitored by ____

Answer 16

PaCO2

Question 17

How will you manage sepsis?

Answer 17

Question 18

MOST common side effect of all VASODILATING agents

Answer 18

Hypotension

Question 19

What mechanical ventilator strategy has shown improvement in survival of patients with ARDS?

Answer 19

Low tidal volume

Question 20

What is the vasopressor of choice in cardiogenic shock?

Answer 20

Norepinephrine

Question 21

Give the type of repiratory failure.

• Acute hypoxemic respiratory failure (PaO2 <55-60mmHg)
• From alveolar flooding and/or intrapulmonary shunting
• Pulmonary edema, pneumonia, alveolar hemorrhage, ARDS

Answer 21

Type I