OA CRITICAL care Questions Part 1

Question 1

Is there any difference in Major complications between percutaneous and open trachesotomies?

Answer 1

No difference in MAJOr issues, but a slightly smaller bit of infection with percutaneous

Question 2

Which type of Diabetes is common in the setting of brain death? Why? How to treat?

Answer 2

DI. Leading up to Brain death, the intracranial pressure increases so much that it progressively reduces flow until there is none. Hypothalamic pituitary infarction results in acute vasopressin deficiency followed by polyuria, hypovokenoa, and hypernatremia. You treat it with DDAVP or Vasopressin And titrate to control UOP to less than 300 cc/hr.

Question 3

T/F Hypoalbuminemia can cause a normal anion gap in the presence of lactic acidosis

Answer 3

True

Question 4

Static Lung Compliance-Formula and what does it represent?

Answer 4

Tidal volume/Pplat-PEEP. It represents pulmonary compliance during periods without gas flow such as inspiratory pause

Question 5

Corticosteroids prior to extinction decrease ____ but don’t affect ___

Answer 5

Decrease stridor, don’t affect risk of reintubation

Question 6

ALI vs ARDS, and how to make the diagnosis?

Answer 6

ARDS: PaO2/FiO2 ratio <200
ALI: that ratio is less than 300
Acute onset, B/l infiltrates on chest x ray, hypoxemia, no evidence of cardiac failure (PAP >18), acutely depressed ejection fraction or wall motion abnormalities. Bilateral segmental lung involvement

Question 7

In patients with asthma exacerbation, be careful of _____ which can lead to hypotension, and why?

Answer 7

Auto-Peep/breath stacking. It can lead to house soon because it can increase intrathoracic pressure and thereby decrease venous return to the right side of the heart, leading to increased pulmonary resistance. Oh can disconnect the patient from the ventilator, change I:E ratio to 1:3, go help with this.

Question 8

Why does refereeing syndrome happen?

Answer 8

It happens with the start of nutrition in patients who are severely malnourished. During refeeeing, insulin secretion increases and causes synthesis of glycogen, fat, and protein. But that process requires phosphate, potassium and magnesium which are typically depleted. It’s can have low calcium too. Hypophosphatemia leads to muscle weakness and glucose intolerance.

Question 9

What is CIM? What is it caused by? How does it differ from polyneuropathy?

Answer 9

MCC cause of ICU acquired myopathy. Strongest risk-IV glucocorticoids. Flaccid paralysis is seen. Diff between this and the polyneuropathy-tendon reflexes and sensation are normal in CIM

Question 10

T/F-Daily sedation holidays don’t help the outcomes of intubated patients in ICU

Answer 10

False. They do help

Question 11

Paralytic in the ICU-negatives, positives

Answer 11

Pos-allow for lower TV in patients with ARDS.

Neg-can cause increased incidence of myopathy and polyneuropathy

Question 12

DI in brain death can be due to infarction of what?

Answer 12

The posterior hypothalamic pituitary-resulting in decrease in ADJ-hypovolemia, and hypernatremia and polyuria

Question 13

When used I the ICU; Compared to ______, precedex causes LESS delirium

Answer 13

Benzodiazepines

Question 14

What’s the first line pressor for sepsis in ICU? With what MAP goal?

Answer 14

Levo-norepinephrine-keeping maps at or greater than 65

Question 15

Vancomycin covers which organism?

Answer 15

Penicillin resistant gram positives

Question 16

Beta lactam plus an aminoglycoside or fluoroquinokone covets

Answer 16

Resistant pseudomonas

Question 17

Echinocandin therapy (micafungin) is first line for what?

Answer 17

Antifungal

Question 18

T/F-albumin, transferrin, and other protein markers can be used to evaluate nutrition status

Answer 18

False

Question 19

In ARDS, peep goals and plateau pressure goals?

Answer 19

Peep-at least 5. Goals between 5-12. Plateau pressure-less than 30

Question 20

What is plateau pressure?

Answer 20

Pressure applied to small airways and alveoli

Question 21

Diagnostic morality of choice for intial assessment of alcalculous chokecystitis?

Answer 21

Ultrasound. If wall is thicker than 3.5 mm. CT is equally diagnostic, but requires transportation

Question 22

T/F, IABP puts you at risk for compartment syndrome?

Answer 22

True

Question 23

Stress ulcer prophylaxis is good, but what… And then, what role does sulcrufate play? Why avoid PPIs?

Answer 23

Can increase gastric volume, allowing for colonization of the gastric mucosa. Sucrulfate can increase pH without increasing volume, but it’s not as effective as H2 blockers and is associated with an increased risk of GI bleeding. PPIs are associated with an increase in VAP and should be avoided.

Question 24

In addition to decreased venousbrwturn, what else (3 things) does PEEP do that lowers the cardiac output?

Answer 24

Shifts IV septum left, decreased LV compliance, increased PVR from over distention of alveolar sacs

Question 25

Abdominal compartment syndrome occurs when: ___. Increased abdominal pressure leads to:

Answer 25

There is increased abdominal pressure in a closed abdomen leading to decreased venous return and cardiac output as well as decreased visceral blood flow, RBF, and GFR. Increased ab pressure leads to increased PCWP, CVP, systemic vascular resistance, Peak inspiratory pressure, and intrapleural pressure.

Question 26

Clinical presentation of abdominal compartment syndrome:

Answer 26

Hypotension, hypoxia (due to increased peak airway pressure), oliguria due to decreased RBF.

Question 27

How do you diagnose it?

Answer 27

Measure bladder pressure. 25-35 mmHg=urgent, greater than 35 mmHg=emergent

Question 28

How to differentiate between a patient with Aortic dissection vs ab compartment syndrome?

Answer 28

Pt with aortic dissection will develop decreased venous return and CVP due to hypovolemia. Pt with CS will have increased peak inspiratory pressures

Question 29

In a pt with new onset seizures, what needs to be ruled out immediately?

Answer 29

CNS infection. CSF for cell count, protein, glucose, gram stain, and culture. PCR for HSV should be performed.

Question 30

NMS (Neuroleptic malignant syndrome) clinical presentation? What lab values will they have? why?

Answer 30

Muscle rigidity, AMS, tremors, trismus, hyperthermia, and autonomic instability (orthostatic hypotension). Will have elevated CK concentration due to rhabdomyolysis. D/t dopaminergic blockade and skeletal muscle defect.

Question 31

Pt with ARDS, best to feed (protein vs carb) and (trophic vs full)?

Answer 31

Protien based formula full feeds. why? Because excess carbs can contribute to respiratory distress

Question 32

Cerebral vasospasm-pt with aneurysmal subarachnoid hemorrhage is 5 days s/p clipping, and acutely develops left sided weakeness. What do you want to order?

Answer 32

Order a CT with CT angio. it can rule out hydrocephalus, can r/o a new intracranial hemmorrhage, and assess the vasculature for narrowing/vasospasm

Question 33

How can you treat a patient with hyperchloremic metabolic acidosis-most likely due to NaCl administration?

Answer 33

Can be treated with sodium bicarbonate. Excessive chloride admin is associated with AKI

Question 34

Which antibody is associated with HIIT?

Answer 34

IgG

Question 35

What is HIIT? Type 1 vs 2? Treatment? What to not give?

Answer 35

> 50% reduction in platelet count that typically occurs 4-10 days after exposure to heparin. Type 1: minimal thrombotic risk. Type 2. Immunologically mediated, may lead to catastrophic thrombosis. ALL heparin must be stopped. Can treat with argatroban-a direct thrombin inhibitor. Warfarin contraindicated d/t risk of warfarin necrosis. (anticoagProtein C is depleted, so natural microthrombosis associated with use of warfarin w/out other anticoagulation

Question 36

Treatment for CVA caused by air?

Answer 36

Hyperbaric oxygen chamber

Question 37

Proportional assist ventilation: AKA: ____, and what does it do?

Answer 37

AKA proportional pressure support, it requires patient to take spontaneous breath, but adjusts the amount of pressure provided to match the patient’s level of inspiratory effort.

Question 38

Which disease has a higher rate of transmission via needle sticks? And what should haealthcare workers vaccinated for this have?

Answer 38

Hepatitis B. Healthcare workers who receive HBV vaccine should have postvaccination serologic testing for anti HBS approx 1-2 mos following last vaccination with anti-HBs titer greater than 10 representing a positive seroconverson. If this has happened, theres no need for postexposure prophylaxis.

Question 39

What’s good for prophylactic tx following needle stick injury?

Answer 39

HBIG. it contains neutralizing antibodies that act immediately. HBV vaccine can be used as postexposure prophylaxis to augment the effects of HBIG

Question 40

what are normal carboxyhemoglobin levels for smokers vs non-smokers?

Answer 40

For smokers: 4-9%, for non-smokers: 0.5-3%

Question 41

When do ppl require tx for carboxyhemoglobin?

Answer 41

Less (or more?) than 10% and also asymptomatic. Sxs: headache, nausea, vomiting, dizziness.

Question 42

Type A vs B Aortic dissection

Answer 42

Type A: Ascending portion of aorta. Type B: Descending portion of aorta

Question 43

Signs of sodium nitroprusside toxicity: _______. What most strongly supports it?

Answer 43

tachyphylaxis, tachycardia, hypertension, arrhythmias, neurologic dysfunction. metabolic acidosis on ABG is most strong supporter. Mixed venous O2 sat can also be increased. KIM normal mixed venous Oxygen is between 65-75%

Question 44

Fluconazole is primarily active against which fungi? it has no activity against what?

Answer 44

Candida. It has no activity against molds.

Question 45

Which IV fluid is most associated with improved oxygenation in patients with ARDS in the first 48 hours?

Answer 45

Albumin, but after 48 hours, it has not been shown to be effective for improving oxygenation in this subset of patients.

Question 46

What is oliguria?

Answer 46

Less than 0.5 ml/kg/hr of urine

Question 47

How does FENa help us wiht anything?

Answer 47

It is useful in distinguishing between prerenal and inrinsic renal causes of oliguria. you calculate serum and urinary sodium and creatinine levels. Less than 1%= prereanl problem such as hypotension or hypovolemia. Greater than 2%=intrinsic renal problem such as acute tubular necrosis.

Question 48

In the setting of diuretic use, is FENa helpful?

Answer 48

it is better to use fractional excretion of urea then

Question 49

Supplemental parenteral nutrition most likely benefits critically ill patients by reducing:

Answer 49

nosocomial infections, reducing antibiotic use, and having a shorter duration of mechanical ventilation.

Question 50

SIRS:

Answer 50

Temp less than 36, RR >20, >10% bands

Question 51

Give the sodium content of Albumin, 0.5 NaCL, LR, Plasmalyte, and Albumin, 0.9% Nacl

Answer 51

Albumin 5%: 154 mEq/L , 0.9% NaCl=154 Meq, 0.5% NacL: 75, LR has 130, Plasmalyte: 140 MEq/L

Question 52

What is most likely to result with abrupt discontinuation of precedex gtt?

Answer 52

Hypertension. Its a selective alpha 2 receptor agonistit causes decreased presynaptic release of catecholamines and decreased stimulation of alpa1 and B adrenergic receptors.

Question 53

What happens if you use precedex for greater than 48 hours?

Answer 53

it can cause downregulation of alpha 2 receptor and up-regulation of the other receptors, so pt can have HTN or hypertensive crisis. Always d/c gradually

Question 54

Best active ingredient for c diff colitis disinfection

Answer 54

Sodium hypochlorite (it has sporicidal activity)