PULMO EXAM MY PART Flashcards
What is the next step for a 72-year-old man on mechanical ventilation with an FiO₂ of 40%, PEEP of 5 cmH₂O, and SaO₂ of 92%?
B) Perform a spontaneous breathing trial (SBT)
The patient is stable with minimal secretions and awake, indicating readiness for SBT.
What is the best strategy for a 70-year-old man with COPD who successfully passes an SBT?
B) Extubate and start noninvasive ventilation (NIV)
The patient’s history of congestive heart failure and APACHE-II score of 14 suggests a need for additional support post-extubation.
Which patient is at the highest risk for post-extubation respiratory failure?
A) 68-year-old with BMI of 32, COPD, and 10 days on mechanical ventilation
Higher BMI and prolonged ventilation increase the risk.
What is the minimum PEEP required before considering extubation for a patient on mechanical ventilation?
A) 10 cmH₂O
PEEP helps maintain alveolar recruitment and oxygenation.
Which criteria must be met before attempting a spontaneous breathing trial (SBT)?
A) Stable hemodynamics, minimal secretions, awake
These factors indicate the patient can tolerate SBT.
What is the best next step for a 62-year-old woman with sepsis-induced ARDS on low-dose norepinephrine and appropriate respiratory parameters for SBT?
B) Proceed with SBT on low-dose norepinephrine
It’s acceptable to conduct SBT even with low-dose vasopressors.
Which ventilatory mode is best for a 72-year-old male with ARDS requiring lung-protective ventilation?
B) Assist control–volume control (AC-VC)
AC-VC controls tidal volume and reduces the risk of barotrauma.
What is the most appropriate ventilatory mode for a 50-year-old male with Guillain-Barré Syndrome requiring full ventilatory support?
B) AC-VC
This mode provides full support for neuromuscular failure patients.
What is a limitation of Volume Control ventilation?
C) Inspiratory pressures can be high
High pressures may lead to barotrauma.
Which mode allows the patient to control their respiratory effort?
B) Pressure Support Ventilation (PSV)
PSV supports spontaneous efforts by providing pressure assistance.
Which of the following would be a contraindication to NIV in a patient with severe dyspnea and increased work of breathing?
B. Severe upper gastrointestinal bleeding
This condition poses a high risk for NIV failure.
If a patient with severe dyspnea has difficulty clearing respiratory secretions, what is the most appropriate action?
B. Intubate and initiate mechanical ventilation
Difficulty clearing secretions can worsen respiratory failure.
Which of the following is NOT a cause of Type II (hypercapnic) respiratory failure?
A) Pulmonary embolism
Pulmonary embolism typically causes Type I respiratory failure.
Which strategy is used for permissive hypercapnia?
C) Accept pH ≥7.2 and avoid high tidal volumes
This approach allows for higher CO₂ levels to reduce lung injury.
What is the optimal respiratory rate for ventilated COPD patients?
B) 9-12 breaths/min
This rate helps minimize CO₂ retention.
What is the best management option for a 40-year-old female with moderate persistent asthma experiencing nighttime awakenings?
A) Increase ICS/LABA dose or switch to a different combination therapy
Nighttime awakenings >2 times/month indicate poor control.
What is the best next step for a 48-year-old male with severe asthma and multiple risk factors for asthma mortality?
A) Admit the patient to the ICU and consider early intubation
High risk for severe exacerbation warrants close monitoring.
What is the most likely diagnosis for a 29-year-old male with chronic cough, hemoptysis, eosinophilia, and a history of swimming in freshwater lakes?
B) Schistosomiasis
Exposure to freshwater in endemic areas suggests this diagnosis.
What is the most appropriate next step for a 65-year-old man with CHF and a transudative pleural effusion?
B) Treat for congestive heart failure
CHF is the most common cause of transudative effusions.
What is the most likely diagnosis for a 32-year-old male with a large anterior mediastinal mass and elevated serum AFP and β-hCG levels?
B) Teratoma
Elevated tumor markers indicate a germ cell tumor.
Which of the following is the most likely diagnosis for a 45-year-old female with chronic back pain and a mass in the posterior mediastinum?
B) Neurogenic tumor
Neurogenic tumors are common in this region.
How would you classify the severity of OSA for a 52-year-old male with an AHI of 18 events/hour?
B) Moderate OSA
Moderate OSA is defined as AHI of 15-29 events/hour.
What best describes a respiratory event with cessation of airflow for ≥10 seconds without respiratory effort?
B) Central apnea
Central apnea indicates a lack of respiratory effort.
What is the most appropriate classification for an event with ≥30% reduction in airflow lasting ≥10 seconds without complete cessation of airflow?
B) Hypopnea
Hypopnea is characterized by reduced airflow with desaturation.
What is the MOST LIKELY reason a 58-year-old male may not be a good candidate for lung transplantation?
D) History of noncompliance with medical treatment
Adherence is critical for post-transplant success.
How does a BMI <18 kg/m² impact lung transplant candidacy?
B) BMI <18 kg/m² is a relative contraindication to lung transplantation
Underweight patients have poorer outcomes post-transplant.
What is true about a 60-year-old male with a PaO₂/FiO₂ ratio of 320 on PEEP 5 cm H₂O regarding lung donation?
C) He is still eligible for lung donation because his PaO₂/FiO₂ ratio is >300
Ideal lung donors typically have a PaO₂/FiO₂ >300.
What is the MOST appropriate diagnosis for a 65-year-old male with acute respiratory failure and bilateral pulmonary opacities post-abdominal surgery?
A) Cardiogenic pulmonary edema
The normal left ventricular function rules out cardiogenic causes.
What is the PaO₂/FiO₂ ratio for moderate ARDS?
PaO₂/FiO₂ ratio between 100-200 mmHg
This is part of the Berlin criteria for ARDS classification.
What type of pulmonary edema is suggested by elevated BNP and reduced LVEF?
Cardiogenic pulmonary edema
This condition indicates heart failure rather than ARDS.
What is the gold standard ventilatory strategy for ARDS?
Low tidal volume ventilation (≤6 mL/kg predicted body weight)
This strategy reduces ventilator-induced lung injury and mortality.
True or False: Prone positioning improves survival in moderate-to-severe ARDS.
True
Prone positioning is recommended to improve oxygenation and reduce mortality.
Inhaled nitric oxide may transiently improve oxygenation but does not improve _______.
survival
It is not routinely recommended in ARDS treatment.
What hemodynamic profile is characteristic of distributive shock?
↓ CVP, ↓ PCWP, ↑ CO, ↓ SVR
This profile is commonly seen in sepsis, anaphylaxis, or neurogenic shock.
What causes cardiogenic shock?
Pump failure
It leads to increased CVP and PCWP, decreased cardiac output, and increased SVR.
What type of shock is indicated by right ventricular dilation on echocardiogram?
Obstructive shock
Commonly caused by pulmonary embolism, cardiac tamponade, or tension pneumothorax.
What is the PaO₂/FiO₂ ratio for severe ARDS?
PaO₂/FiO₂ < 100 mmHg
This classification is also part of the Berlin criteria.
What is a common cause of cardiogenic shock?
Acute myocardial infarction
It is linked to severe left ventricular dysfunction.
What is the significance of increased PCWP in a patient?
Indicates pulmonary congestion
This is often seen in cardiogenic shock.
What are the signs of hypovolemic shock?
Low blood pressure and high heart rate
It is characterized by inadequate circulating volume.
What is the most likely diagnosis for a patient with PaO₂/FiO₂ = 120 mmHg and bilateral pulmonary opacities?
Moderate ARDS
This is based on the Berlin criteria for ARDS classification.
What does an elevated PCWP indicate?
Increased left atrial pressure
This can suggest heart failure or volume overload.
Which condition is characterized by warm extremities and hypotension?
Distributive shock
Commonly associated with sepsis.
What ventilatory strategy should be avoided in ARDS?
High tidal volume ventilation
It can lead to ventilator-induced lung injury.
What is the effect of prone positioning on oxygenation in ARDS?
It improves oxygenation
Particularly beneficial in moderate-to-severe cases.
What does a high cardiac output with low systemic vascular resistance indicate?
Distributive shock
This profile is often seen in septic shock.
