Pulmonary Edema Flashcards
Why does the patient in noncardiogenic pulmonary edema develop hypoxemia?
A. V/Q mismatch
B. Intrapulmonary shunting
C. Sympathetic surge
D. Changes in hydrostatic pressure
Correct Answer: B. Intrapulmonary shunting
Rationale:
In noncardiogenic pulmonary edema, fluid accumulation in the alveoli disrupts normal gas exchange. This leads to areas of the lung that are perfused but not ventilated, creating an intrapulmonary shunt. As a result, blood bypasses oxygenation, leading to severe hypoxemia.
A patient presents with subarachnoid hemorrhage, shortness of breath, anxiety, jugular venous distention, and tachycardia. What type of pulmonary edema do you suspect?
A. Cardiogenic
B. Neurogenic
C. Noncardiogenic
D. Hypoxemic
Correct Answer: B. Neurogenic
Rationale:
Neurogenic pulmonary edema is a well-recognized complication following acute neurological injuries, such as subarachnoid hemorrhage. The sudden surge in sympathetic activity following brain injury can lead to pulmonary capillary leak, resulting in pulmonary edema. Although cardiogenic causes can also produce similar signs, the context of a subarachnoid hemorrhage makes neurogenic pulmonary edema the most likely diagnosis.
Which type of pulmonary edema occurs when there is extravasation of fluid into the interstitial space and alveoli that responds to supplemental oxygen?
A. Cardiogenic
B. Neurogenic
C. Noncardiogenic
D. Hypoxemic
Correct Answer: A. Cardiogenic
Rationale:
In cardiogenic pulmonary edema, elevated hydrostatic pressures cause fluid to leak into both the interstitial space and alveoli. Although this fluid impairs gas exchange, the alveolar-capillary membrane remains relatively intact, allowing supplemental oxygen to improve oxygenation. In contrast, noncardiogenic pulmonary edema—often seen in conditions like ARDS—is typically associated with severe shunting and may not respond as effectively to supplemental oxygen.
Pulmonary Edema / Will Kill)
A patient with acute cardiogenic pulmonary edema presents with severe respiratory distress and hypoxia. Which immediate step prevents rapid deterioration?
A. Administering broad-spectrum antibiotics
B. High-flow oxygen and IV diuretic therapy
C. Avoiding all preload reduction
D. Delaying interventions for imaging
Correct Answer: B. High-flow oxygen and IV diuretic therapy
Rationale:
In acute cardiogenic pulmonary edema, the patient is at high risk for rapid respiratory deterioration due to fluid accumulation in the lungs. Immediate administration of high-flow oxygen improves oxygenation, while IV diuretics help reduce fluid overload and alleviate the pulmonary edema. These steps are critical to stabilize the patient quickly. The other options do not address the immediate life-threatening respiratory compromise.
- (Pulmonary Edema / Will Harm)
In noncardiogenic pulmonary edema, which management error could worsen outcomes?
A. Treating underlying infection if present
B. Conservative fluid management
C. Overzealous fluid administration
D. Checking ABGs
orrect Answer: C. Overzealous fluid administration
Rationale:
In noncardiogenic pulmonary edema, the primary issue is increased capillary permeability rather than fluid overload from the heart. Administering excessive fluids can worsen pulmonary edema by further increasing the extravasation of fluid into the alveoli, thereby exacerbating hypoxemia and respiratory distress. Treating the underlying infection, using conservative fluid management, and checking ABGs are all appropriate management steps in this scenario.
- (Pulmonary Edema / Common)
Which finding on a chest X-ray strongly suggests cardiogenic pulmonary edema rather than ARDS?
A. Normal heart size
B. Cardiomegaly with Kerley B lines
C. Ground-glass opacities only
D. Upper lobe sparing
Correct Answer: B. Cardiomegaly with Kerley B lines
Rationale:
Cardiomegaly with Kerley B lines is a classic finding in cardiogenic pulmonary edema. These findings indicate an enlarged heart and interstitial edema due to elevated hydrostatic pressures in the pulmonary circulation. In contrast, ARDS typically presents with a normal heart size and diffuse bilateral infiltrates, often with ground-glass opacities, but without the signs of chronic cardiac strain seen in cardiogenic pulmonary edema.
- (Pulmonary Edema / ABCs)
A patient presents with acute dyspnea, bilateral crackles, and pink frothy sputum. Under “circulation,” what is a common immediate intervention?
A. IV loop diuretics and monitor strict I/Os
B. Oral fluid boluses
C. Bronchoscopy
D. No IV access needed
Correct Answer: A. IV loop diuretics and monitor strict I/Os
Rationale:
In a patient presenting with acute dyspnea, bilateral crackles, and pink frothy sputum, which are hallmarks of acute pulmonary edema, the “circulation” aspect of the ABCs requires immediate interventions to manage fluid overload. Administering IV loop diuretics helps reduce the excess fluid in the lungs, and monitoring strict intake and output (I/Os) ensures that fluid balance is carefully managed. The other options do not address the immediate circulatory concerns in this scenario.
- Pulmonary edema is most often “really common” in which of the following conditions?
A. Acute decompensated heart failure
B. Chronic obstructive pulmonary disease
C. Asthma
D. Pneumonia without cardiac involvement
Answer: A
o Rationale: Pulmonary edema is a frequent finding in acute decompensated heart failure.
- Which sign “will kill your patient” if pulmonary edema is not rapidly managed?
A. Mild cough
B. Severe hypoxemia leading to respiratory failure
C. Occasional wheezing
D. Slight weight gain
o Answer: B
o Rationale: Severe hypoxemia from pulmonary edema can lead to respiratory failure and death.
- What is the first step in the ABC management of a patient with pulmonary edema?
A. Initiate diuretics after full evaluation
B. Ensure airway and provide supplemental oxygen
C. Begin long-term beta-blocker therapy
D. Schedule outpatient echocardiography
o Answer: B
o Rationale: Securing the airway and administering oxygen are the initial ABCs in any respiratory emergency.
- Which medication is “common” in the acute management of pulmonary edema due to heart failure?
A. Intravenous nitroglycerin
B. Oral antibiotics
C. High-dose steroids
D. Inhaled corticosteroids
o Answer: A
o Rationale: IV nitroglycerin is frequently used to reduce preload and relieve pulmonary congestion.
A 68-year-old man with a history of heart failure presents with severe dyspnea, frothy pink sputum, and tachypnea. He has bilateral crackles and S3 gallop on exam. What is the most likely diagnosis?
A) Acute respiratory distress syndrome (ARDS)
B) Cardiogenic pulmonary edema
C) Chronic obstructive pulmonary disease (COPD) exacerbation
D) Pulmonary embolism
Answer: B
Rationale: Frothy pink sputum, S3 gallop, and crackles suggest cardiogenic pulmonary edema due to heart failure.
- What complication “will harm your patient” if pulmonary edema is not treated appropriately?
A. Improved kidney function
B. Development of respiratory failure and cardiogenic shock
C. Mild cough improvement
D. Weight stabilization
o Answer: B
o Rationale: Untreated pulmonary edema can progress to respiratory failure and shock, which are life-threatening
Which of the following is the most immediate life-saving intervention for a patient with severe cardiogenic pulmonary edema?
A) IV furosemide
B) High-dose corticosteroids
C) Noninvasive positive pressure ventilation (BiPAP)
D) Endotracheal intubation
Answer: C
Rationale: BiPAP provides ventilatory support and reduces preload, improving gas exchange and reducing work of breathing in acute pulmonary edema.
A 45-year-old woman with no history of heart disease presents with acute dyspnea, hypoxia, and bilateral pulmonary infiltrates on chest X-ray. There is no evidence of heart failure. What is the most likely diagnosis?
A) Cardiogenic pulmonary edema
B) Acute respiratory distress syndrome (ARDS)
C) Pneumonia
D) Pulmonary embolism
Answer: B
Rationale: Bilateral pulmonary infiltrates without heart failure suggest ARDS, a common cause of noncardiogenic pulmonary edema
A 70-year-old man presents with acute dyspnea and orthopnea. Physical exam reveals an S3 gallop, jugular venous distension, and pulmonary crackles. What is the most appropriate initial treatment?
A) IV furosemide and nitroglycerin
B) IV fluids and vasopressors
C) High-dose corticosteroids
D) Bronchodilators and inhaled corticosteroids
Answer: A
Rationale: Furosemide reduces preload, and nitroglycerin reduces afterload, both improving pulmonary edema in heart failure.
Which diagnostic test is most useful in differentiating cardiogenic from noncardiogenic pulmonary edema?
A) BNP level
B) Chest X-ray
C) Pulmonary function test
D) D-dimer
Answer: A
Rationale: BNP is elevated in cardiogenic pulmonary edema but not in noncardiogenic causes such as ARDS.
Which of the following best characterizes neurogenic pulmonary edema?
A) Increased left ventricular end-diastolic pressure
B) Caused by increased intracranial pressure and catecholamine surge
C) Typically resolves within hours without treatment
D) Best treated with corticosteroids
Answer: B
Rationale: Neurogenic pulmonary edema occurs due to a catecholamine surge following CNS injury, leading to pulmonary capillary permeability and fluid leakage.
Which chest X-ray finding is most characteristic of cardiogenic pulmonary edema?
A) Peripheral consolidation with air bronchograms
B) Bilateral interstitial infiltrates with Kerley B lines
C) Unilateral alveolar opacities
D) Normal lung fields
Answer: B
Rationale: Kerley B lines, bilateral interstitial infiltrates, and pleural effusions suggest cardiogenic pulmonary edema.
A 55-year-old man presents with acute pulmonary edema due to an acute hypertensive emergency. What is the preferred medication for afterload reduction?
A) IV nitroglycerin
B) IV labetalol
C) IV esmolol
D) IV hydralazine
Answer: A
Rationale: IV nitroglycerin rapidly reduces preload and afterload, improving cardiogenic pulmonary edema due to hypertension.
A 70-year-old woman with heart failure presents with worsening dyspnea. BNP is elevated, and echocardiography shows left ventricular ejection fraction of 35%. What is the best long-term management?
A) Loop diuretics and beta-blockers
B) High-dose corticosteroids
C) Frequent fluid boluses
D) Bronchodilator therapy
Answer: A
Rationale: Loop diuretics and beta-blockers improve symptoms and outcomes in heart failure patients with reduced ejection fraction.
A 67-year-old man with a history of heart failure presents with acute dyspnea, crackles, and pink frothy sputum. His blood pressure is 190/110 mmHg. What is the most appropriate initial intervention?
A) IV furosemide and IV nitroglycerin
B) IV corticosteroids and bronchodilators
C) IV fluids and norepinephrine
D) Beta-blockers and digoxin
Answer: A
Rationale: Acute hypertensive pulmonary edema is best treated with preload and afterload reduction using loop diuretics and nitroglycerin.
A patient with acute decompensated heart failure develops worsening dyspnea and hypotension after receiving high-dose IV furosemide. What is the most likely cause?
A) Overdiuresis leading to hypovolemia
B) Anaphylaxis to furosemide
C) Acute kidney injury
D) Worsening left ventricular function
Answer: A
Rationale: Excessive diuresis can lead to hypovolemia, hypotension, and worsening renal function.
Which of the following is the most appropriate diagnostic test to confirm pulmonary edema in a critically ill patient?
A) Chest X-ray
B) Arterial blood gas
C) Echocardiogram
D) Pulmonary artery catheterization
Answer: D
Rationale: Pulmonary artery catheterization (Swan-Ganz catheter) directly measures pulmonary capillary wedge pressure (PCWP) to confirm cardiogenic pulmonary edema
Which of the following ventilatory strategies is most appropriate for a patient with noncardiogenic pulmonary edema due to ARDS?
A) Low tidal volume ventilation with high PEEP
B) High tidal volume ventilation with low PEEP
C) FiO₂ 100% for prolonged periods
D) Noninvasive ventilation with CPAP
Answer: A
Rationale: Low tidal volume (6 mL/kg) and high PEEP help prevent ventilator-induced lung injury in ARDS-related pulmonary edema
A 50-year-old woman presents with acute shortness of breath and bilateral pulmonary infiltrates. Her pulmonary capillary wedge pressure is normal. What is the most likely cause?
A) Cardiogenic pulmonary edema
B) Noncardiogenic pulmonary edema
C) Myocardial infarction
D) Pulmonary embolism
Answer: B
Rationale: Normal pulmonary capillary wedge pressure suggests noncardiogenic pulmonary edema, often due to ARDS.
A 40-year-old man presents with dyspnea after a subarachnoid hemorrhage. He has diffuse crackles and hypoxia. Which mechanism most likely contributed to his symptoms?
A) Increased left ventricular end-diastolic pressure
B) Sympathetic surge leading to pulmonary capillary leak
C) Right ventricular infarction
D) Pulmonary embolism
Answer: B
Rationale: Neurogenic pulmonary edema occurs due to a catecholamine surge increasing pulmonary capillary permeability
Which of the following findings differentiates cardiogenic pulmonary edema from noncardiogenic pulmonary edema?
A) Bilateral pulmonary infiltrates on chest X-ray
B) Hypoxemia refractory to oxygen therapy
C) Elevated BNP levels
D) Tachycardia and dyspnea
Answer: C
Rationale: Elevated BNP is specific for cardiogenic pulmonary edema, whereas noncardiogenic edema (e.g., ARDS) has a normal BNP.
A 72-year-old man with chronic kidney disease and heart failure is admitted for pulmonary edema. Which diuretic regimen is most appropriate?
A) Low-dose IV furosemide
B) High-dose IV furosemide with possible continuous infusion
C) Oral thiazide diuretics
D) Immediate dialysis.
Answer: B
Rationale: Patients with CKD and heart failure often require higher doses of IV loop diuretics due to decreased renal clearance
A 65-year-old woman presents with worsening dyspnea. Echocardiography shows an ejection fraction of 30%. What additional therapy should be initiated for long-term management?
A) Beta-blockers and ACE inhibitors
B) Corticosteroids
C) High-dose diuretics only
D) Anticoagulation
Answer: A
Rationale: Beta-blockers and ACE inhibitors improve long-term outcomes in heart failure with reduced ejection fraction.
Which of the following is a major complication of untreated pulmonary edema?
A) Pulmonary embolism
B) Hypoxic respiratory failure
C) Hypercapnic respiratory failure
D) Myocardial infarction
Answer: B
Rationale: Pulmonary edema leads to severe hypoxemia, progressing to respiratory failure if untreated.
Which of the following clinical signs is most specific for cardiogenic pulmonary edema?
A) Bibasilar crackles
B) S3 gallop
C) Wheezing
D) Tachycardia
Answer: B
Rationale: An S3 gallop is strongly associated with left ventricular dysfunction and cardiogenic pulmonary edema.
A 60-year-old woman with worsening pulmonary edema is found to have a mitral valve regurgitation. What is the best treatment strategy?
A) Loop diuretics and afterload reduction
B) High-dose beta-blockers
C) Pulmonary vasodilators
D) Bronchodilators and corticosteroids
Answer: A
Rationale: Diuretics relieve volume overload, and afterload reduction (e.g., ACE inhibitors) reduces mitral regurgitation severity.
A patient presents with acute dyspnea, pink frothy sputum, and a new holosystolic murmur at the apex. What is the most likely cause?
A) Acute mitral regurgitation
B) Aortic dissection
C) Pulmonary embolism
D) Pneumonia.
Answer: A
Rationale: Acute mitral regurgitation leads to flash pulmonary edema with a new holosystolic murmur.
Which medication is contraindicated in acute pulmonary edema due to decompensated heart failure?
A) Beta-blockers
B) Loop diuretics
C) Nitroglycerin
D) ACE inhibitors
Answer: A
Rationale: Beta-blockers should be held in acute decompensated heart failure as they can worsen contractility.
Which of the following conditions is most commonly associated with high-altitude pulmonary edema (HAPE)?
A) Chronic obstructive pulmonary disease (COPD)
B) Rapid ascent to high altitude
C) Pulmonary embolism
D) Hypothyroidism
Answer: B
Rationale: HAPE occurs due to rapid ascent to high altitude, causing pulmonary vasoconstriction and fluid leakage.
A 68-year-old patient with a history of systolic heart failure presents with acute pulmonary edema and bilateral crackles on auscultation. His blood pressure is 90/60 mmHg. Which medication is most appropriate to start for rapid symptomatic relief?
A) IV nitroglycerin
B) IV loop diuretic (furosemide)
C) IV beta-blocker
D) IV ACE inhibitor
Answer: B
Rationale: Loop diuretics (furosemide) provide rapid preload reduction and symptom relief in acute decompensated heart failure with pulmonary edema.
A 55-year-old woman presents with acute respiratory failure and bilateral infiltrates on chest X-ray. Her PCWP is normal, and she remains hypoxic despite supplemental oxygen. Which diagnosis is most likely?
A) Cardiogenic pulmonary edema
B) ARDS
C) Pleural effusion
D) Pneumothorax
Answer: B
Rationale: Normal PCWP and refractory hypoxia suggest noncardiogenic pulmonary edema, i.e., ARDS.
A 60-year-old man experiences pink frothy sputum and acute severe dyspnea after a large anterior myocardial infarction. Which pathophysiologic mechanism most likely caused his symptoms?
A) Decreased left ventricular contractility → Elevated pulmonary capillary pressure
B) Right ventricular infarction → Elevated right atrial pressure
C) Pulmonary embolism → Acute V/Q mismatch
D) ARDS due to inflammation
Answer: A
Rationale: Large MI can cause acute left ventricular failure, leading to increased pulmonary venous pressure and cardiogenic pulmonary edema.
A young patient presents with pneumonia and quickly develops hypoxemia and bilateral infiltrates consistent with ARDS. Which direct injury to the lung is most probable here?
A) Overzealous fluid resuscitation
B) Transfusion-related acute lung injury (TRALI)
C) Diffuse alveolar damage due to infection
D) Cardiogenic pulmonary edema from left ventricular dysfunction
Answer: C
Rationale: Pneumonia triggers a local inflammatory response causing diffuse alveolar damage, a hallmark of ARDS.
A 50-year-old man with ARDS is on low tidal volume ventilation. His plateau pressures are 35 cm H₂O. Which ventilator adjustment is best to reduce barotrauma?
A) Increase tidal volume
B) Decrease PEEP
C) Increase respiratory rate
D) Increase inspiratory flow rate
Answer: B
Rationale: High plateau pressures (>30 cm H₂O) can be reduced by lowering PEEP or tidal volume; since tidal volume is already minimized, decreasing PEEP is the next logical step (while carefully monitoring oxygenation).
A 47-year-old woman presents with frothy sputum and severe dyspnea hours after a subarachnoid hemorrhage. BNP is normal, and echocardiogram shows normal LV function. Which subtype of pulmonary edema is this?
A) Cardiogenic pulmonary edema
B) High-altitude pulmonary edema
C) Neurogenic pulmonary edema
D) ARDS
Answer: C
Rationale: Neurogenic pulmonary edema often occurs after significant CNS insult (e.g., subarachnoid hemorrhage) and is noncardiogenic.
In a patient with severe ARDS requiring prolonged mechanical ventilation, which late complication is most concerning?
A) Upper GI bleed
B) Barotrauma-induced pneumothorax
C) Pulmonary fibrosis
D) Malignant arrhythmias
Answer: C
Rationale: Late-stage ARDS can progress to pulmonary fibrosis, leading to chronic restrictive lung disease.
A 70-year-old man with severe sepsis develops acute hypoxemia. Chest X-ray shows bilateral infiltrates, and PCWP is normal. The PaO₂/FiO₂ ratio is 120. Which management step is most appropriate?
A) Start high-dose corticosteroids
B) Increase tidal volume to 10 mL/kg
C) Prone positioning and low tidal volume ventilation
D) Aggressive diuresis
Answer: C
Rationale: A PaO₂/FiO₂ of 120 indicates moderate ARDS. Low tidal volume ventilation and prone positioning can improve oxygenation.
Elevated PCWP, often with S3 gallop, high BNP, managed by diuretics, preload/afterload reduction.
- Cardiogenic Pulmonary Edema
→ sudden onset after CNS insult (e.g., hemorrhage), noncardiogenic mechanism.
Neurogenic Pulmonary Edema
pulmonary fibrosis, chronic respiratory failure, post-intensive care syndrome (PICS).
Long-term ARDS Complications →
A 65-year-old man with heart failure presents with acute dyspnea, tachypnea, and pink frothy sputum. Which of the following is the most likely cause?
A) Pneumonia
B) Cardiogenic pulmonary edema
C) Pulmonary embolism
D) ARDS.
Answer: B
Rationale: Pink frothy sputum, tachypnea, and dyspnea are classic signs of cardiogenic pulmonary edema due to heart failure
