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Critical Care/General Management 1

By Garrett Coyan / April 4, 2022

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Question 1 of 22

1. Question
1. An obese 55 year-old female with end-stage renal disease undergoes percutaneous placement of a large bore dialysis catheter. Due to numerous other attempts at dialysis catheter placement, the only available point of access was her left subclavian. Just before the dialysis nurse arrives to initiate hemodialysis, she is noted to be hypotensive. On exam, she has very prominent neck veins and her heart sounds are muffled. Of the following, what is the most appropriate next step?
- Administration of a 1L normal saline bolus and continued observation
- Initiation of a levophed drip to maintain blood pressure while she is receiving dialysis
- Exchange of the original catheter over a wire for a shorter catheter.
- Transfer to the OR for exploration
- Immediate removal of the catheter and holding pressure at the insertion site
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Question 2 of 22

2. Question
2. Which of these vasopressors has predominantly alpha activity?
- Phenylephrine
- Norepinephrine
- Dopamine
- Epinephrine
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Question 3 of 22

3. Question
3. Which of these conditions would cause pulmonary capillary wedge pressure (PCWP) to underestimate the left ventricular end diastolic pressure (LVEDP)?
- Mitral stenosis
- Left atrial mass
- Pulmonary embolism
- Aortic regurgitation
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Question 4 of 22

4. Question
4. Which organism is most commonly isolated in patients with DSWI?
- Staphylococcus Epidermidis
- Pseudomonas spp.
- Acinetobacter spp
- Staphylococcus Aureus
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Question 5 of 22

5. Question
5. What hemodynamic changes are seen in a patient with cardiac tamponade?
- Hypertension
- Elevated Mixed Venous Oxygen
- Equalization of filling pressures
- Elevated Cardiac Index
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Question 6 of 22

6. Question
6. Which of these does NOT result in low SvO2?
- Decreased cardiac output
- Septic shock
- Anemia
- Hypoxia
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Question 7 of 22

7. Question
7. In what percent of cardiac surgery patients does HIT occur?
- 1-3%
- 6-10%
- 15-20%
- 25-30%
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Question 8 of 22

8. Question
8. A patient is placed on venovenous ECMO but is unable to receive anticoagulation. Which of the following the patient most at risk for?
- Patient thrombosis
- Circuit thrombosis
- Bleeding
- Limb ischemia
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Question 9 of 22

9. Question
9. Which of the following represents a proper indication for venovenous (VV) ECMO for a patient with acute respiratory distress syndrome (ARDS)?
- FiO2 of > 80% for more than 7 days
- High pressure ventilation with end-inspiratory plateau pressures of > 35 cm H2O for more than 7 days
- PaO2/FiO2 ratio ≤ 150 despite peak end-expiratory pressures (PEEP) of greater than 15 cm H2O
- Uncompensated hypercapnia with pH < 7.15
Correct

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Question 10 of 22

10. Question
10. In ARDS the following findings are present EXCEPT:
- PaO2/FiO2 ratio ≤ 300
- Known clinical insult within one week
- Infiltrates on CXR
- High pulmonary capillary wedge pressure
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Question 11 of 22

11. Question
11. The most appropriate statement regarding the benefit of “Lung rest” as a ventilation strategy in ECMO:
- The risk of ventilator-induced lung injury is minimized by relying on low plateau pressures.
- The risk of ventilator-induced lung injury is minimized by relying on low positive end-expiratory pressure (PEEP).
- ECMO permits improved ventilation by allowing a higher respiratory rate.
- ECMO permits improved ventilation by allowing a higher tidal volume.
Correct

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Question 12 of 22

12. Question
12. Which of the following is not a consideration in ECMO cannulation strategy?
- Blood flow requirements
- The patient's mass
- Blood vessel size
- Age of patient
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Question 13 of 22

13. Question
13. Which of the following is NOT a physiologic benefit of prone positioning:
- Decreased need for sedation
- Improved V/Q matching
- Increase homogeneity in ventilation
- Improved response to rectruitment maneuvers
Correct

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Question 14 of 22

14. Question
14. The principle of lung protective ventilation is:
- Maintain an FiO2 of > 60%
- Maintain a peak end-expiratory pressure (PEEP) of < 10 cm H2O
- Minimize the risk of ventilator-induced lung injury
- Reduce the respiratory rate to < 10 breaths per minute
Correct

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Question 15 of 22

15. Question
15. Which of the following represents a likely contraindication to ECMO?
- Bridge to transplant
- Hypoxemic respiratory failure requiring intubation > 10 days
- Hypercapnic respiratory failure with a pH < 7.20
- Massive pulmonary embolism
Correct

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Question 16 of 22

16. Question
16. Blood flow in pumpless extracorporeal lung assist (PECLA) is driven by:
- Gravity
- The patients own blood pressure
- Respiratory rate
- Catecholamine support
Correct

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Question 17 of 22

17. Question
17. Advanced maneuvers for the management of refractory ARDS include all of the following EXCEPT:
- Venovenous ECMO
- High frequency oscillatory ventilation
- Paralytics
- Prone positioning
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Question 18 of 22

18. Question
18. 45-year-old female is 14 hours s/p mechanical AVR. The operation was uncomplicated and early postoperative course uneventful. During the 14th hour she started to complain of feeling nauseous and diaphoretic at times. Her SBP had been ranging from 110-120 but now was 70-80/50’s with a HR in the 120’s. CO is noted to be 3L/min by fick method. What is the next best step in management?
- Give 2uPRBCs
- Stat CBC and continue to monitor
- Bedside Echo, ready for the OR
- Stat CTPA
Correct

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Question 19 of 22

19. Question
19. All of the following are a symptom of low cardiac output EXCEPT:
- Cool extremities
- Pulmonary congestion
- Oliguria
- Anemia
- Altered mental status
Correct

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Question 20 of 22

20. Question
20. The direct Fick method determines cardiac output as a measure of:
- Dissipation of heat generated in PA catheter coils
- Change in blood temperature as a function of time after injecting a cold saline bolus
- Difference in the oxygen content of pulmonary arterial system
- Difference in the oxygen content of arterial versus mixed venous blood
- Change in blood temperature as a function of flow
Correct

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Question 21 of 22

21. Question
21. Factors that determine cardiac output are all of the listed below, EXCEPT:
- Contractility
- Body surface area
- Preload
- Afterload
- Rate
Correct

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Question 22 of 22

22. Question
22. The most appropriate statement regarding the ECMO circuit include:
- VV-ECMO always requires aortic annulation
- VV-ECMO guarantees an adequate systemic oxygenation when the oxygenator is working appropriately
- VV-ECMO with single cannulation is possible
- VV-ECMO enables adequate oxygenation and decreases cardiac work
Correct

Incorrect

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