Deck 27: Acute Lung Injury, Pulmonary Edema, and Multiple System Organ

Question 1

Distinguishing between hydrostatic and nonhydrostatic pulmonary edema is often difficult, even for skilled clinicians.

Answer 1

True

Question 2

What is the name of the period that follows the exudative phase in ARDS?

A)fibroproliferative
B)fibrotic
C)proliferative
D)intraalveolar

Answer 2

A

Question 3

Which of the following mechanisms ultimately leads to ARDS regardless of the etiology?

A)disruption of the endothelial and epithelial barriers
B)alveolar flooding
C)interstitial damage
D)increased oncotic pressure

Answer 3

A

Question 4

Which of the following is not a common finding in the exudative phase of ARDS?

A)dyspnea
B)bradypnea
C)refractory hypoxemia
D)tachypnea

Question 5

What time does the exudative phase of ARDS typically presents?

A)between days 1 and 3
B)between days 4 and 7
C)after 1 week
D)after 1 month

Question 6

Which of the following risk factors for ARDS is considered a secondary risk factor?

A)viral pneumonia
B)gastric aspiration
C)near-drowning
D)sepsis

Question 7

Which of the following white blood cells is most commonly implicated in the inflammatory process of ARDS?

A)eosinophils
B)monocytes
C)neutrophils
D)lymphocytes

Question 8

Which of the following systems is the primary operant to rid the body of fluid accumulation in nonpathologic conditions?

A)respiratory
B)cardiac
C)lymphatic
D)renal

Question 9

Which of the following factors are associated with a higher risk for ARDS?
I)gastric aspiration
II)multiple transfusions
III)septic shock
IV)burn injury

A)I and III
B)II and IV
C)I, II, III, and IV
D)III only

Question 10

Which of the following terms describes programmed cell death?

A)osmosis
B)apoptosis
C)mitosis
D)necrosis

Question 11

Which of the following risk factors for ARDS is considered a secondary risk factor?

A)viral pneumonia
B)gastric aspiration
C)near-drowning
D)sepsis

Question 12

Which of the following clinical features is often common to both ARDS and congestive heart failure (CHF)?

A)PCWP >18 mm Hg
B)diffuse alveolar and interstitial infiltrates in chest radiograph
C)pleural effusions on chest radiograph
D)recent history of trauma

Question 13

According to the Starling's equation, which forces influence the movement of fluid from the bloodstream to the interstitium?
I)microvascular hydrostatic pressure
II)interstitial osmotic pressure
III)microvascular osmotic pressure
IV)interstitial hydrostatic pressure

A)I only
B)I and II
C)III and IV
D)I and IV

Question 14

Which of the following tests provides useful information in making the diagnosis of ARDS for patients with inconclusive results on traditional tests?

A)examination of bronchoalveolar lavage fluid (BALF)
B)measurement of mixed venous oxygen level
C)measurement of total white blood-cell count
D)ventilation/perfusion ratio ( $\dot { V } / \dot { Q }$ ) scanning

Question 15

The mortality rate for patients with acute respiratory distress syndrome (ARDS) has remained stable over the past two decades.

Question 16

Which of the following assessment tools is most useful in distinguishing ARDS from CHF?

A)chest radiograph
B)arterial blood gas
C)Swan-Ganz catheter
D)pulmonary function testing

Question 17

Which of the following parameters are important in the management of patients with ARDS?
I .Keep systolic blood pressure below 90 mm Hg.
II.Keep hemoglobin saturation above 90%.
III.Ensure adequate urine output.
IV.Keep mean arterial pressure above 60 mm Hg.

A)I only
B)I and IV
C)II, III, and IV
D)I, II, III, and IV

Question 18

Which of the following parameters is important in determining the optimal level of positive end-expiratory pressure (PEEP) in a patient with ARDS?

A)PaO₂
B)SaO₂
C)DO₂
D)CaO₂

Question 19

What is recommended in terms of fluid management of patients with ARDS?

A)conservative
B)aggressive volume replacement
C)increased dieresis
D)only administer colloids

Question 20

Which of the following organs plays a major role in induction and modulation of the systemic inflammatory response?

A)heart
B)brain
C)kidneys
D)liver

Question 21

Although promising, inhaled NO remains an experimental therapy for patients with ARDS.

Question 22

What mode of mechanical ventilation is designed to optimize ventilation by reducing alveolar collapse while using small tidal volumes in patients with ARDS?

A)inverse-ratio ventilation
B)high-frequency ventilation (HFV)
C)intermittent mandatory ventilation
D)airway pressure-release ventilation

Question 23

What mode of mechanical ventilation is designed to optimize ventilation by recruiting alveolar units while minimizing ventilator-induced barotrauma in patients with ARDS?

A)inverse-ratio ventilation
B)high-frequency ventilation
C)intermittent mandatory ventilation
D)airway pressure-release ventilation (APRV)

Question 24

Which of the following benefits has not been associated with the use of PEEP in a patient with ARDS?

A)reduced work of breathing
B)lowered FIO₂
C)increased functional residual capacity (FRC)
D)improved venous return

Question 25

What ventilatory strategy has been found to be useful for avoiding barotrauma in the treatment of patients with ARDS?

A)prolonged expiratory time
B)permissive hypercapnia
C)inverse-ratio ventilation
D)intermittent mandatory ventilation

Question 26

Which of the following statements is true about prone-positioning of patients with ARDS?

A)It produces a transient improvement in gas exchange.
B)It dramatically reduces the mortality of patients with ARDS.
C)It does not require experienced staff.
D)It does not improve gas exchange at all.

Question 27

Which of the following complications has been associated with the use of PEEP in patients with ARDS?

A)lung infection
B)reduced cardiac output
C)hepatic failure
D)myocardial infarction

Question 28

What is the maximal inspiratory pressure that should be targeted when using pressure control ventilation in patients with ARDS?

A)20 to 25 cm H₂O
B)25 to 30 cm H₂O
C)30 to 35 cm H₂O
D)35 to 40 cm H₂O

Question 29

What range is now recommended for tidal volumes (V_T) in a patient with ARDS who is being mechanically ventilated?

A)3 to 5 ml/kg
B)5 to 7 ml/kg
C)10 to 12 ml/kg
D)13 to 15 ml/kg

Question 30

The routine use of extracorporeal membrane oxygenation (ECMO) in the treatment of patients with ARDS is not recommended at this time.

Question 31

The lungs of a patient with ARDS are effectively reduced to 20% to 30% of their normal size.

Question 32

What characteristic of a patient with ARDS suggests that the use of inhaled nitric oxide might be useful?

A)elevated CO₂ levels in arterial blood gases
B)severe elevation of pulmonary vascular resistance
C)severe increases in the work of breathing
D)bronchoconstriction as evidenced by wheezing