Anesthesiology VV - ARDS and Acid-base Equilibrium
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Questions and Answers

Timing of a known clinical insult within 2 weeks is a characteristic of ARDS.

  • False (correct)
  • True
  • Abdominal sepsis may be a cause of ARDS.

  • False
  • True (correct)
  • Tidal volume should be adjusted accordingly to the weight of the patient.

  • True (correct)
  • False
  • ARDS includes the presence of lung edema, increased permeability of the alveolar capillary membrane, and hypoxemia due to intra-pulmonary right-to-left shunting.

    <p>True</p> Signup and view all the answers

    The pathophysiology of ARDS is similar to the pathophysiology of COVID-19 pneumonia.

    <p>False</p> Signup and view all the answers

    ARDS causes hypoxemia due to intra-pulmonary right-to-left shunting.

    <p>True</p> Signup and view all the answers

    ARDS causes an increase in respiratory system compliance.

    <p>False</p> Signup and view all the answers

    ARDS generally excludes the presence of lung edema due to increased capillary hydrostatic pressure of the pulmonary circulation.

    <p>False</p> Signup and view all the answers

    The use of prone position during ARDS is effective only in case of COVID-19 pneumonia.

    <p>False</p> Signup and view all the answers

    The use of prone position during ARDS should be considered in patients with a PaO2/FiO2 value higher than 150 mmHg.

    <p>False</p> Signup and view all the answers

    Prone positioning during ARDS often causes an improvement of hypoxemia despite a clear pathophysiological mechanism.

    <p>True</p> Signup and view all the answers

    Prone positioning during ARDS is widely applied worldwide.

    <p>True</p> Signup and view all the answers

    Prone positioning during ARDS normally induces a redistribution of lung densities towards the dependent lung regions.

    <p>True</p> Signup and view all the answers

    PEEP is always indicated in severe ARDS patients.

    <p>False</p> Signup and view all the answers

    The effects of PEEP in severe ARDS patients depend on the distribution of lung densities.

    <p>True</p> Signup and view all the answers

    High levels of PEEP should be based on the potential for lung recruitment.

    <p>True</p> Signup and view all the answers

    PEEP should not exceed 10 cmH2O.

    <p>False</p> Signup and view all the answers

    PEEP may correct hypoxemia by reducing the amount of right to left intrapulmonary shunting.

    <p>True</p> Signup and view all the answers

    According to Stewart's theory, pH is independently regulated by pCO2, A-, and SID.

    <p>False</p> Signup and view all the answers

    The strong ion difference (SID) is the difference between strong cations and strong anions.

    <p>True</p> Signup and view all the answers

    Hypoalbuminemia may lead to metabolic acidosis.

    <p>False</p> Signup and view all the answers

    Saline solution can cause hyperchloremic metabolic acidosis.

    <p>True</p> Signup and view all the answers

    Kidneys compensate for the increase in HCO3- in chronic respiratory diseases by removing chloride.

    <p>False</p> Signup and view all the answers

    Hypoalbuminemia alone can cause metabolic alkalosis.

    <p>False</p> Signup and view all the answers

    Chloride excretion is increased in respiratory acidosis.

    <p>False</p> Signup and view all the answers

    PH is independently regulated by volatile acids, pCO2, and bicarbonate.

    <p>False</p> Signup and view all the answers

    SID is equal to the difference between anions and cations.

    <p>False</p> Signup and view all the answers

    The principle of electrical neutrality, dissociation equilibrium, and mass conservation all apply to acid-base balance.

    <p>True</p> Signup and view all the answers

    High PCO2, per se, causes a decrease in bicarbonate.

    <p>False</p> Signup and view all the answers

    Accumulation of ketone bodies leads to an increase in chloride concentration.

    <p>False</p> Signup and view all the answers

    According to Stewart's theory, pH is independently regulated by pCO2, Atot, and HCO3-.

    <p>False</p> Signup and view all the answers

    Hypoalbuminemia can lead to development of metabolic alkalosis.

    <p>True</p> Signup and view all the answers

    Ketoacidosis is due to an increase in chloride concentration.

    <p>False</p> Signup and view all the answers

    During respiratory acidosis, the increase in PaCO2, per se, leads to a reduction in HCO3- concentration.

    <p>False</p> Signup and view all the answers

    In chronic respiratory acidosis, the renal system increases urinary excretion of chloride as a compensation.

    <p>True</p> Signup and view all the answers

    PH is usually higher than 7.45 during respiratory acidosis.

    <p>False</p> Signup and view all the answers

    The daily requirement for potassium is about 2-4 mmol/kg.

    <p>True</p> Signup and view all the answers

    A plasma potassium level greater than 5.5 mmol/L is always associated with ECG alterations.

    <p>False</p> Signup and view all the answers

    Potassium supplementation should be started during DKA treatment when plasma potassium concentration is lower than 3.5 mmol/L.

    <p>False</p> Signup and view all the answers

    Rhabdomyolysis can cause severe hyperkalemia.

    <p>True</p> Signup and view all the answers

    Treatment of hypokalemia includes the administration of Ca-Cl or Ca-gluconate.

    <p>False</p> Signup and view all the answers

    Sepsis is always associated with hyperlactatemia.

    <p>False</p> Signup and view all the answers

    Fluid balance is better than IV antibiotics for correcting acid-base imbalance during sepsis.

    <p>True</p> Signup and view all the answers

    Patients with septic shock will always be oliguric.

    <p>False</p> Signup and view all the answers

    Patients with septic shock always have WBC counts greater than 10,000/µL.

    <p>False</p> Signup and view all the answers

    Septic shock generally presents some signs of altered tissue hypoperfusion.

    <p>True</p> Signup and view all the answers

    Patients with septic shock may have a plasma lactate level of about 1.5 mmol/L.

    <p>False</p> Signup and view all the answers

    Patients with septic shock may not have a clear site of infection.

    <p>True</p> Signup and view all the answers

    Tension pneumothorax is treated with decompression in the 5th intercostal space, midclavicular line.

    <p>False</p> Signup and view all the answers

    CT scan is the first diagnostic test in a traumatized patient.

    <p>False</p> Signup and view all the answers

    If a patient is bleeding, the first step is to identify and control the source of bleeding.

    <p>True</p> Signup and view all the answers

    Hypothermia is a common problem in trauma patients.

    <p>True</p> Signup and view all the answers

    With a femur fracture, blood loss can be up to 500 ml.

    <p>False</p> Signup and view all the answers

    RBC transfusion is indicated in class IV trauma patients.

    <p>True</p> Signup and view all the answers

    During the B phase of ATLS, it is necessary to evaluate the effectiveness of breathing and ventilation.

    <p>True</p> Signup and view all the answers

    Tension pneumothorax should be confirmed with chest X-ray before decompression.

    <p>False</p> Signup and view all the answers

    Positive pressure ventilation should be applied in cases of flail chest and ineffective ventilation.

    <p>True</p> Signup and view all the answers

    Open pneumothorax should be treated by tightly closing the opening with a sterile occlusive dressing.

    <p>False</p> Signup and view all the answers

    Simple pneumothorax should be treated before moving on to phases C, D, and E of ATLS.

    <p>False</p> Signup and view all the answers

    Hemorrhagic shock can be excluded if systolic blood pressure is within normal range.

    <p>False</p> Signup and view all the answers

    In a patient with abdominal trauma and hemodynamic instability, CT scan is the first line diagnostic test.

    <p>True</p> Signup and view all the answers

    A normal heart rate always excludes the possibility of clinically relevant hemorrhage.

    <p>False</p> Signup and view all the answers

    Hypothermia can worsen bleeding.

    <p>True</p> Signup and view all the answers

    Identifying the source of bleeding and managing it is the first step in the C phase of ATLS.

    <p>True</p> Signup and view all the answers

    Emergency airway management is necessary in severe traumatic brain injury.

    <p>True</p> Signup and view all the answers

    Severe hypoxemia is the leading complication of intubation in critically ill patients.

    <p>False</p> Signup and view all the answers

    Auscultation is the best method to confirm the success of endotracheal intubation.

    <p>False</p> Signup and view all the answers

    Propofol is the best induction agent for critically ill patients.

    <p>False</p> Signup and view all the answers

    Video laryngoscopy can help to increase success of intubation.

    <p>True</p> Signup and view all the answers

    Intravenous administration of Ringer lactate always leads to metabolic alkalosis.

    <p>False</p> Signup and view all the answers

    Ringer lactate generally does not lead to a clinically relevant increase in plasma lactate concentration.

    <p>True</p> Signup and view all the answers

    Ringer lactate can be detrimental to renal function.

    <p>False</p> Signup and view all the answers

    Ringer lactate is not indicated in patients with traumatic brain injury.

    <p>False</p> Signup and view all the answers

    Large volumes of Ringer lactate can cause hypernatremia.

    <p>True</p> Signup and view all the answers

    Colloid-containing solutions are indicated in cases of hemorrhage with the use of HES.

    <p>True</p> Signup and view all the answers

    The use of colloid-containing solutions is generally not indicated in critically ill patients when referring to synthetic colloids.

    <p>True</p> Signup and view all the answers

    Colloid-containing solutions are indicated during traumatic brain injury to maintain cerebral perfusion pressure.

    <p>True</p> Signup and view all the answers

    Colloid-containing solutions are indicated in sepsis to manage severe hypovolemia.

    <p>True</p> Signup and view all the answers

    Albumin is beneficial in patients with septic shock.

    <p>True</p> Signup and view all the answers

    Intravenous Ringer lactate is not indicated during septic shock.

    <p>False</p> Signup and view all the answers

    Intravenous Ringer lactate increases sodium levels.

    <p>True</p> Signup and view all the answers

    Intravenous Ringer lactate does not increase lactate levels at physiological concentrations.

    <p>True</p> Signup and view all the answers

    Intravenous Ringer lactate does not cause acidosis.

    <p>True</p> Signup and view all the answers

    The goal of normal water balance is to maintain the volemia and osmolality of the extracellular and intracellular spaces.

    <p>True</p> Signup and view all the answers

    Approximately 60% of body weight is made up of water.

    <p>True</p> Signup and view all the answers

    ADH is a powerful regulator of both osmolality and volume.

    <p>True</p> Signup and view all the answers

    The minimum amount of water that should be excreted daily in urine is approximately 1 liter.

    <p>False</p> Signup and view all the answers

    The most representative anion within the intracellular space is H2PO4.

    <p>False</p> Signup and view all the answers

    Respiratory system compliance is generally higher in COVID-19 pneumonia with severe respiratory failure compared to classical ARDS.

    <p>False</p> Signup and view all the answers

    Hypoxemia in COVID-19 pneumonia with severe respiratory failure can result from an alteration of the normal distribution of lung perfusion.

    <p>True</p> Signup and view all the answers

    Respiratory support for COVID-19 pneumonia with severe respiratory failure should only be considered when respiratory arrest is imminent.

    <p>False</p> Signup and view all the answers

    High levels of transpulmonary pressure only occur during invasive mechanical ventilation.

    <p>False</p> Signup and view all the answers

    IL-6 receptor blockers are now included in the current WHO international guidelines for treating COVID-19 pneumonia.

    <p>False</p> Signup and view all the answers

    A central vein oxygen saturation (ScvO2) of 45% may indicate impaired oxygen delivery.

    <p>True</p> Signup and view all the answers

    Cardiogenic shock is the most common type of shock seen in the general ICU population.

    <p>False</p> Signup and view all the answers

    Both high and low heart rates can be associated with hypoperfusion.

    <p>True</p> Signup and view all the answers

    A capillary refill time is always normal with a systolic arterial pressure of 130 mmHg.

    <p>False</p> Signup and view all the answers

    Anaphylaxis is the most common form of distributive shock.

    <p>False</p> Signup and view all the answers

    A patient with supraventricular tachycardia (160 bpm) should receive fluids to improve systemic perfusion.

    <p>True</p> Signup and view all the answers

    Cardioversion is the best treatment option for supraventricular tachycardia if associated with signs of hypoperfusion.

    <p>True</p> Signup and view all the answers

    Study Notes

    Anesthesiology VV - ARDS

    • ARDS timing is usually within 2 weeks of insult, not 1 week
    • Abdominal sepsis can cause ARDS
    • Tidal volume adjustment is weight-dependent (5 ml/kg)
    • ARDS is associated with alveolar-capillary membrane permeability increase.
    • COVID-19 pneumonia pathophysiology is not similar to ARDS
    • ARDS reduces respiratory compliance, typically not lung edema from increased capillary hydrostatic pressure.
    • Prone position in ARDS is effective, not limited to COVID-19 pneumonia
    • Prone position redistributes lung densities to dependent regions
    • ARDS PEЕР application is generally indicated—level based on lung recruitment potential; not exceeding 10 cmH2O.
    • PEЕР can correct hypoxemia by reducing right-to-left shunting.

    Acid-base Equilibrium

    • pH is independently regulated by pCO2, strong cation–strong anion difference (SID), and strong acids and bases.
    • SID (strong ion difference) is the difference between strong cations and strong anions.
    • Hypoalbuminemia can cause metabolic alkalosis (not acidosis.)
    • Saline solution can cause hyperchloremic metabolic acidosis on its own.
    • Chloride excretion increases in respiratory acidosis to compensate for HCO3- loss.

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    Description

    This quiz covers critical concepts in anesthesiology, focusing on Acute Respiratory Distress Syndrome (ARDS) and acid-base equilibrium. It explores the causes, physiological changes, and management strategies for ARDS, including the role of prone positioning and PEER application. Additionally, it delves into the regulation of pH and strong ion difference in acid-base balance.

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