16 Critical Care
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Questions and Answers

What is the normal range for cardiac output (CO) in the cardiovascular system?

  • 1,100 ± 300 L/min
  • 11 ± 4 L/min
  • 2.5-4 L/min
  • 4-8 L/min (correct)
  • Which parameter determines cardiac performance in the left ventricle?

  • Systemic vascular resistance (SVR)
  • Pulmonary artery pressure (PAP)
  • Cardiac index (CI)
  • Preload (correct)
  • What percentage of cardiac output does the brain receive?

  • 25%
  • 15% (correct)
  • 5%
  • 75%
  • Which parameter is a surrogate for left ventricular end-diastolic volume?

    <p>Pulmonary capillary wedge pressure</p> Signup and view all the answers

    What is the equation for mean arterial pressure (MAP) in terms of cardiac output (CO) and systemic vascular resistance (SVR)?

    <p>$MAP = CO \times SVR$</p> Signup and view all the answers

    For a given increase in preload, which part of the Starling curve results in a significant increase in stroke volume?

    <p>Part A - steep part of the curve</p> Signup and view all the answers

    Which of the following factors determines the stroke volume?

    <p>Preload, afterload, and contractility</p> Signup and view all the answers

    What is the primary determinant of myocardial oxygen consumption?

    <p>Ventricular wall tension</p> Signup and view all the answers

    What is the formula for oxygen delivery?

    <p>$CO \times arterial O2 content (CaO2) \times 10$</p> Signup and view all the answers

    What causes a right shift of the oxygen–hemoglobin dissociation curve?

    <p>Increased CO2 (Bohr effect)</p> Signup and view all the answers

    In which condition does arterial O2 content increase?

    <p>Hyperbaric O2</p> Signup and view all the answers

    What is the mechanism of hypotension in cardiac tamponade?

    <p>Decreased ventricular filling due to fluid in the pericardial sac around the heart</p> Signup and view all the answers

    What is Beck’s triad associated with?

    <p>Cardiac tamponade</p> Signup and view all the answers

    What is the main cause of adrenal insufficiency?

    <p>Withdrawal of exogenous steroids</p> Signup and view all the answers

    What does a right-sided mechanical valve represent?

    <p>A relative contraindication for Swan–Ganz catheter insertion</p> Signup and view all the answers

    What is the approximate distance from the right internal jugular (IJ) vein to wedge with a Swan–Ganz catheter?

    <p>50 cm</p> Signup and view all the answers

    Which type of shock leads to a decrease in systemic vascular resistance?

    <p>Neurogenic shock</p> Signup and view all the answers

    What occurs with tachypnea and mental status changes in shock?

    <p>Blood shunted to the heart and brain</p> Signup and view all the answers

    Which of the following is the most common cause of acute Respiratory Distress Syndrome (ARDS)?

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

    What is the most common site for atelectasis following surgery?

    <p>Superior segment of the right lower lobe</p> Signup and view all the answers

    Which of the following is a characteristic feature of Acute Respiratory Distress Syndrome (ARDS)?

    <p>Bilateral pulmonary infiltrates</p> Signup and view all the answers

    What is the primary mediator of Acute Respiratory Distress Syndrome (ARDS)?

    <p>PMNs (polymorphonuclear leukocytes)</p> Signup and view all the answers

    Which condition is associated with Mendelson's syndrome?

    <p>Chemical pneumonitis from aspiration of gastric secretions</p> Signup and view all the answers

    What is the most common cause of fever in the first 48 hours after an operation?

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

    Which medication can cause pulmonary shunting and result in hypoxia?

    <p>Nitroprusside (Nipride)</p> Signup and view all the answers

    What is the primary mediator of Systemic Inflammatory Response Syndrome (SIRS)?

    <p>IL-1 and TNF-alpha release</p> Signup and view all the answers

    Which hormone acts on the collecting ducts for water resorption and also acts as a vasoconstrictor?

    <p>Antidiuretic hormone (ADH; vasopressin)</p> Signup and view all the answers

    What is the best test for azotemia?

    <p>FENa &gt; 3%</p> Signup and view all the answers

    What is the most common cause of renal Acute Tubular Necrosis (ATN)?

    <p>Hypotension intraop</p> Signup and view all the answers

    What is the primary effect of NSAIDs on the kidney?

    <p>Efferent arteriole vasoconstriction</p> Signup and view all the answers

    Which of the following is NOT a part of the sepsis triad?

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

    What is the primary cause of hyperglycemia in patients with early gram-negative sepsis?

    <p>Insulin resistance</p> Signup and view all the answers

    Which blood test is good at ruling out sepsis and for discontinuing antibiotics when it normalizes?

    <p>Pro-calcitonin</p> Signup and view all the answers

    What is the target lactate level for guiding volume resuscitation in patients with sepsis?

    <p>&lt; 2.0</p> Signup and view all the answers

    Which blood test is used for detecting invasive fungus?

    <p>Fungitell (1,3 beta-D-glucan)</p> Signup and view all the answers

    Which medication is the primary choice for septic shock?

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

    In which type of emboli can fat be visualized in sputum and urine using Sudan red stain?

    <p>Fat emboli</p> Signup and view all the answers

    What is the most common presentation of pulmonary emboli in intubated patients?

    <p>Decreased ETCO2 and hypotension</p> Signup and view all the answers

    Where should the tip of the intra-aortic balloon pump (IABP) catheter be placed?

    <p>Just distal to left subclavian</p> Signup and view all the answers

    'Inflates on T wave; deflates on P wave' describes the mechanism of action of which cardiovascular device or medication?

    <p>Intra-aortic balloon pump (IABP)</p> Signup and view all the answers

    Which receptor mediates arterial vasoconstriction and water reabsorption at collecting ducts?

    <p>V-2 receptors</p> Signup and view all the answers

    What is the primary effect of dopamine at doses greater than 10 μg/kg/min?

    <p>Alpha-adrenergic activation causing vasoconstriction and blood pressure increase</p> Signup and view all the answers

    Which lung volume represents the additional amount of air that can be inspired following normal inspiration?

    <p>Inspiratory reserve volume</p> Signup and view all the answers

    What is the best predictor of successful extubation from a ventilator?

    <p>Rapid shallow breathing index (RR/TV) &lt; 100</p> Signup and view all the answers

    What can be used to improve oxygenation by keeping alveoli open?

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

    What is the main reason for decreased cardiac output with excessive PEEP?

    <p>Decreased right atrial filling</p> Signup and view all the answers

    Which ventilator mode limits barotrauma and provides variable tidal volumes?

    <p>Pressure control ventilation</p> Signup and view all the answers

    What type of lung disease is characterized by decreased total lung capacity, residual volume, and forced vital capacity?

    <p>Restrictive lung disease</p> Signup and view all the answers

    What represents the maximal volume of air that can be inspired following a normal expiration?

    <p>Inspiratory capacity</p> Signup and view all the answers

    What is the main cause of ventilator-induced lung injury?

    <p>Oxygen radicals and barotrauma</p> Signup and view all the answers

    Which parameter indicates alveolar pressure and is used as an indicator for potential barotrauma?

    <p>Plateau pressure</p> Signup and view all the answers

    Which of the following is a major component of the systemic inflammatory response activated during sepsis?

    <p>TNF-alpha and IL-1</p> Signup and view all the answers

    What is the definition of septic shock?

    <p>SIRS + hypotension</p> Signup and view all the answers

    What is the most important mediator of reperfusion injury?

    <p>Xanthine oxidase</p> Signup and view all the answers

    What condition can falsely increase oxygen saturation reading on a pulse oximeter?

    <p>Carbon monoxide poisoning</p> Signup and view all the answers

    Which of the following parameters is indicative of brain death?

    <p>Unresponsiveness to pain and fixed and dilated pupils</p> Signup and view all the answers

    What is the most likely cause of delayed discharge after cardiac surgery?

    <p>Atrial fibrillation</p> Signup and view all the answers

    What can be used to treat ventricular fibrillation (torsades de pointes)?

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

    During ETOH withdrawal, which of the following should be administered?

    <p>Thiamine, folate, B12, Mg, K</p> Signup and view all the answers

    What can be used to displace carbon monoxide in carbon monoxide poisoning?

    <p>$O_2$ on ventilator</p> Signup and view all the answers

    $Hgb has how many times more affinity for CO than for O_2?$

    <p>$250\times$</p> Signup and view all the answers

    Cyanide toxicity disrupts which of the following cellular processes?

    <p>Electron transport chain</p> Signup and view all the answers

    What condition can lead to failure to wean from ventilation?

    <p>Critical illness polyneuropathy</p> Signup and view all the answers

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