16 Critical Care

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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?

Pulmonary capillary wedge pressure 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)?

$MAP = CO \times SVR$ 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?

Part A - steep part of the curve Signup and view all the answers

Which of the following factors determines the stroke volume?

Preload, afterload, and contractility Signup and view all the answers

What is the primary determinant of myocardial oxygen consumption?

Ventricular wall tension Signup and view all the answers

What is the formula for oxygen delivery?

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

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

Increased CO2 (Bohr effect) Signup and view all the answers

In which condition does arterial O2 content increase?

Hyperbaric O2 Signup and view all the answers

What is the mechanism of hypotension in cardiac tamponade?

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

What is Beck’s triad associated with?

Cardiac tamponade Signup and view all the answers

What is the main cause of adrenal insufficiency?

Withdrawal of exogenous steroids Signup and view all the answers

What does a right-sided mechanical valve represent?

A relative contraindication for Swan–Ganz catheter insertion 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?

50 cm Signup and view all the answers

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

Neurogenic shock Signup and view all the answers

What occurs with tachypnea and mental status changes in shock?

Blood shunted to the heart and brain Signup and view all the answers

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

Sepsis Signup and view all the answers

What is the most common site for atelectasis following surgery?

Superior segment of the right lower lobe Signup and view all the answers

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

Bilateral pulmonary infiltrates Signup and view all the answers

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

PMNs (polymorphonuclear leukocytes) Signup and view all the answers

Which condition is associated with Mendelson's syndrome?

Chemical pneumonitis from aspiration of gastric secretions Signup and view all the answers

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

Atelectasis Signup and view all the answers

Which medication can cause pulmonary shunting and result in hypoxia?

Nitroprusside (Nipride) Signup and view all the answers

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

IL-1 and TNF-alpha release Signup and view all the answers

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

Antidiuretic hormone (ADH; vasopressin) Signup and view all the answers

What is the best test for azotemia?

FENa > 3% Signup and view all the answers

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

Hypotension intraop Signup and view all the answers

What is the primary effect of NSAIDs on the kidney?

Efferent arteriole vasoconstriction Signup and view all the answers

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

Hypertension Signup and view all the answers

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

Insulin resistance Signup and view all the answers

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

Pro-calcitonin Signup and view all the answers

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

< 2.0 Signup and view all the answers

Which blood test is used for detecting invasive fungus?

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

Which medication is the primary choice for septic shock?

Levophed Signup and view all the answers

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

Fat emboli Signup and view all the answers

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

Decreased ETCO2 and hypotension Signup and view all the answers

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

Just distal to left subclavian 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?

Intra-aortic balloon pump (IABP) Signup and view all the answers

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

V-2 receptors Signup and view all the answers

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

Alpha-adrenergic activation causing vasoconstriction and blood pressure increase Signup and view all the answers

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

Inspiratory reserve volume Signup and view all the answers

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

Rapid shallow breathing index (RR/TV) < 100 Signup and view all the answers

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

PEEP Signup and view all the answers

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

Decreased right atrial filling Signup and view all the answers

Which ventilator mode limits barotrauma and provides variable tidal volumes?

Pressure control ventilation Signup and view all the answers

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

Restrictive lung disease Signup and view all the answers

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

Inspiratory capacity Signup and view all the answers

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

Oxygen radicals and barotrauma Signup and view all the answers

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

Plateau pressure Signup and view all the answers

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

TNF-alpha and IL-1 Signup and view all the answers

What is the definition of septic shock?

SIRS + hypotension Signup and view all the answers

What is the most important mediator of reperfusion injury?

Xanthine oxidase Signup and view all the answers

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

Carbon monoxide poisoning Signup and view all the answers

Which of the following parameters is indicative of brain death?

Unresponsiveness to pain and fixed and dilated pupils Signup and view all the answers

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

Atrial fibrillation Signup and view all the answers

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

Magnesium Signup and view all the answers

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

Thiamine, folate, B12, Mg, K Signup and view all the answers

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

$O_2$ on ventilator Signup and view all the answers

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

$250\times$ Signup and view all the answers

Cyanide toxicity disrupts which of the following cellular processes?

Electron transport chain Signup and view all the answers

What condition can lead to failure to wean from ventilation?

Critical illness polyneuropathy Signup and view all the answers