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Formative assessment

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MCQ answers

 

Multiple choice questions

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  1. In a patient with severe pneumonia the major pathophysiological mechanism leading to hypoxaemia is
    1. hypoventilation
    2. decreased diffusing capacity
    3. increased physiological deadspace
    4. intrapulmonary shunting
  2. These are the results from a 25 year old patient with pneumonia: BP 100/50 (mean 70), CVP 2, urine output 60 ml/h, creatinine 52 µmol/l, pH 7.45. The patient is alert and has warm peripheries. The most appropriate haemodynamic intervention is:
    1. IV bolus of 250 ml colloid
    2. no intervention is required
    3. IV bolus of 250 ml normal saline
    4. low dose dopamine infusion
  3. These are the ventilator settings for a patient with atypical pneumonia. Volume control ventilation, tidal volume 270 ml, respiratory rate 20/min, PEEP=10 cmH2O, FIO2=0.4, inspiratory time 65%. This results in airway pressure of 30 cmH2O, inspiratory pause pressure of 24 cmH2O, PEEPtotal=15, pH=7.27, PaCO2=9.0 kPa (68 mmHg), PaO2=13 kPa (92 mmHg). The intrinsic PEEP is
    1. 5
    2. 15
    3. 6
    4. 10
  4. The most appropriate way to reduce the intrinsic PEEP in the patient referred to in question 3 is to:
    1. decrease tidal volume
    2. decrease inspiratory time
    3. decrease respiratory rate
    4. decrease extrinsic PEEP
  5. A patient with bilateral pneumonia is being ventilated with the following settings. Pressure control ventilation of 26 cmH2O above PEEP 2 cmH2O (ie total pressure 28 cmH2O), FIO2=0.8, respiratory rate 30, inspiratory time 30%. This results in tidal volume 500 ml, PEEPtotal=3 cmH2O, pH 7.4, PaO2=7 kPa (50 mmHg). The most appropriate way of increasing the PaO2 is to
    1. increase pressure control level
    2. increase respiratory rate
    3. increase set PEEP
    4. increase inspiratory time
  6. A patient with pneumonia is being ventilated in volume control mode with a tidal volume of 350 ml, respiratory rate 15/min, PEEP 5, FIO2=0.4. The high airway pressure alarm on the ventilator repeatedly sounds. The most appropriate initial action is
    1. endotracheal suction
    2. increase sedation
    3. give nebulized salbutamol
    4. assess the patient
  7. The patient has a SaO2=96%, his chest is moving symmetrically, he is not cyanosed and he is haemodynamically stable. The next step in managing this problem should be:
    1. measure the arterial blood gases
    2. change the endotracheal tube
    3. manually ventilate the patient with a self-inflating resuscitator
    4. take a chest X-ray
 

İCharles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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