Patient With Respiratory Failure

10 Questions | Total Attempts: 262

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Patient With Respiratory Failure

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Questions and Answers
  • 1. 
    A 30-year-old Asian woman presents to the Emergency Department with the sudden onset of pleuritic chest pain and shortness of breath.  Past history is remarkable for 4 first trimester pregnancy losses.  On physical examination she is afebrile but has a respiratory rate of 32/min.  Her heart rate is 120 bpm and her blood pressure is 142/80. An accentuated (loud) S2 is heard on heart auscultation.    Lung examination and chest x-ray are normal.  Arterial blood analysis shows a PCO2 of 30 mm Hg and a PO2 of 58 mm Hg.  Which of the following is the most appropriate next diagnostic step?
    • A. 

      Ventilation perfusion scan

    • B. 

      Transthoracic echocardiogram

    • C. 

      D-dimer assay

    • D. 

      Venous Doppler studies

  • 2. 
    36 hours following admission to the hospital, despite supplemental oxygenation the patient’s respiratory status continued to worsen.  An ABG shows pH 7.3, PO2 55 mmHg, PCO2 38 mmHg.  His chest x-ray is shown below. The decision for intubation and mechanical ventilation is made.  What is the most important consideration when placing this patient on the ventilator?
    • A. 

      Low oxygen concentration

    • B. 

      Increased ventilation

    • C. 

      Low tidal volumes

    • D. 

      High levels of PEEP (Positive End Expiratory Pressure)

  • 3. 
    A 55 year old Bahamian male with a long history of smoking presents to the Emergency Department in severe respiratory distress.  An aterial blood gas shows a PO2 of 50 mm Hg and a PCO2 of 80 mm Hg. What type of respiratory failure does he have?
    • A. 

      Hypoxemic

    • B. 

      Hypercapnic

    • C. 

      Hyperoxic

    • D. 

      Hypocapnic

  • 4. 
    A 55 year old Bahamian male with a long history of smoking presents to the Emergency Department in severe respiratory distress. An aterial blood gas shows a PO2 of 50 mm Hg and a PCO2 of 80 mm Hg. Your treatment of the above patient should concentrate on
    • A. 

      Supplemental O2

    • B. 

      Increased ventilation

    • C. 

      Decreased ventilation

    • D. 

      Immediate intubation because of the severity of the hypoxemia

  • 5. 
    A 47-year-old man is admitted to the hospital with an acute necrotizing pancreatitis. In two days he develops respiratory failure and expires on the 9th day after admission. Postmortem examination reveals the shown lung changes. Which of the following is the most likely diagnosis?
    • A. 

      Bronchopneumonia

    • B. 

      Brown induration of the lungs

    • C. 

      Idiopathic interstitial pulmonary fibrosis

    • D. 

      Adult respiratory distress syndrome

  • 6. 
    Following a vehicular accident with blood loss leading to prolonged, severe hypotension, a 30-year-old man is intubated and placed on a mechanical ventilator. He has progressively decreasing oxygen saturations despite increasing PEEP and FiO2 of 100%. He remains afebrile and dies 3 days later. The microscopic appearance of the lungs is shown. Which of the following pulmonary diseases most likely complicated his course?
    • A. 

      Bronchopneumonia

    • B. 

      Adult respiratory distress syndrome

    • C. 

      Bronchiectasis

    • D. 

      Viral pneumonia

  • 7. 
    A 28 year-old presents with dyspnea at rest and is begun on oxygen supplementation via nasal cannula set at 4 L/min.  Which of the following is the best estimate of the amount of oxygen this patient is receiving? 
    • A. 

      21%

    • B. 

      37%

    • C. 

      45%

    • D. 

      57%

    • E. 

      83%

  • 8. 
    An 80-year-old male with a history of COPD and who is managed as an outpatient with supplemental oxygen, presents to his pulmonologist with the complaint of worsening dyspnea on exertion.  Following his evaluation, the pulmonologist recommends increasing the patient’s supplemental oxygen from 38% to 42% FiO2. Which of the following is the best oxygen supplementation device to achieve this goal?
    • A. 

      Non-rebreather mask

    • B. 

      Venturi mask

    • C. 

      Nasal cannula

    • D. 

      Non invasive CPAP

    • E. 

      Simple face mask

  • 9. 
    The chest x-ray of a 56 year-old female with pancreatitis and respiratory failure shows patchy, wide spread infiltrates without evidence of heart enlargement or congestion.  The decision is made to intubate and mechanically ventilate this patient. The most important ventilator setting to consider in this patient is:
    • A. 

      High levels of positive end expiratory pressure (PEEP)

    • B. 

      High oxygen levels

    • C. 

      Low tidal volumes

    • D. 

      Low minute ventilation

    • E. 

      Continuous positive airway pressure (CPAP)

  • 10. 
    59 year old female presents to the clinic with severe dyspnea at rest associated with fever and a productive cough.  Chest x-ray shows a consolidation in the right middle lobe.  On exam the patient appears to be in respiratory distress and central cyanosis is noted.  Her vitals are: T 101.2 F   (38.4 C) BP  140/88 P 100 bpm   RR  26 bpm O2 saturation on room air = 73%   Which of the following is the best choice for providing supplemental oxygen in this patient?
    • A. 

      Nasal cannula

    • B. 

      Simple face mask

    • C. 

      Non-rebreather mask

    • D. 

      Bag-valve mask

    • E. 

      Venturi mask