MCQ 16

Birbeck bodies are seen in

a - Pulmonary Langerhans' cell histiocytosis

b - Lymphangitic carcinomatosis

c - Lipoid pneumonia

d - Hypersensitivity pneumonitis

Ans: a - Pulmonary Langerhans' cell histiocytosis

Causes of ALI/ ARDS

Causes of Acute Lung Injury and Acute Respiratory Distress Symdrome are:

DIRECT Causes:

• Pneumonia
• Aspiration
• Inhalational injuries
• Blunt pulmonary trauma
• Near drowning

INDIRECT Causes:

• Sepsis
• Severe traumatic shock
• Large volume blood transfusion (>15 units)
• Pancreatitis
• Reperfusion after cardiopulmonary bypass

Although more than 60 conditions have been associated with ARDS, the most frequent cause is sepsis, followed by pneumonia and aspiration.

MCQ 15:

Most common cause of ARDS?

a – Sepsis

b – Trauma

c – Pneumonia

d – Aspiration

Ans: Sepsis

Click here to read about Causes of ARDS

MCQ 14:

All increase oxygenation except:

a. FiO2

b. Minute volume

c. PEEP

d. None of the above

Ans: Minute volume

MCQ 13:

Patient having asynchrony on Assist Control Ventilation,

What will you not do?

a. Adjust the trigger sensitivity

b. Change the inspiratory:expiratory time

c. Change the tidal volume

d. Change the mode of ventilation

Ans: c. Change the Tidal Volume

Knaus Criteria for Multiple System Organ Failure

Multiple systems organ failure is said present when more than one of the system dysfunctions is detected by test values exceeding the threshold values.

1. Respiratory failure (presence of one or more):

- Respiratory frequency <5, >49 (>two years of age)
- Alveolar-arterial difference in O2 >350 mmHg or PaO2/ Fi02 <200 (without congenital cardiac lesion)
- Requires mechanical ventilatory support >24 h
- PaCO2 >50 mmHg and pHa <7.25

2. Circulatory failure (presence of one or more):

- Heart rate <50/mm or episode of ventricular tachycardia/fibrillation
- Mean systemic arterial pressure <50 mmHg and (or) systolic systemic arterial pressure <60 mmHg
- Cardiac Index <2 L/min per sq. meter of body surface (acute onset) and (or) pHa <7.25, PaCO2, <35 without respiratory failure

3. Renal failure (presence of one or more):

- Urine volume 9.3 mL/kg body weight per hour for 8h
- Serum creatinine >266 umol/L
- Urea nitrogen >1.00 g/L or urea >0.60 g/L

4. Hepatic failure (presence of both):

- Bilirubin >60 mg/L or a twofold increase in alkaline phosphatase in serum and
- Prothrombin time >4 s over upper limit of normal range or a twofold increase in aspartate aminotransferase in serum

5. Hematologic failure (presence of one or more):

- Leukocytes <1500/mL or >40000/mL
- Platelets <20000/mL or evidence of ongoing disseminated intravascular coagulation

6. Neurologic failure

- Glasgow Coma Scale <6 (without sedation)

7. Uncontrolled sepsis (presence of one or more):

- Positive blood culture despite antibiotic therapy
- Fever >39.5 °C (rectal temp) for >24 h or spikes on three successive days