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 12:

All increase the chances of VAP ( ventilator associated pneumonia), except:

a – Prolonged ventilator support and reintubation

b – Enteral feeding

c – Prone ventilation

d – Intra-hospital transfer

Ans: c – Prone ventilation

 

Click here to read more about VAP

MCQ 8:

Patient is having ARDS with a Peak Inspiratory Pressure of 65 cm H2O; develops a pneumothorax, what will you do?

a – Increase the Fractional concentration of O2

b – Switch over to Pressure Control Ventilation

c – Decrease the tidal volume

d – Decrease the respiratory rate

Ans: Switch over to Pressure control ventilation

Diagnostic Criteria for ALI and ARDS

1. Acute Onset

2. Presence of a predisposing condition.

3. Bilateral infiltrates on frontal chest x-ray, consistent with pulmonary edema.

4. PaO2 / FiO2 < 200 mm Hg for ARDS, < 300 mm Hg for ALI, regardless of the level of positive end-expiratory pressure (PEEP).

5. Pulmonary artery occlusion pressure =18 mm Hg or no clinical evidence of left atrial hypertension.

Bernard GR, Artigas A, Brigham KL, et al. The American–European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am Rev Respir Crit Care Med 1994;149:818–824.

Well’s Criteria for Pulmonary Embolus

VARIABLES	POINTS
Symptoms/signs of DVT ( minimum of leg swelling and pain with palpation of the deep veins	3.0
Alternative diagnosis deemed less likely than PE	3.0
Heart rate >100 beats/min	1.5
Immobilization/surgery in previous 4 wk	1.5
Previous VTE	1.5
Hemoptysis	1.0
Recent or current malignancy	1.0

Clinical Probability:

Low Probability <2.0

Intermediate Probability 2.0 -6.0

High Probability >6.0

Well’s Criteria for Deep Venous Thrombosis

VARIABLES	POINTS
Cancer (receiving treatment, treated in the past six months, or palliative care	1
Paralysis, paresis, or recent plaster immobilization of the lower extremities	1
Recently bedridden for three days or more, or major surgery within the previous 12 weeks requiring general or regional anesthesia	1
Localized tenderness along the distribution of the deep venous system	1
Entire leg swollen	1
Calf swelling at least 3 cm larger than that on the asymptomatic side (measured 10 cm below tibial tuberosity)	1
Pitting edema confined to the symptomatic leg	1
Collateral superficial veins (non-varicose)	1
Previously documented DVT	1
Alternative diagnosis at least as likely as DVT	Minus 2

</= 1 points: Clinical probability of DVT unlikely
> 1 points: Clinical probability of DVT likely

Risk Factors for Venous Thrombo Embolism

Surgery                                                                                                Trauma (major or lower extremity)                         Immobility, paresis                                                  Malignancy                                                                                             Cancer therapy (hormonal, chemotherapy, or radiotherapy)
Previous VTE
Increasing age
Pregnancy and the postpartum period
Estrogen-containing oral contraception or hormone replacement therapy
Selective estrogen receptor modulators
Acute medical illness
Heart or respiratory failure
Inflammatory bowel disease
Nephrotic syndrome
Myeloproliferative disorders
Paroxysmal nocturnal hemoglobinuria
Obesity
Smoking
Varicose veins
Central venous catheterization
Inherited or acquired thrombophilia

MCQ 1:

Following increase the chances of Pulmonary Embolism during surgery except:

a – Chronic Renal Failure

b – Use of Oral contraceptive Pills

c – Lupus

d – Adenocarcinoma

 

Ans: Chronic Renal Failure

Click here to read more about risk factors for venous thromboembolism

Click here to read Well's criteria for deep venous thrombosis

Click here to read Well's criteria for pulmonary embolus