(C/P Patho) Des Jardins & Burton - Chapter 28 - Acute Respiratory Distress Syndrome (ARDS)

All of the following materials will be found in the alveoli of a patient with ARDS EXCEPT:

a. leukocytes.

b. cellular debris.

c. fibrin.

d. hyaline membrane.

a. Leukocytes

A patient has a prolonged case of ARDS. What changes would be expected in the patient's alveolar cells?

a. Multiplication of the type I cells

b. Influx of macrophages

c. Hyperplasia and swelling of the type II cells

d. Development of emphysema

c. Hyperplasia and swelling of the type II cells

Which of the following pulmonary changes are associated with ARDS?

1. Abnormal surfactant

2. Interstitial edema

3. Decreased shunt

4. Narrowing of the alveolar-capillary membrane

a. 1, 2

b. 3, 4

c. 1, 3

d. 1, 2, 3

a. 1, 2

What is the reason for the elevated risk of developing ARDS associated with massive blood transfusions?

a. Shock (hypovolemia)

b. Receiving the wrong blood type

c. Fat emboli

d. Blockages in pulmonary blood vessels

d. Blockages in pulmonary blood vessels

ARDS can result from the inhalation of all of the following EXCEPT:

a. FIO2 >0.60 for prolonged exposure.

b. nitrogen dioxide.

c. very dry air.

d. chlorine gas.

c. Very dry air

Which of the following are causes of ARDS?

1. Liver failure

2. Heroin abuse

3. Septicemia

4. Goodpasture's syndrome

a. 1, 4

b. 2, 3

c. 2, 3, 4

d. 1, 2, 3, 4

c. 2, 3, 4

Which of the following are recommended to treat alveolar consolidation and atelectasis associated with ARDS?

1. Aerosolized bronchodilator medications

2. Continuous positive airway pressure (CPAP)

3. Chest percussion and postural drainage

4. Positive end-expiratory pressure (PEEP)

a. 4

b. 1, 2

c. 1, 3

d. 2, 4

d. 2, 4

Which of the following are current ventilatory strategies in the treatment of ARDS?

1. Large tidal volume

2. Small tidal volume

3. Rapid respiratory rates

4. Slow respiratory rates

a. 2

b. 3

c. 1, 4

d. 2, 3

d. 2, 3

What initial tidal volume setting on the ventilator would be recommended for a 70-kg adult male with ARDS?

a. 350 mL

b. 420 mL

c. 560 mL

d. 700 mL

c. 560 mL

All of the following would be low-tidal volume ventilation goals in a patient with ARDS, EXCEPT:

a. decrease barotrauma.

b. maintain plateau pressure >30 cm H2O.

c. decrease high transpulmonary pressures.

d. reduce overdistention of the lungs.

b. maintain plateau pressure >30 cm H2O.

Breath sounds associated with ARDS include:

1. vesicular.

2. bronchovesicular.

3. crackles.

4. bronchial.

a. 4

b. 1, 2

c. 3, 4

d. 2, 3, 4

c. 3, 4

Which of the following clinical manifestations are associated with ARDS?

1. Normal or decreased pulmonary capillary wedge pressure (PCWP)

2. Increased CVP

3. Intercostal retractions

4. Cyanosis

a. 1, 2

b. 3, 4

c. 2, 3, 4

d. 1, 2, 3, 4

c. 2, 3, 4

The chest radiograph finding indicative of severe ARDS is:

a. "ground-glass" appearance of the lungs.

b. pleural effusion.

c. bilateral hyperinflation of the lungs.

d. tracheal deviation.

a. "ground-glass" appearance of the lungs.

According to the Berlin definition of ARDS, what does a PaO2/FIO2 ratio of 150 mm Hg indicate for a patient on mechanical ventilation with a PEEP of 10 cm H2O?

a. Normal lungs

b. Mild ARDS

c. Moderate ARDS

d. Severe ARDS

c. Moderate ARDS

What is the most common cause of ARDS?

a. Sepsis

b. Fat embolism

c. Inhalation of irritants

d. Aspiration of gastric contents

a. Sepsis

When would symptoms of ARDS associated with a fat embolism from a long bone fracture be most likely to develop?

a. 2 to 4 hours following the fracture

b. 4 to 12 hours following the fracture

c. 12 to 48 hours following the fracture

d. 48 to 96 hours following the fracture

c. 12 to 48 hours following the fracture

Permissive hypercapnia is typically allowed to:

a. Protect the lungs from high PaO2 levels

b. Protect the lungs from fluid accumulation

c. Protect the lungs from high airways pressures

d. Protect the lungs from high tidal volumes

c. Protect the lungs from high airways pressures

During the early stages of ARDS the patient commonly demonstrates which one of the following arterial blood gas values?

a. Increased HCO2

b. Decreased pH

c. Decreased PaCO2

d. Normal PaO2

c. Decreased PaCO2

During permissive hypercapnia, at what pH level does the PaCO2 become a concern?

a. 7.2

b. 7.5

c. 7.6

d. 7.3

a. 7.2