5/21 CorePendium Board Review

Front

A 65-year-old male with DKA is intubated in the ED. Post-intubation VBG shows pH 6.99 and pCO₂ 74 mmHg. What ventilator strategy best prevents worsening acidosis in this case? Options: Volume control mode with RR 10 bpm and tidal volume 6 mL/kg, Pressure control with permissive hypercapnia, Match pre-intubation minute ventilation with high RR and tidal volume, Initiate PEEP of 10 cm H₂O to augment alveolar ventilation

Back

Match pre-intubation minute ventilation with high RR and tidal volume

Front

A patient with severe asthma is intubated for impending respiratory failure. Which ventilator setting adjustment best minimizes the risk of barotrauma?

Back

Extend expiratory time with low RR and high flow rate

Front

You are managing a ventilated patient with ARDS. Plateau pressure is 34 cm H₂O and tidal volume is 6 mL/kg. What is the next best step?

Back

Decrease tidal volume

Front

A patient on volume assist-control ventilation becomes hypotensive shortly after intubation. High peak pressures are noted. What is the most appropriate first diagnostic step?

Back

Check equipment

Front

Which of the following is preferred for ED sedation in paralyzed patients? Rocuronium alone ensures adequate comfort for the first hour, Sedation should be delayed until transfer to ICU, Use of a continuous propofol infusion titrated to RASS 0 to –2, Lorazepam infusion is first-line due to long duration of action

Back

Use of a continuous propofol infusion titrated to RASS 0 to –2

Front

A 24-year-old tall, thin man presents with sudden onset pleuritic chest pain and dyspnea. Vitals are stable. Chest X-ray shows a 2.5 cm apical pneumothorax. What is the most appropriate initial management?

Back

Needle aspiration with repeat imaging

Front

A 50-year-old smoker with known COPD presents with sudden shortness of breath. CXR reveals a 1.5 cm pneumothorax. He is mildly hypoxic. What is the most appropriate management?

Back

Admission and tube thoracostomy

Front

A trauma patient on positive pressure ventilation becomes hypotensive and hypoxic. What bedside finding would most strongly suggest tension pneumothorax?

Back

Absent breath sounds with JVD and hypotension

Front

Which of the following is most pathognomonic for pneumothorax on bedside ultrasound?
Absence of lung sliding,
Barcode sign on M-mode,
Lung point sign,
B-lines in one lung field

Back

Lung point sign

Front

A patient with a large traumatic pneumothorax undergoes chest tube placement. Over the next 24 hours, continuous bubbling is noted. What is the most likely cause?

Back

Bronchopleural fistula