Post Test WS IACC-ECHO MCVU 2025

A 65-year-old male with decompensated heart failure is monitored using a pulmonary artery catheter. His data show: CVP: 16 mmHg PCWP: 24 mmHg CO: 1.9 L/min SVR: 2800 dyn·s/cm⁵ What is the most likely hemodynamic profile?

• Hypovolemic shock

• Septic shock - early phase

• Cardiogenic shock

• Obstructive shock due to pulmonary embolism

A 44-year-old female with septic shock on norepinephrine is evaluated for fluid responsiveness. She is on controlled mechanical ventilation. Distensibility index 25%. What is the most appropriate intervention?

• Administer fluid bolus

• Increase vasopressor dose

• Give diuretics

• No further intervention needed

A central venous catheter (CVC) is planned for a 56-year-old man in the ICU for vasopressor support. On physical exam, he has active cellulitis over the right neck. Which of the following is the best course of action?

• Proceed with right internal jugular access

• Delay catheter placement until infection resolves

• Choose left femoral vein for access

• Insert catheter through right subclavian vein

A 50-year-old woman in septic shock is being monitored with an arterial line. Despite MAP of 75 mmHg, she remains tachycardic and oliguric. CVP is 3 mmHg. What is the most likely issue?

• Volume overload

• Vasoconstriction from norepinephrine

• Hypovolemia

• Cardiac tamponade

A 70-year-old patient with diagnose STEMI inferior, has a MAP of 57 mmHg, CVP of 16 mmHg, PCWP of 22 mmHg, and CO of 1.8 L/min, SVR 2800 dyn·s/cm⁵ Which of the following therapies is most appropriate?

• Fluid bolus

• Vasopressor escalation

• Inotropes

• Blood transfusion

60 years old male patient on Mechanical ventilation, Which of the following suggests fluid responsiveness in patient?

• IVC collapsibility index < 15%

• IVC distensibility index > 18%

• LVOT VTI increase < 10% with passive leg raise

• IVC diameter > 2.5 cm with no variation

A 63-year-old male is admitted to the ICU with altered mental status, hypotension (BP 85/50 mmHg), and a history of pneumonia. He is febrile and tachycardic. A bedside transthoracic echocardiogram is performed: LV: Hyperdynamic RV: Normal IVC: Collapsing with respiration (>50%) Pericardial space: No effusion Question: Based on the echo findings, what is the most likely hemodynamic state and appropriate next step?

• Cardiogenic shock; start inotropes

• Obstructive shock; consider pericardiocentesis

• Hypovolemic/septic shock; administer IV fluids

• Fluid overload; restrict fluids and start diuretic

A 58-year-old male recovering from septic shock is evaluated before weaning from mechanical ventilation. He remains tachycardic with marginal urine output. Echo shows: LVOT diameter: 2.0 cm LVOT VTI: 10 cm HR: 100 bpm IVC: Minimal variation with respiration Question: What is the estimated cardiac output?

• CO ≈ 2.5 L/min

• CO ≈ 4.0 L/min

• CO ≈ 6.3 L/min

• CO ≈ 3.1 L/min

A 65-year-old female with septic shock is on norepinephrine. MAP is 70 mmHg, but she is oliguric with a lactate of 5 mmol/L. You perform a bedside echo to assess hemodynamic status. Echo Findings: LV: Mildly reduced systolic function LVOT VTI before passive leg raise: 14 cm LVOT VTI after passive leg raise: 18 cm IVC: Dilated, with >10% variability Question: What does this suggest regarding fluid responsiveness?

• She is unlikely to benefit from fluids

• She is fluid responsive; consider volume expansion

• She has obstructive physiology

• She needs inotropes immediately

A 64-year-old male with a history of hypertension and ischemic heart disease is brought to the emergency department at 3:00 AM with sudden onset severe dyspnea, orthopnea, and frothy pink sputum. On arrival: RR: 32/min BP: 170/95 mmHg HR: 110 bpm (irregularly irregular) SpO₂: 86% on room air Bilateral crackles on auscultation Elevated jugular venous pressure Which echo hemodinamic finding most directly suggest the diagnosis?

• TAPSE < 1.6 cm

• SVR: 1900 dyn·s/cm⁵

• Mitral valve area < 1.5 cm²

• LVOT VTI > 25 cm