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Year : 2016  |  Volume : 3  |  Issue : 3  |  Page : 85-86


BLK Superspeciality Hospital, New Delhi & Mediclinic City Hospital, Dubai, UAE

Date of Submission17-Jul-2016
Date of Acceptance24-Jul-2016
Date of Web Publication31-Jul-2016

Correspondence Address:
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Source of Support: None, Conflict of Interest: None

DOI: 10.21304/2016.0303.00137

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How to cite this article:
Khilnani P. PICU Quiz. J Pediatr Crit Care 2016;3:85-6

How to cite this URL:
Khilnani P. PICU Quiz. J Pediatr Crit Care [serial online] 2016 [cited 2022 Dec 8];3:85-6. Available from: http://www.jpcc.org.in/text.asp?2016/3/3/85/282637

  1. A 3-year-old boy with acute respiratory distress syndrome (ARDS) has a PaO2 of 50 mm Hg on a ventilator. After manipulating the ventilator settings and FiO2, his PaO2 increases to 100 mm Hg. His hemoglobin is 10 g /dL. How much does the oxygen content change with the increase in PaO2?

    1. Doubles
    2. Increases more than 25%
    3. Increases more than 10%
    4. Does not significantly change since the increase in PaO2 increased only the dissolved oxygen

  2. Which of the following statements about the carbon dioxide (CO2) content of blood is true?

    1. PaCO2 does not predict the total CO2 content of arterial blood.
    2. Physically dissolved CO2 is the most important form of CO2 content in the blood.
    3. Carbamino compounds are the most important form of CO2 content in the blood
    4. Bicarbonate ion is the most important form of CO2 content in the blood.

  3. Which of the following statements about the characteristics of transfusion-related acute lung injury is true?

    1. Radiographic findings may be unilateral or bilateral.
    2. Clinically, it appears as an acute hypoxemic insult.
    3. Symptoms typically develop 6 to 12 hours after the transfusion.
    4. Acute fluid overload is the usual mechanism of injury.

  4. Which of the following statements about post transplant lymphoproliferative disease is true?

    1. There are no identifiable major risk factors.
    2. Most cases are of T-cell origin.
    3. Lymphadenopathy is a common presenting sign.
    4. BK virus is the most commonly associated virus.

  5. What is the initial ventilation strategy following intubation of a 14-year-old boy who has severe asthma due to hypercapnia and respiratory failure?

    1. Long inspiratory time because of a prolonged time constant
    2. Fast ventilator rate to increase minute ventilation
    3. High positive end-expiratory pressure (PEEP) to reduce atelectasis
    4. Permissive hypercarbia to prevent ventilator- associated complications
    5. Prolonged muscle relaxation until wheezing resolves

  6. 7-year-old boy presents with septic shock and acute respiratory distress syndrome (ARDS). What is the central physiologic derangement of this type of lung injury?

    1. Disruption of the alveolar-capillary barrier
    2. Pulmonary hypertension
    3. Diffuse atelectasis
    4. Surfactant inactivation
    5. Ventilation-perfusion mismatch

  7. A 14-year-old girl has a PaO2 of 68 mm Hg on room air. The alveolar-arterial PaO2 difference (A-a gradient) is normal. What is the most likely cause of her hypoxemia?

    1. Limited diffusion of oxygen across the alveolar-capillary barrier
    2. Ventilation-perfusion mismatch
    3. Intracardiac right-to-left shunt
    4. Intrapulmonary right-to-left shunt
    5. Hypoventilation

  8. A 3-year-old boy presents to the emergency department with signs of smoke inhalation but no superficial burns after he was pulled from a house fire. He is now intubated on pressure- controlled ventilation with an FiO2 of 0.4. His pulse oximeter reading is 100%, and his arterial blood gas values are as follows: pH 7.28, PaO2 150 mm Hg, PaCO2 35 mm Hg, oxygen saturation 100%, bicarbonate 16 mEq/L, and base deficit -8. What is the most likely cause of his metabolic acidosis?

    1. Hypovolemia
    2. Hypotension
    3. Carbon monoxide poisoning
    4. Methemoglobinemia

  9. A 2-year-old boy presents with acute respiratory distress syndrome after a near-drowning incident. He is currently on pressure-regulated volume-controlled (PRVC) ventilation with the following values: tidal volume of 120 mL with a plateau pressure of 26 cm H2O; ventilator rate of 20; PEEP of 8 cm H2O; inspiratory time of 1 sec; and FiO2 of 0.85. His oxygen saturation is 80%. Which of the following maneuvers would be expected to have the greatest effect on mean airway pressure?

    1. Increasing PEEP by 2 cm H2O
    2. Increasing inspiratory time to 1.2 sec
    3. Increasing ventilator rate to 26, maintaining inspiratory time constant
    4. Decreasing inspiratory flow by 10%

  10. A 60-kg, 15-year-old boy who has severe bilateral pneumonia is on high frequency oscillatory ventilation with the following settings: mean airway pressure 32 cm H2O, delta P 75, oscillatory frequency 5 Hz, IT 33%. The patient has persistent hypercarbia and respiratory acidosis. After the frequency is gradually decreased to 3 Hz, the patient’s pH improves from 7.16 to 7.26 and his PaCO2 from 81 to 67 mm Hg. He has a 6.0 cuffed endotracheal tube in place with minimal air leak around it. Why does decreasing frequency increase CO2 removal?

    1. CO2 production decreases.
    2. Tidal volume increases
    3. Chest inflation improves.
    4. Expiratory time increases
    5. Gas exchange improves

  Answers Top

1. C

2. D

3. B

4. C

5. D

6. A

7. E

8. C

9. A

Where MAP = mean airway pressure

Ti = inspiratory time

Te = expiratory time

PIP = positive inspiratory pressure

PEEP = positive end-expiratory pressure

10. B


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