Sample Questions

Farquhar Anzo is a 57-year-old man who develops ventricular fibrillation following acute MI. Immediate defibrillation is unsuccessful. He is intubated and chest compressions are commenced. Breath sounds are equal bilaterally, no air entry is heard over the stomach, and chest wall movement is symmetric. Colorimetric capnometry detects a persistently low end-tidal CO2 of approximately 0.5% over five minutes of resuscitation.

a) List THREE potential causes of low end-tidal CO2 during resuscitation in this setting. (3 marks)

You are caring for Salman Mourad, a 45-year old male with cardiac amyloidosis, congestive heart failure with depressed ejection fraction, pulmonary hypertension on the basis of cardiomyopathy. He is intubated in your ICU for ST elevation myocardial infarction post PCI with subsequent development of hypoxemic respiratory failure on the basis of atelectasis, cardiogenic pulmonary edema and worsened pulmonary hypertension. A light sedation strategy is implemented with RASS +1 on dexmedetomidine 0.3mcg/kg/m. Vitals are as follows: BP 180/110mm Hg HR 110bpm RR 20 SpO2 88% T 36.5. Ventilator settings are: PSV PS 14cm H2O PEEP 10cm H2O FiO2 0.5

a) Inhaled nitric oxide is initiated. Describe ONE indication for inhaled nitric oxide and describe the SINGLE MOST LIKELY vital sign impact (2 marks)

b) Describe the MOST IMPORTANT ALARM providing notification of circuit disconnect in the inhaled nitric oxide (1 mark)

c) Nitroglycerine intravenous infusion is initiated for hypertension and pulmonary edema. Aside from a decrease in blood pressure, describe the SINGLE MOST LIKELY physiologic impact (1 mark)

d) The patient passes a spontaneous breathing trial on the abovementioned settings and inhaled nitric oxide. Immediately post extubation the oxygen saturation is 70% with an FiO2 of 1.0. Aside from atelectasis, LIST ONLY TWO LIKELY ETIOLOGIES for severe hypoxemia in this circumstance (2 marks)

Dee Madison is a patient under your care in the intensive care unit following liver resection for metastatic adenocarcinoma.  This has been complicated by intra-abdominal hematoma.  The patient’s ventilator pressures have increased, and urine output has decreased to < 20 mL/hour.  You are concerned about the development of abdominal compartment syndrome.

Describe the process for measurement of intra-abdominal pressure (2 marks)

Define abdominal compartment syndrome (1 mark)

List TWO approaches to medical (non-surgical) management of intra-abdominal hypertension (2 marks)

James Booth is a 58-year-old male patient extubated 2 hours ago after passing SBT. He was intubated in the Operating Room yesterday for total knee replacement and remained intubated due to prolonged sedation effects. Cuff leak test was 10 mL (1%). Patient now develops inspiratory stridor audible at bedside, respiratory rate 28, SpO2 91% on FiO2 0.40 by facemask, using accessory muscles. The patient is anxious but follows commands with no voice change.

a) Identify which intervention should be attempted first before reintubation and explain the physiologic rationale. (2 marks)

b) List two clinical findings that would indicate this therapy has failed and reintubation is required. (2 mark)

c) List TWO risk factors for post-extubation stridor. (2 marks)

d) State whether you would have performed a cuff leak test for Mr. Booth with YES or NO. (1 mark)

e) Identify which statistical characteristic of cuff leak testing for prediction of post-extubation stridor is higher. Write SENSITIVITY or SPECIFICITY (1 mark)

Annie MacDougall is a 27-year-old patient with severe asthma is intubated and mechanically ventilated. Sequential arterial line measurements are obtained:

Timeline: T0 = before intubation; T1 = 5 min post-intubation; T2 = after 500mL crystalloid bolus and ventilator adjustment; T3 = after additional 500mL bolus

Describe the physiologic trajectory from T0 to T1 that explains the blood pressure change (1 mark)

Identify which intervention between T1 and T2 (fluid vs ventilator adjustment) contributed more to the blood pressure improvement and justify using specific parameter changes (2 marks)

Briefly explain the difference between pulse pressure variability and pulsus paradoxus (2 marks)

Identify TWO clinical situations where pulse pressure variability is unreliable as a marker for preload responsiveness, assuming the arterial line is calibrated correctly (2 marks)