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roddyrodrod roddyrodrod
wrote...
Posts: 564
Rep: 1 0
6 years ago
A patient in the ICU has a chest X-ray that shows bilateral infiltrates and has the following he-modynamic measurements:
 
  : central venous pressure (CVP) 3 mm Hg, pulmonary artery pressure (PAP) 21/10 mm Hg, and pulmonary artery occlusion pressure (PAOP) 8 mm Hg. These findings are consistent with which of the following?
  a. Acute respiratory distress syndrome
  b. Cardiogenic pulmonary edema
  c. Pulmonary hypertension
  d. Right heart failure



Q. 2  Ventricular contractility can be estimated by which of the following?
 
  a. Systemic vascular resistance
  b. Ejection fraction
  c. Pulmonary vascular resistance
  d. Left ventricular stroke work



Q. 3  During mechanical ventilation of a patient with COPD, the PaCO2 = 58 mm Hg and the minute ventilation = 5.5 L/min. The desired PaCO2 for this patient is 45 mm Hg. To what should the mi-nute ventilation be changed?
 
  a. 4.3 L/min
  b. 4.8 L/min
  c. 6.6 L/min
  d. 7.1 L/min



Q. 4  Which of the following can cause an elevated right arterial pressure?
 
  a. Cardiac tamponade
  b. Third-degree heart block
  c. Decreased ventricular compliance
  d. Left ventricular failure



Q. 5  A patient in the ICU has a chest X-ray that shows bilateral infiltrates and has the following he-modynamic measurements: central venous pressure (CVP) 5 mm Hg,
 
  pulmonary artery pressure (PAP) 24/13 mm Hg, and pulmonary artery occlusion pressure (PAOP) 21 mm Hg. These findings are consistent with which of the following?
  a. Pulmonary hypertension
  b. Right ventricular failure
  c. Noncardiogenic pulmonary edema
  d. Cardiogenic pulmonary edema
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Replies
wrote...
6 years ago
(Answer to Q. 1)  ANS: A
The central venous pressure (CVP) and pulmonary artery pressure (PAP) are both within normal limits. Therefore, there is no pulmonary hypertension and no right ventricular failure. The bilateral infiltrates with a normal pulmonary artery occlusion pressure (PAOP) do not suggest cardiogenic pulmonary edema but are indicative of acute respiratory distress syndrome (ARDS).

(Answer to Q. 2)  ANS: B
The ejection fraction is a derived variable that provides an estimate of ventricular contractility. The systemic vascular resistance is an indicator of left ventricular afterload. Pulmonary vascular resistance indicates right ventricular afterload. Left ventricular stroke work reflects the pressure generated by the heart during a ventricular contraction.

(Answer to Q. 3)  ANS: D
Desired VT Known PaCO2 Known VT / Desired PaCO2

(Answer to Q. 4)  ANS: A
BOX 11-3 Causes of Abnormal Right Atrial and Pulmonary Artery Occlusion Pressure (PAOP) Values and Patterns
Abnormal Values Abnormal Patterns
Elevated Right Atrial Pressure (RAP)
Volume overload
Right ventricular (RV) failure
Tricuspid stenosis or regurgitation
Cardiac tamponade
Constrictive pericarditis
Chronic left ventricular (LV) failure
Elevated Pulmonary Artery Occlusion Pressure (PAOP)
Volume overload
Left ventricle failure
Mitral stenosis or regurgitation
Cardiac tamponade
Constrictive pericarditis
High PEEP
Low RAP or PAOP
Hypovolemia Large a Waves
Tricuspid/mitral stenosis
Decreased ventricular compliance
Compliance
Loss of atrioventricular synchrony
Third-degree block
Any other electrical dissociation
Absent a Waves
Atrial fibrillation
Atrial flutter
Junctional rhythms
Paced rhythms
Ventricular rhythms

(Answer to Q. 5)  ANS: D
The central venous pressure (CVP) and pulmonary artery pressure (PAP) are both within normal limits. Therefore, there is no pulmonary hypertension and no right ventricular failure. The elevat-ed pulmonary artery occlusion pressure (PAOP) along with the bilateral infiltrates is consistent with cardiogenic pulmonary edema due to left ventricular failure. Noncardiogenic pulmonary edema would not cause an elevated PAOP.
roddyrodrod Author
wrote...
6 years ago
Confirmed correct!
wrote...
6 years ago
Cool, thanks for replying back
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