Exam (elaborations)

ABSITE - Critical Care Questions and Answers

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ABSITE

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ABSITE

All are potential causes of cardiogenic shock except: - Myocardial infarction. - Pericardial tamponade. - Tension pneumothorax. - Cardiac arrhythmias. - Excessive preload.  :-- Excessive preload.  (Excessive preload is typically not a cause of cardiogenic shock, but is a result of ca...

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absite critical care questions and answers

Institution ABSITE
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Elscores: Aug. 27, 24- 2024/2025

ABSITE - Critical Care Questions and Answers

All are potential causes of cardiogenic shock except:

- Myocardial infarction.

- Pericardial tamponade.

- Tension pneumothorax.

- Cardiac arrhythmias.

- Excessive preload.

 :-- Excessive preload.

 (Excessive preload is typically not a cause of cardiogenic shock, but is a result of

cardiogenic shock.)

A 60-year-old man has an arterial PO of 60 mm Hg when the calculated alveolar PO is 94 mm

Hg. This difference is most commonly due to

 :-- a ventilation-perfusion mismatch

oxygen delivery and consumption

 :-- - Under normal circumstances, approximately 20% to 30% of the oxygen delivered to

the capillary bed is extracted by the tissues.

- In conditions of decreased delivery of oxygen, tissues are capable of extracting up to 50% to

60% of the oxygen content in the capillary blood.

- When cellular oxygen supply does not meet demand, anaerobic respiration results.

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, 2
Elscores: Aug. 27, 24- 2024/2025

(The variables in the equation for the delivery of oxygen are cardiac output, hemoglobin level,

oxygen saturation of hemoglobin, and the partial pressure of oxygen dissolved in blood.

Increases in the first three variables all yield significant increases in the total amount of oxygen

carried by blood. The partial pressure of oxygen is multiplied by a factor of 0.003, however, and

therefore has a miniscule contribution to the total oxygen content.)

Dopamine at doses of 5 to 10 μg/kg/min

 :-- has a largely inotropic action profile

(Dopamine has a dose-dependent action profile. At 3 to 5 μg/kg/min, its actions are largely to

increase renal blood flow. At doses of 5 to 10 μg/kg/min, it largely acts to stimulate myocardial

β receptors and has an inotropic effect. At doses greater than 10 μg/kg/min, it stimulates α

receptors and has a chronotropic effect.)

As oxygen delivery increases on the flat horizontal portion of the oxygen consumption-delivery

curve

 :-- Oxygen consumption remains the same

(On the flat horizontal portion of the oxygen consumption-delivery curve, oxygen delivery meets

cellular demand of oxygen; as oxygen delivery increases, oxygen consumption remains the same.)

Most disorganized ventricular arrhythmias (frequent PVCs, ventricular fibrillation) are caused by

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, 3
Elscores: Aug. 27, 24- 2024/2025

 :-- Metabolic derangements.

(Most disorganized ventricular arrhythmias are caused by some sort of metabolic derangement

such as ischemia or magnesium or potassium deficiencies. These abnormalities are not well

treated by antiarrhythmic medications.)

The best management for a patient with a posterior knee dislocation

 :-- Arteriogram.

(The patient may have fairly normal pulses and still have an intimal injury of the popliteal artery

that is similar to the intimal disruption that can be seen in aortic isthmus injury.)

the possible etiologies of multiorgan failure

 :-- - Anticytokine antibodies have shown therapeutic promise in animal studies.

- Evidence has shown that intestinal mucosa is made permeable by sepsis.

- The "two-hit" hypothesis postulates that after mounting an appropriate response to some

physiologic insult, the patient is left with a primed immune system which manifests an

exaggerated immune response to a second challenge.

- The early stages after injury actually appear to consist of an immediate proinflammatory state as

the organism tries to address the physiologic insult. When properly modulated, this is an

appropriate function. When overexpressed, this proinflammatory state leads to the systemic

inflammatory response syndrome. Later, anti-inflammatory and immunosuppressive mechanisms

are brought into play to bring the organism back to homeostasis. If overmanifested, they can

lead to a relative generalized immunosuppression and late incidents of sepsis or multiorgan

failure.

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compensatory mechanisms in shock

 :-- Antidiuretic hormone causes the reabsorption of free water by the kidney and has

vasoconstrictive properties.

(Antidiuretic hormone is released from the posterior pituitary where it stimulates free water

retention by the kidney and acts as a powerful vasoconstrictor.)

A 71-year-old man with colon cancer is in the intensive care unit following a left hemicolectomy.

His blood pressure is 72/38 mm Hg, pulse rate is 114/min, respiratory rate is 23/min, and

oxygen saturation is 94% on 2 L of oxygen by nasal cannulae. A pulmonary artery catheter shows

a central venous pressure of 8 cm H O, a pulmonary artery pressure of 22/8 mm Hg, a

pulmonary artery wedge pressure of 6 mm Hg, and a cardiac output of 3.4 L/min. The next step

in management should be the intravenous administration of

 :-- a fluid bolus

pulmonary artery catheters

 :-- Allow accurate approximation of left atrial pressure.

The magnitude of a left-to-right shunt in the presence of an ASD is determined by

 :-- Difference in compliance between left and right ventricles.

(The blood will tend to fill the more compliant ventricle which will usually be the right, until

chronic pulmonary hypertension yields right ventricular hypertrophy.)

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