Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map


Self-Assessment Questions

Critical Care Medicine

Hemodynamic Monitoring: Review Questions

Steven Lin, MD, and John M. Oropello, MD, FCCP, FCCM

Dr. Lin is a fellow in critical care medicine, and Dr. Oropello is program director of critical care medicine and an associate professor of surgery and medicine; both are at Mount Sinai School of Medicine, New York, NY.



Choose the single best answer for each question.

1. A 44-year-old man with hypertension and diabetes is admitted to the intensive care unit (ICU) for severe pancreatitis. Soon thereafter, he develops respiratory distress requiring intubation. His blood pressure is 80/30 mm Hg, heart rate is 120 bpm, and respiratory rate is 24 breaths/min. His serum creatinine level is 2.5 mg/dL (baseline, 1.0 mg/dL), and his arterial lactate level is 3.8 mg/dL. An electrocardiogram shows sinus tachycardia with occasional ventricular premature beats, and chest radiograph shows bilateral fluffy infiltrates. The ventilator is set on assist-control mode; tidal volume, 500 mL; respiratory rate, 12 breaths/min, Fio2, 100%; and positive end-expiratory pressure, 10 cm H2O. Pulse oximetry shows Sao2 of 90%. Data from a pulmonary artery catheter (PAC) show central venous pressure (CVP), 24 mm Hg; pulmonary artery pressure, 35/20 mm Hg; pulmonary artery wedge pressure (PAWP), 12 mm Hg; and cardiac output (CO), 4.5 L/min. At this point, what is the best management option for this patient?
  1. Intravenous (IV) furosemide 40 mg
  2. IV ß-blockers
  3. IV amiodarone
  4. IV fluid bolus
  5. IV dobutamine
Click here to compare your answer.


2. A 58-year-old man with liver failure from hepatitis C cirrhosis is admitted to the surgical ICU after liver transplantation. The patient is intubated and has a perioperatively placed PAC. He is 5 ft 8 in, weighs 78 kg, and his vital signs are: blood pressure, 98/50 mm Hg; mean arterial pressure, 66 mm Hg; heart rate, 108 bpm; and temperature, 36°C. Results of laboratory tests show: leukocyte count, 12.0 × 103/mm3; hemoglobin level, 9.0 g/dL; international normalized ratio, 2.3; arterial lactate level, 5 mg/dL (increased from 3.4 mg/dL immediately postoperatively); sodium, 134 mEq/L; potassium,

4.5 mEq/L; bicarbonate, 23 mEq/L; blood urea nitrogen, 20 mg/dL; creatinine, 1.4 mg/dL; and glucose, 123 mg/dL. Results of an arterial blood gas sampling show: pH, 7.36; Pco2, 38 mm Hg; Po2, 120 mm Hg; and Sao2, 95%. Results of mixed venous blood gases show: pH, 7.32; Pco2, 50 mm Hg; Po2, 43 mm Hg; and Svo2, 72%. PAC data are: CVP, 8 mm Hg; PAWP, 12 mm Hg; CO, 4.0 L/min; and systemic vascular resistance, dynes/sec/cm-5. Which of the following statements regarding this patient’s CO is correct?
  1. CO is adequate
  2. CO is not adequate
  3. CO is too high
  4. CO is falsely low
  5. CO cannot be accurately determined in transplant patients
Click here to compare your answer.


3. To clarify the utility of the PAC to improve patient outcome, several major studies have been conducted. These studies have demonstrated which of the following?

  1. Perioperative PAC use benefits high-risk surgical patients
  2. PAC use does not benefit patients with acute respiratory distress syndrome (ARDS)
  3. PAC use harms patients with septic shock
  4. PAC use should not be allowed in the ICU setting
  5. PAC use benefits patients with septic shock
Click here to compare your answer.


 

Self-Assessment Questions Main Page Top

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj