ACCS Oakes practice Exam questions with |\ |\ |\ |\ |\ |\
answers
A difficult intubation is anticipated with an obese pt. The decision
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is made to intubate by video laryngoscopy. Which of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
following is LEAST likely to be needed: |\ |\ |\ |\ |\ |\
A) Cook's Exchanger
|\ |\
|\ B) Rigid Stylet
|\ |\
|\ C) Cuffed Endotracheal Tube
|\ |\ |\
D) Video-enabled Laryngoscope - CORRECT ANSWERS ✔✔A)
|\ |\ |\ |\ |\ |\ |\ |\
cook's exchanger |\
Video laryngoscopy involves use of a normal ET Tube with the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
addition of a rigid stylet, as well as a video-enabled laryngoscope
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and other normal intubation equipment.
|\ |\ |\ |\ |\ |\
A Cook's Tube Exchanger is not necessary - this is used to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
exchange tubes already in place. |\ |\ |\ |\
A 5'6" female has been transferred from Intermediate Care to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Intensive Care in respiratory distress. She is intubated with a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
silver-coated #7.0 Endotracheal tube. CXR immediately following |\ |\ |\ |\ |\ |\ |\
intubation shows Right Upper Lobe infiltrate with bibasilar |\ |\ |\ |\ |\ |\ |\ |\
atelectasis. The ET Tube is noted to be approximately 4 cm above |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the carina.
|\ |\ |\
,The Respiratory Therapist would BEST recommend:
|\ |\ |\ |\ |\
A) Initiation of broad-spectrum antibiotics for probably
|\ |\ |\ |\ |\ |\ |\
pneumonia
|\ B)Withdraw Endotracheal tube at least 3 cm |\ |\ |\ |\ |\ |\
C) Use tube exchanger to replace Endotracheal tube from silver-
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
coated to a low-pressure/high-volume cuffed tube
|\ |\ |\ |\ |\
|\ D) Immediate V/Q Scan - CORRECT ANSWERS ✔✔Correct answer
|\ |\ |\ |\ |\ |\ |\ |\
|\ is A
|\
This pt has gone into respiratory failure, requiring intubation. The
|\ |\ |\ |\ |\ |\ |\ |\ |\
X-ray is consistent with a possible pneumonia diagnosis. The
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
best option therefore is to start antibiotics.
|\ |\ |\ |\ |\ |\ |\
Withdrawing ET Tube is not indicated as 4 cm is likely adequate. |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Pulling back 3 cm could result in inadvertent extubation and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
would cause harm to patient |\ |\ |\ |\
Use of tube exchanger is unnecessary. A silver-coated
|\ |\ |\ |\ |\ |\ |\ |\
endotracheal tube is intended to help prevent VAP |\ |\ |\ |\ |\ |\ |\
Immediate V/Q scan is not indicated - it is a poor use of |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
resources for what is needed right away. |\ |\ |\ |\ |\ |\
You are part of Physician Rounding this morning, and consulting
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
on a patient who is currently on APRV. They were originally
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
admitted with a pneumonia which developed into ARDS with a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
P/F ratio as low as 110. The patient was transitioned to APRV
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,from PC due to an elevated Plateau Pressure required to maintain
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
VT around 4 cc/kg IBW. The patient is arousable and taking
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
breaths on their own. The physician has asked you what should
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
be done to address the patient's latest ABG.
|\ |\ |\ |\ |\ |\ |\ |\
Ph 7.16|\
PaCo2 49 |\
PaO2 88 torr |\ |\
HCO3 19 |\
Mode- APRV |\
Phigh- 24 |\
Plow- 0 |\
Thigh- 5.0 sec |\ |\
Tlow- o.5 sec |\ |\
PS- 26 |\
FiO2- 80% |\
A) Increase Phigh to 28 cmH2O
|\ |\ |\ |\ |\
|\ B) Decrease Phigh to 20 cmH2O
|\ |\ |\ |\ |\
C) Increase sedation
|\ |\
D) Increase Thigh to 6.0 sec - CORRECT ANSWERS ✔✔Correct
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
answer is A |\ |\
This ABG may look deceptively metabolic but is truly a mixed
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Respiratory and Metabolic Acidosis. The PaCO2 has risen, slightly, |\ |\ |\ |\ |\ |\ |\ |\
, as a result of the Metabolic Acidosis. The correct solution is to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
increase Phigh to 28 cmH2O (increasing your delta-P to increase
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minute volume. Decreasing Phigh will decrease minute volume.
|\ |\ |\ |\ |\ |\ |\ |\
Increasing Thigh will increase MAP (good if oxygenation), but will |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
also lower the number of "releases" - which are primarily
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
responsible for dumping CO2. Increasing sedation in a patient |\ |\ |\ |\ |\ |\ |\ |\ |\
who is spontaneously breathing on APRV will result in a lowered
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minute volume and worsening acidosis. While controversy exists,
|\ |\ |\ |\ |\ |\ |\ |\
you may also consider increasing PS if the pt is breathing
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
spontaneously.
A 56-year old woman was admitted for rapid development of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
respiratory failure following a suspected aspiration. Her past |\ |\ |\ |\ |\ |\ |\ |\
medical history includes Diabetes, medication-controlled
|\ |\ |\ |\ |\
Hypertension, and she has a 30-pack year smoking history. |\ |\ |\ |\ |\ |\ |\ |\ |\
She has been intubated and placed on a Ventilator.
|\ |\ |\ |\ |\ |\ |\ |\ |\
Patient data |\ |\
Ph 7.19 |\
PaCO2 62 mmHg |\ |\
PaO2 54 mmHg |\ |\
HCO3 18 mEq/L |\ |\
Mode - pressure control |\ |\ |\
Set PIP- 24 cm H2O
|\ |\ |\ |\
VTE- 380 ml measured |\ |\ |\
Rate- 24/min |\
answers
A difficult intubation is anticipated with an obese pt. The decision
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is made to intubate by video laryngoscopy. Which of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
following is LEAST likely to be needed: |\ |\ |\ |\ |\ |\
A) Cook's Exchanger
|\ |\
|\ B) Rigid Stylet
|\ |\
|\ C) Cuffed Endotracheal Tube
|\ |\ |\
D) Video-enabled Laryngoscope - CORRECT ANSWERS ✔✔A)
|\ |\ |\ |\ |\ |\ |\ |\
cook's exchanger |\
Video laryngoscopy involves use of a normal ET Tube with the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
addition of a rigid stylet, as well as a video-enabled laryngoscope
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and other normal intubation equipment.
|\ |\ |\ |\ |\ |\
A Cook's Tube Exchanger is not necessary - this is used to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
exchange tubes already in place. |\ |\ |\ |\
A 5'6" female has been transferred from Intermediate Care to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Intensive Care in respiratory distress. She is intubated with a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
silver-coated #7.0 Endotracheal tube. CXR immediately following |\ |\ |\ |\ |\ |\ |\
intubation shows Right Upper Lobe infiltrate with bibasilar |\ |\ |\ |\ |\ |\ |\ |\
atelectasis. The ET Tube is noted to be approximately 4 cm above |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the carina.
|\ |\ |\
,The Respiratory Therapist would BEST recommend:
|\ |\ |\ |\ |\
A) Initiation of broad-spectrum antibiotics for probably
|\ |\ |\ |\ |\ |\ |\
pneumonia
|\ B)Withdraw Endotracheal tube at least 3 cm |\ |\ |\ |\ |\ |\
C) Use tube exchanger to replace Endotracheal tube from silver-
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
coated to a low-pressure/high-volume cuffed tube
|\ |\ |\ |\ |\
|\ D) Immediate V/Q Scan - CORRECT ANSWERS ✔✔Correct answer
|\ |\ |\ |\ |\ |\ |\ |\
|\ is A
|\
This pt has gone into respiratory failure, requiring intubation. The
|\ |\ |\ |\ |\ |\ |\ |\ |\
X-ray is consistent with a possible pneumonia diagnosis. The
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
best option therefore is to start antibiotics.
|\ |\ |\ |\ |\ |\ |\
Withdrawing ET Tube is not indicated as 4 cm is likely adequate. |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Pulling back 3 cm could result in inadvertent extubation and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
would cause harm to patient |\ |\ |\ |\
Use of tube exchanger is unnecessary. A silver-coated
|\ |\ |\ |\ |\ |\ |\ |\
endotracheal tube is intended to help prevent VAP |\ |\ |\ |\ |\ |\ |\
Immediate V/Q scan is not indicated - it is a poor use of |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
resources for what is needed right away. |\ |\ |\ |\ |\ |\
You are part of Physician Rounding this morning, and consulting
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
on a patient who is currently on APRV. They were originally
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
admitted with a pneumonia which developed into ARDS with a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
P/F ratio as low as 110. The patient was transitioned to APRV
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,from PC due to an elevated Plateau Pressure required to maintain
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
VT around 4 cc/kg IBW. The patient is arousable and taking
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
breaths on their own. The physician has asked you what should
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
be done to address the patient's latest ABG.
|\ |\ |\ |\ |\ |\ |\ |\
Ph 7.16|\
PaCo2 49 |\
PaO2 88 torr |\ |\
HCO3 19 |\
Mode- APRV |\
Phigh- 24 |\
Plow- 0 |\
Thigh- 5.0 sec |\ |\
Tlow- o.5 sec |\ |\
PS- 26 |\
FiO2- 80% |\
A) Increase Phigh to 28 cmH2O
|\ |\ |\ |\ |\
|\ B) Decrease Phigh to 20 cmH2O
|\ |\ |\ |\ |\
C) Increase sedation
|\ |\
D) Increase Thigh to 6.0 sec - CORRECT ANSWERS ✔✔Correct
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
answer is A |\ |\
This ABG may look deceptively metabolic but is truly a mixed
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Respiratory and Metabolic Acidosis. The PaCO2 has risen, slightly, |\ |\ |\ |\ |\ |\ |\ |\
, as a result of the Metabolic Acidosis. The correct solution is to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
increase Phigh to 28 cmH2O (increasing your delta-P to increase
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minute volume. Decreasing Phigh will decrease minute volume.
|\ |\ |\ |\ |\ |\ |\ |\
Increasing Thigh will increase MAP (good if oxygenation), but will |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
also lower the number of "releases" - which are primarily
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
responsible for dumping CO2. Increasing sedation in a patient |\ |\ |\ |\ |\ |\ |\ |\ |\
who is spontaneously breathing on APRV will result in a lowered
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minute volume and worsening acidosis. While controversy exists,
|\ |\ |\ |\ |\ |\ |\ |\
you may also consider increasing PS if the pt is breathing
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
spontaneously.
A 56-year old woman was admitted for rapid development of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
respiratory failure following a suspected aspiration. Her past |\ |\ |\ |\ |\ |\ |\ |\
medical history includes Diabetes, medication-controlled
|\ |\ |\ |\ |\
Hypertension, and she has a 30-pack year smoking history. |\ |\ |\ |\ |\ |\ |\ |\ |\
She has been intubated and placed on a Ventilator.
|\ |\ |\ |\ |\ |\ |\ |\ |\
Patient data |\ |\
Ph 7.19 |\
PaCO2 62 mmHg |\ |\
PaO2 54 mmHg |\ |\
HCO3 18 mEq/L |\ |\
Mode - pressure control |\ |\ |\
Set PIP- 24 cm H2O
|\ |\ |\ |\
VTE- 380 ml measured |\ |\ |\
Rate- 24/min |\
