ABA Critical Care & Pain Medicine 2

Question 1

A patient in the ICU develops acute respiratory distress syndrome (ARDS). Which ventilator strategy has been shown to reduce mortality?

Accepted Answer

Low tidal volume ventilation at 6 mL/kg IBW with plateau pressure <30 cmH2O

Answer

The ARDSNet trial demonstrated that lung-protective ventilation with 6 mL/kg IBW and plateau pressure <30 cmH2O significantly reduces mortality in ARDS.

Question 2

Which opioid is preferred for continuous infusion in critically ill patients with renal failure due to its lack of active metabolite accumulation?

Accepted Answer

Fentanyl

Answer

Fentanyl is preferred in renal failure because it has no clinically significant active metabolites that accumulate, unlike morphine (morphine-6-glucuronide) or meperidine (normeperidine).

Question 3

In the management of septic shock, what is the recommended initial fluid resuscitation volume within the first 3 hours according to Surviving Sepsis Campaign guidelines?

Accepted Answer

30 mL/kg IV crystalloid

Answer

The Surviving Sepsis Campaign recommends at least 30 mL/kg of intravenous crystalloid within the first 3 hours of sepsis-induced hypoperfusion.

Question 4

A patient on chronic opioid therapy presents with hyperalgesia (increased sensitivity to pain with lower opioid doses). The BEST initial management strategy is:

Accepted Answer

Add an NMDA receptor antagonist and consider opioid rotation

Answer

Opioid-induced hyperalgesia is best managed by opioid rotation with dose reduction combined with NMDA antagonists (e.g., ketamine) to address central sensitization.

Question 5

Which of the following is the MOST reliable indicator of adequate fluid resuscitation in a mechanically ventilated patient with septic shock?

Accepted Answer

Pulse pressure variation (PPV) <13% after fluid challenge

Answer

Pulse pressure variation <13% during mechanical ventilation reliably predicts fluid responsiveness and indicates adequate preload, whereas CVP is poorly predictive.

(ABA) ASA (American Society of Anesthesiologists) Board Certification Practice Test

(ABA) ASA (American Society of Anesthesiologists) Board Certification Practice Test

ABA Critical Care & Pain Medicine 2