FFICM Respiratory Management and Mechanical Ventilation 2

Question 1

Which combination of criteria most appropriately indicates readiness to perform a spontaneous breathing trial (SBT)?

Accepted Answer

FiO2 ≤0.4, PEEP ≤5–8 cmH2O, hemodynamic stability without high-dose vasopressors

Answer

FiO2 >0.6 with improving chest radiograph and stable neurology

Answer

PEEP >10 cmH2O with resolving bilateral infiltrates

Answer

Two or fewer vasopressors regardless of FiO2 requirements

Question 2

What is the dominant mechanism by which ventilator-associated pneumonia (VAP) develops in ICU patients?

Accepted Answer

Microaspiration of colonised oropharyngeal secretions past the endotracheal tube cuff

Answer

Haematogenous seeding from a distant infection source

Answer

Retrograde contamination from the ventilator circuit

Answer

Reactivation of latent pulmonary organisms due to immunosuppression

Question 3

A Rapid Shallow Breathing Index (RSBI) greater than 105 breaths/min/L during an SBT predicts:

Accepted Answer

High likelihood of spontaneous breathing trial failure

Answer

Successful extubation readiness

Answer

Need to increase PEEP before extubation

Answer

Requirement for neuromuscular blockade

Question 4

Ventilator-Induced Diaphragm Dysfunction (VIDD) is best described as:

Accepted Answer

Diaphragmatic atrophy and contractile weakness caused by controlled mechanical ventilation

Answer

Phrenic nerve injury from prolonged endotracheal tube placement

Answer

Diaphragm rupture secondary to excessive tidal volume delivery

Answer

Paradoxical diaphragm motion caused by high PEEP

Question 5

Which single intervention has the strongest evidence for reducing ventilator-associated events (VAE) in ICU patients?

Accepted Answer

Maintaining the head of bed at 30–45 degrees to reduce aspiration

Answer

Changing the ventilator circuit every 24 hours

Answer

Routine prophylactic antifungal therapy in all intubated patients

Answer

Replacing HME filters with heated humidifiers to reduce circuit resistance

Question 6

In inverse ratio ventilation (IRV), the inspiratory-to-expiratory ratio is set to:

Accepted Answer

Greater than 1:1 (e.g., 2:1 or 3:1)

Answer

Less than 1:2 (e.g., 1:3 or 1:4)

Answer

Exactly 1:1 to balance breath phases equally

Answer

Greater than 1:4 to maximise expiratory time

Question 7

The primary mechanism by which recruitment maneuvers improve gas exchange in ARDS is:

Accepted Answer

Transiently increasing airway pressure to re-open collapsed alveoli and restore functional residual capacity

Answer

Removing excess pulmonary oedema fluid through suction

Answer

Improving cardiac output to increase mixed venous oxygen saturation

Answer

Reducing pulmonary vascular resistance to lower right heart afterload