|Year : 2020 | Volume
| Issue : 5 | Page : 298-301
Pradeep Kumar Sharma
Department of Pediatric Critical Care and Pulmonology, Sri Balaji Action Medical Institute, New Delhi, India
|Date of Submission||02-Aug-2020|
|Date of Acceptance||12-Aug-2020|
|Date of Web Publication||14-Sep-2020|
Dr. Pradeep Kumar Sharma
Department of Pediatric Critical Care and Pulmonology, Sri Balaji Action Medical Institute, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma PK. PICU quiz. J Pediatr Crit Care 2020;7:298-301
1. An 11-year-old child with newly diagnosed leukemia is admitted to the pediatric intensive care unit (PICU) in severe respiratory distress. Chest radiograph shows a widened mediastinum. Which one of the following measures is to be avoided during airway management in this child?
- Administration of muscle relaxants
- Endotracheal intubation
- Heliox administration
- Left lateral decubitus position.
2. Which of the following statements regarding near-fatal asthma is true?
- A ventilation strategy of low respiratory rates (<12 breaths/min), moderate-to-high tidal volumes (8–12 mL/kg), and permissive hypercapnia has been proved to be associated with increased mortality and a rate of pneumothorax approaching 100%
- Increasing positive end-expiratory pressure (PEEP) in mechanically ventilated asthma patients receiving neuromuscular blockade has been shown to have unfavorable effects on lung volumes, airway pressure, and hemodynamics
- Ketamine is contraindicated during intubation due to its slow onset of action and tendency to cause bronchoconstriction
- Nearly, all patients have a history of severe persistent asthma with frequent ICU admissions in the 1 year preceding the episode of near-fatal asthma.
3. What is the least accurate statement regarding the management of pulmonary arterial hypertension (PAH) in children?
- Co-administration of sildenafil with ketoconazole or rifampin should be avoided
- Due to the risk of hepatic toxicity, the Food and Drug Administration (FDA) requires that liver function tests is performed at least once in 3 months in patients on endothelial receptor antagonists such as bosentan
- Nitric oxide (NO) is currently the first-line drug in the acute management of PAH or in cases of postoperative PAH arising from congenital heart disease (CHD) repair
- There is a mutual pharmacokinetic interaction between bosentan and sildenafil that may influence the dosage of each drug in a combination treatment.
4. Which best describes the phase variables for pressure-support ventilation (PSV)?
- Patient triggered, flow limited, pressure cycled
- Patient triggered, pressure limited, flow cycled
- Pressure triggered, flow limited, patient cycled
- Pressure triggered, patient limited, flow cycled.
5. A 3-year-old child with a tracheostomy for 2½ years is being decannulated. Immediately following decannulation, he develops stridor and respiratory distress. Possible etiologies include all of the following except:
- Tracheal stenosis or granulation tissue
- An obstructing flap of the posterior tracheal wall
- Fusion of vocal cords
- Temporary laryngeal abductor failure.
6. Unilateral phrenic nerve paralysis is clinically more significant in infants and young children compared with adults because of all of the following except:
- Hemidiaphragmatic paralysis in this age group is equivalent to massive flail chest in an adult
- The excessively compliant chest wall of the young child
- The poor ability of intercostal muscles to stabilize the chest wall in the young infant
- Less compliant chest wall of the young child
- With inspiration, the ipsilateral intercostal muscles and the paralyzed diaphragm are sucked in.
7. The use of hyperbaric O2 therapy for CO poisoning is probably the most common application of this technology. All of the following statements regarding this application are true except:
- The beneficial effect of hyperbaric O2 therapy is directly related to the associated increase in PaO2
- The half-life of CO as measured by carboxyhemoglobin (HbCO) is decreased to 53 min at 3 atmospheric pressure (atm)
- Hyperbaric O2 therapy helps reverse binding of carbon monoxide (CO) to cytochrome α3
- Hyperbaric O2 therapy is indicated in patients who suffer unconsciousness or display signs of central nervous system (CNS) depression.
8. Wrong statement regarding technical errors during sampling of arterial blood gas is:
- A gas bubble in the syringe will falsely elevate PaCO2
- The major blood gas error associated with excess heparin in the sample is a drop in PaCO2
- When a sample that is obtained from a patient breathing room air is interfaced with a bubble, the PaO2 obtained will be close to 150 torr
- In a patient on high FiO2 with normal lungs, the presence of an air bubble in the syringe may spuriously lower PaO2.
9. A 2½-year-old male child has a 2-day history of an upper respiratory tract infection and fever, now having mild stridor and dysphagia. His immunizations are up to date. Attending physician suspects retropharyngeal abscess. Which one of the following statements is incorrect regarding this patient?
- Age of the patient is somewhat atypical
- Inspiratory radiograph films are more informative than expiratory films
- A chest radiograph should be obtained to evaluate mediastinal extension
- The retropharyngeal space extends from the base of the skull to the level of the second thoracic vertebra
- The usual organisms are staphylococci, group A streptococci, and anerobes.
10. A 7-year-old child with status asthmaticus is undergoing treatment in your PICU with systemic corticosteroids, β2-agonists, ipratropium, and 60% FiO2. He has moderate air entry, bilateral wheezes, no nasal flaring, and mild intercostal retractions. Her respiratory rate is 22/min. Her pulse oximetry saturations prior to and after initiation of therapy were 91% and 86%, respectively. Which of the following is the most likely explanation for this observed change in oxygen saturation?
- Excessive fatigue with hypoventilation and resultant hypoxemia
- Increase in airway secretion due to the institution of ipratropium
- Increase in ventilation/perfusion mismatch due to β2-agonist
- Mucus plugging of the airways due to institution of ipratropium.
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Newth CJ, Meert KL, Clark AE, Moler FW, Zuppa AF, Berg RA, et al
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Carter P, Benjamin B. Ten-year review of pediatric tracheotomy. Ann Otol Rhinol Laryngol 1983;92:398-400.