ITE Pulmonary and Critical Care Questions and Answers

Question 1

A 58-year-old male is admitted to the ICU with sepsis and develops acute respiratory distress syndrome (ARDS).
He is intubated and placed on mechanical ventilation.
His height is 178 cm (5'10") and his ideal body weight is 75 kg.
According to the ARDSNet protocol and current clinical practice guidelines, which of the following represents the most appropriate initial ventilator settings?

Accepted Answer

Tidal volume of 450 mL, PEEP of 10 cm H₂O, and plateau pressure < 30 cm H₂O

Answer

Tidal volume of 750 mL, PEEP of 5 cm H₂O, and plateau pressure < 40 cm H₂O

Answer

Tidal volume of 600 mL, PEEP of 5 cm H₂O, and permissive hypercapnia is strictly avoided

Answer

Tidal volume of 300 mL, PEEP of 15 cm H₂O, and respiratory rate of 35 breaths/min

Question 2

A 24-year-old female with a known history of intermittent asthma presents to the urgent care clinic with complaints of wheezing and shortness of breath for the past two days. She uses her albuterol inhaler 4-5 times a day with partial relief. She has no daily controller medication. According to the 2024 GINA guidelines, which of the following is the most appropriate long-term management plan to initiate?

Accepted Answer

Prescribe as-needed low-dose inhaled corticosteroid (ICS)-formoterol

Answer

Continue with as-needed short-acting beta-agonist (SABA) only

Answer

Prescribe a daily low-dose inhaled corticosteroid (ICS) and continue SABA as needed

Answer

Prescribe a daily long-acting beta-agonist (LABA) inhaler

Question 3

A 66-year-old male with a history of COPD presents to the emergency department with increased dyspnea, cough, and sputum production. He has a history of two exacerbations in the past year. His blood eosinophil count is 350 cells/µL. According to the 2024 GOLD report, which of the following is the most appropriate initial pharmacologic management for this patient's chronic condition?

Accepted Answer

A combination of an inhaled corticosteroid (ICS), a long-acting beta-agonist (LABA), and a long-acting muscarinic antagonist (LAMA)

Answer

A long-acting muscarinic antagonist (LAMA) monotherapy

Answer

A combination of a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA)

Answer

A short-acting beta-agonist (SABA) as needed with no maintenance therapy

Question 4

A 72-year-old female is brought to the emergency department from a nursing home with a fever of 39.1°C (102.4°F), a respiratory rate of 28 breaths/min, and confusion. Her blood pressure is 85/50 mmHg despite receiving a 1L bolus of normal saline. A chest X-ray confirms a right lower lobe pneumonia. According to the Surviving Sepsis Campaign guidelines, which of the following interventions is the highest priority within the first hour of recognition?

Accepted Answer

Obtaining blood cultures and administering broad-spectrum antibiotics

Answer

Administering a 30 mL/kg crystalloid fluid bolus

Answer

Measuring serum lactate level

Answer

Initiating vasopressor therapy with norepinephrine

Question 5

A 65-year-old patient is mechanically ventilated in the ICU for pneumonia. The clinical team is discussing the sedation strategy. Which of the following approaches has been associated with improved clinical outcomes, including shorter duration of mechanical ventilation and ICU length of stay?

Accepted Answer

Using daily sedation interruptions combined with a protocol targeting light sedation (RASS 0 to -2)

Answer

Maintaining deep sedation (RASS -4 to -5) to ensure patient comfort and prevent ventilator recall

Answer

Administering continuous high-dose benzodiazepines without a daily awakening trial

Answer

Avoiding all sedation and analgesia to promote rapid extubation

Question 6

A 78-year-old man is admitted to the hospital with radiographically confirmed community-acquired pneumonia (CAP). He is clinically stable with normal vital signs, mental status, and oral intake. According to the most recent American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) guidelines, which of the following is an appropriate duration of antibiotic therapy for this patient?

Accepted Answer

A course of 3-5 days, provided he has achieved clinical stability

Answer

A fixed 10-day course of antibiotics

Answer

Antibiotic therapy for at least 14 days

Answer

Antibiotic treatment until the C-reactive protein level normalizes