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AG-ACNP Barkley Review 2024- Questions & Answers
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AG-ACNP Barkley Review 2024- Questions & Answers
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AG-ACNP Barkley Review 2024-Questions & Answers
PE (risk factors) (6) Correct Ans-1. Prolonged bed rest/immobility
2. Oral contraceptive
3. Surgery to long bones
4. Venous stasis
5. Hypercoagulable states
6. Cardiac thrombi
PE (s/s) (7) Correct Ans-1. Usually occur abruptly
2. Unexplained dyspnea and tachycardia most common
3. Chest pain (retrosternal or lateralized and pleuritic)
4. Hemoptysis
5. Low grade fever
6. Hypotension
7. Cyanosis
PE (lab/diagnostics) (5) Correct Ans-1. Venilation-perfusion (VQ) scan should be performed
in all clinically stable patients
2. ABG: hypoxemia (SaO2 <90%, PaO2 <80mmHG)
3. Hypocapnia (PaCO2 <35mmHg) due to reflexive hyperventilation
4. Spiral CT/D-dimer
,5. Pulmonary angiography when clinical data and VQ scan contradictory*
PE (managment) (5) Correct Ans-1. Supplemental oxygen
2. IV fluids with hypotension and reduced CO2
3. Intubation for worsening hypercapnia
4. Heparin 80 u/kg bolus followed by infusion 18 u/kg/hr to maintain a PTT of 1.5-2 x normal;
Coumadin simultaneously to an INR 2-3
5. Fibrinolytics with hemodynamic compromise or shock (PT and PTT < 2x normal before
starting)
ARDS Correct Ans-A form of acute lung injury attributable to a wide variety of insults
(massive pulmonary edema with shunting of blood around alveoli & scar tissue begins to
develop, worsening condition)
-Add PEEP to manage shunting
ARDS (s/s) (3) Correct Ans-1. Severe dyspnea
2. Cyanosis, tachycardia
3. Rales and wheezes
ARDS (labs/diagnostics) (3) Correct Ans-1. Refractory hypoxemia is a hallmark feature*
2. CXR may be "whited out" or have diffuse bilateral infiltrates
3. Increased SVO2
,ARDS (management) Correct Ans-1. Mechanical ventilation with PEEP
TV 6-8ml/kg IBW
PEEP ~ 10cm H20 (high PEEP --> risk for barotrauma)
2. Tx of underlying infection
If a low pressure alarm is going off on a ventilator, what does this indicate? Correct Ans-1.
Cuff insufficiency
2. Vent disconnected
If there is a high pressure alarm on a ventilator, what does this indicate? Correct Ans-Bucking
the vent
obstruction (mucus plug)
Kinks in trach or circuit
Bronchospasm
Coughing, gagging or fighting the vent
Control (vent) Correct Ans-The machine does all the work; preset tidal volume and RR
Assist-Control (vent) Correct Ans-If not breathing on their own, same as control, but pt can
trigger the machine.
If triggered, the machine delivers the preset volume
, SIMV/IMV (vent) Correct Ans-Pt gets a preset number of breaths at a preset tidal volume but
can take his own breaths at whatever tidal volume he pulls
CPAP (vent) Correct Ans-breathing spontaneously but at a pressure greater than atmospheric
(OSA or pulmonary artery HTN)
PEEP (vent) Correct Ans-maintains intrathoracic airway pressure above atmospheric pressure
Pressure Support (vent) Correct Ans-Inspiratory effort totally unassisted, but a present
amount of airway pressure is delivered with each breath
bilevel positive airway pressure (BiPAP) (vent) Correct Ans-CPAP + PEEP
Used in COPD to avoid ventilator
TV (vent) Correct Ans-amount of gas delivered per breath. Vent: 5-7ml/kg of IBW
How is pulmonary artery hypertension diagnosed and confirmed? Correct Ans-Diagnosed by
2D echocardiogram and confirmed by cardiac cath
PFTs (values) Correct Ans-Airflow rates:
FVC: forced vital capacity
volume of gas forcefully expelled from the lungs after maximal inspiration
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