PRE-WORKSHOP MCQs

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PRE-WORKSHOP MCQs

LIVERPOOL NIV WORKSHOP 2023

Email *

Confidence in management of respiratory failure *

Very low

Low

Moderate

High

Very high

1. Hypercapnia can lead to which of the following physiological consequences? *

1 point

Increase in respiratory drive

Decrease in respiratory drive

Worsening of V/Q inequality

Increased oxyhaemoglobin dissociation

All of the above

2. Which of the following is the main mechanism of acute hypercapnia during COPD exacerbations? *

1 point

Worsened VQ inequality

Diaphragm and respiratory muscle fatigue

Abnormal chest wall mechanics

Inadequate respiratory drive

None of the above

3. With respect to ventilation, which of the following is correct? *

1 point

Increasing bicarbonate levels have no impact on hypercapnic ventilatory responses in normal individuals.

Gender and hypercapnic ventilatory response are strongly correlated

In patients with Obesity Hypoventilation Syndrome, the ventilatory response to hypoxia and hypercapnia is blunted, but not to incremental exercise.

The changes in minute ventilation in sleep in normal adolescents is primarily consequent to changes in tidal volume.

The hypercapnic ventilatory response does not change in sleep when compared with wakefulness

4. Which of the following does not contribute towards development of daytime hypercapnia in patients with obesity hypoventilation syndrome? *

1 point

Increased lung compliance

Reduced chest wall compliance

Upper airway collapse with inspiratory flow limitation during sleep

Small airway collapse with expiratory flow limitation in supine position

Reduced ventilatory response to CO2

5. What proportion of patients with acute hypercapnic respiratory failure have been found to have at least 3 of the major comorbidities known to precipitate it? *

1 point

More than 50%

50%

35%

20%

6. A 75year old female presents to the emergency department with lethargy and morning headaches. An arterial blood gas performed on room air demonstrates a pH of 7.40, pO2 60mmHg, pCO2 60mmHg, HCO3 32mmol/L. The least likely cause of her hypercapnia is: *

1 point

COPD

Kyphoscoliosis

Motor Neurone Disease

Obesity hypoventilation syndrome

Chronic narcotic usage

7. A 68 year old male presents to the emergency department with progressive dyspnoea. He snores, reports orthopnoea, and has a 40 pack-year smoking history. On examination, his respiratory rate is 20bpm, SpO2 is 83% on room air, breath sounds are reduced at the right lower zone and there is global expiratory wheeze. His BMI is 40. Arterial blood gas demonstrates a pH of 7.26, pO2 50mmHg and pCO2 of 60mmHg and HCO3 of 29mmol/L. Which of the following is the least likely contributor to this patient’s hypercapnia based on the above history: *

1 point

COPD

Obstructive sleep apnoea +/- obesity hypoventilation syndrome

Right hemidiaphragmatic palsy

Congestive cardiac failure

Chest wall disease

8. A 68 year old male has Motor Neurone Disease. Following onset of orthopnoea and hypercapnia, home nocturnal NIV was commenced 6 weeks ago. A PEG tube was inserted roughly 4 weeks ago, and he now presents to hospital with a PEG site infection. During the course of his one week hospital stay, you note that his dyspnoea has worsened and he is now reliant on NIV and oxygen for most of the day. NIV downloads demonstrate adequate tidal volumes and minute ventilation. His PaCO2 is normal. His chest X-ray is clear. What should you do next? *

1 point

This is most likely disease progression. Involve palliative care and continue with NIV for symptomatic support.

Organise home ventilators with battery support and ability to provide continuous ventilation

Increase NIV pressures for symptomatic relief

Exclude pulmonary embolism

A, B and C

9. Which of the reasons below is the most common reason for low utilisation of NIV despite patients meeting indications? *

1 point

Physicians lacking adequate knowledge

Inadequate access to appropriate equipment

Poor previous patient experience

Inadequately trained respiratory staff

None of the above

10. The strongest evidence base to support the use of NIV is in: *

1 point

Cardiogenic pulmonary oedema

Acute hypercapnic respiratory failure with exacerbation of COPD

Weaning in hypercapnic patients

Acute asthma exacerbation

Motor Neurone Disease

11. In patients with COPD, which of the following situations has the strongest evidence base for supporting the use of chronic NIV? *

1 point

Those with the most severe hypercapnic respiratory failure

Those with persistent hypercapnia 2-4 weeks after discharge

Those with repeated admissions

Those with most severe airflow obstruction based on lung function tests

All of the above

12. Which of the following are indications for commencing NIV for patients with Motor Neurone Disease? *

1 point

FVC < 50%

FVC < 80% and symptoms

Rapid decline even if asymptomatic

Sniff nasal inspiratory pressure (SNIP) < 40 cmH2O

All of the above

13. Which of the following statements is correct with regards to NIV use in MND with respiratory muscle weakness? *

1 point

NIV improves quality of life for all patients

NIV improves survival only in patients without bulbar involvement

A backup rate should only be used in patients with bradypnoea or inability to trigger the ventilator

An oronasal mask is preferable for most patients

NIV provides no significant benefit for cough augmentation or sputum expectoration

14. Which of the following is the least useful predictor of NIV failure, prior to commencement of NIV? *

1 point

PaCO2

Presence of encephalopathy/ delirium

Comorbidity burden (e.g. SAPS II score)

Secretion volume

15. The following are all potential ventilatory benefits of EPAP/ PEEP, except: *

1 point

Maintains expiratory flow through tubing to washout expired CO2 from single tube circuits

Improves ventilation in obese patients by decreasing functional residual capacity

Prevents upper airways collapse in patients prone to apnoea-hypopnoea syndrome

Counteracts the negative effect of intrinsic or auto-PEEP on work of breathing

Improves gas exchange by increasing alveolar recruitment

16. An increase in which of the following ventilator settings is least likely to result in increased ventilation? *

1 point

Backup respiratory rate

IPAP

EPAP

Ti Min

Rise time

17. A change in which of the following ventilator settings is least likely to be useful in addressing double-triggering? *

1 point

EPAP

Inspiratory time

Rise time

Trigger sensitivity

Cycle sensitivity

18. Which of the following statements regarding interface is correct? *

1 point

Choice of interface is a key factor in determining the success of NIV

Oronasal masks should always be used when setting up patients on NIV in the acute setting

All masks work equally and do not affect the effectiveness of NIV

All of the above are correct

None of the above are correct

19. Which of the following statements regarding leak is correct? *

1 point

Any leak is detrimental to the success of NIV and should be avoided at all cost

Leaks are important in the elimination of CO2

Excess leak can worsen arterial pCO2

A & C are correct

B & C are correct

20. Following commencement of NIV for acute hypercapnic respiratory failure, a repeat arterial blood gas at 2 hours demonstrates an increasing PaCO2. Which of the following could contribute towards this? *

1 point

Poor mask choice or poor mask fitting

Inadequate EPAP

Inadequate IPAP

Too much FiO2

All of the above

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