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Retired NBME Step 2 CK Free 120 Answers

step2ck_free120/Block 3/Question#101 (reveal difficulty score)
A 52-year-old man is brought to the emergency ...
Application of positive end-expiratory pressure ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: Pulm

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 +1  upvote downvote
submitted by โˆ—len49(42)
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This patient has decompensated and has met criteria for ARDS. How to tell it is ARDS:

  1. acute onset

  2. P/F ratio <300 (in this patient it is super low at 55 , which is classified as very severe ARDS)

  3. non-cardiac cause (states no cardiomegaly and no other cardiac hx/disease)

  4. CXR showing diffuse bilateral infiltrates

The most important thing for ARDS treatment is lung protective ventilator strategy which includes low tidal volume based on ideal body weight (6cc per kilo) and high PEEP for recruitment of closed alveoli

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submitted by โˆ—bwdc(697)
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PEEP is like cowbell. Okay not really but when gas exchange is insufficient with increased FiO2, PEEP will help open alveoli and increase the functional area available for ventilation.

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submitted by โˆ—etherbunny(54)
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Never seen a ventilated patient without PEEP, but OK. PEEP splints alveloi and so prevents shearing damage from snapping open from fully closed with every inspiration. Plus what benwhite said.

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