Critical care: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Critical care

Sample item

A patient with pneumonia becomes severely hypoxic with bilateral infiltrates on chest X-ray and a normal pulmonary capillary wedge pressure. Which ventilatory strategy improves survival?

AVentilation with no positive end-expiratory pressureBAggressive fluid loading to raise left atrial pressureCHigh tidal volume ventilation to normalise carbon dioxideDLow tidal volume lung-protective ventilation

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Low tidal volume lung-protective ventilation

Acute respiratory distress syndrome is non-cardiogenic pulmonary oedema with diffuse alveolar damage and refractory hypoxaemia. Ventilating with low tidal volumes and limiting plateau pressure reduces ventilator-induced lung injury and lowers mortality, and some hypercapnia is tolerated.

Option by option

A. Ventilation with no positive end-expiratory pressure
Positive end-expiratory pressure recruits collapsed alveoli and improves oxygenation, so withholding it worsens hypoxia.
B. Aggressive fluid loading to raise left atrial pressure
Fluid loading worsens pulmonary oedema, and a conservative fluid approach is preferred once shock resolves.
C. High tidal volume ventilation to normalise carbon dioxide
High tidal volumes overdistend the remaining aerated lung and increase injury and mortality.
D. Low tidal volume lung-protective ventilation (correct)
Correct. Lung-protective low tidal volume ventilation is proven to reduce mortality in ARDS.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Low tidal volume lung-protective ventilation. Acute respiratory distress syndrome is non-cardiogenic pulmonary oedema with diffuse alveolar damage and refractory hypoxaemia.

Why is "Ventilation with no positive end-expiratory pressure" not the answer?

Positive end-expiratory pressure recruits collapsed alveoli and improves oxygenation, so withholding it worsens hypoxia.

Why is "Aggressive fluid loading to raise left atrial pressure" not the answer?

Fluid loading worsens pulmonary oedema, and a conservative fluid approach is preferred once shock resolves.

Why is "High tidal volume ventilation to normalise carbon dioxide" not the answer?

High tidal volumes overdistend the remaining aerated lung and increase injury and mortality.

What concept does this question test?

It tests Critical care in General Medicine. Ventilating with low tidal volumes and limiting plateau pressure reduces ventilator-induced lung injury and lowers mortality, and some hypercapnia is tolerated.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Critical care?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.