Quizzes – Society of Mechanical Ventilation

The Golden Ticket Quiz

The Golden Ticket Quiz

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2nd SMV Conference 2025

1 / 5

1) The Volumetric Capnometry figure is indicating ?

Pulmonary Embolism

ARDS

High airway resistance

Rebreathing CO2

The concavity of phase 3 indicates high resistance and slow emptying alveoli

2 / 5

2) In the figure above both breath 1 and 2 are indicated by the ventilator as patient triggered breaths (pink arrow under airway pressure). Which statement is correct?

Both breaths are patient triggered

Both breaths are ventilator (time) triggered

1st breath is patient triggered and 2nd one is ventilator (time) triggered

1st breath is ventilator (time) triggered and 2nd one is patient triggered

The first breath is ventilator (time) triggered as indicated by the upward deflection of the esophageal pressure curve and the 2nd breath is patient triggered as indicated by the negative deflection of the esophageal pressure curve

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3) Looking at the figure above in volume controlled mode with inspiratory pause. Peak inspiratory pressure is 40 cmH2O, Plateau pressure 10 cmH2O, PEEP
of 5 cmH2O, Peak inspiratory flow of 60 lit/min, tidal volume 500 ml, respiratory rate of 30. The inspiratory resistance is:

10 cmH2O/L/sec

20 cmH2O/L/sec

30 cmH2O/L/sec

40 cmH2O/L/sec

Inspiratory resistance equal: Peak Insp Pressure (PIP) - Plateau Pressure (Pplat) / Inspiratory flow (L/second)

40 - 10 / 1 = 30 cmH2O/L/sec

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4) A 65-year-old male intubated for traumatic brain injury and shock and ventilated with 100% FiO2. His ABG: PH 7.32, PaCO2 50, PaO2 450. What is the Alveolar-arterial (A-a) gradient?

100

200

The alveolar gas equation is expressed as: PAO2 = FIO2(PB-PH20) -PaCO2/RQ
FIO2: Fraction inspired oxygen, PB: atmospheric barometric pressure at sea level (760 mmHg), PH2O: barometric pressure of water (47 mmHg), PaCO2: partial pressure of arterial carbon dioxide, RQ: respiratory quotient (0.8).

Using the above equation, the PAO2 = 650 mmHg, the PaO2 is 450 mmHg, so difference is very wide of 200 mmHg indicating abnormal physiology

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5) In the figure above, what kind of respiratory pattern is shown?

Kussmaul breathing

Cheyne-Stokes Respiration

Auto-Trigger

Pain

Kussmaul breathing is deep fast breathing usually happens in acidemia, Cheyne-Stokes breathing is characterized by cyclical episodes of apnea and hyperventilation and usually is secondary to brain lesions or injury or heart failure. The figure does not fit auto trigger given the irregularity of the breaths
and the intensity.

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Ventilator Waveforms

Ventilator Waveforms

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Where would you set the PEEP according to that semi-quasistatic P-V curve ?

The low inflection point or the airway closure point (red triangle) is about 11, also the maximum hysteresis (difference in volume between the inspiratory and expiratory tidal volume)

Hysteresis

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Which image has a Stress Index > 1 indicating the need to reduce PEEP?