Question 1

In the gas membrane exchanger,what is one of the limiting factors to the transfer rate of oxygen across the membrane?

Accepted Answer

A) The flow of blood 
B) The concentration gradient of the gas across the membrane 
C) The thickness of the blood film between the membrane layers 
D) The flow of gas in relationship to the flow of blood 
A) The flow of blood 
B) The concentration gradient of the gas across the membrane 
C) The thickness of the blood film between the membrane layers 
D) The flow of gas in relationship to the flow of blood C

Question 2

The therapist should evaluate raceway occlusion because too much roller tension could be associated with which of the following events?

Accepted Answer

A) Inadequate flow 
B) Increased bladder tension 
C) Hemolysis 
D) Recirculation 
A) Inadequate flow 
B) Increased bladder tension 
C) Hemolysis 
D) Recirculation C

Question 3

Which of the following mechanisms affect the output of VV ECMO?
I.Size of the tubing
II.The rotations per minute
III.Tension of the rollers
IV.Blood pressure

Accepted Answer

A) I.II,and III only 
B) I and IV only 
C) II,III,and IV only 
D) I,II,III,and IV 
A) I.II,and III only 
B) I and IV only 
C) II,III,and IV only 
D) I,II,III,and IV A

Question 4

Because the minimum flow rate required to remove condensation in the gas compartment usually results in excessive elimination of carbon dioxide,what should the therapist do?

Accepted Answer

A) Reduce pump flow 
B) Blend sweep gas with a carbogen mixture 
C) Reduce the amount of oxygen blended in the sweep gas 
D) Add more oxygen to the sweep gas 
A) Reduce pump flow 
B) Blend sweep gas with a carbogen mixture 
C) Reduce the amount of oxygen blended in the sweep gas 
D) Add more oxygen to the sweep gas

Question 5

Which of the following conditions are cardiac applications of ECMO?
I.ECPR
II.CDH
III.Fulminant myocarditis
IV.Cardiomyopathy

Accepted Answer

A) I and II only 
B) III and IV only 
C) I,III,and IV only 
D) I,II,III,and IV 
A) I and II only 
B) III and IV only 
C) I,III,and IV only 
D) I,II,III,and IV

Question 6

What is the ECMO flow considered as minimal support?

Accepted Answer

A) 100 mL/Kg 
B) 80 ml/kg 
C) 50 mL/Kg 
D) 30 mL/Kg 
A) 100 mL/Kg 
B) 80 ml/kg 
C) 50 mL/Kg 
D) 30 mL/Kg

Question 7

Which of the following ventilator settings are typically used in ECMO for respiratory support?
I.Vt 5-7 ml/kg
II.PIP 25-25 cm H₂O
III.PEEP 2-3 cm H₂O
IV.Frequency 10-12

Accepted Answer

A) I and III only 
B) II and III only 
C) I,II,and IV only 
D) I,II,III,and IV 
A) I and III only 
B) II and III only 
C) I,II,and IV only 
D) I,II,III,and IV

Question 8

A neonate on mechanical ventilation with respiratory distress has a PaO? of 50 mm Hg,a $\overline{ { Paw }}$ of 20 cm H?O and FiO? of 0.8.Why should the therapist suggest therapies other than ECMO?

Accepted Answer

A) The Fio? is not 100% yet. 
B) The $\overline{ { Paw }}$ is not high enough to justify ECMO. 
C) The OI does not meet ECMO criteria. 
D) The PaO? is within normal limits. 
A) The Fio? is not 100% yet. 
B) The $\overline{ { Paw }}$ is not high enough to justify ECMO. 
C) The OI does not meet ECMO criteria. 
D) The PaO? is within normal limits.

Question 9

During administration of venovenous ECMO,the therapist notices that the SvO₂ is greater than SaO₂.What is the best explanation to this phenomenon?

Accepted Answer

A) The blood flow through the pump is too slow. 
B) Recirculation is excessive. 
C) Native cardiac output has increased. 
D) iNO is being administered concomitantly. 
A) The blood flow through the pump is too slow. 
B) Recirculation is excessive. 
C) Native cardiac output has increased. 
D) iNO is being administered concomitantly.

Question 10

The therapist in charge of a patient on ECMO has noticed an increase in premembrane pressures.What is the most probable explanation?

Accepted Answer

A) Very high pump flow 
B) Clotting in the circuit 
C) Damage of the raceway 
D) Excessive sweep flow 
A) Very high pump flow 
B) Clotting in the circuit 
C) Damage of the raceway 
D) Excessive sweep flow

Question 11

What are the most common causes of a decrease in venous return in ECMO?
I.Hypovolemic state
II.Malpositioning of the venous cannula
III.Kinking of the cannula
IV.Shifting of the mediastinum

Accepted Answer

A) I and III only 
B) II and III only 
C) I,II,and III only 
D) I,II,III,and IV 
A) I and III only 
B) II and III only 
C) I,II,and III only 
D) I,II,III,and IV

Question 12

What is the advantage of having the centrifugal pump automatically respond to resistances against which it is pumping?

Accepted Answer

A) It avoids placing increased pressures on the heart. 
B) It eliminates lowering pulmonary vascular pressures. 
C) It maintains regulated flow through the system. 
D) It ensures that the blood flows smoothly through the membrane oxygenator. 
A) It avoids placing increased pressures on the heart. 
B) It eliminates lowering pulmonary vascular pressures. 
C) It maintains regulated flow through the system. 
D) It ensures that the blood flows smoothly through the membrane oxygenator.

Question 13

Which of the following strategies is greatly responsible for decreasing the need for ECMO in neonates?

Accepted Answer

A) High-flow oxygen therapy 
B) Airway pressure release ventilation 
C) Heliox 
D) HFOV 
A) High-flow oxygen therapy 
B) Airway pressure release ventilation 
C) Heliox 
D) HFOV

Question 14

The ECMO specialist has noticed excessive clotting in the circuit despite increase doses of heparin.What is the most feasible explanation for this event?

Accepted Answer

A) Too many platelet transfusions 
B) Defective heparin 
C) Blood flow too slow 
D) Deficiency of ATIII 
A) Too many platelet transfusions 
B) Defective heparin 
C) Blood flow too slow 
D) Deficiency of ATIII

Question 15

How can membrane malfunction be suspected?

Accepted Answer

A) Narrowing of the premembrane and postmembrane PaCO₂ 
B) Widening of the premembrane and postmembrane PaO₂ 
C) Presence of large clots in the circuit 
D) Presence of air bubbles 
A) Narrowing of the premembrane and postmembrane PaCO₂ 
B) Widening of the premembrane and postmembrane PaO₂ 
C) Presence of large clots in the circuit 
D) Presence of air bubbles

Question 16

The therapist in charge of a patient on ECMO is monitoring ACT every 30 minutes.The last ACT was 100 seconds.What should the therapist suggest at this time?

Accepted Answer

A) Decrease the amount of platelets transfused. 
B) Increase the heparin dose. 
C) Add plasminogen. 
D) Increase blood flow to decrease contact time. 
A) Decrease the amount of platelets transfused. 
B) Increase the heparin dose. 
C) Add plasminogen. 
D) Increase blood flow to decrease contact time.

Question 17

During venovenous ECMO,what effect does the cardiac output have on oxygenation?

Accepted Answer

A) An increase in cardiac output will have a significant effect on the patient's oxygenation. 
B) A decrease in cardiac output will have a major impact on the patient's oxygenation. 
C) Changes in cardiac output either way will have little influence on the patient's oxygenation. 
D) The influence of alterations in cardiac output on the patient's oxygenation cannot be predicted. 
A) An increase in cardiac output will have a significant effect on the patient's oxygenation. 
B) A decrease in cardiac output will have a major impact on the patient's oxygenation. 
C) Changes in cardiac output either way will have little influence on the patient's oxygenation. 
D) The influence of alterations in cardiac output on the patient's oxygenation cannot be predicted.

Question 18

Which of the following parameters have been suggested as indications for pediatric ECMO?
I.PaO₂  35
IV.Pre-ECMO pH < 7.20

Accepted Answer

A) II,III and IV only 
B) I,II,and III only 
C) I,II,and IV only 
D) II and IV only 
A) II,III and IV only 
B) I,II,and III only 
C) I,II,and IV only 
D) II and IV only

Question 19

It is not uncommon for patients undergoing ECMO to experience renal failure.What can be done to enhance renal function?

Accepted Answer

A) Add either colloids or crystalloids to fluid challenge the patient. 
B) Perform hemofiltration. 
C) Add either vasodilators or vasoconstrictors. 
D) Conduct plasmapheresis. 
A) Add either colloids or crystalloids to fluid challenge the patient. 
B) Perform hemofiltration. 
C) Add either vasodilators or vasoconstrictors. 
D) Conduct plasmapheresis.

Question 20

Which of the following statements describes venoarterial ECMO?

Accepted Answer

A) A cannula is inserted into the subclavian vein for the removal of blood. 
B) Blood is removed from the venous circulation through the external jugular vein. 
C) Blood returns to the heart through the subclavian artery. 
D) A cannula is inserted into the right common carotid artery for arterial return. 
A) A cannula is inserted into the subclavian vein for the removal of blood. 
B) Blood is removed from the venous circulation through the external jugular vein. 
C) Blood returns to the heart through the subclavian artery. 
D) A cannula is inserted into the right common carotid artery for arterial return.

Exam 19: Extracorporeal Life Support

In the gas membrane exchanger,what is one of the limiting factors to the transfer rate of oxygen across the membrane?

The therapist should evaluate raceway occlusion because too much roller tension could be associated with which of the following events?

Which of the following mechanisms affect the output of VV ECMO? I.Size of the tubing II.The rotations per minute III.Tension of the rollers IV.Blood pressure

Because the minimum flow rate required to remove condensation in the gas compartment usually results in excessive elimination of carbon dioxide,what should the therapist do?

Which of the following conditions are cardiac applications of ECMO? I.ECPR II.CDH III.Fulminant myocarditis IV.Cardiomyopathy

What is the ECMO flow considered as minimal support?

Which of the following ventilator settings are typically used in ECMO for respiratory support? I.Vt 5-7 ml/kg II.PIP 25-25 cm H₂O III.PEEP 2-3 cm H₂O IV.Frequency 10-12

A neonate on mechanical ventilation with respiratory distress has a PaO? of 50 mm Hg,a Paw‾\overline{ { Paw }}Paw of 20 cm H?O and FiO? of 0.8.Why should the therapist suggest therapies other than ECMO?

During administration of venovenous ECMO,the therapist notices that the SvO₂ is greater than SaO₂.What is the best explanation to this phenomenon?

The therapist in charge of a patient on ECMO has noticed an increase in premembrane pressures.What is the most probable explanation?

What are the most common causes of a decrease in venous return in ECMO? I.Hypovolemic state II.Malpositioning of the venous cannula III.Kinking of the cannula IV.Shifting of the mediastinum

What is the advantage of having the centrifugal pump automatically respond to resistances against which it is pumping?

Which of the following strategies is greatly responsible for decreasing the need for ECMO in neonates?

The ECMO specialist has noticed excessive clotting in the circuit despite increase doses of heparin.What is the most feasible explanation for this event?

How can membrane malfunction be suspected?

The therapist in charge of a patient on ECMO is monitoring ACT every 30 minutes.The last ACT was 100 seconds.What should the therapist suggest at this time?

During venovenous ECMO,what effect does the cardiac output have on oxygenation?

Which of the following parameters have been suggested as indications for pediatric ECMO? I.PaO₂ < 50 mm Hg II.PaO₂/FiO₂ < 75 III.OI > 35 IV.Pre-ECMO pH < 7.20

It is not uncommon for patients undergoing ECMO to experience renal failure.What can be done to enhance renal function?

Which of the following statements describes venoarterial ECMO?

Fetal Lung Development

Fetal Gas Exchange and Circulation

Antenatal Assessment and High Risk Delivery

Exam and Assessment of the Neonatal and Pediatric Patient

Pulmonary Function Testing and Bedside Pulmonary Mechanics

Radiographic Assessment

Bronchoscopy

Invasive Blood Gas Analysis and Monitoring

Noninvasive Monitoring in Neonatal and Pediatric Care

Oxygen Administration

Aerosols and Administration of Medication

Airway Clearance Techniques and Lung Volume Expansion

Airway Management

Surfactant Replacement

Non-Invasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate

Noninvasive Mechanical Ventilation of the Child

Mechanical Ventilation of the Neonate and Pediatric Patient

Administration of Gas Mixtures

Pharmacology

Thoracic Organ Transplantation

Neonatal Complications and Pulmonary Disorders

Congenital and Surgical Disorders That Affect Respiratory Care

Congenital Cardiac Defects

Sudden Infant Death Syndrome Sleep Disorders

Pediatric Airway Disorders and Pulmonary Infections

Asthma

Cystic Fibrosis

Acute Respiratory Distress Syndrome

Shock, Sepsis and Anaphylaxis

Pediatric Trauma

Disorders of the Pleura

Neurologic and Neuromuscular Disorders

Transport of Infants and Children

Home Care

Quality and Safety

Filters

A neonate on mechanical ventilation with respiratory distress has a PaO? of 50 mm Hg,a $\overline{ { Paw }}$ of 20 cm H?O and FiO? of 0.8.Why should the therapist suggest therapies other than ECMO?