Intensive Care Medicine (ICM) Practice Exam

This chest X-ray represents the late phase of which condition?

1. Acute respiratory distress syndrome

2. Pneumonia

3. Tuberculosis

4. Drowning

The correct answer is: Acute respiratory distress syndrome

The late phase of acute respiratory distress syndrome (ARDS) is characterized by specific radiological findings that can be identified on chest X-ray. In this phase, there is often a bilateral, diffuse opacification seen as a result of pulmonary edema and atelectasis. The lungs appear "white-out" or have a ground-glass appearance due to the accumulation of fluid in the alveoli, which is a hallmark of ARDS. In the context of ARDS, these radiological changes typically evolve as the condition progresses. Early in ARDS, the lung opacities may be more localized and less severe, but as the syndrome advances, the extent of the lung involvement increases. The persistence of these findings, even with treatment, underscores the severity and complications associated with ARDS. The other conditions mentioned can also show specific changes on a chest X-ray, but they do not present in the same diffuse and severe manner as ARDS in its late phase. Pneumonia often shows localized consolidation rather than widespread opacification. Tuberculosis can present with cavitary lesions or nodular infiltrates, while drowning typically would show evidence of pulmonary edema but does not fit the classic “white-out” pattern associated with ARDS in its late stage. Thus