2021 Surg Crit Care MCQ Flashcards
A patient has arrested and CPR & defib performed – what is the best sign for success of resuscitation?
a) Femoral pulse
b) Reactive pupils
c) ECG
= a) a palpable femoral pulse is the most critical and immediate sign of successful resuscitation.
Patient has laboured breathing, paradoxical breathing and is cyanotic. How will you manage?
a) Met Call
b) Chin lift, jaw thrust
The correct initial management for a patient with labored breathing, paradoxical breathing, and cyanosis is b) Chin lift, jaw thrust, with subsequent escalation as needed.
In ALS – patient has PEA – what should be done next?
a) Adrenaline
b) Shock
c) Amiodarone
d) Continue compression
In Advanced Life Support (ALS), if a patient is in pulseless electrical activity (PEA), the correct course of action is:
a) Adrenaline and d) Continue compression.
Best mediation for post-operative prevention of chronic pain?
= NMDA receptor - Ketamine
Patient with retropharyngeal abscess. What’s the most likely feature for them to become hypoxic and cyanosed on intubation?
a) Stridor
b) Mallampati 3
c) Beard
d) Thyromental distance 6cm
= a) Stridor
Patient on some SSRI, which analgesic can cause Serotonin syndrome?
a) Tramadol
b) Amitryptiline
= a) Tramadol
What is a major respiratory complication that is preventable post-operatively?
a) Atelectasis
b) Bronchospasm
c) Exacerbation of COPD
= a) Atelectasis - A major preventable respiratory complication post-operatively is atelectasis. Atelectasis refers to the collapse or closure of a lung, which can occur due to shallow breathing or other factors post-surgery. It can often be prevented with strategies such as encouraging deep breathing exercises, using incentive spirometry, and early mobilization. Bronchospasm and exacerbation of COPD can also be significant, but they are not as universally preventable with post-operative interventions as atelectasis.
Which Patient is ASA 3?
a) Person will well controlled essential hypertension
b) Patient with uncontrolled hypertension and diabetes
c) Comatose patient
d) Patient with ARDS secondary to pancreatic Ca
e) Person who is brain dead
The ASA (American Society of Anesthesiologists) classification system is used to assess a patient’s physical status before undergoing anesthesia and surgery. ASA 3 is defined as:
- ASA 3: A patient with severe systemic disease.
So, the patient who is ASA 3 would be:
- b) Patient with uncontrolled hypertension and diabetes
This classification indicates that the patient has significant systemic disease that may increase the risk associated with anesthesia and surgery, but the condition is not necessarily a constant threat to life.
Which patient is most likely to have an MI?
a) Emergency Laparotomy
b) Patient with a history of IHD, emergency AAA repair
c) Elective Knee
d) Two other elective ops
The patient most likely to have a myocardial infarction (MI) is:
b) Patient with a history of IHD, emergency AAA repair
Patients with a history of ischemic heart disease (IHD) are at higher risk for MI, and emergency procedures such as abdominal aortic aneurysm (AAA) repair are associated with higher cardiovascular risk due to the stress and potential complications of the surgery. The combination of pre-existing heart disease and an emergency major surgery significantly increases the likelihood of experiencing an MI.
Shown ECG with Torsades. What would you give?
a) Magnesium
b) Atropine
c) Adrenaline
d) Calcium
For Torsades de Pointes (TdP) on an ECG, the most appropriate treatment is:
a) Magnesium
TdP is a type of polymorphic ventricular tachycardia that is often associated with prolonged QT interval and can be precipitated by electrolyte imbalances. Magnesium is used to stabilize the heart’s electrical activity and is especially effective in TdP, even when the magnesium levels are normal.
Pt with anticholinergic signs and prolonged QRS
a) TCA toxicity
b) Hyperkalaemia
a) TCA toxicity
Tricyclic antidepressant (TCA) toxicity is known to present with anticholinergic signs (such as dry mouth, blurred vision, and urinary retention) and can lead to a prolonged QRS interval on the ECG due to its effect on cardiac conduction. Hyperkalemia can also cause ECG changes, but it is more typically associated with peaked T waves, widening of the QRS complex, and sometimes a sine-wave pattern, rather than anticholinergic symptoms.
58kg person has a scalp lesion to be removed. How much lignocaine (with adrenaline) is needed
a) 40ml
b) 60ml
c) 80ml
d) 20ml
e) 100ml
Which medication is safest to discharge a patient on with regards to addiction and effectiveness etc.
a) Codeine
b) Fentanyl
c) Morphine
d) Oxycodone
e) Tramadol
When considering safety with regards to addiction potential and effectiveness for discharge, tramadol is generally considered the safest option among the choices listed.
Tramadol has a lower risk of addiction compared to stronger opioids like codeine, fentanyl, morphine, and oxycodone. It is a weaker opioid and also has additional mechanisms of action, which can make it effective for moderate pain while generally having a lower potential for abuse.
Given an ABG and UEC. Cause of hypochloraemic alkalosis?
a) 3% Saline
b) Normal Saline
Max dose of lidocaine with adrenaline (mg/kg)
a) 3
b) 4
c) 5
d) 6
e) 7
The maximum recommended dose of lidocaine with adrenaline is generally:
c) 5 mg/kg
This dose can vary slightly depending on specific guidelines and the presence of other factors, but 5 mg/kg is a commonly accepted maximum for lidocaine with adrenaline to minimize the risk of toxicity. Always consult specific guidelines and consider patient factors when determining dosages.
Who’s more likely to get malignant Hyperthermia
a) Patient whose brother went to ICU post op for special cooling
b) Patient whose daughter was managed for PONV
c) Patient whose mother starting sweating after taking antidepressants
= a) Patient whose brother went to ICU post op for special cooling - suggests + family history
Patient is on rivaroxaban when do you stop
a) 2 days
b) 5 days
c) not at all
The timing for stopping rivaroxaban (an oral anticoagulant) before a procedure or surgery depends on the type of procedure and the patient’s renal function. For most procedures, rivaroxaban is typically stopped:
a) 2 days before the procedure.
This timing helps to reduce the risk of bleeding while ensuring that the anticoagulant effect has diminished. However, for specific situations or higher-risk procedures, your healthcare provider might provide different recommendations based on individual patient factors and the procedure being performed. Always follow the specific guidance provided by the prescribing healthcare professional.
Patient has MI and PCI when do you defer elective surgery until?
6-12 months
Most common sign on ECG for a PE
a) T wave inversion
b) ST elevation
c) Sinus Tachycardia
d) S1Q3T3
= c) Sinus Tachycardia
Patient has a BSL of 2mmol. What should you give?
a) Normal Saline
b) Hartman’s
c) 50ml of 50% Dextrose
d) 500ml of 5% dextrose
For a blood sugar level (BSL) of 2 mmol/L, which indicates severe hypoglycemia, you should administer:
c) 50ml of 50% Dextrose
- This provides a rapid and effective way to increase blood glucose levels and quickly correct the hypoglycemia. The other options are not as effective in rapidly addressing severe hypoglycemia:
- Normal Saline and Hartman’s solutions are primarily for fluid resuscitation and do not address hypoglycemia.
- 500ml of 5% dextrose is a less concentrated solution and may not be sufficient for immediate correction of severe hypoglycemia compared to 50% dextrose.
34-week pregnant lady has a seizure, what is the first investigation you would do?
a) BSL
b) Β-HCG
In the case of a 34-week pregnant woman who has had a seizure, the first investigation you would typically perform is:
a) BSL (Blood Sugar Level)
Hypoglycemia can be a cause of seizures, so it’s important to check the blood sugar level to rule out or confirm this as a contributing factor. While β-HCG (beta-human chorionic gonadotropin) is relevant in pregnancy, it is not used for acute investigation of seizures.
Patient present with central facial trauma. He is coughing up blood and talking. How will you secure his airway?
a) Oral intubation
b) Nasal intubation
c) Cricothyroidotomy
d) Tracheostomy
In the case of a patient with central facial trauma who is coughing up blood and talking, the most appropriate method to secure the airway is:
c) Cricothyroidotomy
Facial trauma can compromise the airway due to swelling, bleeding, and potential disruption of the airway anatomy, making intubation difficult or impossible. Nasal intubation is contraindicated due to the risk of further trauma and bleeding. Oral intubation might be challenging due to the facial injuries and blood. Cricothyroidotomy provides a direct access to the airway through the neck, bypassing potential obstructions or damage in the facial region.
At what % blood loss do you start to see decrease in blood pressure?
a) 15%
b) 20%
c) 30%
d) 40%
A decrease in blood pressure typically becomes noticeable with:
c) 30% blood loss
This is approximately when the compensatory mechanisms of the body start to fail, leading to a significant drop in blood pressure. Blood loss up to 15% might not cause a noticeable decrease in blood pressure due to compensatory mechanisms, while a loss of 20% might start to affect it slightly. At 40% blood loss, blood pressure is usually critically low and immediate intervention is required.
What sign indicates 1L of blood lost?
a) Cap refill > 2s
b) Blood pressure drops
c) Anuria
d) Tachycardia > 140
The sign that typically indicates approximately 1 liter of blood loss is:
d) Tachycardia > 140
In the context of significant blood loss, tachycardia (heart rate > 140 beats per minute) is a common physiological response as the body attempts to compensate for the reduced blood volume and maintain adequate perfusion. While other signs like prolonged capillary refill, decreased blood pressure, and anuria can also indicate blood loss and shock, tachycardia is a more immediate and direct indicator of substantial blood loss.
Patient is Rovsing positive. How is this elicited?
a) Palpating in the left lower quadrant
b) Flexion of the hi
c) Hip IR
What is Rovsing’s sign?
Rovsing’s sign is a clinical finding that is indicative of acute appendicitis (the inflammation and possible infection of the appendix). A positive Rovsing’s sign is characterized by right lower abdominal pain upon palpation of the left side of the lower abdomen.
Why is hypertonic saline better than mannitol in a traumatic brain injury?
a) Hypertonic saline can be delivered IV
b) Hypertonic saline is a less potent diuretic
c) Hypertonic saline prevents both primary and secondary brain injury
In the context of traumatic brain injury (TBI), hypertonic saline is often preferred over mannitol for several reasons:
1. Hypertonic saline can be delivered IV: While both hypertonic saline and mannitol can be administered intravenously, hypertonic saline is preferred in many situations because it effectively reduces ICP and increases intravascular volume more rapidly. This can be particularly beneficial in managing acute elevations in ICP.
2. Hypertonic saline is a less potent diuretic: Unlike mannitol, which has strong diuretic effects and can lead to dehydration and electrolyte imbalances, hypertonic saline has less pronounced diuretic effects. This reduces the risk of dehydration and helps maintain better fluid balance.
3. Hypertonic saline prevents both primary and secondary brain injury: This is less accurate. Hypertonic saline primarily helps manage secondary brain injury by reducing ICP and improving cerebral perfusion, but it does not directly prevent primary brain injury. Mannitol, while also used to manage ICP, may have additional neuroprotective effects.
ANSWER = b = less potent diuretic
Young girl presents with ongoing headaches. She is overweight and on the OCP. She has bilateral papilloedema & abducens nerve palsy. All other S/S are normal. What is the management?
a) Take inflammatory markers, analgesia then discharge
b) Analgesia and discharge
c) Urgent CT, LP and bloods
d) CT and LP
e) CT, LP and neuro referral
In a young girl presenting with ongoing headaches, bilateral papilledema, and abducens nerve palsy, these findings suggest increased intracranial pressure, which could be indicative of a serious underlying condition such as idiopathic intracranial hypertension (IIH) or another intracranial pathology. Given the symptoms and the need to assess for potentially serious conditions, the appropriate management is:
e) CT, LP and neuro referral
Patient presents with chest pain & tearing back pain. He has tingling down his left leg. ECG shows STEMI. How should you manage
a) Heparin
b) Thrombolysis
c) CT Angio
= c) CT Angio - suspect aortic dissection
Ten-year-old boy fell from a tree. What medication is best for management of pain in paediatrics?
a) Fentanyl Patch
b) Morphine IM
c) Fentanyl IV
d) Pethidine
= c) Fentanyl IV
Man has an ECG with polymorphic VT, what can cause this?
a) Thiazides
b) Potassium sparing diuretic
= a) Thiazides
Which of these causes normal anion gap metabolic acidosis?
a) Chronic Antacid use
b) Conns syndrome
c) Diabetes mellitus
d) Uraemia
e) Lactate
Chronic Antacid Use is the cause of normal anion gap metabolic acidosis among the options listed.
Chronic Antacid Use (a): Prolonged use of antacids, especially those containing aluminum or magnesium, can lead to a normal anion gap metabolic acidosis due to the accumulation of chloride (hyperchloremic metabolic acidosis). Antacids can neutralize stomach acid, but if they are used excessively, they can cause an imbalance in acid-base homeostasis.
Patient comes in following asthma attack. Took 8 puffs of salbutamol, normal SpO2, speaking in full sentences. How should you manage?
a) Oral steroid
b) Start SAMA
c) Admit
= Oral steroid
Patient using meth admitted to ED. Becoming increasingly aggressive – how should he be managed?
a) Sedate under duty of care
b) Call mental health team then sedate
c) Mental Health Act
d) Two options that were like make him leave
b) Call mental health team then sedate
Patient sustains head injury during a football game. Continues to play, 40 minutes later collapses & is unconscious. Most likely diagnosis?
a) Extradural haematoma
b) Subdural haematoma
c) Concussion
d) SAH
In the scenario described, where a patient sustains a head injury, continues to play, and then collapses and becomes unconscious 40 minutes later, the most likely diagnosis is:
a) Extradural Haematoma
- Onset: Often occurs after a brief loss of consciousness following a head injury, with a lucid interval before deterioration.
- Symptoms: The classic presentation involves a period of apparent recovery (lucid interval) followed by rapid deterioration, which aligns with the timeline described (initial injury, period of playing, then collapse).
- Mechanism: Usually caused by a tear in the middle meningeal artery or vein, leading to bleeding between the skull and dura mater.
Patient presents with tachycardia, hypotension, anti-cholinergic delirium. Which drug caused the OD?
a) Amitriptyline
b) Some Benzo
c) Quetiapine
a) Amitriptyline
Which of these is true for the ABG of HHS?
a) Corrected hypernatremia
b) Low pH
c) High ketones
For Hyperglycemic Hyperosmolar State (HHS), the following is true regarding the arterial blood gas (ABG) findings:
a) Corrected Hypernatremia
In HHS, hypernatremia is often present due to severe dehydration and high serum osmolality. However, it’s important to note that the sodium level in the ABG results can be “corrected” to account for the high glucose levels, reflecting the true level of sodium.
CXR post procedure inserting a central line. What’s wrong?
R bronchus intubated (this photo is in an RNM lecture so it’s probably somewhere if you bother to look)
Endobronchial intubation is the not infrequent finding of the endotracheal tube located in a bronchus and is a trivial diagnosis to make in most instances provided an adequately penetrated chest radiograph is obtained. The incidence of endobronchial intubation is greatest following emergency intubation.
Old lady who has IHD, bipolar disease, is recently started on diuretics. She presents with visual disturbances and has green/yellow halos around objects
a) Lithium toxicity
b) Digoxin toxicity
The visual disturbances with green/yellow halos around objects in a patient who is on diuretics are most likely due to:
b) Digoxin Toxicity
Sexually active 28-year-old presents to ED with dysuria, frequency, and pyuria. what bacteria would you target for treatment?
a) E. coli
b) Chlamydia
In a sexually active 28-year-old presenting with dysuria, frequency, and pyuria, you should consider both common uropathogens and sexually transmitted infections.
Given the symptoms and demographic, the appropriate initial treatment would target:
b) Chlamydia
Chlamydia trachomatis: This is a common cause of dysuria and can be associated with pyuria. It’s also a frequent cause of urethritis in sexually active individuals. Given the presentation and demographic, chlamydia should be considered and treated appropriately.
What would suggest you need to give antivenom in a snake bite?
a) Hyperkalaemia
b) Bite looks like that of a brown snake
c) Creatinine
d) Piloerection of affected limb
e) Ptosis
e) Ptosis - objective neurological signs
Patient with complete heart block found by ambulance. What should they give if pacing is unavailable?
a) Atropine
b) Β-blockers
c) Amiodarone
If pacing is unavailable for a patient with complete heart block (third-degree AV block), the recommended treatment is:
a) Atropine
Atropine: This is a first-line treatment for acute symptomatic bradycardia, including complete heart block, especially when pacing is not immediately available. Atropine works by increasing the heart rate by inhibiting the vagal (parasympathetic) influence on the heart.
Question about someone with pericarditis, what is Mx?
a) Oral NSAIDs and oral colchicine
b) Oral NSAIDs and IV colchicine
a) Oral NSAIDs and oral colchicine
Oral NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and relieve pain associated with pericarditis. Ibuprofen or indomethacin are often used.
Oral Colchicine: Colchicine is recommended as an adjunctive treatment to reduce symptoms and prevent recurrence. It is usually administered orally.
40ish woman has intermittent left sided headaches, feels like electric shock, extends to cheek and jaw, no exam findings.
a) 1mg/kg pred and urgent surgical review
b) Occipital nerve block
c) Sumitriptan
d) Carbamazepine or oxcarbazepine or something like that
Diagnosis = Trigeminal neuralgia
Carbamazepine and oxcarbazepine are the first-line treatment options for TN and offer meaningful initial pain control in almost 90% of patients.
Burns question – chest, front of one arm, front of one leg
a) 22.5%
b) 31.5%
To estimate the total body surface area (TBSA) affected by burns, you can use the “Rule of Nines” for adults, which allocates percentages to various body parts:
Chest (front): 18%
Front of one arm: 4.5%
Front of one leg: 9%
Adding these together:
Chest (front): 18%
Front of one arm: 4.5%
Front of one leg: 9%
Total: 18% + 4.5% + 9% = 31.5%
Patient is currently taking a ACE inhibitor for BP, presents with angio-oedema following new anti-hypertensive. Which one?
a) CCB
b) ACEI
a) CCB - pt is already on an ACEI and this is a new problem.
Patient collapses and ambos have done CPR, ECG performed and shows VT what do you do?
a) Defibrillation
b) Adrenaline
c) Amiodarone
The two shockable rhythms are ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT).
In the case of a patient who collapses and is found to be in VT on the ECG, the immediate management depends on the patient’s hemodynamic status. If the VT is sustained and the patient is unstable (e.g., unresponsive, with poor perfusion), immediate defibrillation is indicated. For stable VT, the treatment approach would include medications like amiodarone.
Patient presents with HHS which could cause?
a) Someone whos surgeon told them to take metformin 5 days later
b) Lady who went on holiday forgot insulin so increased metformin dose
Which finding is most indicative of acute liver failure post paracetamol toxicity?
a) INR 6
b) ALT 3000’s
In acute liver failure following paracetamol toxicity, INR 6 is more indicative of severe liver impairment and is used to assess the degree of liver dysfunction, making it the most critical finding in this scenario.
Patient had BP 77/40 after fluid IV resus – what do you do?
a) Add vasopressor
b) Add inotrope
a) Add vasopressor
What medication is best for treating a patient with bradycardia & hypotension?
a) Amiodarone
b) Lignocaine
c) Adenosine
d) Atropine
d) Atropine
This medication is used to treat bradycardia (slow heart rate) by increasing the heart rate through its action as an anticholinergic agent. It is typically the first-line treatment for bradycardia associated with symptoms such as hypotension.
How can BIPAP help in Multiple rib fractures?
When would increasing minute ventilation work to reverse call?
a) Opioid depression
b) Multiple rib fractures
c) ARDS
d) Pneumonitis
c) ARDS
Management of sepsis due to Candida - what tx?
a) Cotrimoxazole
b) Amphotericin B
Showed a table with a bunch of vitals values. Which results indicate cardiogenic shock?
For cardiogenic shock, high PCP and low CO are the most characteristic findings. Normal lactate does not rule out cardiogenic shock, but elevated lactate would suggest significant tissue hypoperfusion. Low CRT might not be as specific to cardiogenic shock as it can vary depending on overall perfusion status.
Hyperkalemic picture and ECG. What’s the best management?
a) Dialysis
b) Ca and insulin/dextrose
c) Neb salbutamol
ECG features of hyperkalaemia
1. Peaked T waves
2. P wave widening/flattening,
3. PR prolongation
4. Bradyarrhythmias: sinus bradycardia, high-grade AV block with slow junctional and ventricular escape rhythms, slow AF
5. Conduction blocks (bundle branch block, fascicular blocks)
QRS widening with bizarre QRS morphology
Management:
What electrolyte abnormality is most likely in the following scenarios:
1) Lost a heap of urine – hyponatraemia
2) What electrolyte disturbance is most often associated with cardiothoracic surgery – hypomagnesemia
3) There was one like “this electrolyte abnormality is causing the patient’s bleeding” but this might have been absorbed in another one of these
4) Women who has eclampsia that has been managed- hypermagnesemia
a) Could possibly have not mentioned the management part which would make it hypo I guess
5) Patient with bulky lymphoma who’s had chaemo- hyperkalaemia (TLS?)
1) Lost a heap of urine – Hypokalemia (low potassium)
2) What electrolyte disturbance is most often associated with cardiothoracic surgery – hypomagnesemia
4) Women who has eclampsia that has been managed - hypermagnesemia
- Magnesium Sulfate Use:
Treatment for Seizure Prevention: Magnesium sulfate is commonly used to prevent seizures in preeclampsia and eclampsia. Although it is effective in managing seizures, it can lead to hypomagnesemia if not properly managed, especially if the patient is over-treated or has issues with renal excretion of magnesium.
Monitor Levels: Magnesium levels should be monitored regularly during and after treatment with magnesium sulfate to avoid both hypomagnesemia and hypermagnesemia.
5) Patient with bulky lymphoma who’s had chemo- hyperkalaemia (TLS) - Released from intracellular compartments.
Hypotensive patient post MVA with seatbelt sign injury. Complains of plain but CT showed nil intraperitoneal blood. Organ injured:
a) Bowel
b) Liver
c) Spleen
d) Kidney
e) Aorta
Given the hypotension and seatbelt sign, bowel injury is a likely culprit even if no intraperitoneal blood is visible on the CT scan. Further diagnostic exploration such as laparoscopy or exploratory surgery may be needed to identify and manage bowel injuries.
Young male dockworker with longstanding constipation now had pain on defecation. No bleeding. What is the diagnosis?
a) Thrombosed haemorrhoids
b) Fissure in ano
c) Fistula in ano
= b) Fissure in ano
Most appropriate place for split skin graft?
a) Muscle
b) Bone
c) Joint
= a) muscle
Patient with migratory thrombophlebitis – next investigation
a) Urgent triphasic CT for pancreas
b) UGI endoscopy for gastric cancer
Urgent triphasic CT for pancreas is the most appropriate next step to investigate the underlying malignancy associated with migratory thrombophlebitis.
Which nodes does the anus drain to?
a) Inguinal
b) Para-aortic
c) Other
a) Inguinal
Patient with dysphagia – scope shows dilated lower oesophagus. No strictures or mass. Biopsy most likely to show
a) Absent of ganglion myenteric plexus
b) Barret’s oesophagus
c) Adenocarcinoma
The most likely biopsy finding in this case would be absence of ganglion cells in the myenteric plexus, indicative of achalasia.
What is Chancroid?
Chancroid usually presents with non-indurated painful ulcers, characterised by an irregular border surrounding a friable base covered with a necrotic and often purulent exudate. Chancroid is a sexually transmitted infection caused by Haemophilus ducreyi.
What is Lymphogranuloma venereum?
Lymphogranuloma venereum (LGV) is a rare sexually transmissible infection that is mainly seen in gay and bisexual men. It often presents as a single papule or a shallow ulcer, which initially heals after a few days. LGV can cause severe symptoms, however it can be successfully treated with antibiotics. Timely treatment prevents long-term complications. Condom use helps prevent infection.
Hypertensive Retinopathy - Features of each grade?
Features of Proliferative & Non-Proliferative Diabetic Retinopathy (NPDR)?
