Anaesthesiology (Newest) Flashcards by Ilja Hoeglinger

The latest full definition of sepsis is as follows:

a) sepsis is a life-threatening organ failure caused by an incorrect response of the body to blood
infection. Organ insufficiency is recognized on the basis of the SOFA score> 4
b) sepsis is a life threatening organ failure caused by an incorrect response of the body to
infection. Organ failure is diagnosed based on a sudden change in SOFA > 2 due to infection.
c) sepsis is a life-threatening syndrome shaped by factors associated with the pathogen itself as well as factors related to the patient’s body (eg. gender, race, and other genetic factors, age, coexisting disease, environment)
d) sepsis is a life-threatening organ failure diagnosed on the basis of a change in the SOFA scale> 4

b) sepsis is a life threatening organ failure caused by an incorrect response of the body to
infection. Organ failure is diagnosed based on a sudden change in SOFA > 2 due to infection.

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Patient with COPD: CO2 48 mmHg, HCO3 28 mmHg, pH 7.35

a) compensated respiratory acidosis
b) compensated respiratory alkalosis
c) compensated metabolic acidosis
d) compensated metabolic alkalosis

a) compensated respiratory acidosis

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To qSOFA belong all except:

a) temperature above 38 or below 36
b) breath above 22/min
c) systolic pressure below 100
d) disturbances of consciousness 5

a) temperature above 38 or below 36

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65-year old man. It shows the symptoms of cardiogenic shock. You’re connecting a Swann-Ganz catheter and do what you see.

a) Pcwp > 18, CI > 2.1
b) Pcwp < 18, CI > 2.1
c) Pcwp > 18, CI < 2.1
d) Pcwp < 18, CI < 2.1

c) Pcwp > 18, CI < 2.1

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In sepsis, increased fibrin formation may impair the following:

a) Loss of vascular capillary barrier function leading to extensive swelling of
b) expandable and blood-vessel tissues and 5-stage vascular resistance
c) formation of thrombosis in incisions, perturbation disorders, organ ischemia, organ damage and development of multiple organ failure syndrome

c) formation of thrombosis in incisions, perturbation disorders, organ ischemia, organ damage and development of multiple organ failure syndrome

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Pathophysiological changes observed in sepsis are:

a) vascular endothelial dysfunction leading to increased vascular permeability and extensive tissue swelling
b) hemostasis disorders, reduced energy production in the mitochondria
c) circulatory insufficiency and hypotension
d) a, b, c

d) a, b, c

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The term hypoxemia means a reduced content of oxygen in arterial blood. The causes of hypoxemia may be as follows:

a) impaired blood oxygenation (low PaO2 value)
b) low Hb levels (anemia)
c) reduced availability of hemoglobin for oxygen (carbon monoxide poisoning)
d) a, b, c

d) a, b, c

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Measuring the concentration of procalcitonin in patients treated in the intensive care unit is useful:

a) in the diagnosis of severe fungal infections
b) in the diagnosis of severe viral infections
c) in the diagnosis and monitoring of the treatment of thin bacterial infections
d) in the diagnosis and monitoring of treatment of severe coagulation disorders (eg disseminated intravascular coagulation)

in the diagnosis and monitoring of the treatment of thin bacterial infections

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Cardiogenic shock (WK) from septic shock (WS) differs mainly:

a) Patients with cardiogenic shock have greater tachycardia
b) Patients with septic shock are more likely to have severe lactic acidosis
c) The diastolic pressure is very low in patients with cardiogenic shock
d) The septic shock patients are usually characterized by increased vasodilatation

The septic shock patients are usually characterized by increased vasodilatation

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If there are difficulties in ventilating the patient and the presence of a foreign body has been ruled out, which of the following may be helpful in providing ventilation to the mask?

a) Head bending and raising the chin
b) Oral pharyngeal tube
c) nasopharyngeal tube
d) All of the above

All of the above

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Indicates a false statement:

a) In systemic bacterial infections, procalcitonin is produced in all parenchymal devices and excreted into the bloodstream, which provide a high concentration.
b) In severe viral infections, procalcitonin is produced in all parenchymal vessels and excreted into the bloodstream, where it reaches a high concentration
c) outside of procalcitonin can grow after major surgery, reaching the highest values 24-48 hours after treatment. PCT returns to normal values within a few days that they do not have
d) Continuity testing

In severe viral infections, procalcitonin is produced in all parenchymal vessels and excreted into the bloodstream, where it reaches a high concentration

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Treatment of life-threatening hyperkalemia includes:
Magnesium IV
Calcium IV
IV glucose infusion with insulin
Lidocaine IV

Which of the following is true:

a) 1, 2, 3
b) 1, 3
c) 2, 3
d) 3, 4

2, 3

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Which of the painkillers can be used in the treatment of postoperative pain in children?

a) Paracetamol
b) Morphine
c) acetylsalicylic acid
d) A and B

A and B

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It is not true that the dose of adrenalin in the treatment of anaphylactic shock:

a) It should be given only if there is no response to an earlier intravenous GCS supply
b) In adults with spontaneous circulation, it is injected into the lateral surface of the thigh
c) It can be repeated every 5-15 minutes if there is no improvement or the blood pressure is still too low.
d) For adults with spontaneous circulation, the recommended dose is 0.5 mg

It should be given only if there is no response to an earlier intravenous GCS supply

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In the course of resuscitation, the indication to be given adrenalin is:

a) Any form of cardiac arrest
b) Only asystole
c) Only VT
d) Only the PEA

Any form of cardiac arrest

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The indication for defibrillation is:

a) Asystole
b) Ventricular fibrillation
c) Electrical activity without the presence of pulse on the carotid arteries, occurring in the form of tachycardia with narrow QRS syndromes
d) Any cardiac arrest, regardless of the electrical activity of the heart

Ventricular fibrillation

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Recommendations for the treatment of patients with carcinogenic shock include all of the below listed EXCEPT

a) ECG and echocardiographic examinations should be performed immediately on vomiting patients suspected of having cardiogenic shock
b) ECG monitoring and invasive blood pressure monitoring are recommended
c) intravenous inotropic drug (dobutamine) may be considered to increase cardiac output
d) in the first-line treatment, in the absence of symptoms of acute inflammation, urgent administration of fluids IV (saline or Ringer’s solution, > 2000ml/15-30min) is recommended

in the first-line treatment, in the absence of symptoms of acute inflammation, urgent administration of fluids IV (saline or Ringer’s solution, > 2000ml/15-30min) is recommended

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Sepsis may develop:

a) after tattooing
b) urinary tract infection (UTI)
c) from the mosquito bite
d) all of the above

all of the above

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The aim of CRRT therapy (continuously renal replacement therapy) is:

a) fluid homeostasis, volumic control
b) elimination of cytokines
c) metabolism control
d) all mentioned

fluid homeostasis, volumic control

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During ALS, persons performing external cardiac massage should change to ensure the best quality of pressure:

a) after each cycle of chest compressions
b) every 2 minutes
c) if the rescuer is tired
d) at the behest of the team leader

every 2 minutes

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Continuous monitoring of ET CO2 during CPR (cardiopulmonary resuscitation):

a) confirms and monitors the position of the tracheal tube
b) is used only in the case of a public airway device
c) may be an indicator of the quality of CPR and ROSC
d) correct answers a and c

correct answers a and c

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Adrenaline is:

a) the first-line drug in septic shock
b) during resuscitation we give 1mg IV every 2 minutes
c) by activating peripheral beta 1 receptors, it causes vasodilatation
d) has a positive inotropic, chronotropic, bathmotropic and non-tropic effect

has a positive inotropic, chronotropic, bathmotropic and non-tropic effect

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In cardiac arrest in the VF/VT mechanism without heart rate monitored by the patient and witnesses

a) Precordial thump may be effective while waiting for the defibrillator to be used
b) In special cases, defibrillations may be performed in a sequence of three consecutive discharges when the defibrillator is immediately available
c) we give adrenaline after the third defibrillation
d) all correct

all correct

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Amiodaron in sudden cardiac arrest.

a) we always use 300 mg iv
b) we give after 3 defibrillations
c) we use when lidocaine is not available
d) in recurrent PEA we give again after 5 defibrillations

we give after 3 defibrillations

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For the reversible causes of cardiac arrest, do not: a) Hypoxia b) Hyperkalemia c) Hyperthermia d) thromboembolic lesions of coronary vessels

thromboembolic lesions of coronary vessels

The cerebral blood flow (CBF) and brain oxygen supply depend on the brain's perfusion pressure (CPP), which we pour out: a) CPP = CVP + ICP b) CPP = MAP - ICP c) CPP = CVP - ICP d) CPP = PCWP – ICP

CPP = MAP - ICP

In the treatment of increased intracranial pressure > 20mmHg does not include: a) recuperation of the patient in a semi-sitting position b) osmotic treatment with mannitol c) deepening analgosedation d) Hypoventilation

Hypoventilation

A patient's COPD test usually shows a) Hypocrisy b) Hypercapnia c) Hypoxia d) Hypoxia and hypocapnia

Hypercapnia

Depression of the circulatory system during the induction of intravenous anaesthesia is mainly caused by: a) Propofol b) Fentanyl c) Atropine d) Rccuronium

Propofol

Local aesthetic agents are compounds of: a) Acid b) Alkaline c) all of the above d) none of these

Alkaline

Under epidural anesthesia, the extent of the anesthesia obtained depends mainly on: a) The position of the patient during the administration of the local anesthetic b) Anesthetic concentrations c) The volume of the anesthetic agent given d) Adjuqants administered together with the drug for local anesthesia

The volume of the anesthetic agent given

Conclusions regarding subarachnoid anaesthesia include: a) Urinary retention b) Post-operative headaches c) They extend the sympathetic blockade d) All of the above

All of the above

We observe the monitoring of tissue perfusion by assessing: a) Diuresis hourly b) The level of arterial lactate c) Skin warmth d) All listed

All listed

In the treatment of pain, the administration of analgesics is standard: a) After transporting the patient to the recovery rooms b) Anticipating the appearance of pain c) After the patient reports discomfort and pain d) With pain that cause blood pressure to rise

After the patient reports discomfort and pain

Subarachnoid spinal anaesthesia is possible at the level of the spine a) Th12-L1 b) L1-L2 c) L3-L4 d) S1-S2

L3-L4

For the treatment of sepsis, immediate surgical control of the outbreak is always recommended, with the exception of: a) intra-abdominal abscesses b) pleural empyema c) acute pancreatitis d) Cholecystitis and inflammation of the biliary tract

pleural empyema

In the ICU patient with suspected pre-hospital pulmonary infections, the following diagnostic tests should be performed: a) chest x-ray b) microbiological culture of bronchial tree and blood secretion and examination for legionella infection in the direction of chlamydia and mycoplasma from blood, for pneumococcal infection with blood or urine, sputum test or throat swab for viral infection by PCR in justified cases c) blood biochemistry including markers of inflammation (leukocytosis, PCT, CRP) d) all the answers are true

all the answers are true

Prevention of pneumonia in mechanically ventilated patients (VAP) is carried out through: a) elevating the head of the bed at an angle of 30-50 degrees b) vacuum suction and pressure control in the intubation/tracheotomy tube balloon c) decolonizing the oral cavity with disinfectants d) all the answers are true

all the answers are true

You collect an interview and examine a patient admitted to the emergency care system of your hospital diagnosed with STEMI. The patient is monitored (NIBP, EKG, SpO2), has peripheral venous access, receives oxygen therapy, awaits surgery, in the hemodynamic laboratory. During the examination, the patient loses consciousness, and on the cardiomonitor you can see the VF record. Give the order of handling. a) you alert the duty team, you implement external heart massage, you defibrillate as soon as possible b) you implement external cardiac massage, as soon as you perform intubations, and then defibrillation c) you alert the duty team, you implement external heart massage, as soon as you give 1mg of adrenaline d) you alert the duty team, implement the external cardiac massage, as soon as you perform intubations

you alert the duty team, you implement external heart massage, you defibrillate as soon as possible

A 68-year-old patient with a ruptured abdominal aortic aneurysm: HR 120/min, BP 80/40, SpO2 95% without passive oxygen therapy requires immediate laparotomy. What drug do you choose to induce anaesthesia? a) ketamine b) propofol c) thiopental d) midazolam

ketamine

The inotropically positive drug of the first choice in the treatment of septic shock is a) Dopamine b) Dobutarnina c) Adrenaline d) Dopexamine

Adrenaline

The leading cause of cardiac arrest in children is: a) Respiratory problem b) Circulatory problem c) Congenital heart failure d) Trauma

Respiratory problem

Indicate a false statement about central venous pressure (CVP) a) This is the average pressure measured in the left atrium b) The CVP measurement is performed using a zonal central catheter c) It evaluates the vascular vessel fill and the assessment of the pre-load of the right ventricle d) Valid values 0-5 mmHg

This is the average pressure measured in the left atrium

Which of the following clinical conditions does not cause a shift in the haemoglobin dissociation curve to the left? a) Acidosis b) Alkalosis c) Hypothermia d) A reduced level of 2,3 DPG (2,3 diphosphoglycerate)

Acidosis

The trunk reactions evaluated in the second stage of recognition of the brainstem death in Poland are listed below with the exception a) Lack of cerebrovascular reflex b) Lack of corneal reflex c) Lack of temperature sensation d) Lack of motor reactions to a painful stimulus

Lack of temperature sensation

In an adult patient with SCC with clinical features of brain death, in order to find a permanent and irreversible cessation of brain function (brain death) one should: a) after at least a 6-hour pre-observation period, two series of clinical trials should be performed with an interval of 12 hours b) after at least a 24-hour observation period, two series of clinical trials should be performed with an interval of 6 hours c) in this case, brain death must be confirmed in EEG or cerebral artery angiography d) after a minimum of 12 hours of preliminary observation, two series of clinical trials should be performed 24 hours apart

after at least a 24-hour observation period, two series of clinical trials should be performed with an interval of 6 hours

After defibrillation, continuing CPR (cardiopulmonary resuscitation) the first drug that can be administered is: a) lidocaine b) morphine c) adrenaline d) magnesium sulphate

adrenaline

Before diagnosing brain death, exclude EXCEPT a) the use of neuroleptics b) malignant hyperthermia c) primary hypothermia d) inverting metabolic disorders

malignant hyperthermia

A 55-year-old man after successful CPR is admitted to the ICU. No data from the interview. The patient intubated, ventilated mechanic FIO2 O.6, creaks and croaking over the pulmonary fields. Due to the persistent hypotension with symptoms of hypoperfusion, a catheter was introduced into the pulmonary artery with the following values ``` SvO2 = 45% CI = 2.2 L/min/M2 PAOP = 19 mm H ``` The most likely cause of this condition is: a) Left ventricular failure b) Isolation with fluid c) sepsis d) aspiration pneumonia

aspiration pneumonia

You are called to the Hospital Rescue Department to an 18-year-old man brought by the Emergency Service Team after a traffic accident. The patient is unconscious, has a cool, pale, sweaty skin, cyanosis of lips and respiratory effort is visible 30 shallow breaths/min, the pulse on the radial artery is present, filamentous about 120min. The cervical veins are over-filled, the trachea is moved to the right. The thorax cage moves asymmetrically, with a lack of breathing noise on the left. The most probable diagnosis is a) cardiac tamponade b) pneumothorax c) massive pleural hematoma d) closed pneumothorax

closed pneumothorax

The following clinical conditions are associated with hypokalaemia, EXCEPT a) diuretic therapy b) intensive treatment of acidosis c) salbutamol therapy d) Rhabdomyolysis

Rhabdomyolysis

Continuous renal replacement therapy (CRRT) it is used to: a) maintaining correct volition and maintaining fluid balance b) filtering cytokines c) regulating metabolism d) all the answers are correct

all the answers are correct

During rescue compressions the change occurs: a) Every 30 seconds b) As the order of the team leader c) Every 2 minutes d) How will a person get tired

Every 2 minutes

What dose of lidocaine in cardiac arrest: a) 1 mg/kg b) 1,5 mg/kg c) 150 mg d) 1 mg iv

1 mg/kg

The level of lactate typical for shock is: a) > 0,5 b) > 1 c) > 2 d) > 3

> 2

How to calculate CO: a) HR × BP b) HR × SVR c) BP × SVR d) HR × SV

HR × SV

What drug we can give the earliest after defibrillation in the skin and a) adrenalin b) morphine c) lidocaine d) nahco3

adrenalin

Calculate cerebral blood flow, all parameters given: CV, HR, saturation, pressure, MAP 65, intracranial pressure 20 a) 100 b) 60 c) 45 d) 20

How do you assess ASA classification in the following patients? I) 34-years old man with good control of diabetes mellitus II) 86-years old lady with hypertension without treatment and creatinine level 1,2 mg/dl III) 45-years old man with the diagnosis of brain death a) I-1, II-2, III-5 b) I-2, II-3, III-5 c) I-2, II-3, III-6 d) I-2, II-4, III-5

I-2, II-3, III-6

45 year old man was admitted to the emergency department after a traffic accident. Physical examination: conscious, in a logical touch, suffering, heart rate of 120/min, blood pressure 80/50 mmHg, major bleeding due to amputation of the right lower limb, VAS is 10. In CT: without head injury. Which is the most appropriate anesthetic agent during transport the patient to operating theater? a) Propofol b) Edomidate c) Ketamine d) Thiopental

Ketamine

Find a false statement regarding opioids: a) String analgesic properties b) Increase in cerebral flow and metabolism c) Minimal effects of cardiac contractility d) Small decrease in systemic vascular resistance

Increase in cerebral flow and metabolism

Which one of the following muscle relaxants is the most appropriate in patient with kidney failure? a) Succinylcholine b) Pancuronium c) Cis-atracurium d) Tubcurare

Cis-atracurium

ET CO2 is increased in the following conditions except: a) Hyperthermia b) COPD c) Malignant hyperthermia d) Hyperventilation

COPD

The leading cause of cardiac arrest in children: a) Congenital heart failure b) Circulatory problem c) Respiratory problem d) Trauma

Respiratory problem

Epidural anesthesia is contraindicated except: a) Non-availability of patients consent b) Local infection or sepsis at the puncture site c) During childbirth d) Thrombocytopenia

During childbirth

Which one of the following anesthetics is safe in patients with a history of malignant hyperthermia: a) Propofol b) Sewofluran c) Succinylcholine d) Depolarizing relaxant drugs

Propofol

Hypertension is least likely to occur following induction with which of the following agents: a) Etomidate b) Propofol c) Thiopental d) Midazolam

Etomidate

Which of the following local anesthetics can cause an allergic reaction: a) Procaine b) Lidocaine c) Bupiwakaine d) Ropiwakaine

Procaine

Regarding to succinylcholine the following statements are true except: a) It is depolarizing relaxant drug b) Succinylcholine has short duration due to plasma cholinesterase c) Side effects include malignant hyperthermia, muscle pains, acute rhabdomyolysis with high blood levels of potassium d) It is a medication used as part of general anesthesia for long-term paralysis with tracheal intubation

It is a medication used as part of general anesthesia for long-term paralysis with tracheal intubation

Tuohy needle is used to perform: a) Epidural anesthesia b) Spinal anesthesia c) Arterial puncture d) Central vein puncture

Epidural anesthesia

85 year old women with bowel ischemia, taking warfarin due to continuous atrial fibrillation and concomitant chronic heart failure requires urgent surgery with vital indications. Her INR is 10,4 and aPTT 80s. Because the surgery cannot be postponed, the most logical method will be: a) Administration of vitamin K intravenously b) Administration of prothrombin complex concentrate c) 4 units of fresh frozen plasma administration d) 10 units of platelets administration

Administration of vitamin K intravenously

The patient has impaired consciousness, is pale, sweating, presents tachypnoea (30/min), hypotension (BP 80/45 mmHg), tachycardia (HR 180/min). What is the most proper treatment: a) Administer adenosine 12 mg IV b) Start chest compressions with frequency of 100/min c) Perform up to 3 cardioversions followed by 300 mg amiodarone bolus d) Administer 300 mg amiodarone bolus followed by 3 cardioversions

Perform up to 3 cardioversions followed by 300 mg amiodarone bolus

What is the correct treatment of an adult patient with VF: a) Administration of 500 ug digoxin IV b) Administration of 1 mg of adrenaline after each defibrillation c) Administration of 3 mg of atropine after each two loops of CPR d) Performing of the first defibrillation with energy of 150-200J (biphasic)

Performing of the first defibrillation with energy of 150-200J (biphasic)

Chest compressions: a) Should not be stopped for circulation assessment unless ROSC occurs b) Should not be stopped for ventilation of intubated patient c) In adults should be performed with frequency of 60/min d) Should be started in any case of an unconscious patient

Should not be stopped for circulation assessment unless ROSC occurs

After you confirm that the patient is unconscious you should: a) Start immediately CPR b) Give 5 initial rescue breaths c) Call for help before you asses ABC d) Defibrillate the patient in case of asystoly in ECG tracing

Call for help before you asses ABC

The patient with confirmed sudden cardiac arrest presents PEA on ECG tracing. You should: a) Administer 3 mg of atropine each 2-5 min of CPR b) Defibrillate the patient with 360J energy c) Administer 1 mg of adrenaline each 2-5 min of CPR d) Perform cardioversion with 150J energy

Administer 1 mg of adrenaline each 2-5 min of CPR

CVP is typically in all except: a) Congestive heart failure b) Cardiac tamponade c) Hypervolemia d) Sepsis

Sepsis

Which parameters can you measure from the Swan-Granz catheter: ``` I) Pulmonary artery pressure II) PCWP III) CO IV) Mixed venous saturation V) Blood temperature VI) ELVI VII) GEDI ``` a) I, II, III b) I, III, IV, VI, VII c) I, II, III, IV, V d) II, III, IV, VII

I, II, III, IV, V

Calculate cerebral perfusion pressure (CPP) based on the following data: HR 75/min, BP 120/80 (MAP 65 mmHg), ICP 15 mmHg RR 25/min, MV 101/min, CVP 5 mmHg: a) 105 b) 60 c) 50 d) 35

Calculate the PaO2:FiO2 ratio based on the following data: FiO2 1.0, PEEP 10, PaO2 65 mmHg, PH 7.34 mmHg, PaCO2 45 mmHg, SpO2 90% a) 100 b) 95 c) 65 d) 35

A patient with a spinal abscess is admitted to the ICU in septic shock and requires pressors. Which of the following agents would be most efficacious for increasing cardiac output while increasing mean arterial pressure (MAP): a) Digoxin b) Phenylephrine c) Dopamine d) Norepinephrine (noradrenaline)

Norepinephrine (noradrenaline)

Interpret the following blood gas: PaO2 78 mmHg, PaCO2 29 mmHg, pH 7.29, HCO3 14, BE -10: a) Respiratory alkalosis b) Respiratory acidosis c) Metabolic acidosis d) Metabolic alkalosis

Metabolic acidosis

Shortly after insertion of a right subclavian catheter, the patient develops worsening shortness of breath and bibasilar crackles. Blood is noted to be backing up from the central venous catheter and his oxygen saturation decreases with supine positioning. Which one of the following problem is consistent with these findings: a) Pulmonary embolism b) Right heart failure c) Cardiac pulmonary edema d) Hemopneumothorax

Hemopneumothorax

Find true statement regarding pulsoximetry: a) Falsely high SpO2 during CO inhalation b) SpO2 90%=75 mmHg c) Normal value: SpO2 < 96% d) Falsely high SpO2 during hyperbilirubinemia

Falsely high SpO2 during CO inhalation

Regarding CVP find false statement: a) Mean pressure in VCS or RA b) To estimate the filling of vascular bed and preload of the right heart c) Measurement performed with central venous catheter d) It is increased in hypovolemia

It is increased in hypovolemia

Which of the following agents is an inotrope: a) Ramipril b) Metoprolol c) Diltiazem d) Milirone

Milirone

The patient is admitted with cardiogenic shock and oliguric acute kidney injury. Hemodynamics parameters reveal the following: BP 105/60 mmHg, sinus rhythm (108/min), CI 1.8 (CO2.4) CVP 23 mmHg, PCWP 25 mmHg, SVRI 2088 (SVR 1566). Which one of the following interventions would you anticipate: a) Dobutamine at 5 mcg/kg/min b) Captopril 6.5 mg q6h c) Metoprolol 25 mg d) Dopamine at 2 mcg/kg/min

Dobutamine at 5 mcg/kg/min

ARDS is characterized by except: a) Noncardiogenic lung edema b) PaO2/FiO2 > 300 mmHg with PEEP or CPAP < 5 c) Decreased respiratory compliance d) Hypoxemia

PaO2/FiO2 > 300 mmHg with PEEP or CPAP < 5

An infants pulse should be checked by palpation of a pulse on which artery: a) Carotid or femoral b) Carotid c) Radial d) Bronchial or femoral

Bronchial or femoral

The best indicator of adequate fluid resuscitation in the trauma patient is: a) Arterial pH b) Serum lactate level c) Core temperature d) Blood pressure

Blood pressure

After successful completion of a spontaneous breathing trial, extubation is considered. Which one of the following findings would be a contraindication to extubation: a) GCS 4 b) FiO2 0.4 c) PEEP 5 d) Minute volume 10 L/min

GCS 4

50 year old female patient presents with a 12 hour history of feeling unwell and her blood pressure is 80/45 mmHg, her pulse rate is 90 beats/min and her central venous pressure is 12 mmHg. The hypotension is most appropriately managed with: a) Noradrenaline b) Adrenaline c) Dobutamine d) Milrinone

Noradrenaline

Positive end-expiratory pressure can contribute to: a) FRC increase (prevention of airway collapse) b) Increase in systemic venous return c) Decrease in airway pressure d) Increase in work of breathing

FRC increase (prevention of airway collapse)

High central venous pressure, low blood pressure and acute circulatory failure found in following conditions except: a) Tension pneumothorax b) Pulmonary embolism c) Hemorrhage d) Venous air embolism

Hemorrhage

The decrease in hemoglobin causes: a) DO2 increase b) SvO2 decrease c) VO2 decrease d) SvO2 increase

SvO2 decrease

PCWP (POAP): a) Is a reflection of left atrial pressure b) Measurement involves passage of pulmonary artery catheter across the interatrial septum c) Is typically raised in ARDA d) Is typically raised in septic shock

Is a reflection of left atrial pressure

The false statement concerning cardiogenic shock is: a) Is characterized by low cardiac output b) Is characterized by a low systemic vascular resistance c) May be caused by papillary muscle rupture d) Is inability of the heart to maintain the circulation

Is characterized by a low systemic vascular resistance

Septic shock is characterized by: a) A low cardiac output b) Increased capillary permeability c) Vasoconstriction d) A high capillary artery occlusion pressure (PCWP, PAOP)

Increased capillary permeability

Identify the formula for minute volume: a) Forced vital capacity X respiratory rate b) Functional residual capacity – tidal volume c) Tidal volume X respiratory rate d) Cardiac output X respiratory rate

Tidal volume X respiratory rate

The initial MAP target values for the treatment of shock should be: a) MAP 50 mmHg b) MAP 80 mmHg c) MAP 65 mmHg d) MAP 100 mmHg

MAP 65 mmHg

Amiodarone is indicated for the treatment of: a) Arrhythmia b) Hypertension c) Hyperthyroidism d) Seizure

Arrhythmia

What kind of criteria are not useful to diagnose human death: a) Circulatory b) Neurological c) Pulmonary d) Somatic

Pulmonary

These are somatic criteria for death except: a) Putrefaction b) Rigor mortiss c) Cardiac arrest d) Hypostasis

Cardiac arrest

Risk of misdiagnosis of brain death according to circulatory criteria is possible in following circumstances except: a) Hypothermia b) Hyperthermia c) Intoxication d) Metabolic complications

Hyperthermia

Basic goal after the recognition of sepsis is to administer the antimicrobials within: a) 3 hours b) 1 hour c) 6 hours d) 12 hours

1 hour

In the sepsis Six algorithm of severe sepsis treatment step 1 is: a) 1000 ml crystalloids infusion b) Intravenous antibiotics c) 100% oxygen via mask d) Dopamine IV

100% oxygen via mask

Insulin infusion for glucose control in sepsis should be used when 2 consecutive glucose levels are: a) 110 mg/dl b) 150 mg/dl c) 220 mg/dl d) 180 mg/dl

220 mg/dl

What is not typical for the chronic pain syndrome: a) Disease on its own b) Cause usually defined c) Oft learned syndrome d) Increase of activity indicated

Cause usually defined

In the learned chronic pain syndrome typical behavior called “five Ds” concerns following symptoms except: a) Disability b) Dysphagia c) Drug misuse d) Dependency

Dysphagia

Before diagnosis of brain death following causes must be excluded except: a) Depressant drugs b) Malignant hyperthermia c) Primary hypothermia d) Reversible metabolic disturbances

Malignant hyperthermia

The PCA analgetic therapy means: a) Peridural continuous analgesia b) Pain control analgesia c) Perioperative control of pain d) Patient controlled analgesia

Patient controlled analgesia

Gold standard for the diagnosis of death using confirmatory investigations is: a) Evoked potentials b) Arterial angiography c) EEG d) Transcranial Doppler

Arterial angiography

A 14 year old girl has intermittent bifrontal and occipital headaches, which she describes as „squeezing, bandlike or viselike“, that are worse when she is at school. She has undergone counselling at school for depression and anxiety. Which of the following is the most likely diagnosis? a) Temporal arteritis b) Migraine headache c) Tension-type headache d) Malingering

Tension-type headache

A 55 year old man has severe pain on gentle touching of the arm. Six months ago, the median nerve was damaged during creation of an arteriovenous fistula for dialysis. Which of the following terms best describes this phenomenon? a) Hypesthesia b) Hyperalgesia c) Allodynia d) Hypersensitivity

Allodynia

The placebo effect is mediated by: a) Opioid mechanism b) Oxytocin mechanism c) Cannabinoid mechanism d) All of above

All of above

According to international definition pain is: a) An unpleasant sensory or emotional experience described in terms of tissue damage b) Actual or potential tissue damage associated with unpleasant experience c) An acute sensory experience associated with local tissue damage d) An unpleasant sensory and emotional experience associated with actual or potential tissue damage

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

In the study of placebo effect the highest decrease of pain intensity was observed during: a) Open (excepted) injection of analgetic b) Hidden (unexpected) injection of analgetic c) No difference between both interventions d) Hidden injection was effective in neuropathic pain only

Open (excepted) injection of analgetic

What kind of treatment is not used in the postoperative pain therapy? a) Epidural blockade b) Intrapleural blockade c) Spinal blockade d) Neurolytic blockade

Intrapleural blockade

The capnogram below is a sign that your patient has just had: a) Pulmonary embolism b) Severe bronchospasm c) Malignant hyperthermia d) Return of spontaneous circulation (ROSC) after cardiac arrest

Return of spontaneous circulation (ROSC) after cardiac arrest

Which of the following agents is an inotrope? a) Metoprolol b) Milrinone c) Diltiazem d) Ramipril

Milrinone

The patient is admitted with cardiogenic shock and oliguric acute kidney injury. Hemodynamics reveal the following: BP 105/60 mmHg, Sinus rhythm 108 bpm, CI 1.8 (CO 2.4), CVP 23 mmHg, PCWP 25 mmHg, SVRI 2088 (SVR 1566). The most appropriate management is the administration of: a) Captopril 6,5 mg 6h b) Dobutamine at 5 mcg/kg/min c) Metoprolol 25 mg BID d) Dopamine at 2 mcg/kg/min

Dobutamine at 5 mcg/kg/min

Clopidogrel is classified as an: a) Inhibitor of platelets aggregation b) Factor Xa inhibitor c) Vit K antagonist d) Anti-hypertensive

Inhibitor of platelets aggregation

Dabigatran (Pradaxa) is classified as an: a) Factor Xa inhibitor b) Direct thrombin inhibitor c) Inhibitor of platelets aggregation d) Vit K antagonist

Direct thrombin inhibitor

Amiodarone is indicated for the treatment of: a) Hypertension b) Seizure c) Hyperthyroidism d) Arrhythmia

Arrhythmia

Which of the following information is TRUE about Naloxone? a) Naloxone is a pure opioid antagonist that competitively binds to mu-opioid receptors b) Naloxone has a short duration of activity about 30 to 90 minutes c) No tolerance or dependence is associated with Naloxone use d) All informations are true

All informations are true

Basic goal after the recognition of sepsis is to administer the antimicrobials within: a) 1 hour b) 3 hours c) 6 hours d) 12 hours

1 hour

The inotropic drug of the first choice for septic shock is: a) Dopexamine b) Epinephrine c) Dopamine d) Dobutamine

Dobutamine

In the sepsis six algorithm of severe sepsis, treatment step 1 is: a) 1000ml crystalloids infusion b) 100% oxygen via mask c) Intravenous antibiotics d) Dopamine IV

100% oxygen via mask

A patient with a spinal abscess is admitted to the ICU in septic shock and requires pressors. Which of the following agents would be most efficacious for increasing cardiac output while increasing mean arterial pressure (MAP)? a) Digoxin b) Phenylephrine c) Dopamine d) Norepinephrine

Norepinephrine

Atypical bacterial pathogens that are associated with community acquired pneumonia (CAP) include: a) Chlamydia pneumoniae b) Hemophilus influenzae c) Strep. Pneumoniae d) Moraxella catarrhalis

Chlamydia pneumoniae

CVP is typically elevated in all EXCEPT: a) Sepsis b) CHF c) Hypervolemia d) Cardiac tamponade

Sepsis

CVP monitoring: a) Indicates hypovolemia when CVP is low b) Allows assessment of preload of the heart c) May not reflect left heart filling pressures in patient with COPD d) All are true

All are true

Which ONE of the following statements about vasoactive drugs is FALSE: a) Adrenaline has alpha and beta receptor agonist activity b) Noradrenaline is a vasoconstrictor c) Dopamine has a specific renal protective action in critical care patients at risk of renal failure d) Dobutamine is a systemic and pulmonary vasodilator

Dobutamine is a systemic and pulmonary vasodilator

Which ONE of the following statements about PCWP (POAP) is TRUE: a) Measurement involves passage of pulmonary artery catheter across the interatrial septum b) Is typically raised in ARDS c) Is typically raised in septic shock d) Is a reflection of left atrial pressure

Is a reflection of left atrial pressure

Quantitative measurement of cardiac output can be made using all methods EXCEPT: a) An esophageal Doppler probe b) Thermodilution techniques c) Mixed venous saturation (SvO2) and heart rate d) The Fick principle

The Fick principle

Which ONE of the following statements about cardiogenic shock is FALSE: a) Is characterized by inability of the heart to maintain the circulation b) Is characterized by a low systemic vascular resistance c) Can be caused by papillary muscle rupture d) Is characterized by low cardiac output

Is characterized by a low systemic vascular resistance

Septic shock is characterized by: a) A low cardiac output b) Vasoconstriction c) Increased capillary permeability d) A high capillary artery occlusion pressure (PCWP, POAP)

Increased capillary permeability

The following are risk factors for pulmonary embolism except: a) Immobilization after surgery b) Clinically suspected DVT c) Malignancy d) LBBB

Malignancy

Factors influencing preload are all EXCEPT: a) Atrial contraction b) Systemic vascular resistance c) Heart valves diseases d) Intrathoracic pressure

Systemic vascular resistance

Positive end-expiratory pressure (PEEP) can contribute to: a) Increase in systemic venous return b) FRC increase (prevention of airway collapse) c) Decrease in airway pressure d) Increase in work of breathing

FRC increase (prevention of airway collapse)

Infant CPR should be considered for what age? a) Under 6 months b) Under 12 months c) Under 18 months d) Under 24 months

Under 12 months

The leading cause of cardiac arrest in children is: a) Respiratory problem b) Circulatory problem c) Congenital heart failure d) Trauma

Respiratory problem

An infant`s pulse should be checked by palpation of a pulse on which artery? a) Carotid or femoral b) Carotid c) Brachial or femoral d) Radial

Brachial or femoral

According to ERC guidelines for resuscitation 2015 (adults) 1st shock is: a) 150 J for biphasic and monophasic b) 150 J for monophasic and 360 J for biphasic c) 360 J for biphasic and monophasic d) 150 J for biphasic and 360 J for monophasic

150 J for biphasic and 360 J for monophasic

Criteria regarding apnoea testing during brain death examination require: a) Hypoxemia below a specified PaO2 must be achieved to assure that no CNS hypoxia-sensing centers are active b) A specified degree or change in blood pH (acidemia) must be achieved to confirm medullary respiratory center inactivation c) Arterial PaCO2 must reach or exceed a specific level above baseline

Arterial PaCO2 must reach or exceed a specific level above baseline

The diagnosis of brain death: a) Is primarily clinical and no other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and apnoea tests, is conclusively performed b) Ancillary instrumental tests are needed only in patients in persistent vegetative state c) Always needs confirmation by ancillary instrumental tests (EEG, evoked potentials, cerebral angiography, transcranial Doppler, perfusion scintigraphy)

Is primarily clinical and no other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and apnoea tests, is conclusively performed

These are circulatory criteria for death EXCEPT: a) Loss of consciousness b) Apnoea c) Loss of pulse on big arteries d) Stiffness

Stiffness

These are criteria for brain death EXCEPT: a) Loss of consciousness b) Loss of all neurological reflexes c) Loss of brainstem reflexes d) Loss of capacity to breathe

Loss of consciousness

During diagnosis of brain death following brainstem reflexes are examined except: a) Nasocranial b) Oculocephalic c) Vestibulo-ocular d) Corneal

Nasocranial

Criteria for brain death, so called Harvard criteria, were established in the year: a) 1936 b) 1955 c) 1968 d) 1982

1968

Confirmatory investigation for diagnosis of brain death are necessary in following circumstances except: a) Pharmacological derangement possible b) Apnoea test impossible to complete c) Facial injuries d) Acute cerebral bleeding

CAVE: Old questions have two different answers: Apnoea test impossible to complete OR Acute cerebral bleeding

What effect will the following arterial blood gas have on serum potassium? pH 7,20; pCO2 60 mmHg; pO2 85 mmHg; HCO3 23 mEq/L, and BE -4? a) Increase in serum K b) Decrease in serum K c) Movement of serum K into intracellular space d) No change in serum K

Increase in serum K

Which of the following is correct concerning anaphylactic and anaphylactoid reactions? a) Endogenous histamine release occurs only during an anaphylactoid reaction b) Anaphylactic reactions occur on the first exposure to the allergen c) Anaphylactoid reactions are mediated by IgE d) They are clinically indistinguishable

They are clinically indistinguishable

Calculate the PaO2:FiO2 ratio based on the following data: FiO2 1.0, PEEP 10, PaO2 65 mmHg, pH 7.34, PaCO2 45 mmHg, SpO2 90% a) 100 b) 95 c) 65 d) 35

Calculate cerebral perfusion pressure (CPP) based on the following data: HR 75, BP 120/80 (MAP 65), CVP 15, ICP 15, Respiratory rate 25, minute volume 10 l/min. a) 105 b) 60 c) 50 map-icp d) 35

50 map-icp

A patient with diabetic ketoacidosis is scheduled for an emergent laparotomy. Which of the following best explains the decrease in serum potassium concentration that occurs in this patient following administration of insulin? a) Dilutional hypokalemia follows free water retention from decreased osmotic diuresis b) Intracellular potassium is exchanged for extracellular glucose c) Insulin enhances renal excretion of potassium d) Extracellular potassium is actively transported with glucose into cells

Extracellular potassium is actively transported with glucose into cells

Identify the formula for minute volume: a) Tidal volume X respiratory rate b) Cardiac output X respiratory rate c) FVC X respiratory rate d) FRC – TV

Tidal volume X respiratory rate

Administration of an agonist for which of the following autonomic receptors would be expected to cause airway resistance to decrease? a) Histamine b) Cholinergic c) Alpha-adrenergic d) Beta-adrenergic

Beta-adrenergic

The patient with atrial fibrillation is on chronic warfarin treatment. On admittance to hospital, he is diagnosed with bowel ischemia and requires urgent suergey. His INR is 10.4 and aPTT 52s. Which of the following interventions is the priority? a) Vit K infusion b) Octaplex (PCC) c) Protamine sulphate d) Fibrinogen

Vit K infusion

The train-of-four measurement by a peripheral nerve stimulator is used to determine the absence of which category of drugs? a) Nondepolarizing neuromuscular blockers b) Benzodiazepines c) Barbiturates d) Opiates

Nondepolarizing neuromuscular blockers

Select the correct interpretation for the following blood gas set: PaO2 78 mmHg, PaCO2 29 mmHg, pH 7,29, HCO3 14 mmol/L, BE -10 mmol/L. a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic acidosis d) Metabolic alkalosis

Metabolic acidosis

Immediately following intubation, the patient has an end tidal CO2 reading of 1 mmHg. This findings is consistent with: a) Pulmonary embolism b) Right mainstem bronchus intubation c) Esophageal intubation d) Correct placement of endotracheal tube

Esophageal intubation

What is the PRIMARY purpose of preoxygenation (denitrogenation) prior to anesthetic induction? a) Improving matching of ventilation and perfusion b) Increasing oxygen reserve in the functional residual capacity c) Increasing contribution of second gas effect to rate of induction d) Maximizing arterial oxygen content

Increasing oxygen reserve in the functional residual capacity

Pulse oximetry accurately reflects SaO2 in which of the following situations? a) Carboxyhemoglobinemia b) Administration of indocyanine green c) 40% fetal haemoglobin concentration d) Methemoglobinemia

Carboxyhemoglobinemia

Two hours after a laparoscopic cholecystectomy, an obese 45 year old woman is receiving intravenous patient-controlled analgesia with morphine. Her SpO2 is 92% on room air. Which of the following is the most likely cause? a) Absorption of CO2 from the abdomen b) Increased dead space c) Impaired oxygen diffusion d) Hypoventilation

Impaired oxygen diffusion

Which of the following laboratory values is most likely to confirm adequate synthetic hepatic function? a) Partial thromboplastin time b) Prothrombin time c) Total serum bilirubin concentration d) Serum alanine aminotransferase concentration

Prothrombin time

Which ONE of the following statements about pressure support ventilation is TRUE: a) Increases the work of breathing b) Cannot be used in conjunction with continuous positive airway pressure c) Delivers a specified volume regardless of airway pressure d) Can only be used in a spontaneously breathing patient

Cannot be used in conjunction with continuous positive airway pressure

Hypotension is LEAST likely to occur following induction with which one of the following anesthetic agents? a) Midazolam b) Thiopental c) Etomidate d) Propofol

Etomidate

Use of a laryngeal mask airway during general anesthesia is most appropriate for which kind of the following patients? a) A patient undergoing cesarean delivery who cannot be intubated after induction of anesthesia b) A patient who has tracheoesophageal fistula c) A patient who has a peak inspiratory pressure greater than 30 cmH2O d) A patient who requires emergency appendectomy two hours after eating

A patient undergoing cesarean delivery who cannot be intubated after induction of anesthesia

A patient has received atropine 1% eye drops after eye surgery. How many milligrams of atropine are in one drop of a 1% solution? 1ml = 20 drops. a) 0,05 mg b) 0,1 mg c) 0,5 mg d) 1 mg

CAVE: Old questions have two different answers: 0,05 mg OR 0,5 mg Anki: pretty sure it's 0,5mg --> (but 0,05ml/drop)

Which ONE of the following statements about postintubation croup is FALSE: a) Almost always appears within 3 hours after intubation b) Is associated with repeated intubation attempts c) Is associated with early childhood d) The only effective treatment is urgent tracheostomy

The only effective treatment is urgent tracheostomy

Which ONE of the following statements about pediatric patients is FALSE: a) Fluid deficits in infants are usually replaced with 5% glucose b) Infants respond to dehydration with decreased blood pressure but without tachycardia c) The cardiac output of neonates and infants is dependent on heart rate, since stroke volume is relatively fixed d) Postoperative hypothermia in pediatric patients is associated with delayed awakening and respiratory depression

Infants respond to dehydration with decreased blood pressure but without tachycardia