Critical Care Flashcards by Neurosurgery Udayana

Dimercaprol, when used as a chelation agent, can
increase the brain concentrations of which metal?
A. Lead
B. Arsenic
C. Cadmium
D. Chromium
E. Mercury

E. Mercury

How well did you know this?

Not at all

Perfectly

A patient was diagnosed with epilepsy over 30 years
ago and has been on antiepileptic medications
since diagnosis. The patient complains of a lupus-
like syndrome and progressive ataxia and is found
to have gingival hypertrophy on exam. What anti-
epileptic drug has the patient likely been taking?
A. Levetiracetam
B. Phenytoin
C. Primidone
D. Valproic acid
E. Lamotrigine

B. Phenytoin

How well did you know this?

Not at all

Perfectly

A 69-year-old man on aspirin and warfarin under-
went a craniectomy for a traumatic subdural
hematoma. Surgery was uneventful except for high-
volume blood loss, and a blood transfusion was
ordered postoperatively. Ten minutes after the
transfusion was started, the patient started having
tremors. His temperature was 102.8°F, blood pres-
sure was 130/85 mm Hg, pulse was 100 bpm, and
respiratory rate was 22 bpm. Per blood bank poli-
cies, the transfusion was stopped, and the patient
was given acetaminophen. The blood products and
a fresh type and screen sample were sent back to
the blood bank. What was the patient’s most likely
type of blood reaction?
A. Acute hemolytic
B. Delayed hemolytic
C. Febrile nonhemolytic
D. Allergic
E. Transfusion-related acute lung injury (TRALI)

C. Febrile nonhemolytic

How well did you know this?

Not at all

Perfectly

What vitamin should be coadministered with iso-
niazid to prevent neuropathy?
A. Vitamin A
B. Vitamin B12
C. Vitamin C
D. Vitamin B6
E. Vitamin E

D. Vitamin B6

How well did you know this?

Not at all

Perfectly

A 35-year-old patient admitted to the neurology
ICU following polytrauma becomes hypotensive.
What hemodynamic parameters are compatible
with hypovolemic shock?
A. Decreased right atrial pressure, decreased pul-
monary capillary wedge pressure, decreased
cardiac output, and increased systemic vascu-
lar resistance
B. Normal or increased right atrial pressure,
increased pulmonary capillary wedge pres-
sure, decreased cardiac output, and increased
systemic vascular resistance
C. Variable right atrial pressure, variable pulmo-
nary capillary wedge pressure, increased car-
diac output, and decreased systemic vascular
resistance
D. Increased right atrial pressure, normal or de-
creased pulmonary capillary wedge pressure,
decreased cardiac output, and increased sys-
temic vascular resistance
E. Increased right atrial pressure, increased pul-
monary capillary wedge pressure, decreased
cardiac output, and increased systemic vascu-
lar resistance

A. Decreased right atrial pressure, decreased pul-
monary capillary wedge pressure, decreased
cardiac output, and increased systemic vascu-
lar resistance

How well did you know this?

Not at all

Perfectly

A 10-year-old boy with von Willebrand disease
is scheduled to undergo a craniotomy for tumor
resection. Besides having blood products readily
available, what can be administered preoperatively
to ready the patient for surgery?
A. Desmopressin
B. Von Willebrand factor
C. Factor VII
D. Intravenous crystalloids
E. Factor IX

A. Desmopressin

How well did you know this?

Not at all

Perfectly

In the conjunction with absence of brainstem
reflexes, absent motor response, and the absence of
complicating conditions (e.g., hypothermia, intoxi-
cation, etc.), what apnea test PaCO2 finding is con-
sistent with brain death?
A. PaCO2 of 40 mm Hg after 10 minutes of testing
with no spontaneous respirations
B. PaCO2 of 65 mm Hg with a 20 mm Hg rise over
the patient’s baseline after 12 minutes of test-
ing with no spontaneous respirations
C. PaCO2 of 60 mm Hg with a 10 mm Hg rise over
the patient’s baseline after 6 minutes of test-
ing with no spontaneous respirations
D. PaCO2 of 50 mm Hg after 10 minutes of testing
with no spontaneous respirations

B. PaCO2 of 65 mm Hg with a 20 mm Hg rise over
the patient’s baseline after 12 minutes of test-
ing with no spontaneous respirations

How well did you know this?

Not at all

Perfectly

What lumbar puncture cerebrospinal fluid study
profile is consistent with bacterial meningitis?
A. Opening pressure 15, 2 WBC without an abnor-
mal differential, protein 30, glucose 60
B. Opening pressure 22, 250 WBC with more
than 80% being lymphocytes, protein 500, glu-
cose 25
C. Opening pressure 30, 1,500 WBC with more
than 80% PMN, protein 400, glucose 10
D. Opening pressure 21, 110 WBC with more
than 50% lymphocytes, protein 80, glucose 50

C. Opening pressure 30, 1,500 WBC with more
than 80% PMN, protein 400, glucose 10

How well did you know this?

Not at all

Perfectly

What lumbar puncture cerebrospinal study profile
is consistent with viral meningitis?
A. Opening pressure 15, 2 WBC without an abnor-
mal differential, protein 30, glucose 60
B. Opening pressure 22, 250 WBC with more
than 80% being lymphocytes, protein 500, glu-
cose 25
C. Opening pressure 30, 1,500 WBC with more
than 80% PMN, protein 400, glucose 10
D. Opening pressure 21, 110 WBC with more
than 50% lymphocytes, protein 80, glucose 50
Abbreviations: WBC, white blood cells; PMN, poly-
morphonuclear leukocytes

D. Opening pressure 21, 110 WBC with more
than 50% lymphocytes, protein 80, glucose 50
Abbreviations: WBC, white blood cells; PMN, poly-
morphonuclear leukocytes

How well did you know this?

Not at all

Perfectly

What aspect of propofol requires the use of an ad-
ditional intravenous agent when propofol is used
as a sedative in the acute trauma setting?
A. Its lack of analgesia
B. Its lack of hypnotic effects
C. Its poor ability to lower intracranial pressure
and offer cerebral protection
D. Its poor induction properties in the setting of
rapid intubation

A. Its lack of analgesia

How well did you know this?

Not at all

Perfectly

A woman with a family history of unknown but
reportedly “significant” reactions to anesthesia is
undergoing induction of anesthesia with a halo-
genated agent. She is noted to have a sudden
increase in end-tidal PCO2 and tachycardia. The
arterial blood gas reading indicates a metabolic
acidosis. The patient had a previous surgery with-
out any complications. What is the next step in the
management of this patient?
A. Stop the anesthetic agent.
B. Administer dantrolene.
C. Hyperventilate the patient to 100% FiO2.
D. Administer calcium chloride.
E. Administer glucose and insulin.

A. Stop the anesthetic agent.

How well did you know this?

Not at all

Perfectly

What inhalational neuroanesthetic does not reduce
cerebral metabolism?
A. Halothane
B. Enflurane
C. Nitrous oxide
D. Isoflurane
E. Desflurane

C. Nitrous oxide

How well did you know this?

Not at all

Perfectly

What is a major advantage of halogenated inhala-
tional anesthetic agents?
A. They suppress EEG activity.
B. They decrease cerebral blood flow.
C. They increase cerebral metabolism.
D. They decrease intracranial pressure.
E. They are relatively nonhepatotoxic at high
doses.

A. They suppress EEG activity.

How well did you know this?

Not at all

Perfectly

Propofol has what analgesic effect?
A. Complete analgesia reversal
B. No analgesic effect
C. Strong analgesic effect
D. Blunting of the effects of other analgesics

B. No analgesic effect

How well did you know this?

Not at all

Perfectly

What is the major side effect of nitroglycerin and
nitroprusside when used for hypertension control
in neurosurgical patients?
A. Nitroglycerin and nitroprusside lower the sei-
zure threshold.
B. Nitroglycerin and nitroprusside can cause
paralysis in acute use.
C. Nitroglycerin and nitroprusside cause vaso-
constriction.
D. Nitroglycerin and nitroprusside raise intracra-
nial pressure.
E. Nitroglycerin and nitroprusside increase cere-
bral perfusion pressure.

D. Nitroglycerin and nitroprusside raise intracra-
nial pressure.

How well did you know this?

Not at all

Perfectly

A patient with various intraparenchymal hemor-
rhages following trauma has been resuscitated fully
except for a continued coagulopathy. As the coagu-
lopathy is corrected, what fluids should be avoided
for prolonged administration with regard to the
coagulopathy?
A. Nonhypertonic crystalloids (e.g., normal saline)
B. Colloids (e.g., dextran, hetastarch)
C. Hypertonic crystalloids (e.g., 3% normal saline)
D. Osmotic agents (e.g., mannitol)
E. Isotonic solutions (e.g., Isolyte)

B. Colloids (e.g., dextran, hetastarch)

How well did you know this?

Not at all

Perfectly

What is the definitive way to identify a patient at
risk for malignant hyperthermia?
A. Obtaining a muscle biopsy for in vitro testing
B. Performing genetic testing
C. Obtaining an adequate family history
D. Assessing serum potassium levels
E. Assessing serum creatine kinase levels

A. Obtaining a muscle biopsy for in vitro testing

How well did you know this?

Not at all

Perfectly

What pressor agent should be avoided in spinal shock?
A. Dopamine
B. Phenylephrine
C. Isoproterenol
D. Levophed
E. Dobutamine

B. Phenylephrine

How well did you know this?

Not at all

Perfectly

How do the steroid replacement requirements
differ between primary and secondary adrenal
insufficiency?
A. In primary adrenal insufficiency, only gluco-
corticoids need to be replaced.
B. In secondary adrenal insufficiency, only min-
eralocorticoids need to be replaced.
C. In secondary adrenal insufficiency, both gluco-
corticoids and mineralocorticoids need to be
replaced.
D. In primary adrenal insufficiency, both gluco-
corticoids and mineralocorticoids need to be
replaced.
E. In primary adrenal insufficiency, only miner-
alocorticoids need to be replaced.

E. In primary adrenal insufficiency, only miner-
alocorticoids need to be replaced.

How well did you know this?

Not at all

Perfectly

What are the side effects associated with using a
long-term, properly dosed, cortisone regimen for
a patient with panhypopituitarism secondary to a
pituitary adenoma?
A. Hypertension and hypokalemia
B. Hyperglycemia and salt wasting
C. Hyperglycemia and volume depletion through
dieresis
D. Hypertension and hyperglycemia
E. Salt wasting and volume depletion

A. Hypertension and hypokalemia

How well did you know this?

Not at all

Perfectly

What anesthetic is ideal for a patient experiencing
elevated intracranial pressure?
A. Thiopental
B. Enflurane
C. Halothane
D. Isoflurane

A. Thiopental

How well did you know this?

Not at all

Perfectly

A 45-year-old woman developed marked pallor and
a petechial rash following a craniotomy for tumor
resection. Her temperature is 101.2°F, blood pres-
sure is 105/75 mm Hg, heart rate is 90 bpm, and
respiratory rate is 18 bmp. Lab work reveals a
serum creatinine of 2, hemoglobin of 8, platelet
count of 36,000, prolonged bleeding time of 5
minutes, prothrombin time of 12.1 seconds, and
partial thromboplastin time of 30 seconds. A
peripheral blood smear shows fragmented red
blood cells. There is no elevation in the serum
d-dimer level. What is the most likely diagnosis?
A. Idiopathic thrombocytopenic purpura
B. Disseminated intravascular coagulation
C. Thrombotic thrombocytopenic purpura
D. Hemolytic uremic syndrome
E. Sepsis

C. Thrombotic thrombocytopenic purpura

How well did you know this?

Not at all

Perfectly

What is the most reliable indicator that a patient
is experiencing cerebral salt wasting and not the
syndrome of inappropriate antidiuretic hormone
secretion?
A. The patient has a high plasma volume.
B. The patient has a low serum sodium
concentration.
C. The patient has a low urine output.
D. The patient is volume depleted.
E. The patient has increasing cerebral edema.

D. The patient is volume depleted.

How well did you know this?

Not at all

Perfectly

A man with chronic alcoholism is recovering after an alcohol-induced traumatic cerebral contusion. He is neurologically intact awaiting discharge after eating several full meals when he suddenly develops quadriplegia, confusion, difficulty speaking, and
trouble swallowing. Serum sodium is 139 mEq/L. What is the most likely diagnosis?
A. Beriberi
B. Central pontine myelinolysis
C. Pseudohyponatremia
D. Cerebral edema
E. Cervical spinal cord contusion

B. Central pontine myelinolysis

How well did you know this?

Not at all

Perfectly

When/how should hyperventilation be used in the setting of a severe head injury and with what goals? A. It should never be used. B. Prophylactic hyperventilation to achieve a PaCO2 of 30 mm Hg for 48 to 72 hours is safe and effective in reducing intracranial pressure (ICP). C. Hyperventilation to achieve a PaCO2 of 30 to 35 mm Hg is appropriate to use as a temporizing measure for patients with signs of progressive neurologic deterioration when ICP monitoring is not yet established. D. In the case of transtentorial herniation, hyper- ventilation to achieve a PaCO2 less than 25 mm Hg may be more effective in reducing ICP than achieving a PaCO2 less than 30 mm Hg.

C. Hyperventilation to achieve a PaCO2 of 30 to 35 mm Hg is appropriate to use as a temporizing measure for patients with signs of progressive neurologic deterioration when ICP monitoring is not yet established.

In the event of failed maximal medical manage- ment of increased intracranial pressure, what is the dosing regimen for pentobarbital for instituting a pentobarbital coma? A. 20 mg/kg intravenous bolus followed by 100 mg every 8 hours B. 100 mg intravenously every 4 hours C. 20 to 75 µg/kg/min intravenous continuous drip D. 10 mg/kg intravenous bolus over 30 minutes followed by a 1 mg/kg/h infusion

D. 10 mg/kg intravenous bolus over 30 minutes followed by a 1 mg/kg/h infusion

What antipsychotic medication can lead to agranulocytosis? A. Clozapine B. Thioridazine C. Chlorpromazine D. Aripiprazole E. Quetiapine

A. Clozapine

In patients with low albumin, what equation can be used to convert observed phenytoin levels to equivalent/corrected phenytoin levels? A. Equivalent level = Observed level/(0.1(Albumin level) + 0.1) B. Equivalent level = Observed level – 2(Albumin level) C. Equivalent level = Observed level/(2(Albumin level) + 3) D. Equivalent level = Observed level/Albumin level E. Equivalent level = Observed level – 3(Albumin level)

A. Equivalent level = Observed level/(0.1(Albumin level) + 0.1)

What anesthetic agent can lead to the development of tension pneumocephalus following surgery in the supine position? A. Halothane B. Sevoflurane C. Nitrous oxide D. Propofol E. Remifentanil

C. Nitrous oxide

What are the two main factors that should be pres- ent for an air embolism to occur? A. Noncollapsible vein and negative pressure in the vein B. Collapsible vein and positive pressure in the vein C. Noncollapsible vein and positive pressure in the vein D. Collapsible vein and patent foramen ovale E. Patent foramen ovale and negative pressure in the vein

A. Noncollapsible vein and negative pressure in the vein

Following traumatic skull base fractures, if patients are placed on empiric antibiotic coverage, what organism should be targeted with this coverage? A. Staphylococcus aureus B. Staphylococcus epidermidis C. Streptococcus pneumoniae D. Hemophilus influenza E. Neisseria meningitis

C. Streptococcus pneumoniae

A postoperative patient has a potassium level of 6.7, and an electrocardiogram shows peaked T waves. What should be administered next in this patient’s management? A. Calcium gluconate B. Kayexalate C. Insulin and glucose D. Lasix E. Albuterol

A. Calcium gluconate

What is the reversal agent for benzodiazepines? A. Atropine B. Physostigmine C. Flumazenil D. Glucagon E. Phentolamine F. Naloxone G. Protamine H. Dimercaprol

C. Flumazenil

What is the reversal agent for morphine? A. Atropine B. Physostigmine C. Flumazenil D. Glucagon E. Phentolamine F. Naloxone G. Protamine H. Dimercaprol

F. Naloxone

What is the antidote agent for anticholinergic poisoning? A. Atropine B. Physostigmine C. Flumazenil D. Glucagon E. Phentolamine F. Naloxone G. Protamine H. Dimercaprol

B. Physostigmine

What is the reversal agent for dopamine overdose? A. Atropine B. Physostigmine C. Flumazenil D. Glucagon E. Phentolamine F. Naloxone G. Protamine H. Dimercaprol

E. Phentolamine

What is the mechanism of action of isoproterenol? A. Selective β-adrenergic agonism B. Nonselective β-adrenergic agonism C. Selective β-adrenergic blockade D. Nonselective β-adrenergic blockade E. Trace amine–associated receptor 1 (TAAR1) antagonism

B. Nonselective β-adrenergic agonism

How does assist control ventilation work? A. Breaths are patient- or time-triggered with a constant tidal volume for each breath. B. Breaths are patient- or time-triggered, flow limited, and volume cycled; breaths taken by patients are not assisted. C. Breaths are patient-triggered, and inspiratory pressure is added to patient-initiated breaths. D. Breaths are not triggered, and continuous pressure is applied to the ventilation circuit throughout the breathing cycle.

A. Breaths are patient- or time-triggered with a constant tidal volume for each breath.

What pathology is represented by the following arterial blood gas values? pH: 7.30 PCO2: 43 mm Hg HCO3 –: 20 mEq/L A. Respiratory alkalosis B. Metabolic acidosis C. Combined respiratory and metabolic alkalosis D. Partially compensated respiratory acidosis

B. Metabolic acidosis

What pathology is represented by the following arterial blood gas values? pH: 7.56 PCO2: 28 mm Hg HCO3–: 25 mEq/L A. Respiratory alkalosis B. Metabolic acidosis C. Combined respiratory and metabolic alkalosis D. Partially compensated respiratory acidosis

A. Respiratory alkalosis

In an adult patient with a normal head CT follow- ing a concussion, what risk factors increase the likelihood for intracranial hypertension? A. Age greater than 60 years, systolic blood pres- sure less than 100 mm Hg, and posturing on motor exam B. Age greater than 40 years, systolic blood pressure less than 90 mm Hg, and posturing on motor exam C. Age greater than 65 years, systolic blood pres- sure less than 110 mm Hg, and posturing on motor exam D. Age greater than 35 years, systolic blood pres- sure less than 80 mm Hg, and posturing on motor exam

B. Age greater than 40 years, systolic blood pressure less than 90 mm Hg, and posturing on motor exam

What is the conversion factor between mm Hg and cm H2O? A. 1 mm Hg = 1.36 cm H2O B. 1 mm Hg = 1.63 cm H2O C. 1 mm Hg = 0.735 cm H2O D. 1 mm Hg = 0.375 cm H2O

A. 1 mm Hg = 1.36 cm H2O

A 22-year-old patient with a traumatic brain injury is admitted to the intensive care unit with a Glasgow Coma Scale score of 7. What is the recom- mended goal for the body temperature state for this patient? A. Induced hypothermia B. Permissive hypothermia C. Normothermia D. Permissive hyperthermia E. Induced hyperthermia

C. Normothermia

What intravenous anesthetic may cause adrenal insufficiency? A. Propofol B. Dexmedetomidine C. Etomidate D. Ketamine

C. Etomidate

A 55-year-old woman remains comatose for 4 days following resuscitation from a heart attack. She is off sedation and shows absence of brainstem reflexes. The patient is unable to complete the apnea test portion of the brain death examination. Median nerve somatosensory evoked potentials (SSEPs) are obtained. What finding would be pre- dictive of a poor neurologic outcome? A. Bilateral absence of the N20 waveform B. Bilateral absence of the N9 waveform C. Bilateral absence of the N13 waveform D. Unilateral absence of the N13 waveform

A. Bilateral absence of the N20 waveform

How does pressure support ventilation work? A. Breaths are patient- or time-triggered with a constant tidal volume for each breath. B. Breaths are patient- or time-triggered, flow limited, and volume cycled; breaths taken by patients are not assisted. C. Breaths are patient-triggered, and inspiratory pressure is added to patient-initiated breaths. D. Breaths are not triggered, and continuous pressure is applied to the ventilation circuit throughout the breathing cycle.

B. Breaths are patient- or time-triggered, flow limited, and volume cycled; breaths taken by patients are not assisted.

A 35-year-old man with HIV has a multiple ring- enhancing lesions on MRI. What is the most likely diagnosis? A. Tenia solium B. Herpes simplex C. Cryptococcus D. Toxoplasmosis E. West Nile virus F. JC virus

D. Toxoplasmosis

A 70-year-old woman with HIV and noncompli- ance with HAART has 3 weeks of progressively worsening mental status along with a left visual field deficit and right-sided weakness. MRI reveals nonenhancing white matter lesions without sur- rounding edema. The lesions appear hyperintense on T2 and hypointense on T1 sequences. What is the most likely diagnosis? A. Tenia solium B. Herpes simplex C. Cryptococcus D. Toxoplasmosis E. West Nile virus F. JC virus

F. JC virus

A 73-year-old woman with neck stiffness, head- ache, left leg weakness, and fever rapidly pro- gressed to having flaccid paralysis and areflexia. Cerebrospinal fluid studies show a white blood cell count over 200, a normal red blood cell count, pro- tein of 87, and a normal glucose level. Cerebro- spinal fluid Gram stain shows no organisms, and the culture is negative. What is the most likely diagnosis? A. Tenia solium B. Herpes simplex C. Cryptococcus D. Toxoplasmosis E. West Nile virus F. JC virus

E. West Nile virus

A 65-year-old man with a history of chronic obstructive pulmonary disease is admitted for a lobar intracranial hemorrhage. The patient is intu- bated and sedated. He suddenly develops pulseless electrical activity. Auscultation of the lungs reveals absent breath sounds on the right. The trachea is deviated to the left. What is the best next step in the patient’s management? A. Chest tube placement B. Chest radiograph C. Needle thoracotomy D. Ultrasound of the lungs E. Decrease the tidal volume on the ventilator

C. Needle thoracotomy

A 28-year-old man is admitted to the intensive care unit after being hit by a car. He has a 5-mm subdural hematoma on the right and a right femur fracture. Two days after admission, he develops tachypnea, tachycardia, and hypotension and be- comes disoriented. On exam, he has new petechiae across his chest. An electrocardiogram is obtained and is unremarkable. A chest radiograph is normal except for two rib fractures. What is the patient’s most likely diagnosis? A. Subdural hematoma expansion B. Pulmonary embolism C. Fat embolism D. Cardiac contusion E. Pulmonary contusion

C. Fat embolism

What are the major potential side effects of peni- cillin and cephalosporins? A. Benign intracranial hypertension B. Aseptic meningitis C. Cerebellar ataxia D. Cochlear and vestibular damage E. Unpleasant taste

B. Aseptic meningitis

What are the major potential side effects of am- photericin B? A. Benign intracranial hypertension B. Aseptic meningitis C. Cerebellar ataxia D. Cochlear and vestibular damage E. Unpleasant taste

A. Benign intracranial hypertension

What are the major potential side effects of ethambutol? A. Benign intracranial hypertension B. Aseptic meningitis C. Cerebellar ataxia D. Cochlear and vestibular damage E. Unpleasant taste

C. Cerebellar ataxia

How will the urine osmolalities of a patient with central diabetes insipidus (DI) and of a normal individual respond to the injection of DDAVP? A. In a patient with central DI, DDAVP will cause a 50% increase in urine osmolality, whereas it will cause an increase of 5% in a normal individual. B. In a patient with central DI and in a normal individual, DDAVP will cause a 50% increase in urine osmolality. C. In a patient with central DI and in a normal individual, DDAVP will cause a 25% increase in urine osmolality. D. In a patient with central DI, DDAVP will cause a 50% increase in urine osmolality, whereas it will cause a decrease of 5% in a normal individual. E. In a patient with central DI, DDAVP will cause a 25% increase in urine osmolality, whereas it will cause a decrease of 5% in a normal individual.

A. In a patient with central DI, DDAVP will cause a 50% increase in urine osmolality, whereas it will cause an increase of 5% in a normal individual.

What clinical syndrome/condition is associated with opsoclonus-myoclonus in a child? A. Hodgkin lymphoma B. Neuroblastoma C. Small cell lung cancer D. Thymoma E. Carcinoid tumor

B. Neuroblastoma

What clinical syndrome/condition is associated with cerebellar dysfunction in an adolescent? A. Hodgkin lymphoma B. Neuroblastoma C. Small cell lung cancer D. Thymoma E. Carcinoid tumor

A. Hodgkin lymphoma

What clinical syndrome/condition is associated with limbic encephalitis and myasthenia gravis? A. Hodgkin lymphoma B. Neuroblastoma C. Small cell lung cancer D. Thymoma E. Carcinoid tumor

D. Thymoma

What clinical syndrome/condition is associated with Lambert-Eaton myasthenia syndrome? A. Hodgkin lymphoma B. Neuroblastoma C. Small cell lung cancer D. Thymoma E. Carcinoid tumor

C. Small cell lung cancer

During hyperventilation therapy, a PCO2 below what level could worsen cerebral ischemia? A. 35 mm Hg B. 32 mm Hg C. 28 mm Hg D. 25 mm Hg E. 20 mm Hg

C. 28 mm Hg

What is the main anticipated outcome in proceeding with donation after cardiac death? A. Asystole or pulselessness will occur within 1 hour of withdrawal of care. B. The patient needs to undergo brain death ex- amination after withdrawal of care. C. The transplant surgeon will have to declare the patient deceased. D. The heart will be removed for donation.

A. Asystole or pulselessness will occur within 1 hour of withdrawal of care.

What is the total blood volume of a 1-year-old boy weighting 10 kg? A. 200 mL B. 400 mL C. 800 mL D. 1.4 L E. 1.6 L

C. 800 mL

A patient develops leukopenia after starting a new drug therapy regimen for trigeminal neural- gia. What medication likely is the cause of the leukopenia? A. Gabapentin B. Baclofen C. Carbamazepine D. Levetiracetam E. Lamotrigine

C. Carbamazepine

A 45-year-old homeless man is admitted to the hospital after being hit by a car. Thirty-six hours after admission, he becomes agitated and starts complaining of hearing people cursing him and feeling people touching him. His vitals are stable. The patient has a history of alcohol intake and smokes one pack of cigarettes per day. He does not use any drugs and has no significant psychiatric history. What is his most likely diagnosis? A. Alcoholic hallucinosis B. Intensive care unit delirium C. Schizophrenia D. Brief psychotic episode E. Delirium tremens

A. Alcoholic hallucinosis

The lower limit of a normal systolic blood pressure for a given age in children may be estimated by what formula? A. 70 mm Hg + 2(Age in years) B. 70 mm Hg + 3(Age in years) C. 50 mm Hg + 2(Age in years) D. 40 mm Hg + 2(Age in years) E. 40 mm Hg + 3(Age in years)

A. 70 mm Hg + 2(Age in years)

Pulmonary capillary wedge pressure is reflective of: A. Pulmonary artery pressure B. Central venous pressure C. Left atrial pressure D. Right atrial pressure E. Left ventricular pressure

C. Left atrial pressure

In the setting of liver failure, an ammonia level of greater than what value is associated with cerebral herniation due to cerebral edema? A. 100 µmol/L B. 150 µmol/L C. 200 µmol/L D. 250 µmol/L E. No ammonia level is predictive of cerebral herniation

E. No ammonia level is predictive of cerebral herniation

Where does antidiuretic hormone (ADH) act in the kidneys? A. Glomerulus B. Proximal renal tubule C. Distal renal tubule D. Loop of Henle E. Collecting duct

C. Distal renal tubule

What is the mechanism of action of ketamine when used as an intravenous sedative? A. GABA-A agonist B. GABA-B agonist C. NMDA receptor antagonist D. Decreases the extent of gap junction cell coupling E. Unknown mechanism of action

C. NMDA receptor antagonist

What is the crystalloid of choice to be administered along with a blood transfusion? A. Lactated Ringer’s solution B. 0.9% normal saline C. D5 water D. 0.225% normal saline

B. 0.9% normal saline

A patient presents to the emergency room in status epilepticus. According to the standard treatment algorithm for status epilepticus, after securing the patient’s airway, breathing, and circulation, what medication should be given first? A. Lorazepam 0.1 mg/kg intravenously B. Phenytoin/fosphenytoin 20 mg/kg intravenous load C. Phenytoin/fosphenytoin 125 mg/kg intravenous load D. Dextrose 50 mL of D50 intravenous bolus E. Thiamine 100 mg intravenously

E. Thiamine 100 mg intravenously

Deficiency of what nutrient is associated with ophthalmoplegia, ataxia, and confusion? A. Cyanocobalamin B. Thiamine C. Pyridoxine D. Folate E. Niacin

B. Thiamine

A patient is in coma with the respiratory pattern shown in this image. Where is the patient’s lesion? A. Diencephalon or bilateral cerebral hemispheres B. Nonorganic (psychogenic origin) C. Superior medulla or inferior pons D. Superior pons E. Medulla

E. Medulla

A 45-year-old man with a recent diagnosis of von Hippel–Lindau disease is admitted to the hospital with a blood pressure of 199/110. He has been complaining of recurrent headaches for the past few days. What is his most likely diagnosis? A. Pheochromocytoma B. Hyperaldosteronism C. Renal artery stenosis D. Renal cell carcinoma E. Primary hypertension

A. Pheochromocytoma

Following resection of a brain tumor, a patient is maintained on minimal intravenous fluids. The next morning, he has an elevated creatinine. A fractional excretion of sodium (FENa) is obtained and is 0.7. What is the most likely etiology of his elevated creatinine? A. Dehydration B. Acute kidney injury C. Kidney stones D. Drug toxicity

A. Dehydration

What is the most sensitive monitoring method to detect a venous air embolism during surgery? A. Right atrial central venous pressure catheter B. Transesophageal echocardiogram C. Precordial Doppler probe D. Radial arterial line E. End-tidal PCO2 detector

B. Transesophageal echocardiogram

A 78-year-old man develops a pulmonary embolus on day 3 following tumor resection. He is not started on anticoagulation and is scheduled for an inferior vena cava filter placement. While waiting for filter placement, he develops acute abdominal pain with bloody diarrhea. His abdomen is soft. What is the next best step in his management? A. Clostridium difficile studies B. Stool parasitic studies C. Stool for fecal occult blood testing D. Emergent vascular consultation and abdominal CT angiogram E. Abdominal ultrasound

D. Emergent vascular consultation and abdominal CT angiogram

The rapid shallow breathing index (RSBI) is a wean- ing assessment tool measured during 1 minute of spontaneous breathing. A value of more than 105 determines a poor chance of ventilator weaning success. How is the RSBI calculated? A. RSBI = Breath frequency/Tidal volume B. RSBI = Tidal volume/Breath frequency C. RSBI = PaO2/Breath frequency D. RSBI = PCO2/Tidal volume E. RSBI = Tidal volume/PaO2

A. RSBI = Breath frequency/Tidal volume

Although controversial, a negative inspiratory force (NIF) of –25 or less is considered a criterion for readiness for extubation. What is the NIF? A. Pressure generated by a patient during forced expiration B. Pressure generated by a patient during forced inspiration C. Pressure generated by a patient during regular expiration D. Volume circulated by a patient during one breath E. Volume circulated by a patient during 1 min- ute of spontaneous ventilation

B. Pressure generated by a patient during forced inspiration

A 78-year-old man is admitted to the intensive care unit with an intracranial hemorrhage. His sys- tolic blood pressure is 190 mm Hg. What are the current guidelines regarding acute blood pressure lowering in the setting of intracranial hemorrhage for a patient with a presentation systolic blood pressure between 150 and 220 mm Hg? A. Acute lowering of the systolic blood pressure to 140 mm Hg is safe and can be effective in improving functional outcome. B. Acute lowering of the systolic blood pressure to 140 mm Hg is dangerous and should be avoided. C. Acute lowering of the systolic blood pressure to 170 mm Hg is safe and can be effective in reducing mortality. D. Acute lowering of the systolic blood pressure to two thirds of the presentation blood pres- sure is safe and can be effective in improving functional outcome. E. Acute lowering of systolic BP to 120 mm Hg is probably safe.

A. Acute lowering of the systolic blood pressure to 140 mm Hg is safe and can be effective in improving functional outcome.

Emergency administration of what medication is indicated in the setting of symptomatic acute alcohol withdrawal with ataxia and confusion? A. Glucose B. Magnesium C. Beta-blockers D. Nicotine E. Thiamine

E. Thiamine

How does polymyositis compare with dermatomy- ositis regarding associations with malignancy and B- and T-cell infiltration? A. Polymyositis more often is associated with malignancy and T-cell infiltration more than B-cell infiltration. B. Polymyositis more often is associated with malignancy and B-cell infiltration more than T-cell infiltration. C. Polymyositis more often is associated with malignancy and T-cell infiltration more than B-cell infiltration. D. Polymyositis more often is associated with malignancy and B-cell infiltration more than T-cell infiltration. E. Polymyositis and dermatomyositis are associ- ated equally with malignancy and B- and T-cell infiltration.

A. Polymyositis more often is associated with malignancy and T-cell infiltration more than B-cell infiltration.

While doing a myelogram, the radiology resident realizes that he just injected an ionic contrast agent intrathecally. What is the best next step in management of the patient? A. Do nothing, as this should not be a problem. B. Withdraw fluid through a myelogram needle. C. Start intravenous steroids. D. Start antiepileptic drugs. E. Administer antihistamines

B. Withdraw fluid through a myelogram needle.

What is the effect of nimodipine on a patient with an aneurysmal subarachnoid hemorrhage? A. Decreases the risk of vasospasm and mortality rate B. Decreases the risk of vasospasm but not the mortality rate C. Increases the risk of vasospasm and mortality rate D. Does not affect the risk of vasospasm but decreases the mortality rate E. Increases the risk of vasospasm but decreases the mortality rate

D. Does not affect the risk of vasospasm but decreases the mortality rate

A man has an allergic reaction to receiving a blood transfusion. A direct Coombs test is negative, no free hemoglobin was found in the blood, and the urinalysis was normal. The allergic reaction stopped spontaneously during the workup of its cause. What could have been done to prevent the described reaction? A. Warming the transfused blood products B. Transfusing whole blood C. Administering better clerical training D. Premedication with acetaminophen E. Washing the transfused cells

E. Washing the transfused cells

A 26-year-old patient with a history of a selective IgA-deficiency syndrome requires a blood transfu- sion following a traumatic injury. What is the major risk of transfusing regular packed red blood cells to this patient? A. Anaphylactic transfusion reaction B. Rejection of donor blood due to incompatibility C. Sepsis D. Chemical meningitis E. Disseminated intravascular coagulation

A. Anaphylactic transfusion reaction

A 60-year-old man with a glomerular filtration rate of 30 mL/min secondary to chronic diabetes melli- tus type 2 is being evaluated for a newly discov- ered brain mass. Three days after he is discharged from the hospital, he develops large areas of indu- rated skin with fibrotic nodules and plaques. What might have prevented the development of his symptoms? A. Avoiding contrasted MRI studies B. Stopping metformin during hospitalization C. Immediate dialysis following contrast- enhanced CT head scans D. Better management of the blood glucose during hospitalization E. Antihistamine use prior to contrast-enhanced studies

A. Avoiding contrasted MRI studies

A 22-year-old man admitted with a traumatic brain injury develops a pulmonary embolism 4 days fol- lowing a craniectomy. What is the most sensitive clinical sign for detecting a pulmonary embolism? A. Tachycardia B. Hypotension C. Tachypnea D. Oxygen desaturation E. Low-grade fever

A. Tachycardia