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Hamilton 2020 Questions > Critical Care > Flashcards

Critical Care Flashcards

1
Q

A 3-year-old child presents to the ED with 2-days of worsening cough and fever, and now has stridor. He is previously healthy and immunized. In the ED he received dexamethasone 4 hours ago, and has received nebulized epinephrine every hour with minimal effect. On exam, vitals are HR 162, BP 106/62, RR 38, sat 87% with non-rebreather, T 38.8 C. There is severe indrawing and stridor when awake, which slightly improves when calmed. What is the most appropriate next step?

  1. Consult anesthesia for intubation.
  2. Insert a nasopharyngeal airway (NPA)
  3. Administer vancomycin and oseltamivir
  4. Administer a sedative
A
  1. Consult anesthesia for intubation.
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2
Q

A 6m corrected GA (ex-28w) infant with pulmonary hypertension and chronic lung disease is intubated for a viral respiratory tract infection. Following an uneventful intubation, ETT position is verified by CXR. While arranging transfer to the regional PICU, the RT reports he is saturating 88% despite suctioning, and increasing FiO2. His airway and chest exam are unchanged. His most recent capillary blood gas is: pH = 7.33, pCO2 = 46, HCO3 = 26. He is on PEEP 5, Pressure Control 14, Rate 30/min What is the most appropriate ventilation change to make?

  1. Increase inspiratory-time to improve lung recruitment
  2. Increase PEEP to improve lung recruitment
  3. Increase respiratory rate to improve respiratory acidosis
  4. Change to high-frequency oscillation
A
  1. Increase PEEP to improve lung recruitment
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3
Q

An 8-year-old boy is diagnosed with pneumonia and admitted to the pediatric ward for IV ampicillin and low-flow oxygen requirement. The next day he has increased WOB and is requiring 4L/min of oxygen to maintain saturations of 93%. He remains alert and hemodynamically stable with decreased breath sounds to the left side. His CXR today shows interval white-out of the left hemi-thorax. Which one of the following is the most appropriate next step?

  1. Obtain a chest ultrasound
  2. Place a left-sided chest tube
  3. Change antibiotics to vancomycin
  4. Needle decompression of the left chest
  5. Intubate and ventilate
A
  1. Obtain a chest ultrasound
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4
Q

A 7-year old girl is brought to the ED with symptoms of vomiting and difficulty breathing. She ingested a shrimp pad thai an hour earlier. Her vitals are: HR 166, BP 86/28, RR 32, sat 92% with simple face mask, T 37.0 C. On exam she is somewhat somnolent, has labored breathing with wheezing, and an urticarial rash. Her pulses are bounding and CRT is < 2 s. Which of the following best describes her category of shock?

  1. Dissociative Shock
  2. Cardiogenic Shock
  3. Hypovolemic Shock
  4. Distributive Shock
  5. She is not in shock
A
  1. Distributive Shock
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5
Q

A 14-year old patient on treatment for leukemia presents in a state of febrile neutropenia. Blood cultures are obtained, and broad-spectrum antibiotics are administered. The patient has received 60 mL/kg of IV fluid boluses for tachycardia and low BP and remains anuric. Currently, his vitals are: HR 158, BP 90/38, sat 96% with simple face mask, RR 26, T 39.1 C. He has no hepatomegaly, no crackles, pulses are strong, and CRT is 2 seconds. What is the most appropriate next step to manage his shock?

  1. Bolus Albumin 5% 10mL/kg IV
  2. Start norepinephrine infusion
  3. Bolus normal saline 20mL/kg IV
  4. Insert jugular CVL to measure CVP
  5. Secure airway with intubation
A
  1. Start norepinephrine infusion
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6
Q

A 6-month-old infant is brought to the ED by EMS with ongoing CPR after being found at home with absent vital signs. Her current rhythm is asystole, she remains pulseless, and CPR has been ongoing for 10 minutes. She is intubated in the resuscitation bay. What is the correct compression : breath ratio from this point on?

  1. 15: 2
  2. 30 : 2
  3. 100 : 2
  4. Continuous chest compressions, 10 breaths/min
A
  1. Continuous chest compressions, 10 breaths/min
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7
Q

You are called urgently to the ward where a 4-month-old infant admitted for bronchiolitis had acutely desaturated and become bradycardic to 40 bpm (sinus). You position the infant and start chest compressions as there is no immediate improvement with BVM using FiO2 100%. The infant’s HR remains 40 bpm and he continues to be pale and unresponsive. What is the most appropriate next action?

  1. Intravenous epinephrine
  2. Intravenous atropine
  3. Nebulized epinephrine
  4. Nebulized salbutamol
  5. Transcutaneous pacing
A
  1. Intravenous epinephrine
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8
Q

A 3-year-old boy with known epilepsy syndrome presents to the ED with seizures that began approximately 10 minutes ago. EMS administered rectal diazepam once en route. In the ED he continues to exhibit generalized seizure activity. His vitals are HR 142, BP 112/68, Sat 98% in R/A, RR 32, Temp 39.2 C. Blood glucose is 7.1. The first attempt to start a peripheral IV is unsuccessful. What is the most appropriate next action?

  1. Administer rectal acetaminophen
  2. Place an intraosseus line and administer IO lorazepam
  3. Observe the patient for another 10 minutes
  4. Administer buccal lorazepam
  5. Administer intramuscular fosphenytoin
A
  1. Administer buccal lorazepam
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9
Q

A 9-year-old unrestrained girl is ejected from a vehicle following a high-speed MVC. Paramedics drop her off having only applied a C-collar. On neurological exam she opens her eyes only to supra-orbital pressure. In response to painful stimulus she groans and withdraws. What is her Glasgow Coma Scale score?

  1. 4
  2. 7
  3. 8
  4. 9
A
  1. 8
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10
Q

A 9-year-old unrestrained girl is ejected from a vehicle following a high-speed MVC. Paramedics drop her off having only applied a C-collar. On neurological exam she opens her eyes only to supra-orbital pressure, in response to painful stimulus she groans and withdraws. Which of the following will have the most detrimental effect on her prognosis?

  1. Hypotension
  2. Hypoxia
  3. Hypercapnia
  4. Hyponatremia
A
  1. Hypotension
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11
Q

A 9-year-old unrestrained girl is ejected from a vehicle following a high-speed MVC. She is placed appropriately in a C-collar. In the ED her vitals are: HR 62, BP 130/96, sat 97% with non-rebreather mask, RR 14 (irregular), T 36.8. Pupil assessment reveals a fixed and dilated right pupil. What is the most appropriate next step?

  1. Decompressive Craniectomy
  2. Hypertonic Saline IV bolus
  3. CT Head
  4. Intubate and Hyperventilate
A
  1. Intubate and Hyperventilate
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12
Q

An 18-month-old unrestrained girl is ejected from a vehicle following a high-speed MVC. Two days later she is in the PICU in a deep unresponsive coma, her head MRI demonstrates wide-spread injury and hypoxic-ischemic encephalopathy. The bedside RN wonders if she may be brain dead. Which of the following is the recommended process in order to pronounce brain death?

  1. Two licensed physicians performing two complete exams including two apnea tests, separated by 24 hours
  2. One licensed physician performing one complete exam including apnea test
  3. Two licensed physicians performing complete exams, may be done concurrently
  4. Radionucleotide cerebral blood flow study
A
  1. Two licensed physicians performing complete exams, may be done concurrently
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13
Q

A 7-year old girl is brought to the ED with symptoms of vomiting and difficulty breathing. She ingested a shrimp pad thai an hour earlier. Her vitals are: HR 166, BP 78/28, RR 32, sat 95% with simple face mask, T 37.0 C. On exam she is somewhat somnolent, has labored breathing with wheezing, and an urticarial rash. Her pulses are bounding and CRT is < 2 s. What is your most important next step?

  1. Methylprednisolone 2mg/kg IV
  2. 0.9% Saline 20mL/kg IV bolus
  3. Epinephrine 0.01mg/kg IV
  4. Intubate and ventilate
  5. Epinephrine 0.01mg/kg IM
A
  1. Epinephrine 0.01mg/kg IM
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14
Q

An 8-year-old girl presents with symptoms of polyuria and polydipsia. She appears dehydrated and tired, but has a normal level of consciousness. Her vital signs are as follows: HR 148, BP 102/58, sat 98% in R/A, RR 36, T 36.9. Her lab investigations reveal: Glucose = 29.4, pH 7.08, pCO2 18, HCO3- 7, sodium 138, potassium 5.2, urine ketones 3+ What is the most appropriate next step?

  1. 0.9% Saline 10mL/kg over 30-60 mins, followed by insulin infusion and rehydration fluids
  2. Insulin bolus IV
  3. Sodium Bicarbonate bolus IV
  4. Calcium gluconate bolus IV
  5. Start insulin infusion and rehydration fluids
A
  1. 0.9% Saline 10mL/kg over 30-60 mins, followed by insulin infusion and rehydration fluids
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Hamilton 2020 Questions (29 decks)

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