Intensive therapy, Emergency, Toxicology, Acid-base disorders

Question 1

The current 2015 European Resuscitation Council (ERC) adult Basic Life Support (BLS) guideline advises the procedures in the following order:
A) unresponsive – no pulse detected – resuscitation/emergency team contacted – 30 chest compressions – 2 breaths, 30 chest compressions
B) unresponsive – call for help – secure the airway – no breathing detected – resuscitation/emergency team contacted – 30 chest compressions – 2 breaths, 30 chest compressions
C) unresponsive – call for help – secure the airway – no breathing detected – resuscitation/emergency team alerted – 15 chest compressions – 2 breaths, 15 chest compressions
D) unresponsive – call for help – secure the airway – no breathing detected – resuscitation/emergency team alerted – 2 breaths, 30 compressions – 2 breaths, 30 compressions

Answer 1

B) unresponsive – call for help – secure the airway – no breathing detected – resuscitation/emergency team contacted – 30 chest compressions – 2 breaths, 30 chest compressions

Question 2

The current 2015 European Resuscitation Council (ERC) adult Basic Life Support (BLS) guideline permits cessation of chest compressions if the following occurs:
A) the defibrillator is charging
B) pulse is detected
C) the patient start moving, breathing, opens eyes
D) if the AED does not advise shock

Answer 2

C) the patient start moving, breathing, opens eyes

Question 3

Which of the following statements is false regarding chest compressions (according to the 2015 European Resuscitation Council Adult Basic Life Support guideline)?
A) optimal frequency of chest compressions is 100-120/min
B) depth of compressions should be 5-6 cm in adults
C) position of chest compressions: middle of the chest, lower half of sternum
D) CPR providers should be changed over after 5 minutes, because fatigue decreases compression quality

Answer 3

D) CPR providers should be changed over after 5 minutes, because fatigue decreases compression quality

Question 4

The following are all part of the 2015 European Resuscitation Council (ERC) adult Advanced Life Support guideline, except for one:
A) Check carotid pulse immediately after delivering shock.
B) When treating VF/pulseless VT adrenaline 1mg should be given after the 3. shock, after compressions have been resumed, the dose can be repeated after 3-5 minutes (in alternating cycles of CPR).
C) Routine use of atropine is not advised in asystole and PEA (pulseless electrical activity).
D) Targeted temperature management is advised most strongly after cardiac arrest with a shockable rhythm.

Answer 4

A) Check carotid pulse immediately after delivering shock.

Question 5

During cardiopulmonary resuscitation (CPR), if no high-risk intervention (e.g. Intravenous cannulation) is performed, what are possible transmittable diseases or agents?
A) Staphylococcus aureus, Streptococcus pyogenes, SARS, meningococcal meningitis
B) CMV
C) HIV, HBV, HCV
D) Mycoplasma, Chlamydia

Answer 5

A) Staphylococcus aureus, Streptococcus pyogenes, SARS, meningococcal meningitis

Question 6

When assessing a patient with the ABCDE algorithm, the letters refer to the following, except:
A) Acute assessment of consciousness
B) Breathing assessment
C) Circulation assessment
D) Disability (neurological) assessment
E) Exposure assessment

Answer 6

A) Acute assessment of consciousness

Question 7

A 32-year-old male is brought in to the emergency room by relatives after suffering an electric shock, he is unconscious and breathing. Which one of the following actions is necessary?
A) intubation if Glasgow Coma Scale is below 8
B) securing a central line
C) defibrillation with 200J if asystole is present
D) echocardiography

Answer 7

A) intubation if Glasgow Coma Scale is below 8

Question 8

A patient with pneumonia treated in the ICU with mechanical ventilation develops increasing tachycardia, decreasing blood pressure on the fifth treatment day. Which of the following is not the probable cause?
A) septic shock
B) anaphylactic shock
C) normal hemodynamic consequences of arousal reaction
D) consequences of acute cardiac ischemia

Answer 8

C) normal hemodynamic consequences of arousal reaction

Question 9

53-year-old female is admitted with acute right sided hemiplegia, deteriorating consciousness, respiratory distress, hypertension to the ICU with symptom onset in less than an hour. She is intubated and ventilated. Which of the following is incorrect?
A) Acute head CT scan is indicated.
B) Head of the bed should be elevated to 30°.
C) Goal of ventilation is controlled hypercapnia.
D) Thrombolysis with rt-PA (iv. 0,9mg/kg in 60 minutes) might be indicated.

Answer 9

C) Goal of ventilation is controlled hypercapnia.

Question 10

What is the primary goal of packed red blood cell transfusion?
A) Restoring intravascular volume.
B) Normalizing cardiac output.
C) Improving tissue perfusion.
D) Improving oxygen delivery.

Answer 10

D) Improving oxygen delivery.

Question 11

Which of the following is false regarding transfusions?
A) When deciding on a transfusion, universal trigger hemoglobin (Hb) levels should be used.
B) Transfusion is seldom indicated if Hb>10g/dL.
C) Transfusion is always indicated if Hb<6g/dL.
D) If normovolemia is present, as much as an 80% red blood cell loss is survivable.

Answer 11

A) When deciding on a transfusion, universal trigger hemoglobin (Hb) levels should be used.

Question 12

In regards to the oxygen-hemoglobin dissociation curve, the following are true except:
A) Increased pCO2 shifts the curve to the right.
B) Decreased 2,3-disfosfoglycerate (2,3 DGP) concentration shifts the curve to the left.
C) Decreased proton concentration shift the curve to the left.
D) Increased FiO2 (inspired oxygen fraction) shifts the curve to the right

Answer 12

D) Increased FiO2 (inspired oxygen fraction) shifts the curve to the right

Question 13

In the treatment of an unconscious patient with severe hemorrhagic shock, the first and most important step is:
A) transfuse with compatible red blood cell
B) place a central line to replace fluid and monitor central venous pressure
C) rapid infusion of crystalloids and/or colloids
D) secure the airway

Answer 13

D) secure the airway

Question 14

According to current guidelines, when is acute percutaneous coronarography indicated in ST elevation myocardial infarction? (ESC STEMI guideline 2012)
A) Typical chest pain and ST elevation or probable new onset left bundle branch block (LBBB).
B) Typical chest pain and wall motion abnormality on echocardiography.
C) Typical chest pain or LBBB and elevated ectoenzymes.
D) ST elevation or probable new onset LBBB, elevated ectoenzymes and wall motion abnormality on echocardiography.

Answer 14

A) Typical chest pain and ST elevation or probable new onset left bundle branch block (LBBB).

Question 15

Most effective way to diagnose cardiac tamponade:
A) Electrocardiogram
B) Echocardiography
C) Chest X-ray
D) Right heart catheterization

Answer 15

B) Echocardiography

Question 16

All of the statements regarding succinylcholine use are true except for one. Mark the false statement:
A) Succinylcholine is contraindicated in hyperkalemia, burn patient, paraplegia.
B) Side effects include muscle pain, bradycardia, malignant hyperthermia.
C) Effects of succinylcholine can be counteracted with neostigmine.
D) Succinylcholine can be used for the intubation of patients with a full stomach.

Answer 16

C) Effects of succinylcholine can be counteracted with neostigmine.

Question 17

Which of the following is not part of first line treatment for anaphylaxia?
A) oxygen
B) infusion therapy
C) vasoactive treatment
D) antihistamines

Answer 17

D) antihistamines

Question 18

Which of the following are SIRS (Systemic Inflammatory Response Syndrome) criteria (as per American College of Chest Physicians and Society of Critical Care Medicine ACCP/SCCM 1991 Consensus)?
A) temperature > 37°C
B) heart rate > 80/min
C) respiratory rate > 25/min
D) WBC > 12 000/mm3 or < 4000/mm3 or > 10% immature neutrophils

Answer 18

D) WBC > 12 000/mm3 or < 4000/mm3 or > 10% immature neutrophils

Question 19

According to the Surviving Sepsis Campaign the following should be achieved within an hour of the initial treatment of a septic patient:
A) microbiological sampling and starting of adequate antibiotic treatment
B) identifying the microorganism by PCR
C) 2000mL iv. crystalloid
D) surgical source control

Answer 19

A) microbiological sampling and starting of adequate antibiotic treatment

Question 20

Pharmacological treatment of a patient with septic shock includes:
A) Vancomycin, if shock has been present for more than two days
B) high dose methylprednisolone, if shock in unresponsive to iv. fluids
C) insulin, if blood glucose is >10mmol/L
D) dobutamine, if tachycardia persists

Answer 20

C) insulin, if blood glucose is >10mmol/L

Question 21

The goal of fluid resuscitation in a septic patient is:
A) CVP > 20 mmHg
B) MAP > 65 mmHg
C) diuresis > 1,5mL/kg/h
D) ScvO2 > 30%

Answer 21

B) MAP > 65 mmHg

Question 22

Nutrition goal for a patient treated with urosepsis and septic shock includes:
A) enteral nutrition
B) parenteral nutrition
C) reduced protein enteral nutrition
D) enteral nutrition with parenteral supplementation if goal calorie intake is not reached within day 2

Answer 22

A) enteral nutrition

Question 23

23-year-old female is admitted to the ICU because of asthma. Invasive mechanical ventilation is started. Which of the following is not true regarding initial ventilation settings?
A) Minimizing dynamic hyperinflation is key, so expiratory time should be long and PEEP should be low.
B) High inspiratory pressures should be avoided at all costs, since pressure correlates with barotrauma and mortality.
C) FiO2 should be adjusted to reach a SatO2 >94%
D) Minute ventilation should be as low as possible to minimize dynamic hyperinflation.

Answer 23

B) High inspiratory pressures should be avoided at all costs, since pressure correlates with barotrauma and mortality.

Question 24

Which of the following blood gas values is most indicative of acute respiratory failure in a patient suffering from acute exacerbation of COPD?
A) pH < 7,3
B) paO2 < 60 mmHg
C) paCO2 > 50 mmHg
D) HCO3 > 30 mmHg

Answer 24

A) pH < 7,3

Question 25

In the treatment of acute exacerbation of COPD oxygen therapy is carefully titrated because:
A) oxygen therapy does not improve outcomes in chronically hypoxic patients
B) oxygen therapy reduces respiratory drive
C) oxygen therapy results in CO2 retention because of diminished hypoxic vasoconstriction
D) anaerobe metabolism is more energy efficient

Answer 25

B) oxygen therapy reduces respiratory drive

Question 26

NIV (noninvasive ventilation) is an important treatment option in acute exacerbation of chronic obstructive pulmonary disease (COPD) with the right indications, except:
A) it has fewer complications than invasive ventilation
B) it results in less mucus dehydration than invasive ventilation
C) with appropriate settings 80% of patients report improving symptoms
D) it unloads respiratory muscles

Answer 26

B) it results in less mucus dehydration than invasive ventilation

Question 27

The following is not true regarding acute kidney injury (AKI):
A) origin in intensive care is usually prerenal
B) intraabdominal pressures above 25 mmHg promote AKI
C) high dose diuretic therapy can stop progression of AKI
D) NSAID therapy can promote progression of AKI

Answer 27

C) high dose diuretic therapy can stop progression of AKI

Question 28

A mechanically ventilated, hemodynamically stable and normovolemic 24-year-old polytrauma patient has the following parameters on day 4. following trauma: serum creatinine 400 umol/L; diuresis: 30ml/h, pH 7,3; BE: -11, HCO3: 13mmol/L. Which of the following is advised first?
A) 1-5ug/kg/min dopamine drip
B) combination of osmotic and loop diuretics
C) at least 2L positive fluid balance to improve hydration
D) renal replacement therapy

Answer 28

D) renal replacement therapy

Question 29

When treating a patient with acute kidney failure in intensive care which of the following is true:
A) antibiotic dose should be adjusted according to renal clearance.
B) Dose of LMWH (low molecular weight heparin) treatment should be increased because of increased thrombosis risk.
C) Parenteral nutrition should be protein free due to the risk of protein intoxication.
D) All of the above.

Answer 29

A) antibiotic dose should be adjusted according to renal clearance.

Question 30

64-year-old male is admitted to the emergency room with repeated occurrence of syncope. Loss of consciousness occurs again while circulation and ventilation remain intact, the monitor shows a 220/min frequency regular, narrow QRS rhythm. The following is indicated:
A) start BLS
B) start amiodarone treatment
C) perform synchronized DC shock
D) perform ablation therapy in electrophysiology lab

Answer 30

C) perform synchronized DC shock

Question 31

64-year-old patient with palpitations is admitted to the emergency room, the monitor shows a 220/min frequency, regular, narrow QRS rhythm. BP is 130/70mmHg, SatO2 100%, GCS: 4-5-6. The following is advised:
A) start BLS
B) amiodarone loading
C) perform synchronized DC shock
D) adenosine therapy

Answer 31

D) adenosine therapy

Question 32

64-year-old male is admitted to the emergency room because of weakness and fainting, the monitor shows a 30/min frequency wide QRS, regular rhythm without P waves. BP 70/30Hgmm, SatO2 98%, GCS: 3-5-6. The following is advised:
A) start BLS
B) synchronized DC shock
C) transcutaneous pacing
D) give atropine

Answer 32

D) give atropine

Question 33

A patient with hyperactive nodular goiter is admitted to the ICU 12 hours after an elective partial thyroidectomy with hyperpyrexia, weakness, confusion, vomiting, atrial fibrillation and hypotension. The most probable cause and adequate treatment are as follows:
A) Malignant hyperthermia; Dantrolene and supportive therapy.
B) Wound infection and sepsis; iv. fluids, microbiological sampling, vasopressor, combination antibiotic therapy.
C) Thyreotoxic crisis; iv. fluid therapy, methimazole or propylthiouracil, propranolol, methylprednisolone, plasma exchange if needed.
D) Thyreotoxic crisis; reoperation to eliminate residual thyroid tissue.

Answer 33

C) Thyreotoxic crisis; iv. fluid therapy, methimazole or propylthiouracil, propranolol, methylprednisolone, plasma exchange if needed.

Question 34

A 24-year-old male with no previous medical conditions is admitted to the ICU with dyspnea, general weakness after a history of symptoms of respiratory infection. T: 38,5C, BP: 120/70Hgmm, HR: 120/min, SatO2: 88%, on 4L/min nasal O2. Chest X ray shows bilateral homogenous effusions. What is the first line ventilation strategy?
A) Immediate active respiratory physiotherapy to increase mucus clearance
B) Invasive ventilation with high PEEP and volume controlled mode
C) Noninvasive ventilation in CPAP mode.
D) Invasive ventilation with high PEEP and pressure support mode.

Answer 34

B) Invasive ventilation with high PEEP and volume controlled mode

Question 35

Which of the following promotes postoperative respiratory failure after abdominal surgery?
A) Combined general and regional anesthesia during the operation
B) Early postoperative mobilization
C) Smoking cessation in the preoperative period (1-2 week prior)
D) Ongoing epidural analgesia

Answer 35

C) Smoking cessation in the preoperative period (1-2 week prior)

Question 36

Which of the following is incorrect regarding the treatment of pneumothorax (ptx)?
A) Asymptomatic, iatrogenic, 1cm wide, apical position pneumothorax developed after pleural tap does not need immediate drainage
B) Tension pneumothorax does not always need to be drained.
C) Positive pressure ventilation may worsen existing pneumothorax, promoting tension pneumothorax.
D) Reexpansion pulmonary edema and hypotension is most often associated with drainage of total pneumothorax that has been present for a longer time.

Answer 36

B) Tension pneumothorax does not always need to be drained.

Question 37

Which of the following is true regarding the treatment of acute pancreatitis?
A) In case of acute, severe pancreatitis caused by a biliary stone, ERCP (endoscopic retrograde cholangiopancreatography) is advised within 72 hours.
B) Nasogastric tube is needed permanently.
C) Epidural analgesia might mask the symptoms of acute abdomen, so use in severe pancreatitis is not advised.
D) Because of severe pain nonstreoid analgesics need to be supplemented with morphine.

Answer 37

A) In case of acute, severe pancreatitis caused by a biliary stone, ERCP (endoscopic retrograde cholangiopancreatography) is advised within 72 hours.

Question 38

Which of the following is incorrect regarding the treatment of diabetic ketoacidosis?
A) Fluid resuscitation started immediately helps moderate contraregulating hormone (nor/epinephrine, glucagon, growth hormone, cortisol) release, improved renal blood flow and promotes glucose clearance
B) Metabolic acidosis needs to be corrected according to the following equation: NaHCO3 mmol = -BE x 0,3 x kg
C) Insulin drip is advised in a dose of 0,1E/kg/hour
D) Potassium replacement might be needed in doses as high as 0,5 mmol/kg/hour (2,6g/hour of KCl for a 70-kg patient)

Answer 38

B) Metabolic acidosis needs to be corrected according to the following equation: NaHCO3 mmol = -BE x 0,3 x kg

Question 39

The following is not true regarding therapy of hepatic coma.
A) cerebral edema is the most common cause of death
B) increased prothrombin time, metabolic acidosis predicts unfavorable outcome
C) Nutrition needs to mainly include aromatic amino acids and glucose.
D) 30-45 ml lactulose is advised 3 times daily per os or through NG tube

Answer 39

C) Nutrition needs to mainly include aromatic amino acids and glucose.

Question 40

A 22-year-old, previously healthy female lost a significant amount of blood (about 700 ml) during labor, bleeding has been stopped and currently there is no further blood loss. Hb is 95g/L, Hct is 35%, blood pressure is 100/70 mmHg, heart rate 120/min, SatO2 98%, circulation is centralized, capillary refill time is 5 secs, peripheries are cold, jugular vein collapsed, oliguria is present. Which management is advised?
A) Currently no treatment is needed, the patient is young with no comorbidities, bleeding will be compensated.
B) Blood loss warrants about 2 units of typed red blood cell transfusions.
C) 2000 ml isotonic, balanced crystalloid therapy is needed with further therapy based on monitored parameters.
D) 2000 ml normal saline is needed with further therapy based on monitored parameters.

Answer 40

C) 2000 ml isotonic, balanced crystalloid therapy is needed with further therapy based on monitored parameters.

Question 41

Which of the following is incorrect regarding the nutritional therapy of intensive care patients?
A) Parenteral nutrition is advised if enteral nutrition is not possible within 3 days.
B) 900 mOsm/l osmolarity infusion can be administered through a peripheral line.
C) Minimal carbohydrate need is 2g/kg glucose.
D) Parenteral nutrition needs to be supplemented with trace elements and vitamins daily.

Answer 41

B) 900 mOsm/l osmolarity infusion can be administered through a peripheral line.

Question 42

What is the goal blood glucose level for critically ill patients?
A) 4-5 mmol/L
B) 4-6 mmol/L
C) 6-8 mmol/L
D) <10 mmol/L

Answer 42

D) <10 mmol/L

Question 43

A patient admitted because of chest pain radiating to the left arm and dyspnea has the following vitals: blood pressure 90/60, heart rate: 110/min, SatO2: 93%, with bilateral rails over the lungs. Which of the following is not indicated?
A) Morphine 2-4mg iv.
B) Oxygen 2-6 l/min
C) Nitrate drip 1mg/h iv.
D) Aspirin 100mg po.

Answer 43

C) Nitrate drip 1mg/h iv.

Question 44

In the following condition noninvasive rather than invasive ventilation is advised:
A) hypercapnic respiratory failure due to COPD acute exacerbation caused by bronchitis
B) symptoms of cardiac decompensation after a successful 20-minute-long CPR
C) respiratory failure manifesting on the 2. postoperative day after large abdominal surgery
D) ARDS

Answer 44

A) hypercapnic respiratory failure due to COPD acute exacerbation caused by bronchitis

Question 45

A patient on ICU with a history of ischemic heart disease has been ventilated because of pneumonia for a week. Newly developed abdominal expansion, tenderness and diffuse pain might be a consequence of:
A) calculous cholecystitis
B) ischemic colitis
C) gastric perforation
D) all of the above

Answer 45

D) all of the above

Question 46

The following anesthesia plans are adequate for the following conditions:
A) Thiopental-fentanyl iv. anesthesia for a gynecological operation of a patient with a history of asthma bronchiale
B) Inhalational sevoflurane induction and maintenance for abdominal exploration for ileus
C) Etomidate-fentanyl iv. induction and sevoflurane maintenance for valve replacement operation for a cordal rupture causing cardiogenic shock
D) All of the above

Answer 46

C) Etomidate-fentanyl iv. induction and sevoflurane maintenance for valve replacement operation for a cordal rupture causing cardiogenic shock

Question 47

Adequate methods for maintaining a secure airway in the following procedures are:
A) Oropharyngeal airway, bag-valve-mask ventilation for a 65-year-old female with hypertension, paroxysmal atrial fibrillation during narcosis for elective cardioversion
B) Laryngeal mask airway, ventilation for a 3-year-old girl undergoing elective hernia repair under inhalation anesthesia.
C) Endotracheal tube, ventilation for a 65-year-old patient with COPD undergoing elective laparoscopic cholecystectomy under iv. anesthesia
D) All of the above

Answer 47

D) All of the above

Question 48

An hour following extubation of a female ventilated for 12 days for exacerbation of COPD, tachycardia, dyspnea, agitation and disorientation develop. What is the most probable diagnosis and treatment?
A) intravasal hypovolemia, iv. fluids
B) persistent respiratory failure, reintubation
C) persistent respiratory failure, noninvasive ventilation (NIV)
D) delirium, haloperidol therapy

Answer 48

B) persistent respiratory failure, reintubation

Question 49

Tracheostomy is beneficial with protracted ventilation for the following reasons:
A) per os nutrition is possible
B) mobilization is easier
C) intermittent ventilatory breaks can be administered
D) all of the above

Answer 49

D) all of the above

Question 50

A 17-year-old female with no previous medical history has been brought to the ER by EMT. The patient was found lying in bed with an empty bottle of alprazolam and vodka bottles. At admittance, respiratory arrest is observed and the patient is intubated. What are the probable initial blood gas values?
A) metabolic acidosis
B) acute respiratory alkalosis
C) chronic respiratory acidosis
D) acute respiratory acidosis

Answer 50

D) acute respiratory acidosis

Question 51

Which of the following is true for assist/controlled volume controlled ventilation?
A) Inspiratory time is controlled by the ventilator and is always the same
B) Inspiratory pressure is constant throughout inspiration
C) All breaths are triggered by the patient and therefor there can be longer periods of apnea
D) Assisted breaths tend to have smaller tidal volumes than controlled breaths
E) null

Answer 51

A) Inspiratory time is controlled by the ventilator and is always the same

Question 52

Hypokalemic, hyperchloremic metabolic alkalosis following gastrointestinal surgery is most often a result of what?
A) nutritional therapy
B) acute renal failure
C) diarrhea
D) gastric paralysis, prolonged NG tube placement

Answer 52

D) gastric paralysis, prolonged NG tube placement

Question 53

Which of the following blood gas values are characteristic for a 65-year-old smoker suffering from chronic bronchitis?
A) pH 7,46; pO2 98 mmHg; pCO2 28 mmHg; HCO3 24 mmol/L; BE -0,2
B) pH 7,37; pO2 65 mmHg; pCO2 59 mmHg; HCO3 27 mmol/L; BE +4
C) pH 7,28; pO2 98 mmHg; pCO2 28 mmHg; HCO3 11 mmol/L; BE -12
D) pH 7,46; pO2 60 mmHg; pCO2 58 mmHg; HCO3 11 mmol/L; BE -12

Answer 53

B) pH 7,37; pO2 65 mmHg; pCO2 59 mmHg; HCO3 27 mmol/L; BE +4

Question 54

Which of the following seems to be a false blood gas read due to sampling mistake?
A) pH 7,28; pO2 98 mmHg; pCO2 28 mmHg; HCO3 11 mmol/L; BE -12
B) pH 7,46; pO2 98 mmHg; pCO2 28 mmHg; HCO3 24 mmol/L; BE -0,2
C) pH 7,46; pO2 60 mmHg; pCO2 58 mmHg; HCO3 11 mmol/L; BE -12
D) pH 7,37; pO2 65 mmHg; pCO2 59 mmHg; HCO3 27 mmol/L; BE +4

Answer 54

C) pH 7,46; pO2 60 mmHg; pCO2 58 mmHg; HCO3 11 mmol/L; BE -12

Question 55

Which of the following does not cause high anion gap (AG>16mmol/L) metabolic acidosis?
A) large amount of normal saline infusion
B) uremia
C) diabetic ketoacidosis
D) ethylene glycol intoxication

Answer 55

A) large amount of normal saline infusion

Question 56

Arterial blood gas is as follows: pH 6,9, pO2 89 mmHg, pCO2 18 mmHg, HCO3 9 mmol/L, BE -18. Anion gap is 22mmol/L. Which of the following is not a likely diagnosis?
A) pancreatic fistula
B) methanol intoxication
C) hepatic failure, lactate accumulation
D) diabetic ketoacidosis

Answer 56

A) pancreatic fistula

Question 57

A 37-year-old patient with a history of chronic pancreatitis, alcoholism is brought in with decreased consciousness and cardiorespiratory insufficiency, having been intubated and ventilated. Blood pressure 80/40 mmHg; heart rate 118/min, capillary refill time: 3sec. Arterial blood gas values: pH 6,9, pO2 89 mmHg, pCO2 18 mmHg, HCO3 9 mmol/L, BE -18. Anion gap: 22mmol/L. The patient is oligo-anuric. Urine sample is negative for ketone bodies. Which of the following is not indicated?
A) toxicology studies
B) iv. fluid therapy (crystalloids, colloids)
C) dobutamine therapy
D) renal replacement therapy

Answer 57

C) dobutamine therapy

Question 58

What isn’t an advantage of continuous renal replacement therapy over intermittent therapy in critically ill, hemodynamically unstable patients?
A) Circulatory stability is better achieved.
B) Daily costs are lower.
C) Permanent negative fluid balance is better achieved.
D) There’s a better chance for kidney recovery.

Answer 58

B) Daily costs are lower.

Question 59

Which of the following is not a probable cause of mechanical ventilation weaning failure?
A) Dystelectasis.
B) Cardiac decompensation.
C) Muscle weakness and fatigue.
D) Increased FRC.

Answer 59

D) Increased FRC.

Question 60

The following statement is true regarding preoperative fasting:
A) Breast milk can be consumed up to 2 hours before surgery.
B) Water can be consumed up to an hour before surgery.
C) Solid food can be consumed up to 4 hours before surgery.
D) Tea can be consumed up to 2 hours before surgery.

Answer 60

D) Tea can be consumed up to 2 hours before surgery.

Question 61

Which of the following is incorrect regarding lung transplantation?
A) Donor management influences outcome of lung transplantation.
B) Average survival time after lung transplantation is 15 years.
C) Organ allocation in Eurotransplant is based on LAS (lung allocation score).
D) Initiation of immunosuppression is indicated perioperatively.

Answer 61

B) Average survival time after lung transplantation is 15 years.

Question 62

The following is true concerning epidural analgesia:
A) Insertion of the epidural catheter can be done through a Touhy needle.
B) Epidural catheter can only be inserted below the level of L3-4.
C) Effective epidural analgesia involves motor blockade.
D) Epidural analgesia can be used for a maximum of 48 hours.

Answer 62

A) Insertion of the epidural catheter can be done through a Touhy needle.

Question 63

Which of the following is incorrect regarding infusions?
A) Normal saline may cause hyperchloremic acidosis in excessive amounts.
B) Balanced crystalloids are safer for rehydration.
C) Hydroxy-ethyl starch solutions are recommended in sepsis, dehydration and severe trauma.
D) Distribution of infusions inside the body depends on their oncotic and osmotic qualities.

Answer 63

C) Hydroxy-ethyl starch solutions are recommended in sepsis, dehydration and severe trauma.

Question 64

Regarding transfusions in critically ill patients, the following is true:
A) Transfusion is indicated below a hemoglobin level of 10g/dL.
B) Inotropic therapy is indicated below a hemoglobin level of 7g/dL.
C) Plasma transfusion should be performed simultaneously in 1:1 ratio.
D) Transfusion is indicated below a hemoglobin level of 7g/dL.

Answer 64

D) Transfusion is indicated below a hemoglobin level of 7g/dL.

Question 65

Hyperdynamic shock is characterized all of these, except:
A) Bradycardia
B) Hypotension
C) Oliguria
D) Warm extremities

Answer 65

A) Bradycardia

Question 66

Which of the following is incorrect regarding paracetamol intoxication?
A) Hepatic phase starts 1-4 days after ingestion with vomiting, jaundice, altered consciousness, hypoglycemia and kidney dysfunction.
B) Diagnosis is based on symptoms since serum level cannot be measured.
C) Active charcoal within 1 hour of intoxication can improve outcome
D) N-acetylcysteine works as an antidote for paracetamol.

Answer 66

B) Diagnosis is based on symptoms since serum level cannot be measured.

Question 67

Which of the following is true for regarding parenteral nutrition?
A) Parenteral nutrition infusions only include macronutrients, so they need to be supplemented with vitamins and micronutrients.
B) It can safely be administered through central venous lines.
C) It increases the chance for nosocomial infections.
D) All of the above

Answer 67

D) All of the above

Question 68

Which of the following is part of emergency treatment of hyperkalemia?
1) hemodialysis
2) plasmapheresis
3) calcium
4) glucose-insulin-potassium infusion
5) forced diuresis
6) β-agonist inhalation

A) 1st, 2nd and 4th answers are correct
B) 1st, 3rd and 6th answers are correct
C) 3rd and 5th answers are correct
D) 1st answer is correct

Answer 68

B) 1st, 3rd and 6th answers are correct

Question 69

Which of the following is correct concerning thrombolysis?
1) In acute myocardial infarction thrombolysis is indicated within 12 hours if PCI is not available.
2) In acute stroke thrombolysis is indicated within 3 hours if bleeding can be ruled out.
3) Thrombolysis is indicated in massive pulmonary embolism.
4) Thrombolysis is contraindicated in ages > 75 years.
5) Menstrual bleeding is a contraindication for thrombolysis.
6) Platelet count below 100 G/L is a contraindication for thrombolysis in ischemic stroke.

A) 1st, 2nd, 3rd and 6th answers are correct
B) 1st, 3rd and 6th answers are correct
C) 3rd and 5th answers are correct
D) 1st, 4th and 5th answers are correct

Answer 69

A) 1st, 2nd, 3rd and 6th answers are correct

Question 70

Which of the following are indicative of pulmonary embolism?
1) new onset right bundle branch block
2) infarction pneumonia on chest X-ray
3) new onset negative T waves in V1–3
4) elevated pro-BNP
5) perfusion defect on ventilation/perfusion pulmonary scintigraphy
6) reduced alveolo-arterial oxygen difference

A) 1st, 2nd, 3rd and 6th answers are correct
B) 1st, 3rd and 6th are answers correct
C) 1st, 3rd, 4th and 5th answers are correct
D) 2nd, 3rd, 4th and 5th answers are correct

Answer 70

C) 1st, 3rd, 4th and 5th answers are correct

Question 71

Which of the following can lead to distributive shock?
1) sepsis
2) thyrotoxicosis
3) burn
4) left ventricle aneurysm rupture
5) cardiac tamponade
6) diabetic ketoacidosis

A) 1st, 2nd and 6th answers are correct
B) 1st, 3rd and 6th answers are correct
C) 3rd and 6th answers are correct
D) 1st, 3rd and 5th answers are correct

Answer 71

A) 1st, 2nd and 6th answers are correct

Question 72

Severe aspirin intoxication can cause:
1) high anion gap metabolic acidosis
2) hypoglycemia
3) hypoprothrombinemia
4) tinnitus
5) one marrow depression
6) respiratory alkalosis

A) 1th, 2nd and 4th answers are correct
B) 3rd and 5th answers are correct
C) 1st, 2nd, 4th and 5th answers are correct
D) 2nd and 6th answers are correct

Answer 72

C) 1st, 2nd, 4th and 5th answers are correct

Question 73

Which of the following is true for ARDS?
1) therapy refractory hypoxia
2) increased dead space
3) high mortality
4) bilateral opacities on the chest X-ray
5) reduced functional residual capacity
6) protein rich pulmonary edema

A) 1st and 3rd answers are correct
B) 2nd, 4th and 5th answers are correct
C) 1st, 3rd, 4th and 6th answers are correct
D) all of the answers are correct

Answer 73

D) all of the answers are correct