Mixed Topics Flashcards
1
Q
- A 65-year-old female recovering from hip surgery is experiencing reduced mobility and poor oral intake. She has hypoactive delirium and a history of diabetes. Which intervention addresses her delirium and nutrition simultaneously?
A) Administer haloperidol and encourage oral hydration
B) Optimize glucose control and provide enteral nutrition
C) Start benzodiazepines and initiate IV fluids
D) Prescribe risperidone and begin parenteral nutrition
A
Answer: B) Optimize glucose control and provide enteral nutrition
2
Q
- A 72-year-old male with COPD and chronic malnutrition is admitted for pneumonia. His BMI is 18, and he has hypoalbuminemia. What is the best nutrition management plan?
A) Start enteral nutrition immediately and provide high-protein feeds
B) Administer parenteral nutrition until albumin levels normalize
C) Recommend a high-fat diet to increase caloric intake
D) Delay nutritional support until the infection resolves
A
Answer: A) Start enteral nutrition immediately and provide high-protein feeds
3
Q
- A 34-year-old male is brought to the ER with confusion, jaundice, and right upper quadrant pain. Labs reveal elevated liver enzymes and a history of acetaminophen overdose 48 hours prior. Which is the most appropriate treatment?
A) Activated charcoal
B) Flumazenil
C) N-acetylcysteine (NAC)
D) Hemodialysis
A
Answer: C) N-acetylcysteine (NAC)
4
Q
- A 45-year-old female presents with tremors, tachycardia, and nausea 12 hours after stopping alcohol consumption. Which stage of alcohol withdrawal is she likely experiencing?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
A
Answer: B) Stage 2
5
Q
- A 52-year-old male with a history of heavy alcohol use is admitted for seizures occurring 24 hours after his last drink. What is the most appropriate first-line medication for treatment?
A) Propofol
B) Lorazepam
C) Flumazenil
D) Esmolol
A
Answer: B) Lorazepam
6
Q
- A 28-year-old male presents with agitation, mydriasis, tachycardia, and hyperthermia after ingesting a recreational drug at a party. Which drug is most likely responsible?
A) Methamphetamine
B) Benzodiazepine
C) Barbiturate
D) Acetaminophen
A
Answer: A) Methamphetamine
7
Q
- A 60-year-old male is brought to the ER with hypothermia, bradycardia, and decreased reflexes. He has a history of barbiturate use. Which treatment is appropriate?
A) Flumazenil
B) Phenobarbital and alkalization of urine
C) Gastric lavage and activated charcoal
D) Esmolol and benzodiazepines
A
Answer: C) Gastric lavage and activated charcoal
8
Q
- A 19-year-old male presents after a benzodiazepine overdose. He is lethargic but has a patent airway. Which treatment is contraindicated if the patient has a history of seizures?
A) Supportive care
B) Flumazenil
C) Gastric lavage
D) Activated charcoal
A
Answer: B) Flumazenil
9
Q
- A patient is diagnosed with Wernicke encephalopathy secondary to chronic alcohol use. What is the most critical initial treatment?
A) Benzodiazepines
B) Thiamine supplementation
C) Propofol infusion
D) Dextrose administration
A
Answer: B) Thiamine supplementation
10
Q
- A 40-year-old female presents with severe agitation and hyperthermia after using ecstasy (MDMA). What is the first priority in her management?
A) Administer esmolol for tachycardia
B) Cool the patient to manage hyperthermia
C) Perform gastric lavage
D) Administer dantrolene
A
Answer: B) Cool the patient to manage hyperthermia
11
Q
- A 50-year-old male presents with symptoms of delirium tremens 4 days after his last drink. He is disoriented, tachycardic, and hypertensive. What additional intervention can help control his symptoms?
A) Administer clonidine for hypertension and tachycardia
B) Use propofol as a first-line sedative
C) Administer flumazenil
D) Perform gastric lavage
A
Answer: A) Administer clonidine for hypertension and tachycardia
12
Q
- A 33-year-old male presents 1 hour after an intentional overdose of acetaminophen. His serum level is 6 µg/mL. What is the appropriate next step?
A) No treatment needed as the level is low
B) Administer activated charcoal
C) Administer N-acetylcysteine
D) Begin hemodialysis
A
Answer: C) Administer N-acetylcysteine
13
Q
- A 42-year-old male presents to the ER 6 hours after ingesting a large dose of acetaminophen. He reports nausea, and labs show elevated liver enzymes. What phase of acetaminophen toxicity is he likely in?
A) Phase 1
B) Phase 2
C) Phase 3
D) Phase 4
A
Answer: A) Phase 1
14
Q
- A 38-year-old female presents with tremors, nausea, and tachycardia 8 hours after her last drink. Which tool would be most appropriate to assess the severity of her withdrawal?
A) RASS
B) CIWA-Ar
C) CAGE
D) SAS
A
Answer: B) CIWA-A
15
Q
- A 60-year-old male presents with hallucinations and agitation 36 hours after his last drink. Which stage of alcohol withdrawal is this?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
A
Answer: C) Stage 3
16
Q
- A 22-year-old male is brought to the ER with confusion, tachycardia, hyperthermia, and seizures after taking a recreational stimulant. What is the primary focus of treatment?
A) Administering benzodiazepines for agitation
B) Cooling the patient to reduce hyperthermia
C) Administering esmolol for tachycardia
D) Gastric lavage
A
Answer: B) Cooling the patient to reduce hyperthermia
17
Q
- A patient is admitted to the ICU with delirium tremens. What is the most important medication to administer?
A) Flumazenil
B) Benzodiazepines
C) Clonidine
D) Dantrolene
A
Answer: B) Benzodiazepines
18
Q
- A 46-year-old male presents with slurred speech, lethargy, and respiratory depression after taking an unknown amount of a sedative. Which medication is indicated if benzodiazepine overdose is suspected?
A) Flumazenil
B) Naloxone
C) N-acetylcysteine
D) Esmolol
A
Answer: A) Flumazenil
19
Q
- A 55-year-old patient with a history of heavy alcohol use is admitted for evaluation of confusion and ataxia. What deficiency is most likely responsible for his symptoms?
A) Vitamin D
B) Thiamine
C) Folate
D) Magnesium
A
Answer: B) Thiamine
20
Q
- A 28-year-old male presents with tachycardia, mydriasis, and irritability after ingesting MDMA. Which symptom would most likely indicate life-threatening toxicity?
A) Anxiety
B) Hyperthermia
C) Agitation
D) Tachycardia
A
Answer: B) Hyperthermia
21
Q
- A 30-year-old female presents with CNS depression after taking a barbiturate. Labs reveal metabolic acidosis. What is the most appropriate intervention?
A) Flumazenil administration
B) Gastric lavage and activated charcoal
C) Administration of dantrolene
D) Benzodiazepine administration
A
Answer: B) Gastric lavage and activated charcoal
22
Q
- A 40-year-old male with known alcohol use disorder presents with disorientation, hallucinations, and severe hypertension 72 hours after his last drink. What complication should be suspected?
A) Delirium tremens
B) Alcoholic ketoacidosis
C) Wernicke encephalopathy
D) Hepatic encephalopathy
A
Answer: A) Delirium tremens
23
Q
- What is the primary neurotransmitter imbalance associated with delirium?
A) Elevated serotonin and reduced dopamine
B) Acetylcholine deficiency and elevated dopamine
C) Excess glutamate and reduced GABA
D) Reduced norepinephrine and increased acetylcholine
A
Answer: B) Acetylcholine deficiency and elevated dopamine
24
Q
- Which process is responsible for the regulation of the sleep-wake cycle over a 24-hour period?
A) Process S
B) Process C
C) Homeostatic adaptation
D) Melatonin suppression
A
Answer: B) Process C
25
3. In opioid overdose, respiratory depression occurs due to:
A) Increased vagal tone
B) Suppression of the brainstem respiratory centers
C) Excess stimulation of GABA receptors
D) Peripheral airway obstruction
Answer: B) Suppression of the brainstem respiratory centers
26
4. What is the primary physiological consequence of refeeding syndrome in malnourished patients?
A) Hyperkalemia
B) Hypophosphatemia
C) Hypernatremia
D) Hyponatremia
Answer: B) Hypophosphatemia
27
5. Which screening tool is most appropriate for assessing delirium in an ICU setting?
A) Confusion Assessment Method (CAM-ICU)
B) Mini-Mental State Examination (MMSE)
C) Richmond Agitation-Sedation Scale (RASS)
D) Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar)
Answer: A) Confusion Assessment Method (CAM-ICU)
28
6. A patient presents with sleep disturbances. Which test provides the most definitive diagnosis?
A) Serum melatonin level
B) Polysomnography
C) Actigraphy
D) Patient sleep diary
Answer: B) Polysomnography
29
7. A patient with chronic alcohol use exhibits tremors, sweating, and tachycardia. Which diagnostic tool should be used to assess the severity of withdrawal?
A) AUDIT
B) CIWA-Ar
C) CAGE
D) Glasgow Coma Scale (GCS)
Answer: B) CIWA-Ar
