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A. Amiodarone
B. Normothermia
C. Primary seizure prophylaxis with phenytoin
D. Hypothermia (32°C - 34°C [89.6°F-93.2°F])
E. Beta blockade
A. Cerebral MRI
B. Comprehensive blood hepatic profile
C. Blood cultures
D. Electroencephalogram
E. Random cortisol
A. Systemic thrombolytics
B. Immediate IV antibiotics
C. IV phenytoin
D. Local thrombolytics
E. Intracranial pressure monitor
A. Antibiotics
B. Thiamine and dextrose
C. Naloxone
D. Haloperidol
E. Dextrose solution
A. IV dexamethasone
B. Immediate neurosurgical evaluation
C. IV acyclovir
D. IV amphotericin B
E. Preforming another lumbar puncture in 6 hours
A. Administer IV bicarbonate.
B. Decrease the minute ventilation by lowering tidal volume.
C. Start dantrolene.
D. Start IV hydrocortisone.
E. Increase minute ventilation
A. Broca aphasia
B. Wernicke aphasia
C. Transcortical motor aphasia
D. Conduction aphasia
E. Global aphasia
13. A 72-year-old man was admitted to the ICU 2 weeks ago with a
left basal ganglia hypertensive hemorrhage without
intraventricular extension. The patient has a medical history
significant for chronic obstructive pulmonary disease,
hypertension, and hyperlipidemia. He remains in the ICU
because of an ongoing need for mechanical ventilation. On
examination he remains hemiparetic over his right side. Lower
extremity ultrasonography reveals a right common femoral
deep venous thrombosis.
A. Systemic tPA
B. External ventricular drain
C. Decompressive hemicraniectomy
D. Brain tissue oxygen monitor
E. Local tPA
A. Basal ganglia
B. Cerebellum
C. Internal capsule
D. Parietal lobe (unilateral)
E. Pons
A. Electroenecephalography
B. Checking blood glucose level
C. Performing the pyridostigmine test
D. MR angiography of the brain
E. Noncontrast CT
22. The patient whose brain image is shown in the Figure has
suffered severe traumatic brain injury. He remains comatose.
Which of the following treatments can be eliminated from
consideration?
27. The patient with the brain imaging shown in the figure had
severe traumatic brain injury due to fall from the second floor of
his home. On arrival he was awake, conversant, and wanted to
go he was found comatose with a 7-mm un reactive pupil on the
right and hemiplegia on the left.
The survival of this patient will depend on:
A. Burr holes
B. Emergent craniotomy
C. External ventricular drain
D. Corticosteroids
E. Starting 3% saline solution at 30 mL/h
A. The patient may not be brain dead and the findings of his
motor examination suggest that medical therapy should
continue
B. The patient is brain dead and there is no reversibility
C. The patient should have a cerebral angiography to confirm
brain death
D. A trail of superamaximal elevation of mean arterial pressure
may be helpful
E. Seizure are likely, so trail of IV midazolam may be indicated
31. A 65-year-old man has suffered a devastating intracerebral
hemorrhage. An extraventricular drain was inserted for
hydrocephalus, and he remained in the ICU for 12 hours. He is
currently receiving norepinephrine at maximum doses to keep a
mean arterial pressure greater than 65 mm Hg, and his urine
output has been 300 mL/h. on physical examination, his BP is
98/58 mm Hg, HR is 118/min, RR is 14/min on the ventilator,
oxygen saturation is 98% (0.6), and temperature is 36°C
(96.7°F). His pupils are 5 mm and nonreactive, with no corneal
reflex, no oculocephalic reflexes and no cold-caloric responses.
Gag and cough reflexes are absent, as are spontaneous
respirations. During nail-bed pinching, he has a triple flexion
response of the both lower extremities. The team repeats the
examination within 6 hours and finds similar results, but at this
time fasciculations are apparent in the upper and lower
extremities
1-D; 2-D; 3-B; 4-D; 5-B; 6-C; 7-D; 8-C; 9-A; 10-B; 11-C; 12-A; 13-C;
14-D; 15-C; 16-D; 17-E; 18-B; 19-C; 20-D; 21-A; 22-E; 23-E; 23-B;
24-E; 25-C; 26-E; 27-B; 28-D; 29-A;30-B; 31-A; 32-B; 33-C; 34-A
A. Phenylephrine
B. Milrinone
C. Dobutamine
D. Vasopressin
A. Nitroglycerin
B. Milrinone
C. Dopamine
D. Norepinephrine
A. Furosemide
B. Inotropic-dose dopamine
C. Beta blockade
D. Nitroglycerin
A. Splenic laceration
B. Myocardial infarction
C. Tension pneumothorax
A. Type and cross for 4 units of packed red blood cells (PRBCs);
give 4 units of fresh frozen plasma (FFP), 6 units of platelets, and
sodium bicarbonate;warm patient to 35°C (94.9°F); place central
line.
A. Class I
B. Class II
C. Class III
D. Class IV
E. Exploratory laparotomy
28. Which of the following TEE views would have best informed
the attending anesthesiologist of the patient’s volume status?
A. Deep transgastric long-axis view
A. Discontinue PEEP.
C. Pericardial tamponade
D. Pulmonary embolism
A. Pulmonary regurgitation
B. Mitral regurgitation
C. Aortic regurgitation
A. Aortic stenosis
C. Cardiac tamponade
D. Mitral regurgitation
F. Mitral stenosis
C. IV administration of digoxin
D. IV administration of propranolol
E. Electrical cardioversion
A. Atrial fibrillation
B. Administration of phenylephrine
E. Synchronized cardioversion
A. Nitroprusside infusion
B. Nitroglycerin infusion
C. Labetalol infusion
D. Beta-blockers
A. Systemic thrombolysis
C. External defibrillation
ANSWERS:
1–A; 2–C; 3–D; 4–C; 5–D; 6–C; 7–A; 8–C; 9–B; 10–C; 11–C; 12–
D; 13–D; 14–C; 15–B; 16–A; 17–B; 18–A; 19–A; 20–C; 21–C;
22–C; 23–D; 24–A; 25–C; 26–C; 27–A; 28–D; 29–D; 30–B; 31–
B; 32–C; 33–E; 34–A; 35–A; 36–D; 37–A; 38–D; 39–C; 40–D
A. Nebulized epinephrine
C. Observation
B. Weight
C. Height
D. Age
C. Tension pneumothorax
D. Pulmonary embolus
11. A 50-year-old woman intubated 7 days for pneumonia and
severe sepsis is being evaluated for weaning from mechanical
ventilation. Current ventilator settings include volume-assist
mode with a tidal volume of 450 mL, rate of 12/min, FIO2 of
0.35, and positive end-expiratory pressure of 5 cm H20. She
has stable vital signs off sedative or vasoactive drips and is
awake and able to follow simple commands. Her hand grip is
weak bilaterally, lungs are clear, and heart rate is regular with
no murmurs or gallop. She is placed on continuous positive
airway pressure for 3 minutes, during which time her RR is
25/min with an average tidal volume of 350 mL, and a negative
inspiratory force measured at –30 cm H20. An arterial blood
gas study is pending.
A. Acute delirium
E. Endocrine dysfunction
A. Trimethoprim/sulfamethoxazole
B. Furosemide
C. Methylprednisolone
D. Factor VIIa
E. Rituximab
14. A 28-year old man presents to the emergency department
with worsening shortness of breath and a cough productive of
blood-tinged sputum and lasting 2 days. He denies fever, chills,
or chest pain but admits to shortness of breath while jogging on
the day of presentation. He denies injection drug use or
tuberculosis exposure. Patient smokes 1 pack of cigarettes a
day. Patient has no past medical problems and recently had a
normal physical examination with normal blood findings at
work. Physical examination reveals an anxious young male in
respiratory distress; temperature is 37.3°C (99°F), RR is
28/min, HR is 110/min, BP is 138/70 mm Hg, and Spo2 is 87%.
There are no petechiae or ecchymoses; cardiac examination
shows tachycardia with normal S1 and S2, and no murmurs or
gallops. Lung auscultation reveals crackles over both bases;
abdomen is soft, nontender, and nondistended, with no
organomegaly. Chest radiograph reveals bilateral patchy
alveolar infiltrates. Additional testing reveals hemoglobin level
of 10 g/dL, WBC count of 10,800/µL with normal differential,
platelet count of 450,000/µL, and serum creatinine level of 3.5
mg/dL. Urinalysis shows 10 RBCs, RBC casts, proteinuria, and
no bacteria.
E. LMWHs are not indicated for critically ill patients with PE.
A. Point A
B. Point B
C. Point C
D. Point D
A. Increase Thigh
C. Increase Tlow
E. Decrease Phigh
C. Methylprednisolone
D. Furosemide
28. A 25-year-old man with asthma that is managed with
albuterol and inhaled steroids is admitted to the hospital after a
3-day history of increasing shortness of breath, coughing, and
wheezing. He has had multiple asthma exacerbations during the
past year and has taken a short course of systemic
corticosteroids. He admits to poor adherence with his asthma
regimen when he is feeling well. Initial assessment in the
emergency department reveals severe bronchospasm and
tachypnea. After aggressive treatment with
albuterol/ipratropium, magnesium, and corticosteroids, the
patient shows improvement and is admitted to the medical
floors. He is continued on IV corticosteroids,
albuterol/ipratropium inhalers, and levofloxacin. Several hours
after admission, he starts having increased respiratory distress
unresponsive to bronchodilators and is transferred to the ICU,
where he is intubated and started on mechanical ventilation.
Because of refractory bronchospasm, he requires sedation and
neuromuscular paralysis. On day 3 in the ICU, he develops new
fevers. Chest radiography shows diffuse alveolar infiltrates.
Nondirected bronchial aspirates are obtained and sent for Gram
stain and culture. Antibiotic coverage is expanded to vancomycin
and cefepime. On day 4, the lab reports that the Gram stain from
the sputum has gram-positive, dichotomously branching hyphae.
Clinically, the patient has persistent fevers and increased oxygen
requirements.
B. Initiate fluconazole.
C. Initiate voriconazole.
D. Initiate trimethoprim/sulfamethoxazole.
29. You are part of the critical care rapid response team called to
the general medical floor to evaluate a 41-year-old woman with
acute shortness of breath. The patient has a history of sickle cell
disease and was admitted 4 days ago with upper extremity and
flank pain reminiscent of previous vaso-occlusive sickle cell
crisis. Temperature is 38.4°C (101°F), HR is 110/min, RR is
38/min, BP is 165/ 92 mm Hg, and oxygen saturation is 74%. On
examination, the patient is in distress from labored breathing.
Lung auscultation reveals diffuse crackles with expiratory
wheezes, and an emergent portable chest radiograph shows new
diffuse, bilateral pulmonary infiltrates. Bedside focused
ultrasonography of the heart reveals a dilated right ventricle
with decreased right ventricular contractility, normal left
ventricular contractility, and no pericardial effusions or regional
wall motion abnormalities. The patient is intubated after
becoming lethargic and transferred to the ICU.
A. IV heparin infusion
B. Broad-spectrum antibiotics
C. Blood transfusion
D. Corticosteroids
E. Furosemide
C. Presence of A-lines
D. Absence of B-lines
A. Decrease frequency to 5 Hz
B. Increase frequency to 7 Hz
C. Decrease power by 5 cm H2O
A. Amplitude
B. Frequency
C. Power
D. Bias flow
A. Pneumothorax
B. Chest mass with diaphragm invagination
C. Pleural effusion
D. Pericardial effusion
E. Diaphragmatic paralysis
ANSWERS: 1–C; 2–D; 3–A; 4–B; 5–C; 6–C; 7–E; 8–A; 9–C; 10–B;
11–B; 12–C; 13–C; 14–D; 15–D; 16–C; 17–E; 18–C; 19–D; 20–B;
21–B; 22–A; 23–C; 24–E; 25–C; 26–D; 27–A; 28–C; 29–C; 30–A;
31–A; 32–B; 33–D; 34–C; 35–C
This patient most likely has vocal cord motion disorder or vocal
cord dysfunction. This is a syndrome that commonly presents as
asthma. During the respiratory cycle, the vocal cords normally
partially abduct with inhalation and partially adduct with
exhalation. This physiological movement allows the unimpeded
movement of air inward to the lungs and outward to the
atmosphere, while maintaining alveolar patency. In paradoxical
vocal cord motion disorder (PVCM) or vocal cord dysfunction,
the vocal folds will adduct during inhalation and/or exhalation.
This typically leads to episodic or recurrent episodes of dyspnea,
wheezing, and/or stridor. Because of these manifestations, PVCM
is often confused with asthma and patients receive steroid
treatment without symptom relief. Rarely, this can lead to
intubation and mechanical ventilation for “refractory asthma.”
The gold standard for diagnosing PVCM is laryngoscopy.
B. Emergent colectomy
C. Diagnostic colonoscopy
D. CT of the abdomen
E. IV metronidazole
A. Guillain-Barré syndrome
C. Lactic acidosis
D. Hypertriglyceridemia
E. Fanconi syndrome
A. Mycophenolate
B. Voriconazole
C. Tacrolimus
D. Prednisone
E. Propofol
11. A 63-year-old man was admitted to the ICU 4 days ago after
undergoing a partial colectomy for a perforated diverticulum. He
has been febrile since postoperative day 1 despite treatment
with vancomycin and piperacillin/tazobactam. This afternoon he
developed hypotension requiring blood pressure support. Which
antimicrobial medication should be added empirically to his
regimen?
A. Amphotericin B
B. Liposomal amphotericin B
C. Caspofungin
D. Fluconazole
B. IV fluconazole
C. IV voriconazole
D. Caspofungin
E. Posaconazole
A. Ceftriaxone alone
A. Fluconazole
B. Micafungin
C. Liposomal amphotericin B
D. Voriconazole alone
16. A 57-year-old man was admitted to the ICU 5 days ago with
an ST-elevation myocardial infarction. Yesterday he developed a
fever and cultures of blood, sputum, and urine were sent. Chest
radiography showed a new right lower lobe infiltrate. Results of
urinalysis were entirely within normal limits. The patient was
started on piperacillin/tazobactam for the pneumonia and is
afebrile today. The microbiology laboratory reports that more
than 100,000 colony-forming units per millilter of yeast are
growing from the urine culture. The most appropriate next
course of action is:
A. No intervention
B. Oral fluconazole
C. IV caspofungin
E. IV fluconazole
A. Coccidioidomycosis
B. Aspergillosis
C. Mucormycosis
D. Blastomycosis
A. Cytomegalovirus
B. Adenovirus
C. Legionella species
D. Parainfluenza 3
B. Begin IV acyclovir.
C. Begin valacyclovir.
A. Ribavirin
B. Acyclovir
C. Oseltamivir
A. Oseltamivir, enteral
B. Zanamivir, inhaled
C. IV amantadine
D. IV immunologlobulins
E. IV foscarnet
24. A 44-year-old woman with weakness and difficulty in
breathing presents to the emergency department reporting
fever, abdominal pain, and a pruritic maculopapular rash on her
back and chest for the past 24 hours. She was diagnosed 10 years
ago with HIV, which had been controlled with
lamivudine/zidovudine and lopinavir/ritonavir for the past 3
years. Approximately 2 weeks ago, her physician added abacavir
to her regimen to achieve an undetectable viral load. She also has
diastolic dysfunction, hypertension, and hypothyroidism. She
only takes lisinopril in addition to antiretrovirals. She is found to
be hypotensive, tachycardic, and tachypneic. Radiography shows
an interstitial pneumonitis, but oxygen saturation is 95% on
room air.
D. Pneumocystis pneumonia
ANSWERS:
1–D; 2–A; 3–C; 4–B; 5–D; 6–B; 7–C; 8–A; 9–C; 10–C; 11–C; 12–A;
13–D; 14–C; 15–B; 16–A; 17–D; 18–C; 19–D; 20–B; 21–B; 22–E;
23–A; 24–C; 25–D
1. What are the risk factors that have the strongest correlation
with stress-related bleeding in critically ill patients?
A. Surgical intervention
C. Neostigmine
D. Atropine
E. Colonoscopy
B. Acute pancreatitis
C. IV octreotide
D. Repeat EGD
E. Angiography
C. Heparin-induced thrombocytopenia
C. IV antibiotics
D. Mesenteric angiography
E. Surgical consultation
B. IV contrast-enhanced chest CT
B. IV mannitol therapy
D. IV hypertonic saline
E. Initiation of hypothermia
C. Lumbar puncture
C. Plasmapheresis
E. Surgical consultation
C. Repeat echocardiography
D. Measurement of bladder pressure and paracentesis
B. Cryoprecipitate
C. Factor IX concentrate
C. Conjugated estrogens
D. Cryoprecipitate
E. Desmopressin acetate A
A. Argatroban
B. Dexamethasone
C. Plasmapheresis
D. Platelet transfusion
E. IV immunoglobulin
A. Platelet transfusion
B. Splenectomy
C. IV immunoglobulin
D. Rituximab
E. Danazol
E. Discontinue anticoagulation.
B. Hypothermia
E. Citrate toxicity
D. Platelets only
E. No blood products
A. Methylprednisolone
B. Magnesium sulfate
C. Pamidronate
D. Sodium phosphate
E. Mannitol
A. Exchange transfusion
B. Simple transfusion
C. Administration of IV dexamethasone
A. Chemotherapy alone
B. Radiation therapy
D. Dexamethasone alone
A. Allopurinol
B. Immediate hemodialysis
C. Urine alkalization
D. Furosemide
E. Rasburicase
A. Vancomycin alone
B. Amphotericin
C. Fluconazole
A. Leukapheresis
B. Exchange transfusion
C. Combination chemotherapy
D. Bone marrow biopsy
A. Warfarin
B. Diuretics
C. Steroids
D. Intravascular stenting
E. Radiation therapy
ANSWERS: 1–C; 2–C; 3–A; 4–D; 5–D; 6–E; 7–A; 8–C; 9–B; 10–D;
11–C; 12–D; 13–A; 14–D; 15–E; 16–C; 17–C; 18–D; 19–C; 20–E;
21–C; 22–A; 23–C; 24–A; 25–E; 26–E; 27–A; 28–D; 29–C
The clinical findings in association with the large lung mass are
suggestive of hypercalcemia. The main clinical manifestations of
hypercalcemia are gastrointestinal (anorexia, nausea, vomiting,
abdominal pain, constipation), cardiovascular (hypertension,
prolonged PR and QRS intervals, shortened QT interval,
bradyarrhythmias), renal (polyuria, nephrocalcinosis),
neurologic (apathy, lethargy, coma), and skeletal (bone pain).
Hypercalcemia due to lung cancer is usually associated with
non–small cell tumors, and the most common mechanism is
parathyroid hormone–related peptide. Other mechanisms of
hypercalcemia associated with malignancy include ectopic
production of vitamin D and bone metastasis. The initial step in
management of severe hypercalcemia involves replacing
intravascular volume with isotonic saline solution to increase
renal blood flow and enhance calciuresis. After volume
expansion is achieved, administration of a loop diuretic to
increase renal excretion of calcium may help. Potassium and
magnesium will usually require replacement during diuresis.
Additional specific therapy is usually required with extreme
elevations of calcium, and includes bisphosphonates and
calcitonin. Glucocorticoids may be helpful in hypercalcemia
associated with excess vitamin D, such as granulomatous
diseases or in patients with hematologic malignancy, such as
lymphoma or multiple myeloma.
B. 3% saline solution
C. Water restriction
D. Conivaptan
E. Furosemide
A. Lower cost
B. Improved mortality
D. Hemodynamic tolerance
A. Hypovolemia
B. Nephrotoxin
C. Urinary retention
D. Glomerulonephritis
First
Second
Third
Fourth
A. Epinephrine
B. Calcium chloride
C. Sodium bicarbonate
D. Sodium polystyrene sulfonate
B. Initiate rasburicase.
D. Initiate hemodialysis.
12. An 80-year-old woman presents to the hospital with
shortness of breath and hemoptysis. She has been feeling sick
over the last few days, and this morning she started coughing
bright red blood. Her past medical history is significant for
hypertension and diabetes. On physical examination she has BP
of 120/65 mm Hg, HR of 95/min, RR of 32/min, and Spo2 of 90%
on nonrebreather mask. The rest of the physical examination is
unremarkable.
B. Bowel movements
C. Hemodynamic stability
A. Oral propylthiouracil
B. Oral saturated solution of iodine
C. Oral aspirin
D. IV diltiazem
PART 6: Renal and Metabolic Disorders in the ICU
ANSWERS:
1–A; 2–D; 3–B; 4–A; 5–B; 6–D; 7–B; 8–C; 9–C; 10–C; 11–D; 12–A;
13–C; 14–B; 15–C; 16–A
The low pH indicates acidemia, and the low bicarbonate level and
decreased Paco2 suggest a metabolic process. The respiratory
compensation appears appropriate: (1.5 × 7) + 8 = 18. The anion
gap is calculated as 19 mEq/L, which is increased and defines the
presence of an anion gap metabolic acidosis. This is consistent
with the patient’s worsened renal function. In the presence of an
anion gap acidosis, the delta gap should be calculated. In this
case, the difference between the measured and normal anion gap
is 7 and the bicarbonate value would be expected to decrease to
17 mEq/L (24 minus 7 mEq/L). The very low bicarbonate value
means that more bicarbonate has been lost than can be
accounted for by compensation for the increase in hydrogen ion.
Therefore, a non–anion gap metabolic acidosis is also present
that accounts for the very low bicarbonate value. The clinical
scenario suggests loss of bicarbonate through diarrhea, but this
patient was also receiving cyclosporine and may have tubular
dysfunction as well. The tachypnea in this patient is
compensation for the acidoses rather than a sign of pulmonary
disease
A. Arteriovenous shunting
Which amount and type of fluid should be infused over the first 8
hours?
A. Pyridostigmine
B. Atropine
E. Pralidoxime
A. Dantrolene
B. Lorazepam
C. Propranolol
D. Bromocriptine
E. Neuromuscular blocker
D. Initiate hemodialysis.
B. Warm blanket, and gastric and bladder lavage with warm fluid
A. Tachycardia
B. Orthostatic hypotension
C. Seizures
E. Absence of sweating
A. Milrinone
B. Transcutaneous pacing
D. Hemodialysis
D. IV vitamin K alone
A. Ethanol infusion
B. IV fomepizole alone
C. Hemodialysis alone
D. Hemodialysis and IV fomepizole
A. IV metoprolol
B. IV lorazepam
C. IV fosphenytoin
D. Observation
A. 20–25 kcal/kg
B. 25–30 kcal/kg
C. 30–40 kcal/kg
D. 40–50 kcal/kg
PART 7: Environmental and Toxicologic Injury
ANSWERS:
1–B; 2–B; 3–C; 4–D; 5–B; 6–B; 7–B; 8–A; 9–A; 10–C; 11–D; 12–C;
13–A; 14–C; 15–B; 16–C
The electrical current travelled from his hands and exited from
his groin and left foot (vertical pathways). Any tissue between
these sites may have suffered injury. As a result, the extent of the
burn, 5% total body surface area (TBSA), may be misleading. The
potential for this patient to develop myoglobinemia due to
muscle necrosis is high. Fluid resuscitation should be targeted to
keep the urine output brisk in order to prevent acute renal injury.
With severe muscle necrosis or a pH lower than 7.1, sodium
bicarbonate (correct answer B) at 1–2 mEq/kg will alkalize the
urine and limit the precipitation of myoglobin in the renal
tubules. Calcium channel blockers (option A) given systemically
will cause hypotension. Elevation of the arm (option C) may
decrease perfusion, while lowering the arm (option D) will result
in increased edema formation.
Rat poisons contain “super warfarins” that are more potent and
longer acting than warfarin. The most common agent involved in
poisonings is brodifacoum. These agents inhibit the synthesis of
vitamin K and thus the synthesis of clotting factors II, VII, IX, and
X. The risk of bleeding increases with a higher international
normalized ratio (INR). In a patient with active bleeding,
immediate factor replacement is required along with
administration of IV vitamin K. In this patient, bleeding with a
pharyngeal hematoma posed a threat to airway patency and
requires emergent treatment. Fresh frozen plasma in large doses
is required (15 mL/kg) and must be repeated every 6 to 8 hours
to maintain sufficient factor levels. Although not approved for
this use, other options for factor replacement are prothrombin
complex concentrate or activated factor VII. IV vitamin K is
indicated in this situation because it corrects the INR faster than
subcutaneous administration. Thus, Option A offers the best
interventions to quickly reverse the coagulopathy. Oral vitamin K
is indicated after stabilization for weeks to months due to the
long half-life of the “super warfarin.”
A. Morphine
B. Meperidine
C. Butorphanol
D. Hydromorphone
E. Oxycodone
B. Cyanocobalamin
C. Pyridoxine
D. Glucagon
E. Calcium chloride
A. Midazolam
B. Propofol
C. Haloperidol
D. Lorazepam
E. Morphine
A. Succinylcholine
B. Vecuronium
C. Pancuronium
D. Cisatracurium
A. Nimodipine
B. Phenytoin
C. Aminoglycosides
D. Famotidine
7. A 34-year-old man is admitted to the ICU after he is found
unconscious at home. He has a history of chronic back pain,
diabetes mellitus, and depression. His current medications
include the following:
Glipizide, 10 mg/day
A. Morphine
B. Fentanyl
C. Methadone
D. Meperidine
A. Ischemic stroke
D. Huntington chorea
E. Autoimmune demyelination
A. Iatrogenic pneumothorax
B. Aspiration pneumonitis
C. Intracardiac shunt
D. Topical benzocaine
A. Pancuronium
B. Vecuronium
C. Atracurium
D. Rocuronium
Blood testing is done 4 weeks later and the patient is called by his
primary physician to be admitted as soon as possible to the
hospital. Laboratory data show the following: sodium, 132
mEq/L; potassium, 4.0 mEq/L; chloride, 108 mEq/L; bicarbonate,
7 mEq/L; blood urea nitrogen, 18 md/dL; creatinine, 0.9 mg/dL;
and glucose, 96 mg/dL. His WBC count is 8,000/µL with no left
shift, hemoglobin level is 14 g/dL, and platelet count is
98,000/µL.
A. Early sepsis
C. Alcoholic ketoacidosis
A. Cisatracurium
B. Succinylcholine
C. Pancuronium
D. Vecuronium
E. Rocuronium
15. Which of the following bacteria are adequately treated with IV
colistin (colistimethate)?
A. Serratia marcescens
B. Burkholderia cepacia
C. Acinetobacter baumanii
E. Proteus vulgaris
B. Discontinue propofol.
C. Discontinue linezolid.
ANSWERS:
1–C; 2–A; 3–A; 4–E; 5–D; 6–B; 7–C; 8–B; 9–C; 10–D; 11–D; 12–D;
13–B; 14–B; 15–C; 16–B; 17–D
B. Obtain an arteriography.
C. Perform fasciotomy.
C. Subarachnoid hemorrhage
E. Cortical contusion
B. C5-C6 fracture/dislocation
C. Alcoholic polyneuropathy
C. Brown-Sequard syndrome
10. Which of the following causes for the patient’s acute change in
status is most likely?
B. Anaphylactic shock
D. Severe sepsis
B. Atrial flutter
C. Sinus tachycardia
B. Continue fluconazole.
C. Discontinue fluconazole and start voriconazole.
B. Emergent laparotomy
C. Transesophageal echocardiography
B. Emergent laparotomy
B. Systemic anticoagulation
D. Close observation
C. CT of the abdomen
A. Transesophageal echocardiography
D. Abdominal ultrasonography
B. Emergent dialysis
D. Emergent laparotomy
C. CT of the head
D. Electromyography
C. Intercostal blocks
D. Paravertebral blocks
B. IV phenytoin
C. IV methylprednisolone
D. IV acyclovir
B. Broad-spectrum antibiotics
C. Noninvasive ventilation
D. Mechanical ventilation
ANSWERS:
1–C; 2–C; 3–C; 4–A; 5–B; 6–D; 7–C; 8–B; 9–A; 10–B; 11–B; 12–B;
13–A; 14–B; 15–D; 16–C; 17–B; 18–D; 19–C; 20–D; 21–B; 22–B;
23–A; 24–A; 25–D
III. Pseudoaneurysm
IV. Occlusion
A. 15
B. 13
C. 10
D. 8
E. 6
3. A 56-year-old man is admitted to the hospital after a motor
vehicle collision. His Glasgow Coma Scale score after
resuscitation is 4 and he has flexor posturing bilaterally. His
pupils are asymmetric and the right is dilated to 5 mm. His
temperature is 36°C (96.7°F), BP is 90/50 mm Hg, HR is 110/min,
RR is 18/min, and oxygen saturation is 98% (1.0). CT of the head
shows bilateral frontal contusions and subarachnoid hemorrhage
with a large right subdural hematoma. The cervical spine was
immobilized in the usual fashion. Focused assessment with
sonography for trauma shows a small collection at the right
retrocolic recess. The neurosurgery team has evaluated the
patient and is planning to take him to the operating room.
A. Autonomy
B. Independence
C. Utilitarianism
D. Beneficence
E. Virtue
A. Prospective cohort
B. Retrospective cohort
C. Case-control
D. Case-cohort
E. Cross-sectional
E. Can’t be calculated
A. 425/1,550
B. 1,575/3,250
C. 1,575/2,000
D. 425/2,000
E. 1,575/3,250
A. Test A
B. Test B
C. Test C
D. Test D
14. A critical care fellow in the ICU was interested in whether the
implementation of a daily checklist was associated with reduced
ICU length of stay (LOS). To test his hypothesis. he measured the
LOS in days in 2 different groups of critical care patients. Group 1
had the checklist implemented during working rounds and Group
2 had no checklist implemented for working rounds. Patients
admitted to the ICU between 7 am and 7 pm were in Group 1, and
those admitted between 7 pm and 7 am were in Group 2. After 6
months, he collected information on 258 patients. The results
showed that the ICU LOS of Group 1 was 4.5 ± 2.1 days and in
Group 2 was 5.1 ± 1.8.
C. Mann-Whitney test
D. Linear regression
E. Logistic regression
A. Alpha
B. Beta
C. 1 – beta
D. 1 – alpha
PART 10: Administrative and Ethical Issues in the Critically Ill
ANSWERS:
1–A; 2–D; 3–A; 4–B; 5–E; 6–A; 7–C; 8–B; 9–D; 10–E; 11–D; 12–C;
13–D; 14–B; 15–C
The team should switch the goals of care from full medical
management to “comfort care” and issue a do-not-resuscitate
order after documenting discussion on the chart based on the
best-interest standard. In the case of In re Conroy, (486 A.2d
1209 NJ 1985), Claire Conroy, an elderly mentally and physically
incapacitated woman residing in a nursing home had a guardian
(nephew) who did not know her explicit wishes but felt she
would not have liked to have a feeding tube. In this case, the New
Jersey Supreme Court permitted the use of the best-interest
standard, which is applicable in those cases where the burden of
a therapy outweighs the benefits and the pain of interventions
which would make them inhumane. The standard is based on the
principle of nonmaleficence, or primum non nocere (first do no
harm).