Review course 2013 Answer key

MCQ

Q1. Which of the following statements is true regarding ventilator associated

pneumonia:

a. VAP is the most commonly observed nosocomial infection in the intensive care unit. (t)

b. There are universally accepted diagnostic criteria.(F) c. The aspiration of infected material from the stomach plays an important

part in development of VAP.(F) d.The use of sucralfate as stress ulcer prophylaxis confirmed risk factor.(f)

e. A specimen obtained by bronchoalveolar lavage containing > 103

colony forming units/ ml signifies invasive infection.(f)

f. optimal management of VAP always requires :

F1 Identification of the responsible pathogen before the start of

antibiotic regime.(f)

F2. Close liaison with microbiology service.(t)

Q2. A 55 yr old man evaluated in hospital for 2 day history of fever, recently

diagnosed AML,for which he received chemotherapy 11 days ago.CVC it situ

with erythema at site, On physical examination T-39.1,B.P 100/70,HR-

110/min,R.r-22/min, HB-7gm%,TLC-1000,PL-20,000

A)-pt is having

A) Sepsis

B) SIRS

C) Severe SEPSIS

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D) Septic shock

2 B) what is the likely source? Likely organism?. Staplyloccocus

2c.. Multiple blood culture reveals growth of MRSA, medical history significant

for Vancomycin IgE Mediated Hypersensitivity reaction

C) In addition to catheter removal which of the following is appropriate

treatment.What complication you will watch for.

A) cefazolin

b) clindamycin

c) daptomycin (myopathy—cpk Levels)

d) Naffcillin

Q3. Which of the following sets of vital signs is most compatible with diagnosis

of isolated head injury with increase intracranial pressure.?

A) B.p-80/60,p-50/min

B) B.p-80/60,p-130/min

C) B.p-170/80,p-50/min(cushing reflex)

D) B.P-170/80,p-130/min

Q4. Which of the following seizure patients requires electroencephalographic

(EEG) monitoring for optimal treatment?

(A) 35-year-old status post a witnessed tonic–clonic seizure with resolution of

the postictal period in 10 min

(B) 40-year-old alcoholic status post two witnessed seizures in the ED, with lucid periods after each seizure (C) 28-year-old with status epilepticus controlled with fosphenytoin

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(D) 30-year-old with refractory status epilepticus requiring vecuronium(motor paralysis may hamer seizure activity) Ans

• Q5. 18 year old girl is admitted with bilateral ptosis to the ward. She also

has double vision. Over the past few days she has some difficulty getting

out of a chair (reflecting proximal lower limb weakness) and while

combing her hair her arms get very fatigued. Which of the following is

the most sensitive and specific test for her condition?

a) Tensilon test

b) Acetylcholine receptor antibodies(ANS)( Ach-R-Ab test has a 85%

sensitivity and about 90% specificity for Myasthenia Gravis)

c)

d) Repetitive Nerve Stimulation

e) Muscle biopsy

Q6. Regarding weaning

1) Which one of the following criteria is necessary to initiate discontinuation

from mechanical ventilation?

a) Improvement in underlying condition(ans).

b) Positive end expiratory pressure of 10 cm of water or less.

c) Ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen

of more than 100.

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d) Systolic Blood pressure greater than 120 mm of hg.

2) An unsuccessful spontaneous breathing trial would involve which one of the

following outcomes?

a) Heart rate of more than 110 beats per min.

b) oxygen saturation of less than 95%

C) Systolic blood pressure of more than 165 mm of hg.

d) Diaphoresis.(ans)

3) Which one of the following variables is considered to be risk factor for

unsuccessful discontinuation of mechanical ventilation?

a) Age Older than 60 yrs

b) APACHE 2 Score greater than 5 on the day of extubation.

C) Chronic obstructive pulmonary disease as a cause of respiratory failure.

D) Chronic heart failure(ans).

Q7. Which drug is most likely to cause hypotension, seizures, and

cardiac arrhythmia when taken in an overdose?

A. Acetaminophen

B. Diazepam

C. Methyl alcohol

D. Morphine

E.Amitryptiline(ans)

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Q8. .All of the following are signs of acetylcholinesterase inhibitor toxicity

EXCEPT

(A) miosis (B) salivation(C) diarrhea (D) muscle fasciculations(E)

anhydrosis(ans)

Q9. Which of the following is First sign of compensated hypovolemic

shock?

A—pallor

B—wide pulse pressure

C—Narrow pulse pressure(ans)

D—tachycardia

D-weakened peripheral pulse

Q 10. In a teaching session you are discussing path physiology of ARF you are

Asked which part of kidney is most susceptible to hypoxia as a result of

decrease in blood flow.correct response will be

A) Inner medulla (ans) B)Cortex C)Outer medulla D)All of the above

Q.11)

While treating a patient of crush syndrome consultant advises you to achieve

airway control of the patient and ventilation,which of the following agent needs

to be avoided

A)Pancuronium B)Atracurium C)Succinyl choline(ans) D)Vecuronium

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Q12. . A 60 yr old 10 days post clipping of ACOM aneurysm develops

change in mental status and lethargy .postoperative angiography reveals

excellent clip placement without evidence of cerebral vasospasm.

• Lab= Na- 119

• BUN-50mg%

• Ur ine spot Na- 65 CVP-2cm Of H20

• What is the most likely explanation for the hyponatremia?

A)SIADH B)Diabetes insipidus C)Renal failure

D)Cerebral salt wasting syndrome (ans)

Q13. With regards to non-variceal GI bleed, which of the following are true?

a) Approximately 20% of patients will stop bleeding spontaneously

without recurrence(False: 80%)

b) Low initial Hemoglobin is a clinical indicator of potential rebleeding

((True)

c)Onset of bleeding while being hospitalised for another reason is

associated with increased mortality risk (True)

d)Second look endoscopy is routinely recommended to ensure that

bleeding has stopped(false)

e)Patients at low-risk after endoscopy can be fed within 24 hours (True)

f)Increased risk of rebleeding has been noted with ulcers located in the

posterior lesser gastric curvature and posterior duodenal wall(True)

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Q14. With regards to portal hypertension & variceal bleeding which of the

following are true

A) Beta-blockers have been proven to help reduce the incidence of ‘first

bleed’ in patients with portal hypertension .(true)

B)In patients who cannot tolerate beta blockers, nitrates may be used(true)

C) In patients with cirrhosis routine endoscopies every two years and

sclerotherapy when appropriate can prevent or delay ‘first variceal

haemorrhage’

D)Prophylactic antibiotics for seven days in patients with variceal bleeding

increases long term survival(False improves short term survival)

E)Variceal ligation is as effective as sclerotherapy in controlling acute

variceal haemorrhage (TRUE)

Terlipressin is superior to vasopressin in controlling bleeding and may be

given as bolus unlike vasopressin(true)

Q 15

A patient has the following arterial blood gas results on oxygen 15 litre/min of

oxygen flow Ph 6.9,Paco2 -54 mm of hg ,Pao2- 76 mm of Hg,HCO3- 10. m

mol/litre,BE- 8 ,His acid base abnormality is typical of

A) Diabetic ketoacidosis.

B) Severe acute pulmonary odema(answer)

C) Hepatic and renal failure

D) Patient with copd treated with diuretics.

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Q 16. An 89-year-old woman suffers respiratory arrest at a nursing home.

She’s rushed to the ED, where she’s breathing on her own. The Registrar

knows that before this patient is treated, her ox hemoglobin dissociation

curve must

• :A. be normal. B. show a shift to the right.(ANSWER) C. show a shift to

the left. D. be flattened

• Q 17. Patient of stroke 3 day in ICU,starts with fever,Cough with

expectoration, breathlessness , TLC 18000, doctor on duty rings U up

and ask about which investigation to do as patient was not on DVT

prophylaxis ,thinks of P.E

a) CT pulmonary angio

b) 2D echo

c) D dimer(answer)

d) Chest X- RAY

Q 18. .Alcohol-based hand rubs have good antimicrobial activity against all of

the following except-

A)Viruses

B) Fungi

C) Mycobacteria

D) Bacterial spores (ANSWER)

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Q19. 56 yr old male patient with IHD admited with chest

discomfort,palpitation and B.P-70Systolic

Rhythm as

shown

Treatment protocal as per ACLS would be,

A) Adenosine 6mg B) Observe and monitor C) Synchronized cardioversion(answer) D) Call expert

Q20.Ninety six hours following admission to the trauma centre in ICU a post splenectomy develops oliguric renal failure and progressive pulmonary failure with rapidly increasing airway pressure, I AP measured by foley catheter is 45 torr,which intervention will help. A) H.D and HFJV B) Laprotomy(ANSWER) C) CAVHD D) FLUID restriction and diuretics.

Q21.A 70 yr old 60 kg man with intracerebral bleed .He is obtuntded and has NG tube in place.The resident found his abdomen to be some what distended and peristalsis sounds were poor .He decided to start him on parenteral nutrition.What you will prefer as the route/how will you feed him. A.Enteral(answer)

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B.parenteral C.no nutrition till gut settles Q 22.Pt. Above was fed 80 gm of protien enterally and 1800 non protien calories. His 24 hr UUN came back As 9 gm/day Does he have adequate protien intake. A.yes(Protien intake/6.25-24hUUN+4=nitrogen balance) (protien calories/day/25-uungm/day-5g/day B.No. Q23.A 40 yr old 35 kg wt NHL patient is admitted for his sixth cycle of chemo.he looks cachetic and has a serum albumin of 2 gm% .What precaution you take while feeding him. A.feed according to his ideal body weight. B.feed according to his present body weight C.feed him excess to normal requirement. D.Feed him less than normal requirement.(ANS) refeeding syndrome) Q 24.All of the following are correct regarding apnea test Except. A.preoxygenate the pt with 100% oxygen.for 15 min B.paco2 is allowed to be 20mmof hg above the normal base line value C.Visual observation for respiratory movement 5min.(ans) D.should be terminated if pt becomes hemodynamically unstable.

• Q25. While shopping in a camp your friend suddenly c/o chest pain and become unresponsive and gasping correct sequence of BLS you will provide

A) Call for help, open airway ,give rescue breath ,get AED,give chest

compression 30:2

B)Activate EMS,Get AED,start chest compression,check rhythm after

2 min shock if indicated(ANS) c-a-b

C)Precordial thump,call for help,give rescue breath start compression

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D)Open airway,look-listen-feel,give 2 breaths,check pulse,give

compression

Q26. • As per ACLS 2010 capnography after advance airway placement helps in

all of the following except.

• A)Helps monitoring of resus efforts

• B)ROSC depicted by sustained increase in PetCo2 >40 mm of hg

• C) Confirmation of ETT placement if graph appears.2 breath(ANS) (6

breath)

• D)IF PetCO2<10 mm of hg attempt to improve CPR quaility

§ Q27

§ 42 yr old known case of asthma shifted from ER c/o Breathlessness,

silent chest, confusion bradycardia,decresed spo2 ventilated invasive

with following setting, as set by your registrar, which one you will ask

him to modify and why Sedation ± NMBA

§ Ventilator Mode CMV

§ Respiratory Rate 18/min

§ Tidal Volume 7-ml / kg

§ Inspiratory Flow Rate 80 L / mt

§ PEEP 4

§ FiO2 1.0

.

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