Critical Care MCQ

Critical Care MCQ

Hemodynamics & Cardiology

Which arenot indications of temporary pacing in AMI?

a) Mobitz type II.

b) Alternating right and left bundle branch block (BBB).
c) Mobitz type I + normal BP.
c  ??????

Indication of permanent pacemaker in MI:

a) Sinus brabycardia.
b) Lt Ant. Hemiblock.
c) Persistent Mobitz type II with BBB. (or with hemiblock)
d) Persistent Mobitz type II. ??????
c 

Rt heart failure PCWP 18, treatment:

a) Fluids.
b) Lasix.
c) Dobutamine.
d) Dopamine.
c 

Absolute contraindication to IABP:

a) Severe heart disease.
b) Unstable angina.
c) Acute mitral insufficiency.
d) Aortic insufficiency.
 Relative CI:
o Bilateral ilio-femoral peripheral artery disease.
o Aortic aneurysm.
o Iliac artery stent or prosthetic ilio-femoral graft
d
o Coagulopathy.
 Absolute CI: Aortic insufficiency , aortic dissection (risk to be inserted in in aneurysmal lumen),
PDA
 Confirm place of IABP by CXR (tip at carina)

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Critical Care MCQ

Which have the most effect on flow of fluids in IV catheters?

a) Diameter.
b) Length.
c) Viscosity of the fluid.
d) Site of insertion.
 Flow (Q) = k (ΔP/R)(L= Length, η = Viscosity, r = radius, P=pressure,R=Resistance)
 R= L.η/ r4
a  k =Л / 8,
 Q = ΔP. Л.r4/ 8 L.η
 Radius (diameter is raised to the fourth power so small change → significant effect)

All increase risk of pulmonary embolism during surgery except:

a) CRF (CKD).
b) Use of oral contraceptive pills (OCP).
c) Lupus (SLE).
d) Adenocarcinoma.
 Hypercoagulopathy: OCP, SLE(&APAS), malignancy
a
 CKD (platelet dysfunction

All are contraindication to CVC except:

a) Coagulation disorder.
b) Thrombocytopenia.
c) Scar at site of insertion.
d) Unconscious (or uncooperative) patient.
a  ????? Marino 66

Test used to diagnose heart failure:

a) Troponin.
b) cK MB.
c) LDH.
d) B type Natriuretic Peptide (BNP).
 BNP >500 Pg/ml is diagnostic to HF &< 100 good negative value
d
 Not dependent test in RI or hemodialysis (false high)

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Critical Care MCQ

All are indications of CVC replacement except:

a) Purulent drainage from catheter site.

b) Percutaneously inserted is suspected to be a source of systemic
sepsis.
c) Catheter inserted emergently without strict aseptic technique.
d) Subclavian catheter inserted >48 h.
e) Femoral catheter inserted >48 h.
d 

Decompensated HF with (↑PCWP + ↓CO or CI + ↑BP); TTT of choice is:

a) Vasodilators.
b) Dobutamine.
c) Dopamine.
d) Milrinone.
a  Forrester classification

Decompensated HF with (↑PCWP + ↓CO or CI + normal BP); TTT of

choice is:

a) Milrinone.
b) Dobutamine.
c) Dopamine.
d) Norepinephrine.
b  Forrester classification

RT HF with (PCWP 12 + ↓BP); TTT of choice is:

a) Dobutamine.
b) Dopamine.
c) Norepinephrine.
d) IV fluid
 Need to increase preload
d
 To give inotropes PCWP >15

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Critical Care MCQ

Decompensated HF with (↑PCWP + ↓CO or CI + normal BP) + patient on

BB medication; TTT of choice is:

a) Milrinone.
b) Dobutamine.
c) Dopamine.
d) Norepinephrine.
 ??????Milrinone. PDI 3 → inodilator(VD+ inotrope)not depend on B receptors
 Patients treated with beta blockersbefore admission and requiringconcomitant inotropic therapy
a
should bepreferably treated with a PDE III inhibitororlevosimendan rather than a betaadrenergic
agonist such as dobutamine

Subclavian CVC, most common complication is:

a) VTE.
b) Pneumothorax.
c) Hemothorax.
d) Rupture of free wall of the heart.
 Subclavian CVC, most common complication is Pneumothorax (nearly no risk difference between
b jugular and Subclavian to Pneumothorax).
 Femoral catheter common complication VTE & infection.

Case: 72 years old exploratory laparotomy → remain elective ventilation→

develops hypotension over several hours (BP = 110/70) → develops
manifestation of septic shock require high dose vasopressors → evidence
of hypoperfusion (pH = 7.24 + PCO2 = 28 + PO2 = 80 + O2sat=97% + Hb =
8 ) → PAC is inserted giving this data (CVP = 10 + PCWP = 18 + CI= 1.5
L/min/m2+ mixed venous O2 saturation 54%). Which is most likely to
increase O2 delivery?

a) 2L normal saline.
b) Blood transfusion to increase Hb to 10.
c) Vasopressor + inotropes to increase CI to 3.
 DO2 = CO x CaO2 x 10 as CaO2 = (1.34 x Hb x SO2) + 0.003 x PO2)
 DO2 = CO x [(1.34 x Hb x SO2) + 0.003 x PO2)] x 10 → so effect of Hb change is more than CO change
c
 To increase DO2 →↑CO or ↑Hb (but indication of BL transf is Hb<7 unless IHD or SaO2 – SvO2 >50)
 So increase CO is better choise

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Critical Care MCQ

Case: VF according ACLS you do:

a) DC 400 J.
b) DC does not exceed 630.
c) 2nd DC is between 200-300.
d) Impedance increase with pressure on paddles.
d 

Pulmonary artery catheter (PAC) in patient has no cardiac nor respiratory

disorders, measure SO2 = 91; proposed cause is:

a) FiO2 = 100%.
b) Distal end is at right ventricle.
c) Catheter tip is at top of pulmonary artery occlusion.
c 

DVT prophylaxis for patient fall on his back &has lumbar fracture is:

a) SC heparin 5000 U / 12h.

b) SC enoxaparin 40 mg/24h.
c) SC enoxaparin 40 mg/12h.
b  Spinal cord injury best 30 mg/12h.

For unfractionated heparin for DVT:

a) Can be used even with neurosurgery procedure.

b) No role in patient recovered from MI.
c) Not warranted in stroke in evolution.
d) Dose of prophylaxis is same as therapeutic for thromboembolic
state.
 Based on the current literature, the use of bothunfractionated and low-molecular-weight heparin
a appearsto be safe when given at least 24 hours after the conclusionof surgery or admission for
/ traumatic closed head injury.
b  Double-blinded prospective studies are needed to addressdefinitively the safety and efficacy of
unfractionatedand low-molecular-weight heparin for VTE prophylaxisin neurosurgical patients.

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Critical Care MCQ

What is rate of the rate of performing chest compression for victim of any
age?
a) 2 ventilation + 15 compression at rate 80-100 / min.
a 

Which of the following descries the way you can allow the chest to recoil
completely after each compression?
 Take your weight off your hands and allow the chest to come back to its normal position.

When you don’t suspect cervical spine injury, what is the best way you
open an unconscious victim airway?


Patient with central line develops sepsis, what is the organism?

a) Staph aureus.
a 

Patient of Lt Heart failure on Lanoxin(serum level of digoxin is

subnormal) + Lasix patient develops dyspnea; do what?
a) Atenolol.
b) ACEi.
c) Increase dose of lanoxin.
d) Increase dose of Lasix.
b  Options for this case: ACEi

Prolonged QT is seen all except:

a) Hyponatremia
 Na is the only electrolye do not ECG changes
Prolonged OT interval (9-11 small squar or > 0.4 RR interval):
 ANTI [arrhythmic (Ia,Quinidine&III, amiodarone), psychotics (Haloperidol), depressant (TCA),
fungal (amphotericin), histaminic (terfenadine), biotic(erythromycin, quinolones), insects (OP
poisons)]
a
 Hypos [magnesimia, kalemia, calcemia]
 TTT of long QT syndrome:
o BB are drugs of choice (Propranolol, Nadolol, Metoprolol, Atenolol)
 Surgical TTT (Implantablecardioverter-defibrillators = ICD, pacemaker, Left
cervicothoracicstellectomy)

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Critical Care MCQ

Case: 60 year-old ♂ + chronic renal insufficiency + HTN + admitted POC:

AAA repair initial hemodynamic (CO = 3.2 L/min + PCWP = 12) + low
UOP → 500 mL colloid, which of the following dynamic change indicates
diastolic dysfunction?
CO PCWP
A 3.4 14
B 4.2 14
C 3.8 18
Answer (c): Increase preload, little effect on CO (Pt is suspected to have LDD: cause
HTN)
Also diastolic dysfunction in: IHD, restrictive CM, tamponade, myocardia fibrosis.

The best prophylaxis of DVT initially in the post-op patient (safe and cost-
effective):

a) LMWH
b) Warfarin
c) Aspirin
d) Unfractionated heparin
a 

Aortic dissection:

a) BB is first line of TTT + Na nitoprusside for patient with ongoing

HTN.
b) CCB if BB is contraindicated.
a 

Patient with sepsis develops chest pain; ECG change in II,III, aVF; (CVP
= 4 + PAOP = 18):

a) Sepsis + cardiogenic shock.

a 

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Critical Care MCQ

Case: ♀ patient + menstrual period + fever + HR 132 + RR31 +

hypotension; do what?

a) Intubation & MV
b) Start dopamine.
c) Start TTT of septic shock.

c  Toxic shock syndrome

If CVP= (8)& intra-esophageal pressure (representing intra-pleural

pressure) = (-4), so RT atrial trans-mural pressure is:

a) 8
b) 4
c) -4
d) 12
d 

Best anti HTN used in aortic aneurysm:

a) Hydralazine. --------increase shearing

b) Nitropusside.
c) Nitropusside + BB.
c 

Which is not a cause of pulsusparadoxus?

a) Tamponade.
b) BA.
c) Restrictive CM.
d) PE.
d 

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 Critical Care MCQ

Case: DM +HTN +post op (aorto-femoral bypass) after 72 h develops

hypotension; what is the cause?
a) Bowel ischemia
b) Obstruction of graft
c) MI
 The most common causes of death after surgery are perioperative myocardial infarction
c
(MI) and stroke. Other causes of death include renal and respiratory failure

Case: pt with history of 3 vessel bypass + DCL → Subclavian CVC

inserted → 30 min patient develops hypotension; all explain hypotension
except:
a) Venous air embolism.
b) Pneumothorax.
c) Hemothorax.
d) Rupture of free wall of ventricle.
a  ?????

In PE; if V/Q is low probability +high clinical suspicion; do what?

a) Start anticoagulation.
b) D dimer.
c) LL duplex.
d) Echo.
a  ?????

Forrester classification of acute heart failure (in MI)

Classification points
CI PAOP class Description Findings Mortality % Therapy
(L/min/m2) (cm H2O)
Warm
↓ < 18 I Compensated 3 Chronic HF therapy
Dry
N or ↑ CI >2.2 Warm
Wet Diuretic + v.dilator
↑ > 18 II Congestion 9
(nitrate)
Pul. edema
Hypovolemic shock Cold
↓ < 18 III 23 Fluid repletion
(Hypoperfusion) Dry
↓ CI <2.2
Cardiogenic shock Cold Norm. BP → v.dilator
↑ > 18 IV 51
(Congestion + Wet ↓BP → inotrope +

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 Critical Care MCQ

hypoperfusion) Pul. edema pressor

Thromboprophylaxis
Risk level Clinical Situation Recommended Prophylaxis
Major trauma LMWH2 or leg compression (IPC)
High risk Spinal cord injury LMWH2 plus leg compression
Hip or Knee arthroplasty LMWH2
Gynecologic Benign disease LDUH1
surgery Malignancy LDUH2 or LMWH2
Closed procedures Early mobilization only
Urologic
Moderate risk LDUH1 or leg compression (IPC)
surgery Open procedures
High-risk medical illness LDUH1 or LMWH1
Intracranial surgery Leg compression (IPC)
Thromboprophylaxis for General Surgery
Description
Risk Categories Prophylaxis
Surgery Age Other risk
Low risk Minor <40 No Early mobilization only
LDUH1 or LMWH1:
Moderate risk Major <40 No
First dose 2 hr before surgery
LDUH2 or LMWH2:
High risk Major >40 or other risk
First dose 2 hr before surgery
LDUH2 or LMWH2 as above +
Highest risk Major >40 other risk
mechanical aid
Prophylaxis Regimens:
 UFH: variable sized particles (smaller →more effective) bind to Antithrombin III (AT III) →complex
→inactivating several coagulation factors (IIa [thrombin], IXa, Xa, XIa, and XIIa, (LDUH →only
antithrombineffect→inhibit thrombus formation),disadvantage: HIT
o LDUH1: Unfractionated heparin, 5,000 units SC every 12 hr
o LDUH2: Unfractionated heparin, 5,000 units SC every 8 hr
 LMWH:enzymatically produced smaller uniform size molecules of heparin (more potent),with renal failure, the
prophylactic dose of Enoxaparin, 40 mg SC once daily (No dose adjustment for dalteparin)
o LMWH1: Enoxaparin, 40 mg SC once daily, or dalteparin, 2,500 units SC once daily
o LMWH2: Enoxaparin, 30 mg SC every 12 hr, or dalteparin, 5,000 units SC once daily
 Mechanical aid:
o Graded compression stockings:pressure gradient acts as a driving force for venous outflow from the legs (18
mm Hg at ankles and 8 mm Hg at thigh)
o Intermittent pneumatic compression (IPC): inflatable bladders wrapped around leg (35 mm Hg at ankle and
20 mm Hg at the thigh)→inflating and deflating at regular intervals
 PE → 10% of postop mortality (incidence of PE increase 50% with major surgery or trauma)
 Determinant risk of PE in surgery: vascular injury (orthopedic) and hypercoagulable state caused by
thromboplastin release during surgery&Patient-specific factors.
 Minor surgery: performed under local or spinal anesthesia and lasts <30 min
 major surgery: performed under general anesthesia and lasts >30 min
 Other risk factors: cancer, obesity, history of thromboembolism, estrogen or other hypercoagulability.

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 Critical Care MCQ

Hemodynamic &Oxygen Transport Parametersmonitoring

Distributive
Hypovolemia LVF Tamponade RVF Obstructive
Vasogenic
SBP ↓ ↓ ↓ ↓ ↓ ↓
DBP ↓ ↓ ↓ ↓ ↓ ↓↓↓
Pulse P ↓ ↓ ↓ ↓ ↓ ↑
MAP ↓ N-↓ ↓ ↓ ↓ ↓
CO
CI = CO/SA
↓ ↓ ↓ ↓ ↓ N-↑
Nail refill
Temp
SVRI ↑ ↑ ↑ ↑ N-↑ ↓
PVRI N N N N ↑ N
CVP ↓ ↑ ↑ ↑ ↑ N-↓
PAOP ↓ ↑ ↑ ↑ N-↓ N-↓
DO2 ↓ ↓ ↓ ↓ ↓ ↑
SvO2 ↓ ↓ ↓ ↓ N-↓ N-↑
Cancer Pneumothx,
Hge, Secondary to Septic, spinal,
(breast, lung, P.E, air &
Etiology dehydration, MI, acute HF LVF, anaphylaxis
lymph) amniotic fluid
burn Corpumonale Liver failure
RF, TB embolism
Suspect cause
Dyspnea not
(infection, S.C.
PAH, improving wiyh
injury,
RVEDP= congested O2 (mostly clear
Gallop, anesthesia)
Other clinical S/S PAP = liver, lung)
Pul. edema spinal shock:
PAOP peripheral Target CVP in
Bradycardia +
edema PE therapy 20-
BP+ within
25 cm H2O
hours from injury
 Systolic Blood Pressure (SBP) = 90-140 (120) mm Hg
 Diastolic Blood Pressure (DBP) = 60-90 (80) mm Hg
 Pulse Pressure = SBP-DBP = 40 mm Hg
 Mean Arterial Pressure (MAP) = DBP + 1/3(SBP-DBP) = 90 mm Hg (target in shock correction >65)
 Heart Rate (HR) = 60-100 (75)bpm
 Cardiac Output (CO) = SV.HR = 4.0 - 8.0 (6) L/min
 Stroke Volume (SV) = CO/HR =End-Diastolic Volume (EDV=120) - End-Systolic Volume (ESV=50) = 55-100 (70) mL
 Stroke Index (SI) = CI/HR = 20–40 mL/m2
 Body Surface Area (SA)= (Kg+Cm-60)/100 = m2
 Cardiac Index (CI) = CO/SA= 2.4-4 L/min/m2
 Systemic Vascular Resistance (SVR) = 80 ×(MAP – CVP)/CO = 800 –1200dynes•sec-1•cm-5
 Pulmonary Vascular Resistance (PVR)=80 ×(Mean PAP – PAOP)/CO = <250dynes•sec-1•cm-5
 Systemic Vascular Resistance Index (SVRI)=(MAP – CVP)/CI = 25-30 Wood
 Pulmonary Vascular Resistance Index (PVRI)=(Mean PAP – PAOP)/CI = 1-2 Wood
vascular resistance is expressed in Wood units (mm Hg/L/min/m2), which can be multiplied by 80 to obtain more conventional units
of resistance (dynes•sec-1•cm-5/m2)→ so: SVRI =2000 -2400 dynes•sec-1•cm-5/m2& PVRI = 80-160 dynes•sec-1•cm-5/m2
 Central Venous Pressure (CVP) = 0-5 mm Hg (8–15 cm H2Owhen measured from mid axillary point as mmHg = 1.36 Cm H2O)
CVP = JVP + 5 (JVP is measured from angel of sternum which is perpendicularly higher than mid axillary point by 5 Cm)
 Pulmonary artery occlusion Pressure (PAOP) = Pulmonary Capillary Wedge Pressure(PCWP)= 6-12 mm Hg
 Pulmonary Artery Pressure (PAP)= systolic 15–30 (25) mm Hg/ diastolic 5–15(15) mm Hg
 Mean PAP =10- 20 mm Hg
 Content of Arterial O2 (CaO2) = 1.3 × Hb × SaO2+ 0.003× PO2 = mL O2(0.003× PO2 is insignificant as a content)
 Delivery of O2 (DO2) = CI ×CaO2 = CI ×1.3 × Hb × SaO2 = 520-570 mL/min/m2
(CO may be used as alternative to CI in all oxygen parameters so the unit is mL/min)

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 Critical Care MCQ

 O2 uptake = Oxygen consumption (VO2)= CI × CaO2 - CvO2 = CI × 1.3 × Hb × (SaO2 – SvO2)= 110-160 mL/min/m2
(<100 → impaired aerobic metabolism)also Compensated Heart Failure (normal VO2) vs. Cardiogenic Shock (low VO2)
 Oxygen Extraction Ratio (O2ER)= VO2/DO2×(100)= 25 (±5)%
 Mixed venous oxygen saturation (SvO2)= 70-75% (decreased by low CO as high oxygen extraction)
 Arterial oxygen saturation (SaO2)= 90-100%
Matching question: hemodynamics with diagnosis: (so important)
CI SV CVP PAOP Diagnosis (choice)
a 1.5 20 2 2 Hypovolemia
b 1.5 25 16 18 Biventricular failure
c 1.9 40 19 8 Rt Ventricular failure
d 7.2 102 6 6 Hepatic failure

Case, matching:(so important)

66 year female + suspected biliary sepsis + hypotension in ER → aggressive fluid but still hypotensive
(78/40) → continued fluid therapy and inserted PAC giving 1st measures (shown below), match expected
dynamic change with administration of vasoactive drug:
a) Dopamine 8 mic/kg/min.
b) Dopamine 25mic/kg/min.
c) Dobutamine.
d) Norepinephrine.
e) Phenylephrine.
1st
Event 1 Event 2 Event 3 Event 4 Event 5
measure
BP 88/42 99/48 120/65 120/65 130/70 80/36
MAP 57 65 83 83 90 51
HR 108 120 125 80 100 120
CVP 10 8 8 12 10 8
PAOP 18 15 15 20 16 15
CI 2.1 3 3.1 1.8 2.5 3.3
SVR 895 760 968 1578 1280 521
Choice - a b e d c
β1 dose: α 1 dose: Phenylephrine. NE: (α > β) Dobutamine:
 ↑HR  ↑SVR  ↑SVR  ↑SVR  ↓SVR (β2
 ↑BP  ↑BP  ↑BP  ↑BP initially)
 ↑CI  ↑CI  ↓HR  ↑HR  ↑CI
Explanation
 ↑HR (reflex (little)  ↑HR
(β action is bradycardia, no  ↑CI Should be used
still with effect on CI) (little) initially with
this dose) pressor

12
Critical Care MCQ

a Atrial contraction
c Carotid pulse (contraction of vent.→ tricuspid pulg in atrium )
x Diastole
v Venous return
y Passive filling of vent (tricuspid open)

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Critical Care MCQ

Ventilation & Pulmonology

Which would increase Ppeak not Pplat?

a) Pneumothorax.
b) Pulmonary embolism.
c) Tube obstruction.
 Ppeak = PIP →represent dynamic compliance; Cdyn=Vt/(Ppeak - PEEP) affected by airway
 Pplat →represent static compliance; Cstat=Vt/(Pplat - PEEP) affected by alveoli & chest wall
c  Causes of isolated high P peak: bronchospasm, AW obstruction (plug, kink, FB, ETT cuff herniation)
 Causes high peak & plat pr: pneumothx, atelectasis, Pul edema, pneumonia, bronchial intubation,
pl effusion, increasedabd pressure.

Heliox is indicated for use in:

a) ARDS.
b) Severe pneumonia.
c) Pulmonary embolism.
d) Upper airway obstruction.
 Heliox is mix 80% helium + 20% O2→ ↑laminar flow & ↓ resistance to turbulent flow&
better delivery nebulizers
 Uses: COPD, BA, FB aspiration, bronchiolitis, croup, vocal folds dusfunction.

The use of a helium-oxygen (heliox) mixture in patients with airway obstruction was used
d
as early as the 1930s. Although heliox does not resolve airway obstruction, it decreases
airway resistance providing time to allow other treatments to become therapeutic, and
thus, possibly preventing the need for intubation and mechanical ventilation. Despite new
and advanced treatment options in airway obstruction, heliox continues to be a choice for
treatment.

In life threatening conditions what is best way of intubation?

a) Fiberoptic without anesthesia of post pharynx.

b) Nasal intubation under GA.
c) Tracheostomy.
d) Oral ETT by Direct laryngoscope.
d  Time saving is life saving

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Critical Care MCQ

What increase peak and plateau pressure…..

a) Tension pneumothorax.
a  See above also bronchospasm
Dead space ventilation is the relation of:

a) Tidal volume to vital capacity.

b) Vital capacity to tidal volume.
c) Physiological dead space to vital capacity.
 Physiologic dead space (VD)= anatomical + alveolar (non-perfused normally 5% of alveoli)=2ml/kg
 Dead space = VD/ Vt = 2/6 = 30% in awake upright person
 Causes ofincreased VD:
Anatomical VD:GA, artificial airway, head extension jaw thrust, PPV(+ve airway pr), upright position
c Perfusion of alveoli: PE, He, hypotension, lung surgery, PAH
Overventilation with decreased flow (emphysema), age
The Bohr equation is used to quantify the ratio of physiological dead space to the total tidal
volume, and gives an indication of the extent of wasted ventilation. It is stated as follows: [1]

Case: RTA + GCS 9/15 + tracheostomy done → on weaning developed

increase in Bp and agitation; do what?

a) Clonidine.
b) Sedate and MV.
c) Endotracheal intubation.
 Clonidine (Catapress®)α1 blocker →↓(stress, HR, BP) that it facilitates weaning from mechanical
a ventilation
 Pt is already on tracheostomy with weaning failure

Which mode doesn’t contain mandatory ventilation?

a) PSV.
b) AC.
c) SIMV.
d) PCV.
a  PSV: Pt trigger all breaths and vent support all breathes within pressure limit

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Critical Care MCQ

Which is not a cause of weaning failure?

a) Heavy sedation.
b) Electrolyte imbalance.
c) Pneumonia.
d) Minimal secretions.
d  Review criteria of weaning

Patient has aspiration pneumonia, admitted, intubated, mech. vent. (R.

failure)… suddenly his SaO2 decreased….what is most correct initial
management…..

a) Suction of secretion. (Or disconnect vent & ventilate by ambu).

b) Check ETT position.
a  Suction &ambu (confirm gas delivery)

Radical O2 toxicity occurs in…..

a) FiO2 (50- 60%) for 24 hrs.

a 

Lt sided atelectasis….can be proved by:

a) Rt recumbent position.
b) Crowding of Lt Ribs.
c) Shift of mediastinum to RT.
 Lt side atelectasis: patient prefer Lt recumbent (better Rthealthy lung inflation, but treatment
b based on ling on healthy side to enhance drainage), shift mediastinum to Lt, crowding ribs &
vessels of Lt side (collapsed Lt lung)

ARDS…..the following is not criteria of ARDS:

a) PO2 over fiO2 less than 300.

 Hypoxic index = PO2 /fiO2: ARDS <200, ALI 200-300, normally 800 to 100/0.2=400 to 500, as
a
criteria of weaning >200

16
Critical Care MCQ

Effect of autoPEEP is following except:

a) Increased work of breathing.

b) Risk factor to barotrauma.
c) Decreased venous return, hypotension.
d) It easily can be measured at end expiration.
d 
Tobin index:

a) Respiratory rate/ spontaneous tidal volume.

a  Tobin index = RSBI = f/Vt rapid shallow breathing index

Which of the following increase peak pressure (PIP)?

a) Decrease of inspiratory time.

b) Decrease flow rate.
 ↓Ti→↑peak flow→↑PIP
a
 Decreased flow rate is a result of high airway pressure (not a cause)

Which is not an indication of isolated lung intubation?

a) Bronchial hemorrhage.
b) Broncho-pleural fistula.
c) Bronchial……..
d) PE.
d 

Case: patient 70 kg + ARDS + FiO2 = 0.7 + PEEP = 8 + Vt = 420 →

develops hypoxia; do what?
a) ↑ FiO2 to 0.8
b) ↑ PEEP 10-12
c) ↑ Vt to 550

17
 Critical Care MCQ

b 

Ventilator graphs:

Spontaneous
ventilation

Spontaneous with
CPAP

BiPAP

Best to detect small pneumothorax in CXR; done in:

a) Upright position + during expiration.

b) Upright position + during inspiration.
c) Supine position + during expiration.
d) Supine position + during inspiration.
b  Marino 72

Case: obstetric + ARDS:

a) NIPPV is treatment of choice.

b) Increase PEEP> 10 may cause pneumothorax.
c) Alveolar fluid has less protein.

18
Critical Care MCQ

d) Diuretics improve oxygenation.

b  ??

Case: patient ventilated; PS = 12 → PIP = 50 + Pplat = 48 + tachypnea +

desaturation despite FiO2 = 100%. Probable cause is:

a) Secretion in airway.
b) Massive P.E.
c) Pneumothorax.
c  See above

Expansion of chest measure:

a) TLC Volume of air in the lungs at the end of a maximal

inspiration.
a

Permissive hypercapnia is beneficial in:

a) ARDS, BA.
a

Diffusion capacity of the lungs measure transfer of the gas from air in the
lung to RBC in the lung blood Vessels, increased in:
Lung conditions that increase Diffusion capacity
 Alveolar hemorrhage Goodpasture'ssyndrome,polycythemia, left to right intracardiac shunts, due
a increase in volume of blood exposed to inspired gas.
 Asthma due to better perfusion of apices of lung. This is caused by increase in pulmonary arterial
pressure and/or due to more negative pleural pressure generated during inspiration due to

19
Critical Care MCQ

bronchial narrowing

Aspiration occurring in intubated patient with well intact inflated cuff:

a) Micro……
b) Macro…….
c) Chemical causing pneumonitis.
a ???? I think micro-aspiration

All are indication of NIPPV except:

a) BA exacerbation.
b) COPD exacerbation.
c) Acute respiratory acidosis.
d) An obtunded patient.
d

Lung volumes & capacities

Lung volumes & capacities
volume of air moved in and out of the respiratory tract
TV Tidal volume 500 mL
(air moving with normal inspiration & expiration)
Inspiratory max amount of air inspired after a normal inspiration 3100mL
IRV
reserve volume (with max inspiration)
Expiratory
ERV max amount of air expired after normal expiration 1000mL
Reserve Volume
Volume remainin the lungs aftermaximal
RV Reserve Volume expiration(after ERV) 1200mL
RV = FRC - ERV
volume remain in the lungs is after normal
Functional
FRC expiration(after a tidal volume) 2400mL
Residual Capacity
FRC = ERV+RV
Max volume of air that can be inhaled following a
Inspiratory
IC resting state. 3600 mL
Capacity
IC = TV + IRV
Max amount of air expelled after max inhalation
VC Vital Capacity 4800mL
VC = IRV+TV+ERV
Volume of air in the lungs at the end of a maximal
Total lung
TLC inspiration. 5200 mL
capacity
TLC= IRV + TV + ERV + RV

20
Critical Care MCQ

21
 Critical Care MCQ

Pulmonary function tests (PFTs)

Minute volume is the  Volume of air exhaled per minute.
Maximal breathing capacity
 Maximum volume of air that can be exhaled by voluntary effort in a 15 second
(maximal voluntary
interval. This volume is multiplied by 4 and expressed as litres per minute
ventilation)
Forced expiratory volume 1
 Volume of air that is forcefully exhaled in one second.
(FEV1)
Forced vital capacity  Volume of air that can be maximally forcefully exhaled.
(FVC)
 expressed as a percentage (Normal FEV/FVC ~ 80% )
Ratio of FEV1 to FVC
 Restrictive (fibrosis) ratio normal or increased
(FEV1/FVC)
 Obstructive (asthma, COPD) usually low
Forced expiratory flow
 Average forced expiratory flow during the mid (25 - 75%) portion of the FVC.
(FEF25 - 75)
Peak expiratory flow rate
 peak flow rate during expiration
(PEFR)

22
Critical Care MCQ

Sepsis& immunological response

In sepsis best to decrease mortality and morbidity is:

a) SpO2> 97%.
b) Keep CVP 10- 12.
c) Keep mean BP > 55.
d) ScvO2> 50.
 Targets in TTT of sepsis are: Keep CVP 10- 12 (8-12 in spont breathing, 12-15 in vent Pt), MAP> 65,
ScvO2 > 70, best result with precocious TTT & massive fluid challenge
a
 Mortality predictors in sepsis: male, bad APACHE & SOFA scores, positive fluid balance, need to
hemodialysis, need to steroid,leukopenia, lactatemia, BNP

Common cause of MOF:

a) Stroke.
b) Trauma.
c) Sepsis.
c 

In study (??????????) 1996, mortality rate is:

a) SIRS 9%.
b) Sepsis 19%.
c) Severe sepsis.
d) Septic shock 90%.
d 

23
 Critical Care MCQ

Case: smoker + fever + cough + CXR: RT lung infiltrates + WBC: 14 +

sputum C/S: no organism + neutrophil ↑↑; give what?

a) Cefuroxime and erythromycin.

b) Vancomycin.
c) Ceftriaxone + gentamycin.
 Cefuroxime 2nd cephalosporin (but can cross BBB)
 Common organism CAP: st pneumonia, Hinflu, staph, moraxella, mycoplasma, legionella.
a
 CAP empirical AB: β lactam (penicillin or cephalosporin)+ Quinolone or macrolide
i.e. [Tavanic + Unasyn or Ceftriaxone + Azithromycin] aztreonam if β-lactam allergy

Case, bacterial meningitis (DCL, fever, CSF: glu=40, prot=2.5) treatment:

a) Ceftriaxone 2 gram.
b) Penicillin G.
c) Vancomycin.
d) Chloramphenicol.
 All choices can be used in bacterial meningitis but (Ceftriaxone in England)& (Vancomycin is
added in American protocol), ampicillin in elderly, acyclovir if suspect HSV
 Only disease with normal protein is MS
a
 Protein decrease is not significance
 Bacterial meningitis: Neisseria Meningitides (child), St. Pneumonia (adult), staph (openhead
injury), H. influ&Gm -ve

CSF analysis
Aspect Opening pr Glucose Protein cells C&S
<5WBC (<PMN)
Normal Clear 15±5 Cm H2O 60±20 mg/dl 30±15 mg/dl Sterile
↑in neoborn
Bacterial Turbid ↑ ↓ ↑↑ (250) >500(1000)/↑PMN +ve
fungal Variable Variable ↓ ↑↑(25-500) 10-1000(<500)/MNC +ve fungi
10-1000(100)/
Viral Clear N N or ↓ N or ↑ -ve
Early (PMN) & late (MNC)
AFB
TB Variable Variable ↓↓ ↑(50-500) 10-1000(<500)/MNC
ZN stain
GuillianBarre N N N ↑(esp 1st week) N -ve
MS N N N N ↑/MNC -ve
SAH Red ↑↑ N ↑ RBC, MQ, MNC -ve

The most common organisms in CAP are:

24
Critical Care MCQ

a) Staph, Pseudomonas.
b) Staph, Pneumococci.
c) Klebsiella.
b See above

Which is not a risk factor for VAP?

a) NGT.
b) Reintubation.
c) Semi-setting position. (Head elevation)
c C: is preventive measure, Reintubation (↑V AP), NGT (better to use orogastric tube→↓VAP)
The most common organisms in early VAP are:

a) Pseudomonas, MRSA.
b) H. Influenza → enteric bacilli→→methicillin sensitive staph
(MSSA).
c) Pneumococci →H. Influenza → gram –veenterococci.
Early VAP (<4days):Pneumococci→ H. Influenza → MSSA→gram –ve bacteria (like CAP)
Late VAP (>4days): pseudomonas → acitenobacter → MRSA
*pseudomonas 19% & staph 19% pneumo 13%, E coli 9% H iflu 7% (2003)
c
* other studies (2012): no difference between early & late and the incidence is (MRSA
44%,Acinetobacterbaumanii30%, Pseud 12%, Stenotrophomonas7%, Klebsiella 6%, and
Serratiamarcescens 2%.

In Auto immune hemolytic anemia due to mycoplasma which will reveal

the cause of abnormal blood count:

a) Indirect bilirubin.
b) Bone marrow aspiration.
c) Direct coomb.
c Direct coomb test (agglutinin test)detect autAb& complement against RBC causing hemolysis:
mycoplasma induced hemolysis (cold i.e. body temp 28-31, it is transient)alsoIMN, HIV,SLE, RA,
CML,PNH, Hodgkin lymphoma, Waldenstormmacroglobulinemia
Indirect coomb test detect recipientAbagainst donor RBC e.g. Rh in pregnant& blood cross match
Tech:
o Direct: add Pt washed RBC(proposed to have auto Ab on surface) + comb reagent (contain Ab
against antiRBCAb)→ agglutination → +ve
o Indirect: Pt serum(proposed to have Ab to donor RBC) + Donor RBC (proposed to be antigenic to

25
Critical Care MCQ

recipient)→PtAb attach surface or donor RBC → then add comb reagent (as direct test) →
agglutination → +ve

Patient had kidney transplant 10 years ago (photo showing multiple red
skin lesions on the anterior chest and abdomen):

Kaposi sarcoma. [Type a quote from the document or the summary of an interesting
point. You can position the text box anywhere in the document. Use the Drawing Tools tab to
change the formatting of the pull quote text box.]

a)

b) Metastatic melanoma.
c) T-cell virus.
All occurs as long term complication of renal transplant
a
Kaposi sarcoma?????? Non melanoma skin cancer

Patient admitted with severe sepsis after 10 days of treatment he developed

watery diarrhea, colonoscopy showed white plaques:

a) IV vancomycin.
b) Oral vancomycin.
c) Oral metronidazole.
26
Critical Care MCQ

d) Loperamide.(antiperistalsis agent)
Clostridium Difficel infection (CDI):pseudomembranous colitis
o Asymptomatic only +veby investigation: NAAT (Nucleic Acid Amplification Test ), toxin ELISA,
PCR, C&S (most sensitive but time consuming)
o Mild to moderate (NAAT +ve + smelly watery diarrhea)
o Severe (NAAT +ve + smelly watery diarrhea + at least one of: fever, WBC>20, ↑Cr)
o Complicated severe (severe + one of: BP, ileus, fatal ileitis, toxic megacolon, perforation, need
colectomy, need ICU)
o Recurrence
c
TTT: (IV vancomycin is not effective in CDI)
o Mild to moderate: POmetronidazole 500mg x 3 x 14
o Severe: PO vancomycin 125mg x 4 x 14
o Complicated severe: IV metronidazole 500mg x 3 +vancomycin 500 mg or higher x 4 (PO or NGT)
± colectomy ± IVIG (fulminant colitis)±ileus (vancomycin enema)
o Recurrence: if once(same initial), >1 recurrence (tapering vancomycin → allow flora growth)
±fidaxomycin (local AB not affect flora)±stool transplant from healthy person
o In pregnancy only Vancomycin is allowed (metronidazole is teratogenic)

Fever > one week in neutropenic patient; do what?

a) Continue AB.
b) IV Amphotericin as possibility of fungal infection.
c) Discontinue AB and no more drugs.
d) Start clindamycin for possible Pseudomonas
b  Fever > 5 days in compromised patient suspect fungal infection

The most common non-infectious pulmonary disorder in neutropenic

patient:

a) Diffuse alveolar Hge.

b) Drug toxicity.
c) Malignancy.
d) Radiation pneumonitis.
a 

Accurate diagnostic method for pneumonia:

a) Bronchoalveolar lavage (BAL).

b) Protected specimen brush (PSB).

27
Critical Care MCQ

c) Tracheal aspirate (TA).

 BAL (most accurate:sen73%, sp82%), PSB (most specific:sen 66%, sp 90%), quantitative TA
a
(most sensitive sen 76%, sp 75%), qualitative TA (most sensitive sen 90%, sp 27%)

HUS due to mycoplasma:auti immune hemolytic ane,ia caused by

mycoplasma

a) Cold agglutinin.
b) Autoimmune.
c) Cholesterol adherence.
a  See above

All are used in treatment of pseudomonas except:

a) Ciprofloxacin
b) Levofloxacin.
c) Amikin.
d) Imipenem.
e) Ceftazidim.
f) Tobramycin.
b  All can be used???!!!!!!

Treatment of anaphylactic shock includes all of the following except:

a) Epinephrine.
b) Corticosteroid.
c) Diphenhydramine.
d) O2.
e) IV fluid.
b 

How to confirm tetanus infection?

a) Tissue Culture.

28
Critical Care MCQ

b) Blood culture.
c) Clinical finding & physical examination.
 Laboratory confirmation of tetanus infection is often difficult. C. tetani antibodies are sometimes
c detectable in serum samples but may result from waning past immunization. Cultures from the
site of infection should be attempted although the organism is often not recovered

Which of the following AB is not associated with CDI?

a) Gentamycin.
a 

Which organism is common with T-cell virus?

a) Pneumocystis carinii.
b) Pseudomonas.
c) Staph.
 cytomegalovirus, histoplasmosis, scabies, pneumocystis pneumonia, and staphylococcal
a infections. HIV testing should also be performed, as some patients may be co-infected
with both viruses.

Which is correct about VAP?

a) Occurs in all intubated patients.

b) Increased incidence in 10 days MV. (?????)
c) Early VAP is worse prognosis than late VAP
d) Early VAP ……..
 Late-onset VAP had poor prognosis in terms of mortality (66%) as compared to the early-
onset type (20%).

b It was proved in our study that duration of mechanical ventilation is an important risk
factor for VAP, which is similar to other studies[12] where the mean duration of
ventilation was around 10 days and the incidence of VAP was found to be 9.3%.

Which of the following is the least common reversible cause of cardiac

arrest?

a) Hypokalemia.

29
Critical Care MCQ

b) Tamponade.
c) Anaphylaxis.
d) Rupture of free wall of ventricle.
d 
Pharmacology

Which is known side effect of Haloperidol overdose?

a) Bradycardia.
b) Hypotension.
c) Torsade de point.
d) Depress respiration.
Haloperidol is antipsychotic
Prolonged OT interval (9-11 small squar or > 0.4 RR interval):
 ANTI [arrhythmic (Ia,Quinidine&III, amiodarone), psychotics (Haloperidol), depressant (TCA),
fungal (amphotericin), histaminic (terfenadine), biotic(erythromycin, quinolones), insects (OP
poisons)]
C
 Hypos [magnesimia, kalemia, calcemia]
 TTT of long QT syndrome:
o BB are drugs of choice (Propranolol, Nadolol, Metoprolol, Atenolol)
o Surgical TTT (Implantablecardioverter-defibrillators = ICD, pacemaker, Left
cervicothoracicstellectomy)

Mannitol; which is true?

a) Regular doses (q 6 h) better than PRN (as needed).

b) Reduce edema in injured cells more than non-injured cells.
c) Fluid restriction improves results.
d) Not used more than 5 days.
 Mannitol filtered by glomeruli & not reabsorbed by tubule (80% excreted by 3 hours)→ drag water
by osmolarity (casing ↓Na dehydration)
 Use: brain edema ( ICP >20), glaucoma, forced alkaline diuresis, oliguric RI 0.2 g/kg over 5min &
can be repeated once), in CP bypass (decrease hemolysis)& renal transplant, cystic fibrosis &
bronchiectasis (inhalational powder)
a  Rate of administration is usually adjusted to maintain a urine flow of at least 30 to 50 mL/hour
 CI:RF, dehydration, pul congestion, CHF, pregnancy (teratogenicity), active ICH
 SE: hypervolemia (esp if RF), dehydration (should replace UOP of first 2 hours after mannitol), NA,
metabolic acidosis (mannitol pH=4.5-7 &osm= 1100), hyperkalemia (transcellular shift), may
cause also hypokalemia
 Must monitor RFT, Na , osmolarity, ICP

30
Critical Care MCQ

Which is not appropriate for heparin prophylaxis?

a) Post MI.
b) Post SAH.
c) Recent AO aneurysm repair.
d) Pregnancy with sever bronchial asthma.

• Measures to prevent DVT should be

employed in all SAH patients
• Sequential compression devices should
be routinely used in all patients
• Unfractionated heparin for prophylaxis
could be started 24 h after undergoing
surgery
• Unfractionated heparin and low
d molecular weighted heparin should be
withheld 24 h before and after
intracranial procedures
• Low molecular weight heparin or
unfractionated heparin for prophylaxis
should be withheld in patients with
unprotected aneurysms and expected to
undergo surgery


In rTPA all are correct except:

31
Critical Care MCQ

a) ………………..
b) Premedication with heparin 10,000 units.
b 

This is not appropriate to use neuromuscular blocker:

a) High Frequency oscillatory Ventilation (HFOV) adequately

sedated.
b) MV with inverse ratio 2:1.
c) Seizuringdespite of sedation and antiepileptic.
 All choices are uses of NMB (but a is adequately sedated)
 In HFOV, NMB is better to be used as bolus doses
c
 Seizure (sedation and antiepileptics → GA → NMB)
NMB agents will mask the muscule activity associated with seizures

Drug has pure alpha agonist:

a) Dopamine.
b) Dobutamine.
c) Phenylephrine.
 Dopamine (D, β1, α1)
 Dobutamine (β)
c  Phenylephrine(α1)
 Vasopressin is pure Vasoconstrictor but difficult titration reduces its use compared to
Phenylephrine

Which is the most correct CI of ant HTN in HTN emergencies?

a) Hydralazine is contraindicated in dissecting aortic aneurysm.

b) Labetalol is contraindicated in 1st degree HB.
c) Labetalol is contraindicated in diastolic dysfunction.
d) Phentolamine is contraindicated in pheochromocytoma.
a  Drugs contraindicated in Ao aneurysm: Hydralazine &minoxidil (reflex
tachycardia)&acebutolol&pindolol (sympathomimetic action) +veinotropy → ↑shearing
(documented rupture)
 Ao aneurysm TTT: BB(labetalol, metoprolol, esmolo), CCB (verapamil, deltiazem) if SBP is still> 110
add nitroprusside0.2-2 mic/kg/min (never before BB? ↑Shearing effect), also ACEi can be used

32
Critical Care MCQ

 Labetalol α1 & β (2>1)blocker[α:β = 1:3 orally, 1:7 IV]→CI:BA, non-compensated HF, severe
bradycardia,2nd& 3rd HB
 BB is beneficial in diastolic dysfunction: ↓ HR → allow heart to relax better → better filling
 CCB may replace BB in diastolic dysfunction except HOCM + PAH ( reported sudden death)

Which of the following least to decrease heart rate:

a) Norepinephrine.
b) Phenylephrine.
c) Dopamine.
 Dopamine (D, β1, α1)
 Dobutamine (β)
c
 Phenylephrine(α1)→ reflex bradycardia
 Norepinephrine (α 1> β)

Which drug of the following has no analgesic effect?

a) Propofol.
b) Ketamine.
a  Propofol insignificant short analgesic effect but ketamine is used as analgesic (& not CI in B asthma)

Which is not adverse effect to Propofol?

a) Myoclonic activity.
b) Green urine.
c) SVT.
d) Hypotension. e) hyperlipidemia
C  SE of propofol: allergy, nausea, vomiting, pancreatitis, green urine (phenol compounds), fits,hypotension
Adenosine can cause all except:
a) Coronary dilatation.
b) Bronchial dilatation.
c) Delay AV conduction.
d) Hypotension.
b  Adenosine SE: B spasm (CI in asthma), cardiac standstill, ↓BP (VD), HB

Aspirin all are correct excep:t

a) Selective inhibitor of COX1.

33
Critical Care MCQ

b) Plasma t1/2 is 1 hour.

c) Does not prolong bleeding time.
d) Antiplatelet effect lasts for lifetime of platelet (7-10days).
 Nonselective COX1&2, t1/2 (low dose 2-3h, high dose 20-30h), prolong bleeding time (affect
a
platelet), irreversible inhibitor (lasts for lifetime of platelet)

Digitalis toxicity causes all of the following except:

a) Sinus bradycardia.
b) AV block.
c) Atrial tachycardia.
d) v.tach.
c 

Rebound HTN can be caused by:

a) Nifedipine.
b) Hydralazine.
c) Clonidine.
d) Tridil.
 Clonidine (Catapres®)α1 blocker →↓stress, ↓HR, ↓BP, ↓menopausal hot flushes
c
 should generally be gradually tapered off when discontinuing therapy to avoid rebound effects

All are Quinolones SE except:

a) Neurotoxic.
b) Prolonged QT.
c) Polymorphic V tach. (trades de point)
d) Decrease of effect of Warfarin &Theophylline.
 Quinolones &macrolides are enzyme inhibitor →↓metabolism of warfarin (also↓ B flora →↓vit K)
d
 Quinolones are enzyme inhibitor →↓metabolism of theophylline

All are Vancomycin SE except:

34
Critical Care MCQ

a) Red man syndrome.

b) Irreversible hearing loss with level 40 mg/L.
c) Nephrotoxicity.
 Reversible ototoxicity is with >40 mg/L (Irreversible hearing loss with level 80 mg/L)
 Nephrotoxicity.
b
 Rare SE: anaphylaxis, toxic epidermal necrolysis, erythema multiforme, red man syndrome,
superinfection, thrombocytopenia, neutropenia, leukopenia, tinnitus.

Side effects of high dose of Haloperidol:

a) Malignant neuroleptic syndrome.

b) Serotonin syndrome.
c) Hepatotoxicity.
 Side effects of Haloperidol: Extrapyramidal, Hypotension, atropine like action , Prolonged QT interval,
a Pancytopenia, Seizure, Neuroleptic malignant syndrome, visual disturbance, liver dysfunction &
cholestasis, disturbed mood, ↓↑glucose level

In Aspirin overdose:

a) Elevated liver enzymes with peak within 3-4 hours.

a 

Patient with end stage renal failure + colectomy, the best analgesia is:
a) Midazolam.
b) Meperidine.
c) Ketorolac.
d) None of the above
d  None of them is suitable!!!!
Dexamethasone is best used in:

a) ICH.
b) TBI.
c) …blastoma.
c 

35
Critical Care MCQ

Trauma &Neurology

Case: 92 ys old woman admitted 2 days ago with altered mental status. She
is bedridden 6 years ago demented and had Rt CVA. CT brain showed
large LT cerebral stroke.

At midnight she developed hypotension 70/40 and is hypoxic even on non-

rebreathing mask. What is most appropriate?

36
Critical Care MCQ

a) Insert CVc.
b) Start dopamine.
c) Call her doctor to discuss code stat of the patient.
d) Immediate intubation.
d Suspect PE

Vasospasm in SAH:

a) Occurs 48-72 h after SAH.

b) May be improved by good hydration.
c) Independent of the presence of bleeding in subarachnoid space.
 Vasospasm in SAH is delayed complication ( after 4 days, peak 7days upto12 days)
 Amount of blood is good predictor of severity of Vasospasm (esp. thick layer or clots)
b
 TTT: triple H (Hypertension160-200, Hypervolemia by colloid albumin but no effect on mortality,
Hemodilution; PCV 30), nimodepine, papaverin (short effect and rebound)

Patient has head trauma, Bp 180/90, intracranial pressure 15.

What is cerebral perfusion pressure (CPP)?

a) 100.
b) 105.
c) 120.
 CPP=MAP-ICP
b  MAP=DBP+1/3(SBP-DBP)
 Example: 90+1/3 (180-90)=90+30=120 → CPP=120-15=105

Case: RTA+seat belt cause trauma + BP=70/30 + HR=120 + SaO2=89%

→ after intubation & IV fluids (BP=90/40 + HR=110+ SaO2=95%) what
next?
a) ……….
b) …………
c) Fast ultrasound scan.
d) CT chest with contrast.

37
Critical Care MCQ

c  Time & response suspect internal Hge

RTA - front trauma to head, chest and abdomen; which is most fatal?

a) Closed head injury.

b) Transection of Aorta. (aortic disruption)
c) Cardiac contusion.
d) Pelvic trauma.
b  Most fatal !!!!!

CXR of aortic disruption include all of the following except:

a) 1st& 2nd ribs fractures.

b) Tracheal shift to Lt Side.
c) Wide mediastinum.
d) Presence of pleural cap.
b  The trachea is displaced to the patient’s right

Patient with Cervical injury on collar need intubation:

a) Jaw thrust.
b) Head tilt chin lift.
a  Avoid suspected cx fracture displacement

Case: ………162/90+ deep ICH + no hydrocephalus; do what?

a) Antihypertensive.
b) Urgent neurosurgical evacuation.

38
Critical Care MCQ

c) Dexamethasone.
d) Continue observation.
d

Case: RTA: GCS 7/15 +heamodynamic stable + his CT is shown.

Management should include:

a) Hypothermia.
b) Sedation and intubation.
c) Neurosurgical consultation for decompression.
d) Mannitol.
e) ICU observation.
b  Sedation →↓ICP & ETT secure airway (GCS 7): priority to ABC

Case: RTA +GCS7/15 +Decerebrate + CT of no abnormality & follow up

CT is the same but still decerebrate.

a) Neurosurgical consultation for decompression.

b) Monitor ICP
c) Cardiological consultation.
d) ICU observation.
b 

RTA, photo showing RT pneumothorax:

a) Spiral CT.
b) Chest tube.
c) Echo.
d) Thoracoscopy.
b  Save time save life

Case: young ♂ + sudden headache + vomit+ altered LOC + mild neck

rigidity + no focal deficit: appropriate investigation is:
39
Critical Care MCQ

a) CT.
b) LP.
c) EEG.
 Time consuming compared to EEG, less ivasive compared to LP
a
 S/S of SAH

Case: Old ♂ + fall at home; in ER, pale + hypotension + lab: Hb = 6 +

radiology: Lt Neck femur fracture. Initial management is:

a) Open fixation.
b) Laparotomy.
c) Pelvic angiography.
d) Conservative.
d 

In flam burn, the most common cause of immediate death is:

a) Smoke inhalation.
a 

Rule of nine in burn in calculation of resuscitation fluid management:

a) ?
?  Missed choices

Burn both arms & both forearms +front torso; initiated volume is:
a) 1.5 L.
b) 3 L.
c) 5.6 L
c

Lung contusion; what is the true?

40
Critical Care MCQ

a) Caused by stab injury.

b) Mortality is 60 %.
c) Pneumonia is not acomplication.
d) TTT is conservative.
pulmonary contusions will usually resolve in 3 to 5 days, provided no secondary insult
occurs. The main complications of pulmonary contusion are ARDS and pneumonia.
d
Pneumonia is also a common complication of pulmonary contusion, blood in the alveolar
spaces providing an excellent culture medium for bacteria.

41
Critical Care MCQ

Surgery & obstetric

Case: Pregnant + severe vaginal bleeding + 2 previous abortions,

Bp=100/60 + Hb=9 + Plt=66 + PT=21 + PTT=54 + fibrinogen= 0.5: what
is next?

a) Plt transfusion.
b) 2 units of O –ve PRBCs.
c) Antithrombin III.
d) Fibrinogen replacement (Cryoprecipitate).
d Cryoprecipitate to keep fibrinogen > 60 mg/ dL
in PPH report that fibrinogen concentrate therapy is important in patients with
hypofibrinogenemia.6 Initial fibrinogen levels below 2 g/L in women with PPH are associated
with more severe hemorrhage.

Most effective anticonvulsant in Eclampsia:

a) Mg SO4.
a

42
Critical Care MCQ

Hepato-biliary

In liver cell failure encephalopathy (or fulminant cell failure):

a) Daily CT brain.
b) Intra-cerebral pressure monitoring.
c) Echo.
 Target ICP <20 with CPP >50
b
 High ICP is associated with mortality 80% of FHF & 75% of grade 4 encephalopathy

In acute fulminant hepatitis due to paracetamol what is the definitive

treatment?

a) ……………
b) ……………
c) Liver transplant.
c 

What are the most common organisms in spontaneous bacterial

peritonitis?

a) E. coli, Strept.
b) E. coli, pseudomonas.
c) B. fragilis ,klebsilla.
 E-coli 50%, st. pneumonia 25%, klebsiella& enterococci
 TTT: cefotax, cipro, tinam
a
 The most common organisms are E. coli and Streptococcus
pneumoniae.

The following are risk factors for hepatic encephalopathy except:

43
Critical Care MCQ

a) Hypovolemia.
b) Hypokalemia.
c) GI bleeding.
d) Acidosis.
 Risk factors ofhepatic encephalopathy:Hypovolemia (dehydration), Hypokalemia, hyponatremia,
d
GI bleeding (protein content), Alkalosis

Case: 17 year-old boy + Irish + white + PH (not significant except for his
premature delivery) + presented by hematemesis + only splenomegaly 4
Cm under costal margin → supportive TTT + invasive venous monitoring
introduced & measures hepatic wedge pressure = 6 (< 7) & IVC pressure =
3 (<4); what is the diagnosis?

a) Amyloidosis.
b) Bilharziasis.
c) Chronic portal vein thrombosis.
d) Chronic hepatic vein thrombosis.
c  hepatic vein portal gradient = wedged hepatic vein pressure - free hepatic vein pressure

TYPE OF PORTAL HVPG

WHVP FHVP
HYPERTENSION
Prehepatic Normal Normal Normal
Presinusoidal Normal Normal Normal
Sinusoidal Increased Increased Increased
Postsinusoidal
Increased Normal Increased
Posthepatic
Heart failure Increased Increased Normal
Hepatic vein
Budd‐Chiari
— cannot be —
syndrome
cannulated

44
Critical Care MCQ

Acid Base , Electrolytes& Renal

SAH+↓ Na + ↓osmo + urine Na = 100 + UOP = 200ml/h + urea &cr→ N:

a) SIADH.
b) Cerebral salt wasting syndrome.
c) Addison's. (adrenal insufficiency)
 All three options cause: ↓Na+ ↓osmo + ↑urine Na>20
 SIADH is normovolemic (no increased UOP even decreased)
b
 CSWS cause hypovolemic state (↑ UOP) → s/s DCL (↓Na)& hypotension
 TTT: SIADH (fluid restriction) & CSWS (NS± fludrocortisone)

Na=115, UOP is Normal; urine osmolarity is increased in patient with

closed brain injury:

a) SIADH.
b) Salt wasting syndrome.
c) Diabetes insipedus.
a  See above

Which is not a feature of ↑K?

a) Wide QRS.
b) Depressed P wave.
c) Prolonged QT.

45
Critical Care MCQ

 Hypokalemia ECG changes: U waves (height >1 mm), Flat and inverted T waves, Prolonged QT
interval, these changes are not specific for hypokalemia (the T wave changes and U waves can be
seen with digitalis or left ventricular hypertrophy, and QT prolongation can be seen with ↓Ca and
↓Mg).
 Hyperkalemia ECG changes: when the serum K+ reaches 6.0 mEq/L (always abnormal ECG if
c K+ > 8 mEq/L) →
o Earliest: tall, tapering (tented) T wave that is most evident in precordial leads V2 and V3.
Similar “peaked T” waves have been observed in metabolic acidosis.
o Later: the P wave amplitude decreases and the PR interval lengthens, Eventually: advanced
ECG changes → P waves disappear and the QRS duration becomes prolonged & deep S-wave
→ Final event: sine wave ECG pattern which deteriorates to asystole

Patient has Na=142&osm=240:

a) Lab error.
b) SIADH.
 Osmo = 2 Na +Glu/18 + BUN/2.8
a
 So: osm = 2 x 142 =284 (hence it is lab error as glucose & BUN insignificant compared to Na)

All of the following are indications for dialysis CRF except:

a) Volume overload.
b) Hyperkalemia.
c) Hypernatremia.
d) Pericardial rub.

46
Critical Care MCQ

 Pericarditis or pleuritis (urgent indication)

 Progressive uremic encephalopathy or neuropathy, with signs such as
confusion, asterixis, myoclonus, wrist or foot drop, or, in severe cases,
seizures (urgent indication)
 A clinically significant bleeding diathesis attributable to uremia (urgent
indication)
c
 Persistent metabolic disturbances that are refractory to medical therapy; these
include hyperkalemia, metabolic acidosis, hypercalcemia, hypocalcemia, and
hyperphosphatemia
 Fluid overload refractory to diuretics
 Hypertension poorly responsive to antihypertensive medications
 Persistent nausea and vomiting
 Evidence of malnutrition


All are causes of lactate accumulation except:

a) Global tissue (ischemia)???
b) Hepatic insufficiency
c) Thiamine deficiency
d) Severe sepsis
e) Intracellular alkalosis
 LOCAL NOT GLOBALischemia ALSO INCREASES IN MALIGNANCY ,SIEZURES ,POST CARDIAC
ARRREST SEVERE EXERCISE ,LINZOLID ,METFORMAIN,ACETOMINOPHEN,INBORN ERROR OF
a
METABOLISM ,DKA,ALL TYPES OS SHOCK, HEPATIC CELL FAILURE, MITOCHONDRIAL DISEASE,
EPINEPHRINE, PROPOFOL, B2 AGONIST ,THEOPHYLLINE .

Big kidney in CRF except:

a) Amyloidosis.
b) Polycystic kidney.
c) Diabetic nephropathy.
d) Recurrent renal calculi.
 End stage kidney disease caused by diabetes, glomerulonephritis, high
blood pressure, etc.
c Generally speaking, atrophic kidneys have a close link with end-stage
renal disease, because kidney disease can cause damage to nephrons
especially glomeruli that makes kidneys shrunk largely.

False low anion gap (AG) in all except:

47
Critical Care MCQ

a) Lithium ingestion.
b) Hypernatremia.
c) Hypoalbuminemia.
d) Hyperparathyroidism.
AG = Na + K – ( Cl+ HCO3)
there are several important causes of a falsely low anion gap.
These include:

 Laboratory error
 Hypoalbuminemia
 Increased unmeasured cations
 Monoclonal and polyclonal gammopathy; and,
 Salicylate poisoning

B low or even negative AG can develop if there is a reduction in unmeasured anions

or an increase in unmeasured cations [ 2,4,8 ].

The major unmeasured anion in serum is albumin. Albumin has many positive
and negative charges due to ionization of various amino acid side chains. The
ratio of albumin's positive and negative charges changes with the pH of the
solution. At  pH 7.4, albumin carries about 20 more negative charges than positive
charges (therefore each molecule has a net charge of -20). Other unmeasured
anions include phosphate, urate, and sulfate. Unmeasured cations include
potassium (in the United States, where potassium is not included in the anion gap
calculation), ionized calcium, magnesium, and certain abnormal proteins.


ABG interpretation: pH= 7.32 + PCO2 = 75 + PO2 = 65 + HCO3 = 35:
a) Respiratory acidosis
b) Respiratory Alkalosis
c) Metabolic acidosis
d) Respiratory acidosis with Metabolic compensation
 Primary disorder is Respiratory acidosis (pH & PCO2 change in opposite direction)
d  There is partial metabolic compensation as bicarbonate start to change (and this is chronic
disorder)

Calculation of compensation:
Expected pH in respiratory disorder (assuming normal pH 7.40)

48
 Critical Care MCQ

Disorder Common Other methods

Acute respiratory acidosis ∆pH = 0.008 units per 1 mm Hg
∆ pH = 7.40 + [0.008 × (40 - PCO2)]
Acute respiratory alkalosis ∆PCO2 (opposite)
Chronic respiratory acidosis ∆pH = 0.003 units per 1 mm Hg
∆ pH = 7.40 + [0.003 × (40 - PCO2)]
Chronic respiratory alkalosis ∆PCO2 (opposite)

Expected HCO3 in respiratory disorder (Assume a Baseline HCO3 of 24 mEq/L)

Disorder Common [Boston Rule] Other methods
Acute respiratory acidosis HCO3 = 24 + 0.1 (PCO2 – 40)
SBE = 0 ± 3
Acute respiratory alkalosis HCO3 = 24 + 0.2 (PCO2 – 40)
Chronic respiratory acidosis HCO3 = 24 + 0.3 (PCO2 – 40) pH is normal
or
Chronic respiratory alkalosis HCO3 = 24 + 0.5 (PCO2 – 40)
SBE =0.4 × (PCO2 – 40)

Expected PCO2 change for metabolic primary disorder:

Disorder Common Other methods
PCO2 = 40 + SBE (PCO2 rarely < 10 mmHg)
Winter’s Equation:
PCO2 = 1.5 × (HCO3 + 8 ) [Boston Rule]
Metabolic Acidosis Exp.PaCO2 = (1.5× HCO3) + 8 (+/- 2)
PCO2 = last two digits of pH
[1.2 (24 - HCO3)]
∆PCO2 =1.2 ×∆ HCO3
PCO2 = 40 + SBE (PCO2 rarely >60 mmHg)
PCO2= 0.6 × (HCO3 - 24) [Boston Rule]
Metabolic Alkalosis Exp. PaCO2 = (0.7 × HCO3) + 21 (+/- 2)
PCO2 = last two digits of pH
∆PCO2 =0.7 ×∆ HCO3

Which of the following is most correct regarding differentiation between

SIADH & CSWS?

a) Assessment of ECV.
a  See above
Case: Patient on HTN → HF → lanoxin + Lasix +capoten + lab: (urea =
N + cr = 110 Mmol/L + K =4.4) a week later (urea = ↑ + cr= 170 Mmol/L +
K =5); do what?
a) Renal arteriography
b) Flow duplex of renal artery
c) Captopril renogram.
d) Kidney biopsy.
b approach to the evaluation of renovascular disease in patients with renal
insufficiency:

 If technical expertise is available, duplex Doppler ultrasonography is the preferred

initial noninvasive diagnostic test since both gadolinium and radiocontrast media

49
Critical Care MCQ

exposure are avoided .

 If expertise with Doppler ultrasonography is unavailable, we prefer spiral CT scan
with CT angiography in patients with an estimated glomerular filtration rate (GFR)
less than 30 mL/min, despite the risk of radiocontrast nephropathy. In such
patients, preventive measures for contrast nephrotoxicity should be used. (See
"Prevention of contrast-induced nephropathy" .)
 Although MRA with gadolinium had been widely used in the past mainly to avoid
exposure to iodinated radiocontrast media, its use in patients with moderate to
severe renal disease is now severely limited by hospitals because of the risk of
nephrogenic systemic fibrosis, which is often severe. As a result, it is recommended
that gadolinium-based imaging be avoided , if possible, in patients with an
estimated GFR less than 30 mL/min. Opinion among experts differs as to whether
or not one would expose patients with an estimated GFR of 30 to 60 mL/min to
gadolinium since the risk has not been defined. (See "Nephrogenic systemic
fibrosis/nephrogenicfibrosingdermopathy in advanced renal failure", section on
'Avoidance of gadolinium' .)


In hypomagnesemia, all are true except:

a) Hypotension.
b) Seizures.
c) Torsades de pointes.
 Hypotension is due to hypermagnesemia
a  Hypomagnesemia s/s: irritability, Seizures, reactive CNS Mg
deficiency syndrome, Torsades de pointes

In hypomagnesemia, all are true except

a) Hypokalemia.
b) Hypocalcemia.
c) Decreased QT interval.
c 

Case: BP = 80/50 + Na = 165 + Cl = 138 + K = 5.5 + pH= 7.24 + HCO3 =

16 +Glu = 145 + Cr = 1.9. Treatment of hypernatremia is:
a) Normal saline.
b) D5%
c) D5%-NS
d) H2O

50
Critical Care MCQ

d  ?????

Sodium content in normal saline 0.9% is:

a) 154 mmol/L
a  NS 154, ringer 147, LR 130

Hemodialysis is not appropriate for:

a) Lithium toxicity.
b) Aspirin toxicity.
c) Ethylene glycol.
 Drugs not removed by dialysis: Digoxin, Tricyclic antidepressants, Beta blockers,
? Benzodiazepines, Sulphonylurea, Phenytoin
/a  Drugs removed by dialysis: Ethanol, Methanol, Aspirin, Lithium, Barbiturates, Gentamicin,
Cephalosporins, Paraquat, Ethylene Glycol

Metabolic alkalosis:
a) Low anion gap + high base excess
Metabolic acidosis:
a) high anion gap + base deficit

a  AG = Na – (Cl + HCO3)

Young man altered LOC → ER; ABG (pH = 7.35 + PCO2 = 29 + HCO3 =
14 + O2 sat = 97); interpretation is:
a) Delay of ABG analysis.
b) Respiratory alkalosis.
c) Compensated Respiratory acidosis
d) Compensated Metabolic acidosis
d 

Case: RTA + trapped 2 h in the car → ER (ETT + resusc) +ICU admission

after 6 hours; nurse call for little urine withred brown color do what?

51
Critical Care MCQ

a) IV fluid bolus.
b) Do cK& start NS + ampule HO3with rate 100mL/h.
b 

Nutrition

In TPN which does not need monitoring:

a) Cholesterol.
b) Mg and Ph.
c) Liver function.
 All choices are to be monitored but cholesterol is the least important (TAG is more important to
predict complication e.g. pancreatitis)
a  22% of long-term PN patient deaths arerelated to PN-related liver failure (Fatty liver,
Cholestaticliver&AcalculousCholecystitis)
 Mg and Ph. For refeeding syndrome

BeriBeri heart failure cause:

a) Thiamine deficiency.
a  B1

SIDE effects of NGT:

a) Sinusitis.
a 

Patient on NGT feeding develops increased frequency of stool loss; do

what?
a) Stop feeding.
b) IV ciprofloxacin.
c) Add metronidazole.
 Must first exclude infectious cause of diarrhea
c
 Then assume concentrated formula as a cause (TTT: dilution, add lopeamide)

52
Critical Care MCQ

Case: Patient with pneumonia + Vancomycin for MRSA + start entral

feeding; nurse inform that Pt has 7 stool loss in last 8 hours; do what?

a) Stop Vancomycin.
b) Add metronidazole 500mg/8h IV.
c) Stop feeding.
d) Add kaopectate to feeding formula.
 intravenous metronidazole at a dose of 500 mg every eight hours may also be used for
treatment of CDI in patients in whom oral therapy is not feasible. Fecal concentrations in
b
the therapeutic range are achievable with this regimen because of the drug's biliary
excretion and increased exudation across the intestinal mucosa during CDI
Which of the following is not acceptable in diagnosis of CDI?

a) Stool culture with growing clostridium difficile.

b) Detection of Toxin in stool.
c) Colonoscopy.
d) Sigmoidscopy.
 ? in some cases, pseudomembranes may be absent in the rectosigmoid area but may be
d
visualized more proximally with colonoscopy

53
Critical Care MCQ

Miscellaneous

In euthyroid sick syndrome:

a) ↓T3.
b) ↓T4.
c) ↑T3.
d) ↑TSH.
 Euthyroid sick syndrome: generally ↓T3 + ↓T4 + ↓TSH (but mainly conversion of T4 to T3 →↓↓T3)
a  Etiology: severe illness, tumor, other endocrinal alternation
 TTT: no clinical significance (may not need TTT)

Case: 17 year female + 2 hours acetaminophen toxicity; do what?

a) Charcoal.
b) Ipecac.
c) Lavage + N-acetyl cysteine.
 Toxic dose of acetaminophen at 150 mg/kg or smaller doses over several days
 NAC is administered as early as possible, although its effect is seen even 48 hours after ingestion
 Dose: either
c o IV; loading 150 mg/kg + D5W →50 mg/kg over 4 hs→100 mg/kg over 16 hs.
o PO; loading 140 mg/kg → 70 mg/kg /4hs ×16 doses (4 days) → (bad taste & sever vomiting
even need multiple antiemetic).
o No time limit to NAC (may be continued till transplant or cure or death)

54
Critical Care MCQ

Organophosphors poisoning; what is antidote?

a) Atropine
 Antidote is atropine and in severe cases with DCL & twitches PAM (Obidoxime Chloride =
a
Toxogonin®)

All are S/S of TTP except:

a) Liver dysfunction.
a  TTP pentad: MAHA, thrombocytopenia, fever, RI, neurosymptomps

All causing alveolar Hge except:

a) Pneumocystis carnii.
a 

SAP (Simplified Acute Physiology) score is based on:

a) Underlying comorbid illness.
a 

Methanol toxicity all occur except:

a) Renal failure.
b) High osmolar gap.
c) Blindness.
d) Severe severe anion acidosis.
c 

Which is not correct about malignant hyperthermia?

a) Autosomal dominant inheritance.

b) Occurs with non-depolarizing NMD.
c) May cause rhabdomyolysis.
d) TTT is Dantrolene.
b 

55
Critical Care MCQ

Level of evidence in Study:

 Ia: Evidence from Meta-analysis of Randomized Controlled Trials

(RCT)
 Ib: Evidence from at least oneRCT
 Ic:All or none RCT
 IIa: Evidence from at least one well designed controlled trial which
is not randomized (cohort)
 IIb: Evidence from at least one well designed experimental trial
 III: Evidence from case-control study, correlation, and comparative
studies.
 IV:Case-series (and poor quality cohort and case-control studies)
 V:Evidence from a panel of experts

Important issues:
 Dose of Ipanutin (Phenytoin)
 Side effect of betablocker
 Treatment of dissecting aortic aneurysm
 ACLS
 Salt wasting syndrome
 Na
 ARDS
 Rhabdomyolysis
Review the book:Self-Assessment in multiprofessional critical care, 6thed

+(side effect labetalol…….orthostatic hypotension………role of 9 in

burn…..parkland formula……epanutin max rate>>50mg\min……cmv
and liver…..chapter hemdynamic self Ass 6)

Questions branches
Percent 70
Item
100% questions
Ventilator & ARDS 20% 14

56
Critical Care MCQ

Hemodynamic & Shock 20% 14

Cardiovascular Diseases 10% 7
Infectious Diseases 10% 7
Trauma 10% 7
Surgical Critical Care & Gynecology& others 10% 7
Pharmacology & Medical Therapeutics 5% 4
Nephrology, electrolyte & ABG 5% 4
Pulmonary Diseases 5% 3
Neurological Critical Care 5% 3
Pass degree 60%

‫ال تنسونى~ من صالح دعائكم بالهداية و المغفرة ومعذرة اذا كنت نسيت شئ وبالتوفيقان شاء هللا‬

1. 70y old pt with history of angina. Develop weakness in both LL &

urine retention, 4 hrs later the weakness became in the 4 limbs most
common cause is:

a. Anterior spinal artery occlusion

b. Transverse myelitis
c. Spinal cord compression
d. ‫) مش فاكر~ بس مش‬ischemia or hge)

2. In rta blood transfusion at hb level of:

a. 50g/l b. 60 c. 70 d. 80
b. transfusion is rarely indicated when the haemoglobin concentration is >10 g dl–1 but is
almost always indicated when it is <6 g dl–1

3. 19y pt with rt tender calf pt, tt normal apt 73 (high)

a. Lupus coagulant b. dic c. heamophilia
c. von wilbrand

57
Critical Care MCQ

Prolonged PTT tests may be due to:

 Inherited factor deficiencies:

o vonWillebrand disease is the most common inherited bleeding disorder and it
affects platelet function due to decreased von Willebrand factor.
o Hemophilia A and hemophilia B (Christmas disease) are two other inherited
bleeding disorders resulting from a decrease in factors VIII and IX, respectively.
o Deficiencies of other coagulation factors, like factors XII and XI

4. 52y pt smoker presented by hemoptysis most incorrectmanag. Is

a. Till determine the amount of bleeding Npo as it may be preop.
b. 2 L of fluid i.v
c. Ttt of infection is important
d. Encourage cough to prevent blood to accumulate in lungs

5. Pt with community acquired pneumonia treated by antibiotic 3days

ago but still symptomatictlc 8 developed maculopapular rash on
trunkcxr bilateral consolidation most cottrct organism is:

a. Epstein bar v. b. influenza virus c. klebsillapn.

e. Mycoplasma pn.

6. 14 y female developed fever, puffiness of eye led after sore throat .at
age 10 she had attack of sore throat but resolve uneventful. The ptwt
increased 5 kg last few months. Urine protein ++++ . serum albumin
25 g/l ,edema of both ll. correct ttt is:

a. Sodium poor albumin b. aminoglycosides c. cyclosporine ‫او‬

cyclophosphamide ‫مش فاكر‬
d. high dose steroids

58
Critical Care MCQ

7. 50y pt on assisted control vent. Rr 10 but assisted to 18. Abgph 7.51

po2 75 paco2 28

a. Put pt on psv
b. Sedate the pt to decrease assisted breathes
c. Put him on pressure control
d. Add 200ml of dead space

8. The following curve of pressure waveform is due to:

a. Psv
b. Spontaneous brathing with cpap
c. Pressure control
d. simv

‫شبه ده تقريبا‬

9. 90y ischemic ef 35 % dmhtn , after falling in bath; fracture neck

femur. Presented by hypotension tachycardia hb 6. ct abdomen
collection. most correct management

a. Laparotomy
b. Open fracture repair
c. Conserve
d. Angiogram

59
Critical Care MCQ

10.62y pt history of stroke .na 168 k 5.5 glucose 146 cr 1.8 urea 75
bicarb 16 blood pr 80/60
Correct fluid therapy is:

a. d5% in water
b. 0.45 nacl
c. D5% in water with 150meq nabicarb
d. 0.9 nacl

11.Most common risk in uti in icu is:

a. cordum catheter c. systemic infection and bacteremia

b. ……..

12.Old Pt DM, HTN post aortofemoral bypass in icu. 3 days later

develop tachycardia & decrease in blood pressure most common
cause is:

a. Pancreatitis
b. Bowel ischemia
c. Graft occlusion
d. Myocardial infarction

13.70y old pt with history of angina. Develop weakness in both LL &

urine retention, 4 hrs later the weakness became in the 4 limbs most
common cause is:

e. Anterior spinal artery occlusion

f. Transverse myelitis
g. Spinal cord compression
h. ‫) مش فاكر~ بس مش‬ischemia or hge)

60
‫‪Critical Care MCQ‬‬

‫دول اللي كانو رخمين شوية الباقي من االسئلة السابقة اللي الزمالء كانوا منزلينهم~ قبل كده‬
‫‪ + hemodynamics‬اسئلة الكتاب اللمعروفة بتاعت ال‬
‫بالتوفيق ان شاء هللا‬

‫‪.‬‬

‫‪61‬‬