Day 1 Critical Care Answers TP_Yeung

Critical Care MCQs: 

Critical Care MCQs Dr Joyce Yeung SpR Anaesthesia and ICM

Question 1: 

Question 1 False True convection (‘solvent drag’) plus ultrafiltration False does not require any blood pressure in patient(!) False variable and difficult to predict dosage adjustment False can use heparin as first line (cheaper), prostacyclin in HIT

Question 2: 

Question 2 False 32-34°C False only studied in VF arrest True True False 2 studies, 275 patients and 77 patients Bernard SA , Gray TW, Buist MD et al . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002 ; 346:557-563 The Hypothermia after Cardiac Arrest Study Group . Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002 ; 346:549-556. Anaesthesia UK

Question 3: 

Question 3 False non-specific; plus 2 of: purulent secretions, WCC ↑or↓, temp>38 True True False not thought cost-effective; worry over C. Diff. and resistance True NICE guideline, PSG002

Question 4: 

Question 4 True False Hagen-Poisseuille equation True True eg hand washing, gown, mask; ‘Matching Michigan’ False NHS Saving Lives Campaign, High Impact Intervention 1

Question 5: 

Question 5 False not required but recommended True eg Portex True serial dilatation True Portex Blue Rhino False (Higgins KM et al. Laryngoscope. 2007 Mar;117(3):447-454)

Question 6: 

Question 6 True due to possibility of air trapping True True eg incomplete emptying True lower inflection point; static better than dynamic False not predictable

Question 7: 

Question 7 True False Compliance is all or none True False Not a substitute True

Question 8: 

Question 8 False no legal time limit True electrolyte abnormality must be consequence, NOT cause False EEG not required in UK; should be isoelectric True potential cause of unconsciousness True slowly towards, sometimes fast nystagmus away Academy of Medical Royal Colleges 2008

Question 9: 

Question 9 True True False absolute contraindication False warm ischaemic time<30 min False excludes primary brain tumour and non-melanoma skin cancer Donation after circulatory death. CEACCP 11(3); June 2011

Question 10: 

Question 10 False open lung True keeps bronchoalveolar units open False not clear how CO2 moves out of lung False no minimum, but efficiency decreases with increasing impedance True movement of chest from shoulder to groin

Question 11: 

Question 11 True Pinet et al, Lancet 2000 356:1307-1312 False False NHS Evidence True Cochrane, Issue 3, 2009 False no persuasive evidence published

Question 12: 

Question 12 True False some weak α 1 True seen in around 20% patients at start of administration False mcg/kg/ min False not recommended in saline, use water or dextrose

Question 13: 

Question 13 True True False 1-4 for 6 organs True False urine output, serum creatinine compared to baseline A comparison of severity of illness scoring systems for intensive care unit patients: Results of a multicenter, multinational study Xavier et al. Critical Care Medicine 23(8);1327-1335

Question 14: 

Question 14 True Verma et al. Critical Care 199, 3 (suppl 1):P182 False clotting factor synthesis is more accurate False >95% False although abstinence is preferable False mannitol better, furosemide causes uraemia

Question 15: 

Question 15 False Pedonomos et al. Critical Care 2005, 9 (Suppl 1):P404 True True True may prevent uric acid crystal formation False occurs in 10-40% cases

Question 16: 

Question 16 True False fibrinogen must be low to diagnose DIC False cryoprecipitate contains more fibrinogen; need other factors too True True

Question 17: 

Question 17 True False should be continued or change to treatment dose if required False 1 hour True True ICU and patients with haematological malignancy. CEACCP 10(6); Dec 2010

Question 18: 

Question 18 True False should be greater than 7.1 False must have airway reflexes False True British Thoracic Society; NICE

Question 19: 

Question 19 True True False dangerous to correct rapidly – central pontine myelinolysis True False up to 20mmol/l is normal

Question 20: 

Question 20 True 3:2 False 10% False Fischer Score is based on CT appearance True False Only Nimodipine has been shown to improve outcome

Single Best Answer questions: 

Single Best Answer questions Single Best Answer questions

Question 1: 

Question 1

Question 1: 

Question 1 Sepsis a: not top priority; blood cultures first b: will be useful later for S CV O 2 and CVP c: helps assess adequacy of resuscitation; need ‘baseline’ d: resuscitation needed in this case e: important, but after resuscitation has been commenced Surviving Sepsis Campaign 2008, Resuscitation (6hr) Bundle

Question 2: 

Question 2

Question 2: 

Question 2 Vasospasm a: may need doing soon, but not first b: not helpful unless evidence of raised ICP also c: restore perfusion; prevent ischaemia d: neurosurgeons and/or radiologist should be made aware e: may help but time-consuming to arrange; questionable accuracy Guidance from WFNS; later, balloon angioplasty, papaverine (AJNR)

Question 3: 

Question 3

Question 3: 

Question 3 Status epilepticus a: 4mg is adequate dose b: maybe needed, no history c: unlikely to be effective in acute setting d: 20mg/kg to be given not quicker than 50mg/min e: second dose NICE guidelines CG20

Question 4: 

Question 4

Question 4: 

Question 4 Catheter-related BSI a: resistance, cost, side effects b: effective, cheap, safer overall (NB risk of CVC insertion) c: may deteriorate in meantime; source control d: wound problem not mentioned e: not a treatment but possibly for patient comfort CDC guidelines; British Society for Anti-microbial Chemotherapy (BSAC)

Question 5: 

Question 5

Question 5: 

Question 5 Myaesthenia gravis a: possible but ptosis not common; usually generalized weakness b: common presentation c: not usually dysphagia; trunk weakness uncommon; balance d: focal signs more commonly e: muscle pain common; eye signs late Oxford Textbook of Medicine

Question 6: 

Question 6

Question 6: 

Question 6 ARDS a: usually anatomic delineation (eg lobar) b: more localized c: apical sparing; multitrauma; criteria (4) d: usually unilateral e: would be more ‘solid’ ardsnet.org; British Thoracic Society; Radiology for Anaesthetists

Question 7: 

Question 7

Question 7: 

Question 7 Cooling after cardiac arrest a: moderately effective; vasoconstriction may decrease effect; frostbite b: vasoconstriction c: most effective of these options d: quite effective; cheap; infection risk? e: useful adjunct; not effective alone Also possible: ice plunge, cold fluids NG/PU/PR; intranasal; endovascular (eg Arctic Sun)

Question 8: 

Question 8

Question 8: 

Question 8 Organ donation a: if on ODR, no legal power to veto b: no relevant power to prevent donation but may request halting process c: cannot block process but may refuse to prosecute if carried out d: can ethically refuse but must find another colleague to take over e: only HM Coroner can absolutely refuse to allow donation Ministry of Justice

Question 9: 

Question 9

Question 9: 

Question 9 Atrial fibrillation a: rapid loading dose effective, effect more sustained than DC*; avoids GA b: requires GA; reverts more often* c: risk of hypotension; good for rate control but NOT cardioversion** d: slows rate but not cardioversion e: may revert spontaneously * North American Society of Pacing and Electrophysiology; **SAFE-T trial (Sotalol)

Question 10: 

Question 10

Question 10: 

Question 10 Diabetes insipidus (central) a: longer acting than vasopressin; no effect on bp; nasal route available b: replace water deficit; quicker than NG c: replace water; more ‘physiological’ d: will help, but Na + homeostasis is not usually the problem e: No effect * ↓ECF causes ↓GFR and increased proximal tubule water and Na + reabsorption