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Anaesthesiology MCQs 1- 5th Year PMU

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Anaesthesiology Final MCQs- 5th Year PMU
Med Student
Quiz by Med Student , updated more than 1 year ago
Med Student
Created by Med Student over 4 years ago
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Question 1

Question
All but ONE of the following are predictors of a difficult intubation. Indicate the exception
Answer
  • Mouth opening of only 3 fingerbreadths
  • Short, thick neck with limited mobility
  • Mallampati Class IV
  • Thyromental distance of 2 fingerbreadths

Question 2

Question
ALL BUT ONE of the following factors represent an indication for intubation in a patient who is about to undergo surgery. Indicate the exception
Answer
  • Surgery is a lumbar laminectomy
  • Surgery is removal of a lymph node of the neck
  • Surgery is appendectomy
  • Surgery is tonsillectomy

Question 3

Question
Which ONE of the following structures is not encountered during direct laryngoscopy?
Answer
  • Vallecula
  • Cricoid cartilage
  • Epiglottis
  • Arytenoid cartilage

Question 4

Question
The COMPLETE absence of a capnographic waveform immediately following endotracheal intubation may indicate ALL BUT ONE of the following. Indicate the exception
Answer
  • Circuit disconnection
  • Cardiac arrest
  • Endobronchial intubation
  • Complete airway obstruction
  • Esophageal intubation

Question 5

Question
After induction of anesthesia, the anesthesiologist is unable to intubate the patient. Which ONE of the following is the most important management priority?
Answer
  • Ensuring that intubation is achieved as soon as possible
  • Inserting a laryngeal mask
  • Ensuring that bag-mask ventilation is achievable
  • Ensuring that the patient does not awaken until intubation is successfully achieved

Question 6

Question
Advantages of a Laryngeal mask airway include ALL BUT ONE of the following. Indicate the exception
Answer
  • It frees up the anesthesiologist’s hands
  • It protects against aspiration
  • It can allow mechanical ventilation
  • It can be readily inserted without the use of muscle relaxants

Question 7

Question
ALL BUT ONE of the following are ways to confirm endotracheal intubation. Indicate the exception
Answer
  • Auscultation of both lung fields and over the stomach
  • Visualization of the endotracheal tube through the vocal cords
  • Easy advancement of the endotracheal tube without resistance
  • Presence of a stable CO2 trace on the end-tidal capnography

Question 8

Question
The “transfusion trigger” (the lowest allowable hemoglobin level) intra-operatively is
Answer
  • 100 g/L
  • 80g/L
  • 60g/L
  • Individualized to every patient

Question 9

Question
ALL BUT ONE of the following are early indicators of hypovolemia. Indicate the exception
Answer
  • Tachycardia
  • Decreased pulse pressure
  • Decreased urine output
  • Lactic acidosis

Question 10

Question
The maintenance fluid requirement for an 80 kg man using the 4-2-1 rule is
Answer
  • 100 cc/hr
  • 120 cc/hr
  • 150 cc/hr
  • 170 cc/hr

Question 11

Question
Milllilitre for millilitre, which of the following provides the most intravascular volume expansion?
Answer
  • Packed red blood cells
  • Albumin (5%)
  • Pentaspan
  • Ringers Lactate

Question 12

Question
A patient has lost 500ml of blood during a low anterior bowel resection. His hemoglobin is 115 g/L. What is the most appropriate volume replacement?
Answer
  • Pentaspan 1500 mL
  • DSW 500 mL
  • Ringers Lactate 500 mL
  • Normal Saline 1500 mL

Question 13

Question
Regarding vascular access and fluid resuscitation, which ONE of the following statements is TRUE?
Answer
  • An intravenous is required for procedures under local anesthesia such as carpal tunnel release or cystoscopy
  • Cannulation of a lower limb vein is inappropriate for use in the operating room
  • Cannulation of the jugular vein for central venous pressure monitoring is recommended in lengthy cases with the potential for significant fluid shifts.
  • A 14 gauge central line will allow more rapid fluid resuscitation than a 14 gauge peripheral canula

Question 14

Question
A patient receives 10 units of packed red blood cells. Which ONE of the following chemistry profiles is most likely?
Answer
  • Hyperkalemia, hypercalcemia
  • Hypokalemia, hypocalcemia
  • Hyperkalemia, hypocalcemia
  • Hypokalemia, hypercalcemia

Question 15

Question
Which ONE of the following procedures would be associated with the most “third space" loss of fluid?
Answer
  • Open reduction, internal fixation of the pelvis
  • Whipple resection of the pancreas
  • Resection of large frontal brain tumour
  • Caesarian section

Question 16

Question
Routine preoperative hemoglobin is NOT required for
Answer
  • A healthy female over 50 years of age
  • A patient who has been crossmatched for surgery
  • A patient on anticoagulant medication
  • A young female patient with menorrhagia

Question 17

Question
Which ONE of the following is the most important determinant of peri-operative risk?
Answer
  • Patient’s underlying health
  • Length of surgery
  • Duration of surgery
  • Emergency surgery

Question 18

Question
Which of these patients is NOT at increased risk of aspiration?
Answer
  • A pregnant patient (32 weeks gestation) who has been NPO (nil per os) for 10 hours
  • A patient with fractured femur who has been NPO since the accident 12 hours ago
  • A healthy patient with appendicitis
  • A healthy patient who had 8 ounces of clear tea 4 hours pre-operatively

Question 19

Question
The following medication should be discontinued prior to surgery and anesthesia
Answer
  • Anticonvulsants
  • Thyroid replacement
  • Monoamine-oxidase inhibitors
  • Antihypertensives

Question 20

Question
A patient with which ONE of the following conditions requires antibiotic prophylaxis prior to tonsillectomy?
Answer
  • Uncorrected Tetralogy of Fallot
  • Aortic stenosis
  • Uncomplicated heart transplant
  • Prophylaxis is not required for tonsillectomy

Question 21

Question
A patient is on prednisone 30 mg daily for rheumatoid arthritis and presents for coronary bypass surgery. Which of the following best describes their peri-operative steroid requirements?
Answer
  • 30mg prednisone orally on day of surgery
  • 25 mg hydrocortisone IV on day of surgery
  • 25 hydrocortisone IV for 72 hours
  • 100 mg hydrocortisone IV for 72 hours

Question 22

Question
A 60-year old man for minor surgery has a BP of 170/100 mmHg in the pre-operative clinic. In retrospect, he admits that his blood pressure has been consistently high when he checks it at the drugstore. Assign an ASA class.
Answer
  • ASA 1
  • ASA 2
  • ASA 3
  • ASA 4

Question 23

Question
ALL BUT ONE of the following describes the CO2 absorber. Indicate the exception
Answer
  • Changes colour as the soda lime becomes exhausted
  • Is required if a circle circuit is being used
  • Allows for economical use of anaesthetic gases
  • Provides a waveform of exhaled carbon dioxide

Question 24

Question
Which ONE of the following statements regarding the peripheral nerve stimulator is true?
Answer
  • Delivers four successive impulses at a rate of 2 per second
  • Is a sensitive indicator of neuromuscular blockade
  • Must be used on the awake patient to achieve a baseline
  • Is commonly applied to the radial nerve

Question 25

Question
A patient is receiving a balanced anesthetic with volatile anesthetic gases, opioids and muscle relaxants. Which ONE of the following monitors is required to be in continuous use during the care of this patient?
Answer
  • Temperature probe
  • Agent-specific gas monitor
  • Peripheral nerve stimulator
  • Spirometer

Question 26

Question
ALL BUT ONE of the following interfere with accurate pulse oximetry measurements. Indicate the exception:
Answer
  • Nail polish
  • Peripheral vasoconstriction due to hypothermia
  • Severe anemia (Hg 60 g/L)
  • Methemoglobinemia
  • Carbon monoxide

Question 27

Question
ALL BUT ONE of the following conditions will cause the capnograph to give a reading that is much lower than the arterial CO2. Indicate the exception
Answer
  • Pulmonary embolus
  • Exhausted CO2 absorber soda lime
  • Cardiac arrest
  • Severe bronchospasm

Question 28

Question
The abbreviation “MAC” stands for
Answer
  • Minimal arterial concentration
  • Minimal alveolar concentration
  • Maximal arterial concentration
  • Maximal alveolar concentration

Question 29

Question
Regarding awareness, ALL BUT ONE of the following statements are correct. Indicate the exception
Answer
  • There is no "gold" standard for measuring level of consciousness
  • Volatile agents are effective amnestic agents
  • Changes in heart rate and blood pressure can be used as surrogate indicators of level of consciousness
  • Opioids (in high doses) provide effective hypnosis

Question 30

Question
The immediate goals of emergence include ALL BUT ONE of the following. Indicate the exception
Answer
  • The ability of the patient to protect their airway
  • Stable cardiovascular status
  • Normal mental status examination
  • Effective analgesia

Question 31

Question
The advantages of regional anesthesia include ALL BUT ONE of the following. Indicate the exception
Answer
  • Improved outcomes for certain procedures (e.g. thoracic surgery, Caesarean section
  • Ability to continue technique postoperatively to provide pain relief
  • A reliable option for patients not well enough to undergo general anesthesia
  • Avoidance of systemic administration of drugs and consequent side effects

Question 32

Question
Hypothermia is associated with ALL BUT ONE of the following. Indicate the exception
Answer
  • Post operative hypoxemia
  • Decreased platelet function
  • Myocardial ischemia
  • Increased analgesic requirements

Question 33

Question
Adequacy of reversal of muscle relaxation can be assessed by ALL BUT ONE of the following. Indicate the exception
Answer
  • Strong hand grip
  • The return of the eyelash reflex
  • Train of four shows 4 twitches with no fade
  • 5 second head lift

Question 34

Question
Tracheal intubation would be required in ALL BUT ONE of the following procedures. Indicate the exception:
Answer
  • Open cholecystectomy
  • Laparoscopic cholecystectomy
  • Excision of lymph node from the neck
  • Tonsillectomy

Question 35

Question
Known complications related to positioning include ALL BUT ONE of the following. Indicate the exception
Answer
  • Brachial plexus injury with arm abduction of 60°
  • Hypoxemia in the Trendelenburg position
  • Common peroneal nerve injury in the lithotomy position
  • Retinal ischemia in the prone position
  • Venous air embolus with the sitting position

Question 36

Question
Regarding the comparative considerations of epidural and spinal anesthesia, which ONE of the following is CORRECT?
Answer
  • The lumbar puncture for a spinal anesthetic should be performed above L1 to avoid trauma to the cauda equina
  • The epidural space is identified by puncture of the dura and free flow of cerebral spinal fluid
  • A postdural puncture headache is a potential complication that occurs with both spinal and epidural techniques
  • Epidural anesthesia is usually faster in onset than spinal anesthesia

Question 37

Question
Early signs and symptoms of local anesthetic toxicity include ALL BUT ONE of the following. Indicate the exception
Answer
  • Tinnitus
  • Perioral numbness
  • Dizziness
  • Hypertension

Question 38

Question
Shivering can lead to ALL BUT ONE of the following. Indicate the exception:
Answer
  • Myocardial ischemia
  • Increased oxygen consumption
  • Decreased carbon dioxide production
  • Interference with monitor signal interpretation

Question 39

Question
Which ONE of the following statements about shivering is correct?
Answer
  • Shivering is a response controlled by the brainstem
  • Shivering can occur in the absence of hypothermia
  • Shivering is effectively treated with small doses of naloxone
  • Shivering is an uncomfortable, though harmless, effect of anesthesia

Question 40

Question
ALL BUT ONE of the following are used as intravenous antiemetics. Indicate the exception
Answer
  • Prochlorperazine
  • Ranitidine
  • Dimenhydrinate
  • Dexamethasone

Question 41

Question
Which of the following is a risk factor for PONV?
Answer
  • History of gastroesophageal reflux
  • Smoking
  • Diabetes mellitus
  • Female gender

Question 42

Question
Which ONE of the following is part of a rational approach to post-operative nausea and vomiting?
Answer
  • All patients should receive pharmacologic prophylaxis
  • Avoidance of anti-emetic anesthetic agents is an effective management strategy
  • Prophylaxis must be given prior to induction of anesthesia for maximal effectiveness
  • Dimenhydrinate remains the mainstay of PONV prevention and treatment

Question 43

Question
Which ONE of the following is least likely to be the cause of hypertension in the PACU?
Answer
  • Pain
  • Airway obstruction
  • Prolonged spinal blockade
  • Full bladder

Question 44

Question
Which ONE of the following is a criteria that the patient must meet prior to transfer from the post-anesthetic care unit (PACU) to the ward?
Answer
  • Normal cognitive function
  • Adequate pain control
  • Ability to hold down food
  • Ability to weight-bear

Question 45

Question
You see a patient in the preoperative assessment clinic prior to her laparotomy for colon cancer. If the patient has an epidural inserted for post-operative pain, she is likely to experience ALL BUT ONE of the following. Indicate the exception
Answer
  • Reduced adrenal activation
  • Hypertension
  • Improved respiratory function
  • Excellent post-operative pain control

Question 46

Question
Your patient's most recent surgery was thirty years ago after which she received "conventional" nurse-administered opioid analgesia. For her upcoming lumbar spinal decompression and instrumentation, she will be receiving PCA (patient- controlled analgesia). The comparative advantages of PCA morphine include ALL BUT ONE of the following. Indicate the exception
Answer
  • Less labor intensive for nurses
  • More opioid delivered to the patient
  • Improved patient satisfaction
  • Small doses at frequent intervals minimizing the pharmacokinetic "peaks" and “valleys”

Question 47

Question
ALL BUT ONE of the following is a relative contraindication to post-operative epidural analgesia. Indicate the exception
Answer
  • Multiple sclerosis
  • Lumbar disc disease
  • Hypertrophic obstructive cardiomyopathy
  • Myasthenia gravis

Question 48

Question
All BUT ONE of the following are true regarding malignant hyperthermia (MH). Indicate the exception
Answer
  • Newer volatile anesthetics such as desflurane are not believed to trigger MH
  • Nitrous oxide is safe
  • Dantrolene is the only therapeutic drug treatment
  • Mortality is as high as 10% even with prompt treatment

Question 49

Question
Which of the following is the first sign of a malignant hyperthemic reaction?
Answer
  • Hyperthermia
  • Hypercarbia
  • Tachycardia
  • Ventricular arrhythmias

Question 50

Question
Treatment of a malignant hyperthermia crisis includes ALL BUT ONE of the following. Indicate the exception
Answer
  • Turning off the volatile anesthetic
  • Active cooling measures
  • Dantrolene
  • Beta blockers

Question 51

Question
Maternal hypotension in the supine position during pregnancy is most often due to
Answer
  • Decreased blood volume
  • Decreased peripheral vascular resistance
  • Decreased hematocrit
  • Compression of the vena cava

Question 52

Question
ALL BUT ONE of the following represent relevant physiologic changes of pregnancy in the 40 week gestation parturient. Indicate the exception
Answer
  • Decreased cardiac output
  • Delayed gastric emptying
  • Increased blood volume
  • Decreased anesthetic requirements

Question 53

Question
In the obstetrical patient in her third trimester, the supine position
Answer
  • Should be avoided by placing a pillow under her knees
  • Is detrimental due to the risk of causing excessive venous return to the right heart
  • Is harmful to the mother, but is harmless to the fetus
  • Is safe at 20 weeks of pregnancy

Question 54

Question
ALL BUT ONE of the following are part of rational fasting guidelines for pediatric patients. Indicate the exception
Answer
  • Solids up to 8 hours pre-op
  • Clear fluids up to 3 hours pre-op
  • Breast milk up to 4 hours pre-op
  • Formula up to 2 hours pre-op

Question 55

Question
The narrowest portion of the neonate's airway is at the level of the
Answer
  • Glottis
  • Cricoid
  • Trachea
  • Pharynx

Question 56

Question
The appropriate size endotracheal tube for a 4 year old child is
Answer
  • 4.0
  • 4.5
  • 5.0
  • 6.0

Question 57

Question
ALL BUT ONE of the following represents attributes of the pediatric cardiovascular system. Indicate the exception
Answer
  • Cardiac output is heart-rate dependent
  • Hypoxemia is an important cause of bradycardia
  • Blood volume is greater, relative to size
  • Vagal responsiveness is under-developed

Question 58

Question
Which ONE of the following is an explanation for rapid desaturation during apnea that is seen in the pediatric patient?
Answer
  • Increased functional residual capacity (FRC)
  • Increased oxygen consumption
  • Increased minute ventilation
  • Obligate nasal breathing

Question 59

Question
ALL BUT ONE are features of the pediatric airway compared to the adult. Indicate the exception
Answer
  • Larynx situated higher
  • Larynx situated more anteriorly
  • Epiglottis shorter and less mobile
  • Narrowest part of the airway at the cricoid

Question 60

Question
The use of epidural analgesia for labour is likely to result in which ONE of the following
Answer
  • Prolonged second stage
  • Increased risk of operative delivery
  • Neonatal depression
  • Maternal sedation

Question 61

Question
ALL BUT ONE of the following is a disadvantage of general anesthesia for Caesarian section. Indicate the exception
Answer
  • Increased risk of aspiration in the pregnant patient
  • Increased anesthetic requirements
  • Exacerbation of uterine atony
  • Increased risk of awareness under anesthesia

Question 62

Question
Which ONE of the following is an accurate statement regarding the use of spinal anesthesia for Caesarian section?
Answer
  • Quick and easy in the setting of emergency Caesarian section
  • Associated with decreased maternal morbidity
  • Associated with increased neonatal depression
  • Presents less of a risk of maternal hypotension compared with general anesthesia

Question 63

Question
Nitrous oxide is contraindicated in ALL BUT ONE of the following settings. Indicate the exception
Answer
  • Total hip arthroplasty in the lateral position
  • Laparotomy for bowel obstruction
  • Multiple trauma with pneumothorax
  • Patient with history of severe post operative nausea and vomiting

Question 64

Question
Which class of drugs is most commonly responsible for intraoperative anaphylactic (or anaphylactoid) reactions?
Answer
  • Opioid analgesic agents
  • Induction agents
  • Muscle relaxants
  • Volatile anesthetic agents

Question 65

Question
Other than analgesia, what is the most important clinical effect of the opioid analgesics?
Answer
  • Cardiac depression
  • Sedation
  • Nausea and vomiting
  • Respiratory depression

Question 66

Question
Which ONE of the following describes an advantage of sevoflurane over desflurane?
Answer
  • Lower lipid solubility therefore quicker onset and offset of effect
  • Less pungent therefore more practical for mask induction
  • Can be used with lower flows therefore more economical
  • Mild sympathomimetic effect minimizes hypotension

Question 67

Question
Which ONE of the following best describes the reason for the rapid OFFSET of effect of the induction agents
Answer
  • Ester hydrolysis
  • Liver metabolism
  • Redistribution
  • Renal excretion

Question 68

Question
ALL BUT ONE of the following conditions predisposes the patient to prolonged effect of non-depolarizing muscle relaxants. Indicate the exception
Answer
  • Hyperkalemia
  • Hypothermia
  • Gentamycin administration
  • Myasthenia gravis

Question 69

Question
ALL BUT ONE of the following are contraindications to succinylcholine. Indicate the exception
Answer
  • Cervical spinal cord injury (1 week ago)
  • Monoamine oxidase administration
  • Malignant hyperthermia susceptibility
  • Burn injury (24 hours ago)

Question 70

Question
Which of the following is the correct MAXIMUM safe dose of bupivacaine (plain)
Answer
  • 1 mg/kg
  • 2 mg/kg
  • 5 mg/kg
  • 7 mg/kg

Question 71

Question
ALL BUT ONE of the following describes a feature of phenylephrine. INDICATE THE EXCEPTION
Answer
  • Phenylephrine causes (reflex) bradycardia
  • Phenylephrine can be safely used in patients with cocaine intoxication
  • Phenylephrine acts directly at the alpha adrenergic receptor
  • Phenylephrine improves cardiac performance in cardiogenic shock

Question 72

Question
ALL BUT ONE of the following are effects of the synthetic opioids (fentanyl, sufentanil and remifentanil). Indicate the exception
Answer
  • Muscle rigidity
  • Biliary spasm
  • Myocardial depression
  • Bradycardia

Question 73

Question
Which ONE of the following most closely describes the MAC of three commonly-used volatile anesthetic agents?
Answer
  • Desflurane 6%; Sevoflurane 1%; Isoflurane 2%
  • Desflurane 2%; Sevoflurane 6%; Isoflurane 1%
  • Desflurane 1%; Sevoflurane 2%; Isoflurane 6%
  • Desflurane 6%; Sevoflurane 2%; Isoflurane 1%
  • Desflurane 2%; Sevoflurane 1%; Isoflurane 6%
  • Desflurane 1%; Sevoflurane 6%; Isoflurane 2%

Question 74

Question
Which of the following opioids are most commonly administered into the intrathecal (spinal) space?
Answer
  • Morphine and sufentanil
  • Fentanyl and sufentanil
  • Morphine and fentanyl
  • Fentanyl and remifentanil

Question 75

Question
Which ONE of the following receptors is NOT targeted in the treatment or prevention of post-operative nausea and vomiting?
Answer
  • GABA
  • Histamine
  • Serotonin
  • Dopamine

Question 76

Question
Which ONE of the following sets correctly describes the cholinergic effects of neostigmine?
Answer
  • Bradycardia and bronchospasm
  • Mydriasis and confusion
  • Urinary retention and constipation
  • Dry mouth and dry eyes

Question 77

Question
Which of the following correctly describes an important principle in the use of ketorolac as an adjunct for post-operative pain?
Answer
  • IV therapy should be minimized to less than 5 days
  • Ketorolac must not be given to patients with renal insuffciency
  • Potentiation of opioid effect is a risk
  • Gastrointestinal bleeding is not a concern with the Cox 1 inhibitors such as ketorolac

Question 78

Question
What is the main advantage of the use of glycopyrrolate compared to atropine to counteract the cholinergic effects of anticholinesterase administration?
Answer
  • Faster onset of action
  • Does not cross the blood brain barrier
  • More effective anticholinergic activity
  • Safe in patients with narrow angle glaucoma

Question 79

Question
Which statement about the distribution of water in the body Is true?
Answer
  • Most of the body water content is located within the extracellular compartment
  • Water content in a newborn child is 30-60% of its body weight
  • Plasma water content is only 5% of the body weight
  • Total body water content in adult females is 60% of their body weight

Question 80

Question
Which of the following is not associated with high anion-gap metabolic acidosis
Answer
  • Tissue hypoxia with hyperlactatemia
  • Kidney failure
  • Methanol intoxication
  • Diarrhea

Question 81

Question
Which of the following statements about ARDS in adults is NOT correct
Answer
  • Bilateral opacities consistent with pulmonary edema on chest radiography or computed tomography (CT) scan that are not fully explained by pleural effusions, lobar/lung collapse, pulmonary nodules or heart failure are required for the diagnosis
  • Several conditions’can lead to the development of ARDS, including aspiration of gastric contents, pneumonia, sepsis (most common cause), trauma, transfusion of blood products (particularly plasma-rich products), pancreatitis, fat emboli, and drowning
  • Most patients with ARDS require intubation and mechanical ventilation with low tidal volumes (6 mL/kg predicted weight) and targeted plateau pressures of equal to or less than 30 cm H2O
  • Moderate to severe impairment of oxygenation ts defined by the ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2). In Severe ARDS (PaO2/FiO2) ts between 200 and 300 mmHg on PEEP >5 cm H2O

Question 82

Question
Which of the following drugs is of first therapeutic choice in managing anaphylactic shock?
Answer
  • Methylprednisolone i.v.
  • Adrenaline i.m.
  • Diphenhydramine i.m.
  • Atropine i.v.

Question 83

Question
Which of the following suggested clinical and laboratory parameters are Not part of the SOFA score for sepsis?
Answer
  • Bilirubin, creatinine and urine output
  • Blood pressure and PaO2/FiO2 ratio
  • Platelets and GCS
  • Body temperature and WBCs

Question 84

Question
Which of the statements about FAST is NOT correct?
Answer
  • It is a rapid and noninvasive No to evaluate the abdomen for presence of pathological fluid collection in peritoneal and pericardial cavity
  • It is comparable to diagnostic peritoneal lavage (DPL) as a method for detecting peritoneal fluid
  • Abdominal areas to examine are three: right upper quadrant, left upper quadrant and subxyphoid
  • Extended FAST (E-FAST) examination includes views of the bilateral hemithoraces and the upper anterior chest wall

Question 85

Question
20 year old male cyclist is hit by a car. On the primary evaluation the GCS was 9 points and quickly deteriorated to a maximum of 6, but the breathing and hemodynamic status were initially stable. The patient was intubated, mechanically ventilated and mannitol infusion was started during the transport. On emergent CT scan of the head only diffuse brain oedema is found with no focal lesions of the brain parenchyma or intracranial hematomas. CT scan of the neck, chest and abdomen shows clear spine, fractures of fourth and fifth ribs on the right, no pleural fluid or air collections, intact heart and great vessels, no injuries to the abdominal organs or free fluid in the abdominal cavity. The patient is admitted in the ICU. Which of the suggested monitoring is not part of the initial management of that patient?
Answer
  • EEG
  • ETCO2 measurement
  • CVP measurement
  • Invasive arterial blood pressure measurement

Question 86

Question
Generally accepted definition of coma includes a GCS score of
Answer
  • < 6
  • < 8
  • < 10
  • < 12

Question 87

Question
Augmenting O2, delivery to the tissues is undoubtedly one of the first and foremost priorities in the management of circulatory shock. Which of the following suggested measures cannot help for for that purpose?
Answer
  • Administration of vasopressor drugs if no response to fluid therapy is achieved
  • HCO3 administration for correction of acidosis
  • Blood transfusion in case of hemorrhagic shock
  • Supplementary O2 administration

Question 88

Question
Which drugs can be administered endotracheally during CPR if I.V. or I.0. access cannot be established? [blank_start]Adrenaline[blank_end] [blank_start]Naloxone[blank_end] [blank_start]Lidocaine[blank_end] [blank_start]Vasopressin[blank_end]
Answer
  • Adrenaline
  • Naloxone
  • Lidocaine
  • Vasopressin

Question 89

Question
A characteristic feature of cerebral salt wasting syndrome (CSWS) that distinguishes it from the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is
Answer
  • Pathological process affecting the brain
  • Decreased extracellular fluid volume (hypovolemia)
  • Increased Na+ loss with urine
  • Hyponatremia (serum (Na‘] <135 mmol/l)

Question 90

Question
Which of the following statements about the acid-base disorders is false?
Answer
  • Metabolic alkalosis is the most common acid-base disturbance in hospitalised patients
  • Successful treatment of all acid-base disorders depends on the identification and elimination of the cause
  • Most cases of respiratory acidosis are due to increased production of CO2
  • As a rule acid-base disorders of metabolic origin involve a respiratory compensatory response and vice versa

Question 91

Question
List Pulmonary causes of ARDS [blank_start]Aspiration[blank_end] Severe [blank_start]Pneumonia[blank_end] [blank_start]Smoke[blank_end] Inhalation [blank_start]Trauma[blank_end]
Answer
  • Aspiration
  • Pneumonia
  • Smoke
  • Trauma

Question 92

Question
Which of the following pairs of different types of hypoxia and possible causes does not match?
Answer
  • Heart failure → Stagnant hypoxia
  • Acute hemolysis → Anemic hypoxia
  • Anaphylaxis → Cytopathic hypoxia
  • High altitude → Hypoxic hypoxia

Question 93

Question
Microblologic analysis of blood cultures is
Answer
  • Required for diagnosis of sepsis
  • Required before starting antimicrobial therapy for sepsis
  • Required for narrowing of the empiric antimicrobial therapy
  • Required for selection of the optimal route for antimicrobials administration

Question 94

Question
Which of the following suggested compensatory responses to shock state does not increase the Frank-Starling mechanism in the heart (increased preload=increased cardiac output)
Answer
  • Fluid redistribution to the vascular space
  • Decreased venous capacitance
  • Increased heart rate
  • Decreased renal losses of fluid

Question 95

Question
Possible disastrous complication from overly rapid correction of hyponatremia is
Answer
  • Cerebral edema and brain herniation
  • Insipid diabetes
  • Ischaemic Stroke
  • Central pontine myelinolysis

Question 96

Question
A 12-year old boy with unremarkable previous medical history regularly vaccinated, was hospitalised two days ago with flu-like symptoms, abdominal pain and vomiting. His condition was gradually worsening with changes in, mentation (GCS initialty was 15 now is 12), rapid and noisy breathing arterial hypotension (BP 95/50 MmHg), oliguria (after initial polyuria), hyperthermia, with 38.8°C despite the antiviral (Oseltamivir) and the symptomatic therapy that were started initially. You run a blood and urine analysis and receive the following results: arterial blood pH 7.0, PaCO2 20 mmHg. BE (-16), [HCO3-] 10 mmol/L, blood glucose 2 mmol/L, [K+] 3.4 mmol/l, [Na+] 132 mmol/L, [Cl-] 90 mmol/L, and serum creatinine 60 μmol/l, urea 3 μmol/l, 4(+) glucose and 3(+) ketones in urine What are the first therapeutic intervention you would start with in this case?
Answer
  • Immediate administration of sodium bicarbonate to correct the acidosis
  • Aggressive restoration of extracellular fluid volume with balanced cystalloid solutions
  • Subcutaneous administration of insulin
  • Endotracheal intubation and Mechanical Ventilation

Question 97

Question
All of the following are part of the therapeutic strategy for ARDS in adults, except
Answer
  • Ventilation with low tidal volumes (6 ml/kg) and PEEP
  • Periodically switching to ventilation in prone position
  • Avoiding positive fluid balance
  • Administration of Surfactant and inhaled Nitric Oxide

Question 98

Question
Which of the following statements about cyanosis is correct?
Answer
  • It is a late sign of respiratory failure
  • It is characteristic for type 1 (hypoxemic) respiratory failure
  • It is caused by increased amount of reduced Hb (>50-60 g/l)
  • Patients with anaemia manifest cyanosis at higher SaO2 values (earlier) than patients with normal Hb values

Question 99

Question
Name four major categories of circulatory shock and give examples for every type [blank_start]Hypovolemic[blank_end] Shock- [blank_start]Hemorrhage[blank_end] [blank_start]Cardiogenic[blank_end] Shock- [blank_start]Heart[blank_end] failure [blank_start]Obstructive[blank_end] shock- [blank_start]Blockage[blank_end] of the aorta [blank_start]Distributive[blank_end] shock- [blank_start]Anaphylaxis[blank_end]
Answer
  • Hypovolemic
  • Cardiogenic
  • Obstructive
  • Distributive
  • Hemorrhage
  • Heart
  • Blockage
  • Anaphylaxis
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