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Anaesthesiology Final MCQs- 5th Year PMU

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Anaesthesiology MCQs 1- 5th Year PMU

Anaesthesiology MCQs 1- 5th Year PMU

Question 1 of 99

1

All but ONE of the following are predictors of a difficult intubation. Indicate the exception

Select one of the following:

  • Mouth opening of only 3 fingerbreadths

  • Short, thick neck with limited mobility

  • Mallampati Class IV

  • Thyromental distance of 2 fingerbreadths

Explanation

Question 2 of 99

1

ALL BUT ONE of the following factors represent an indication for intubation in a patient who is about to undergo surgery. Indicate the exception

Select one of the following:

  • Surgery is a lumbar laminectomy

  • Surgery is removal of a lymph node of the neck

  • Surgery is appendectomy

  • Surgery is tonsillectomy

Explanation

Question 3 of 99

1

Which ONE of the following structures is not encountered during direct laryngoscopy?

Select one of the following:

  • Vallecula

  • Cricoid cartilage

  • Epiglottis

  • Arytenoid cartilage

Explanation

Question 4 of 99

1

The COMPLETE absence of a capnographic waveform immediately following endotracheal intubation may indicate ALL BUT ONE of the following. Indicate the exception

Select one of the following:

  • Circuit disconnection

  • Cardiac arrest

  • Endobronchial intubation

  • Complete airway obstruction

  • Esophageal intubation

Explanation

Question 5 of 99

1

After induction of anesthesia, the anesthesiologist is unable to intubate the patient.
Which ONE of the following is the most important management priority?

Select one of the following:

  • 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

Explanation

Question 6 of 99

1

Advantages of a Laryngeal mask airway include ALL BUT ONE of the following. Indicate the exception

Select one of the following:

  • 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

Explanation

Question 7 of 99

1

ALL BUT ONE of the following are ways to confirm endotracheal intubation. Indicate the exception

Select one of the following:

  • 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

Explanation

Question 8 of 99

1

The “transfusion trigger” (the lowest allowable hemoglobin level) intra-operatively is

Select one of the following:

  • 100 g/L

  • 80g/L

  • 60g/L

  • Individualized to every patient

Explanation

Question 9 of 99

1

ALL BUT ONE of the following are early indicators of hypovolemia. Indicate the exception

Select one of the following:

  • Tachycardia

  • Decreased pulse pressure

  • Decreased urine output

  • Lactic acidosis

Explanation

Question 10 of 99

1

The maintenance fluid requirement for an 80 kg man using the 4-2-1 rule is

Select one of the following:

  • 100 cc/hr

  • 120 cc/hr

  • 150 cc/hr

  • 170 cc/hr

Explanation

Question 11 of 99

1

Milllilitre for millilitre, which of the following provides the most intravascular volume expansion?

Select one of the following:

  • Packed red blood cells

  • Albumin (5%)

  • Pentaspan

  • Ringers Lactate

Explanation

Question 12 of 99

1

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?

Select one of the following:

  • Pentaspan 1500 mL

  • DSW 500 mL

  • Ringers Lactate 500 mL

  • Normal Saline 1500 mL

Explanation

Question 13 of 99

1

Regarding vascular access and fluid resuscitation, which ONE of the following statements is TRUE?

Select one of the following:

  • 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

Explanation

Question 14 of 99

1

A patient receives 10 units of packed red blood cells. Which ONE of the following chemistry profiles is most likely?

Select one of the following:

  • Hyperkalemia, hypercalcemia

  • Hypokalemia, hypocalcemia

  • Hyperkalemia, hypocalcemia

  • Hypokalemia, hypercalcemia

Explanation

Question 15 of 99

1

Which ONE of the following procedures would be associated with the most “third space" loss of fluid?

Select one of the following:

  • Open reduction, internal fixation of the pelvis

  • Whipple resection of the pancreas

  • Resection of large frontal brain tumour

  • Caesarian section

Explanation

Question 16 of 99

1

Routine preoperative hemoglobin is NOT required for

Select one of the following:

  • 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

Explanation

Question 17 of 99

1

Which ONE of the following is the most important determinant of peri-operative risk?

Select one of the following:

  • Patient’s underlying health

  • Length of surgery

  • Duration of surgery

  • Emergency surgery

Explanation

Question 18 of 99

1

Which of these patients is NOT at increased risk of aspiration?

Select one of the following:

  • 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

Explanation

Question 19 of 99

1

The following medication should be discontinued prior to surgery and anesthesia

Select one of the following:

  • Anticonvulsants

  • Thyroid replacement

  • Monoamine-oxidase inhibitors

  • Antihypertensives

Explanation

Question 20 of 99

1

A patient with which ONE of the following conditions requires antibiotic prophylaxis prior to tonsillectomy?

Select one of the following:

  • Uncorrected Tetralogy of Fallot

  • Aortic stenosis

  • Uncomplicated heart transplant

  • Prophylaxis is not required for tonsillectomy

Explanation

Question 21 of 99

1

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?

Select one of the following:

  • 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

Explanation

Question 22 of 99

1

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.

Select one of the following:

  • ASA 1

  • ASA 2

  • ASA 3

  • ASA 4

Explanation

Question 23 of 99

1

ALL BUT ONE of the following describes the CO2 absorber.
Indicate the exception

Select one of the following:

  • 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

Explanation

Question 24 of 99

1

Which ONE of the following statements regarding the peripheral nerve stimulator is true?

Select one of the following:

  • 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

Explanation

Question 25 of 99

1

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?

Select one of the following:

  • Temperature probe

  • Agent-specific gas monitor

  • Peripheral nerve stimulator

  • Spirometer

Explanation

Question 26 of 99

1

ALL BUT ONE of the following interfere with accurate pulse oximetry measurements.
Indicate the exception:

Select one of the following:

  • Nail polish

  • Peripheral vasoconstriction due to hypothermia

  • Severe anemia (Hg 60 g/L)

  • Methemoglobinemia

  • Carbon monoxide

Explanation

Question 27 of 99

1

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

Select one of the following:

  • Pulmonary embolus

  • Exhausted CO2 absorber soda lime

  • Cardiac arrest

  • Severe bronchospasm

Explanation

Question 28 of 99

1

The abbreviation “MAC” stands for

Select one of the following:

  • Minimal arterial concentration

  • Minimal alveolar concentration

  • Maximal arterial concentration

  • Maximal alveolar concentration

Explanation

Question 29 of 99

1

Regarding awareness, ALL BUT ONE of the following statements are correct.
Indicate the exception

Select one of the following:

  • 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

Explanation

Question 30 of 99

1

The immediate goals of emergence include ALL BUT ONE of the following.
Indicate the exception

Select one of the following:

  • The ability of the patient to protect their airway

  • Stable cardiovascular status

  • Normal mental status examination

  • Effective analgesia

Explanation

Question 31 of 99

1

The advantages of regional anesthesia include ALL BUT ONE of the following.
Indicate the exception

Select one of the following:

  • 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

Explanation

Question 32 of 99

1

Hypothermia is associated with ALL BUT ONE of the following.
Indicate the exception

Select one of the following:

  • Post operative hypoxemia

  • Decreased platelet function

  • Myocardial ischemia

  • Increased analgesic requirements

Explanation

Question 33 of 99

1

Adequacy of reversal of muscle relaxation can be assessed by ALL BUT ONE of the following.
Indicate the exception

Select one of the following:

  • Strong hand grip

  • The return of the eyelash reflex

  • Train of four shows 4 twitches with no fade

  • 5 second head lift

Explanation

Question 34 of 99

1

Tracheal intubation would be required in ALL BUT ONE of the following procedures. Indicate the exception:

Select one of the following:

  • Open cholecystectomy

  • Laparoscopic cholecystectomy

  • Excision of lymph node from the neck

  • Tonsillectomy

Explanation

Question 35 of 99

1

Known complications related to positioning include ALL BUT ONE of the following. Indicate the exception

Select one of the following:

  • 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

Explanation

Question 36 of 99

1

Regarding the comparative considerations of epidural and spinal anesthesia, which ONE of the following is CORRECT?

Select one of the following:

  • 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

Explanation

Question 37 of 99

1

Early signs and symptoms of local anesthetic toxicity include ALL BUT ONE of the following. Indicate the exception

Select one of the following:

  • Tinnitus

  • Perioral numbness

  • Dizziness

  • Hypertension

Explanation

Question 38 of 99

1

Shivering can lead to ALL BUT ONE of the following. Indicate the exception:

Select one of the following:

  • Myocardial ischemia

  • Increased oxygen consumption

  • Decreased carbon dioxide production

  • Interference with monitor signal interpretation

Explanation

Question 39 of 99

1

Which ONE of the following statements about shivering is correct?

Select one of the following:

  • 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

Explanation

Question 40 of 99

1

ALL BUT ONE of the following are used as intravenous antiemetics. Indicate the exception

Select one of the following:

  • Prochlorperazine

  • Ranitidine

  • Dimenhydrinate

  • Dexamethasone

Explanation

Question 41 of 99

1

Which of the following is a risk factor for PONV?

Select one of the following:

  • History of gastroesophageal reflux

  • Smoking

  • Diabetes mellitus

  • Female gender

Explanation

Question 42 of 99

1

Which ONE of the following is part of a rational approach to post-operative nausea and vomiting?

Select one of the following:

  • 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

Explanation

Question 43 of 99

1

Which ONE of the following is least likely to be the cause of hypertension in the PACU?

Select one of the following:

  • Pain

  • Airway obstruction

  • Prolonged spinal blockade

  • Full bladder

Explanation

Question 44 of 99

1

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?

Select one of the following:

  • Normal cognitive function

  • Adequate pain control

  • Ability to hold down food

  • Ability to weight-bear

Explanation

Question 45 of 99

1

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

Select one of the following:

  • Reduced adrenal activation

  • Hypertension

  • Improved respiratory function

  • Excellent post-operative pain control

Explanation

Question 46 of 99

1

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

Select one of the following:

  • 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”

Explanation

Question 47 of 99

1

ALL BUT ONE of the following is a relative contraindication to post-operative epidural analgesia.
Indicate the exception

Select one of the following:

  • Multiple sclerosis

  • Lumbar disc disease

  • Hypertrophic obstructive cardiomyopathy

  • Myasthenia gravis

Explanation

Question 48 of 99

1

All BUT ONE of the following are true regarding malignant hyperthermia (MH). Indicate the exception

Select one of the following:

  • 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

Explanation

Question 49 of 99

1

Which of the following is the first sign of a malignant hyperthemic reaction?

Select one of the following:

  • Hyperthermia

  • Hypercarbia

  • Tachycardia

  • Ventricular arrhythmias

Explanation

Question 50 of 99

1

Treatment of a malignant hyperthermia crisis includes ALL BUT ONE of the following.
Indicate the exception

Select one of the following:

  • Turning off the volatile anesthetic

  • Active cooling measures

  • Dantrolene

  • Beta blockers

Explanation

Question 51 of 99

1

Maternal hypotension in the supine position during pregnancy is most often due to

Select one of the following:

  • Decreased blood volume

  • Decreased peripheral vascular resistance

  • Decreased hematocrit

  • Compression of the vena cava

Explanation

Question 52 of 99

1

ALL BUT ONE of the following represent relevant physiologic changes of pregnancy in the 40 week gestation parturient.
Indicate the exception

Select one of the following:

  • Decreased cardiac output

  • Delayed gastric emptying

  • Increased blood volume

  • Decreased anesthetic requirements

Explanation

Question 53 of 99

1

In the obstetrical patient in her third trimester, the supine position

Select one of the following:

  • 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

Explanation

Question 54 of 99

1

ALL BUT ONE of the following are part of rational fasting guidelines for pediatric patients. Indicate the exception

Select one of the following:

  • 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

Explanation

Question 55 of 99

1

The narrowest portion of the neonate's airway is at the level of the

Select one of the following:

  • Glottis

  • Cricoid

  • Trachea

  • Pharynx

Explanation

Question 56 of 99

1

The appropriate size endotracheal tube for a 4 year old child is

Select one of the following:

  • 4.0

  • 4.5

  • 5.0

  • 6.0

Explanation

Question 57 of 99

1

ALL BUT ONE of the following represents attributes of the pediatric cardiovascular system. Indicate the exception

Select one of the following:

  • 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

Explanation

Question 58 of 99

1

Which ONE of the following is an explanation for rapid desaturation during apnea that is seen in the pediatric patient?

Select one of the following:

  • Increased functional residual capacity (FRC)

  • Increased oxygen consumption

  • Increased minute ventilation

  • Obligate nasal breathing

Explanation

Question 59 of 99

1

ALL BUT ONE are features of the pediatric airway compared to the adult. Indicate the exception

Select one of the following:

  • Larynx situated higher

  • Larynx situated more anteriorly

  • Epiglottis shorter and less mobile

  • Narrowest part of the airway at the cricoid

Explanation

Question 60 of 99

1

The use of epidural analgesia for labour is likely to result in which ONE of the following

Select one of the following:

  • Prolonged second stage

  • Increased risk of operative delivery

  • Neonatal depression

  • Maternal sedation

Explanation

Question 61 of 99

1

ALL BUT ONE of the following is a disadvantage of general anesthesia for Caesarian section. Indicate the exception

Select one of the following:

  • Increased risk of aspiration in the pregnant patient

  • Increased anesthetic requirements

  • Exacerbation of uterine atony

  • Increased risk of awareness under anesthesia

Explanation

Question 62 of 99

1

Which ONE of the following is an accurate statement regarding the use of spinal anesthesia for Caesarian section?

Select one of the following:

  • 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

Explanation

Question 63 of 99

1

Nitrous oxide is contraindicated in ALL BUT ONE of the following settings. Indicate the exception

Select one of the following:

  • 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

Explanation

Question 64 of 99

1

Which class of drugs is most commonly responsible for intraoperative anaphylactic (or anaphylactoid) reactions?

Select one of the following:

  • Opioid analgesic agents

  • Induction agents

  • Muscle relaxants

  • Volatile anesthetic agents

Explanation

Question 65 of 99

1

Other than analgesia, what is the most important clinical effect of the opioid analgesics?

Select one of the following:

  • Cardiac depression

  • Sedation

  • Nausea and vomiting

  • Respiratory depression

Explanation

Question 66 of 99

1

Which ONE of the following describes an advantage of sevoflurane over desflurane?

Select one of the following:

  • 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

Explanation

Question 67 of 99

1

Which ONE of the following best describes the reason for the rapid OFFSET of effect of the induction agents

Select one of the following:

  • Ester hydrolysis

  • Liver metabolism

  • Redistribution

  • Renal excretion

Explanation

Question 68 of 99

1

ALL BUT ONE of the following conditions predisposes the patient to prolonged effect of non-depolarizing muscle relaxants. Indicate the exception

Select one of the following:

  • Hyperkalemia

  • Hypothermia

  • Gentamycin administration

  • Myasthenia gravis

Explanation

Question 69 of 99

1

ALL BUT ONE of the following are contraindications to succinylcholine. Indicate the exception

Select one of the following:

  • Cervical spinal cord injury (1 week ago)

  • Monoamine oxidase administration

  • Malignant hyperthermia susceptibility

  • Burn injury (24 hours ago)

Explanation

Question 70 of 99

1

Which of the following is the correct MAXIMUM safe dose of bupivacaine (plain)

Select one of the following:

  • 1 mg/kg

  • 2 mg/kg

  • 5 mg/kg

  • 7 mg/kg

Explanation

Question 71 of 99

1

ALL BUT ONE of the following describes a feature of phenylephrine. INDICATE THE EXCEPTION

Select one of the following:

  • 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

Explanation

Question 72 of 99

1

ALL BUT ONE of the following are effects of the synthetic opioids (fentanyl, sufentanil and remifentanil). Indicate the exception

Select one of the following:

  • Muscle rigidity

  • Biliary spasm

  • Myocardial depression

  • Bradycardia

Explanation

Question 73 of 99

1

Which ONE of the following most closely describes the MAC of three commonly-used volatile anesthetic agents?

Select one of the following:

  • 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%

Explanation

Question 74 of 99

1

Which of the following opioids are most commonly administered into the intrathecal (spinal) space?

Select one of the following:

  • Morphine and sufentanil

  • Fentanyl and sufentanil

  • Morphine and fentanyl

  • Fentanyl and remifentanil

Explanation

Question 75 of 99

1

Which ONE of the following receptors is NOT targeted in the treatment or prevention of post-operative nausea and vomiting?

Select one of the following:

  • GABA

  • Histamine

  • Serotonin

  • Dopamine

Explanation

Question 76 of 99

1

Which ONE of the following sets correctly describes the cholinergic effects of neostigmine?

Select one of the following:

  • Bradycardia and bronchospasm

  • Mydriasis and confusion

  • Urinary retention and constipation

  • Dry mouth and dry eyes

Explanation

Question 77 of 99

1

Which of the following correctly describes an important principle in the use of ketorolac as an adjunct for post-operative pain?

Select one of the following:

  • 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

Explanation

Question 78 of 99

1

What is the main advantage of the use of glycopyrrolate compared to atropine to counteract the cholinergic effects of anticholinesterase administration?

Select one of the following:

  • Faster onset of action

  • Does not cross the blood brain barrier

  • More effective anticholinergic activity

  • Safe in patients with narrow angle glaucoma

Explanation

Question 79 of 99

1

Which statement about the distribution of water in the body Is true?

Select one of the following:

  • 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

Explanation

Question 80 of 99

1

Which of the following is not associated with high anion-gap metabolic acidosis

Select one of the following:

  • Tissue hypoxia with hyperlactatemia

  • Kidney failure

  • Methanol intoxication

  • Diarrhea

Explanation

Question 81 of 99

1

Which of the following statements about ARDS in adults is NOT correct

Select one of the following:

  • 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

Explanation

Question 82 of 99

1

Which of the following drugs is of first therapeutic choice in managing anaphylactic shock?

Select one of the following:

  • Methylprednisolone i.v.

  • Adrenaline i.m.

  • Diphenhydramine i.m.

  • Atropine i.v.

Explanation

Question 83 of 99

1

Which of the following suggested clinical and laboratory parameters are Not part of the SOFA score for sepsis?

Select one of the following:

  • Bilirubin, creatinine and urine output

  • Blood pressure and PaO2/FiO2 ratio

  • Platelets and GCS

  • Body temperature and WBCs

Explanation

Question 84 of 99

1

Which of the statements about FAST is NOT correct?

Select one of the following:

  • 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

Explanation

Question 85 of 99

1

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?

Select one of the following:

  • EEG

  • ETCO2 measurement

  • CVP measurement

  • Invasive arterial blood pressure measurement

Explanation

Question 86 of 99

1

Generally accepted definition of coma includes a GCS score of

Select one of the following:

  • < 6

  • < 8

  • < 10

  • < 12

Explanation

Question 87 of 99

1

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?

Select one of the following:

  • 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

Explanation

Question 88 of 99

1

Fill the blank spaces to complete the text.

Which drugs can be administered endotracheally during CPR if I.V. or I.0. access cannot be established?



Explanation

Question 89 of 99

1

A characteristic feature of cerebral salt wasting syndrome (CSWS) that distinguishes it from the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is

Select one of the following:

  • Pathological process affecting the brain

  • Decreased extracellular fluid volume (hypovolemia)

  • Increased Na+ loss with urine

  • Hyponatremia (serum (Na‘] <135 mmol/l)

Explanation

Question 90 of 99

1

Which of the following statements about the acid-base disorders is false?

Select one of the following:

  • 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

Explanation

Question 91 of 99

1

Fill the blank spaces to complete the text.

List Pulmonary causes of ARDS

Severe
Inhalation

Explanation

Question 92 of 99

1

Which of the following pairs of different types of hypoxia and possible causes does not match?

Select one of the following:

  • Heart failure → Stagnant hypoxia

  • Acute hemolysis → Anemic hypoxia

  • Anaphylaxis → Cytopathic hypoxia

  • High altitude → Hypoxic hypoxia

Explanation

Question 93 of 99

1

Microblologic analysis of blood cultures is

Select one of the following:

  • 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

Explanation

Question 94 of 99

1

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)

Select one of the following:

  • Fluid redistribution to the vascular space

  • Decreased venous capacitance

  • Increased heart rate

  • Decreased renal losses of fluid

Explanation

Question 95 of 99

1

Possible disastrous complication from overly rapid correction of hyponatremia is

Select one of the following:

  • Cerebral edema and brain herniation

  • Insipid diabetes

  • Ischaemic Stroke

  • Central pontine myelinolysis

Explanation

Question 96 of 99

1

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?

Select one of the following:

  • 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

Explanation

Question 97 of 99

1

All of the following are part of the therapeutic strategy for ARDS in adults, except

Select one of the following:

  • 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

Explanation

Question 98 of 99

1

Which of the following statements about cyanosis is correct?

Select one of the following:

  • 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

Explanation

Question 99 of 99

1

Fill the blank spaces to complete the text.

Name four major categories of circulatory shock and give examples for every type
Shock-
Shock- failure
shock- of the aorta
shock-

Explanation

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