- A patient is on a ventilator, which is on assist control mode set at 10 breaths per minute, tidal volume set at 800 mL. Which ONE of the following is true [1]?
A. The patient's actual respiratory rates may be between eight and 12 breaths per minute
B. The patient's tidal volume during spontaneous breaths may be much less than 800 mL
C. Assists control mode is an excellent mode for weaning to extubation
D. Patient receives at least 10 controlled breaths per minute regardless of spontaneous breathing
E. If no spontaneous breaths are taken, the minute ventilation is 12 liters - All of the following are true concerning lung overdistension EXCEPT [2]:
- A pulmonary artery catheter is inserted into a patient after in-hospital cardiac arrest and rapid successful resuscitation has been carried out. The catheter tip is correctly positioned in the right ventricular outflow tract and is functioning properly. The patient is on dopamine at 15µg/kg/min intravenously and the phenylephrine has been tapered off. The heart rate is 125 beats per minute, the pulse is 120 beats per minute and weak, systemic blood pressure is 90/70, the RV pressure is 40/25, PA pressure is 35/25, PCWP (wedge) pressure is 30, cardiac output is 2.4 Liters per minute, and there is prominant central venous distension. Which ONE of the following is the most likely diagnosis [3] ?
A. Septic shock
B. Cardiogenic shock
C. Right ventricular failure
D. Hypovolemic Shock
E. Cardiac tamponade - All of the following are complications of intravenous total parenteral nutrition EXCEPT [4]:
A. Catheter related infection
B. Electrolyte imbalance
C. Clostridium difficile diarrhea
D. Fluid imbalance
E. Acid-base disturbances - All of the following are true concerning organophosphate poisoning EXCEPT [5]:
A. Inhibition of central and peripheral acetylcholinesterase occurs
B. Central cholinergic toxicity causes most of the effects
C. Insecticides such as malathion cause most of the cases in the USA
D. Many nerve gas agents inhibit acetylcholinesterase
E. Blushing, lacrimation, urination, salivation and hypotension are common symptoms - All of the following may be found in heat stroke EXCEPT [6]:
A. Proteinuria and renal insufficiency
B. Pure metabolic acidosis
C. Disseminated intravascular coagulopathy (DIC)
D. Liver function abnormalities
E. Multiorgan-system failure - A 32 year old man with a history of smoking and recreational drug abuse is brought to the emergency room by his friends. They had been "partying" and the patient began complaining of severe chest pain and shortness of breath. He was given a glass of water which he regurgitated immediately. On examination, the patient appears severely agitated, diaphoretic and frightened. He is complaining of chest pain, a severe headache, and nausea. His pulse is regular at 130 beats per minute, blood pressure 170/100mm Hg, equal in both arms, respiratory rate 30 per minute, and temperature (ear probe) 38.2°C. His examination is notable for watery eyes, equal and reactive, highly dilated pupils, bloodshot eyes, alcohol on his breath, and mild non-focal abdominal tenderness. Electrocardiogram (ECG) shows sinus tachycardia at a rate of 132, 1-2mm ST elevations in the anterior chest leads V2 through V5, and 1mm ST depressions in leads aVL and I, with diffuse T wave abnormalities. A toxicology screen and full chemistry and blood panels are ordered. Two 18 gauge peripheral intravenous lines are established. The most appropriate next step is [7]:
A. Sublingual nifedipine
B. Intravenous bolus esmolol (a ß-blocker) followed by a continuous infusion
C. Intravenous bolus diltiazem followed by a continuous infusion
D. Intravenous thrombolytic therapy with tissue plasminogen activator (TPA)
E. Regular strength aspirin plus intravenous heparin bolus with continuous infusion - After 10 minutes, the patient's blood pressure is 160/100, his pulse is 110 beats per minute and regular, and he is less diaphoretic with minimal chest pain. His ECG shows sinus tachycardia at a rate of 100, 0.5mm ST elevations in the anterior chest leads V2 through V5, and some T wave abnormalities. His urine shows 2+ protein and trace blood. He is somewhat agitated and thinks he is seeing insects crawling around the emergency room. The most appropriate next step is [8]:
A. Give benzodiazepines for agitation and nitroprusside to reduce blood pressure
B. Give morphine for agitation and intravenous metoprolol to reduce blood pressure
C. Give haloperidol for hallucinations and increase diltiazem to reduce blood pressure
D. Begin thrombolytic therapy with TPA and add heparin
E. Give morphine and haloperidol an d monitor blood pressure - All of the following are true concerning Malignant Hyperthermia EXCEPT [9]:
A. Is more common in children than in adults
B. Mutations in calcium release channel (ryanodine receptor) are causative
C. Anesthetics inducing malignant hyperthermia cause massive unregulated calcium release
D. Muscle rigidity, hyperthermia, hypercapnea, hyperkalemia and arrhythmias occur
E. Despite treatment with dantrolene, mortality remains >50% - Permissive hypercapnea is reasonable in all of the following situations EXCEPT [10]: A. Elevated intracranial pressure
A. Overdistension causes release of inflammatory cytokines
B. Application of positive end expiratory pressure (PEEP) can reduce lung overdistension
C. Overdistension is particularly detrimental in patients with pre-existing lung disease
D. Setting tidal volume to >12mL/kg is likely to reduce overdistension
E. Pressure controlled modes of ventilation are less likely than volume control modes to cause overdistension
B. Adult respiratory distress syndrome (ARDS)
C. Decompensation in chronic obstructive pulmonary disease
D. Severe asthma
E. Acute pulmonary edema
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