1) The document contains a review course answer key with multiple choice questions (MCQ) covering topics like ventilator associated pneumonia, sepsis, shock, seizures, myasthenia gravis, weaning from mechanical ventilation, overdoses, acid-base abnormalities, dysrhythmias, and more. 2) It provides the answers to the MCQ questions along with short explanations for some answers. 3) The questions and answers would be useful for reviewing critical care and emergency medicine topics.

1. Review course 2013 Answer key
MCQ
Q1. Which of the following statements is true regarding ventilator associated
pneumonia:
a. VAP is the most commonly observed nosocomial infection in the
intensive care unit. (t)
b. There are universally accepted diagnostic criteria.(F)
c. The aspiration of infected material from the stomach plays an important
part in development of VAP.(F)
d.The use of sucralfate as stress ulcer prophylaxis confirmed risk factor.(f)
e. A specimen obtained by bronchoalveolar lavage containing > 103
colony forming units/ ml signifies invasive infection.(f)
f. optimal management of VAP always requires :
F1 Identification of the responsible pathogen before the start of
antibiotic regime.(f)
F2. Close liaison with microbiology service.(t)
Q2. A 55 yr old man evaluated in hospital for 2 day history of fever, recently
diagnosed AML,for which he received chemotherapy 11 days ago.CVC it situ
with erythema at site, On physical examination T-39.1,B.P 100/70,HR-
110/min,R.r-22/min, HB-7gm%,TLC-1000,PL-20,000
A)-pt is having
A) Sepsis
B) SIRS
C) Severe SEPSIS
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

2. D) Septic shock
2 B) what is the likely source? Likely organism?. Staplyloccocus
2c.. Multiple blood culture reveals growth of MRSA, medical history significant
for Vancomycin IgE Mediated Hypersensitivity reaction
C) In addition to catheter removal which of the following is appropriate
treatment.What complication you will watch for.
A) cefazolin
b) clindamycin
c) daptomycin (myopathy—cpk Levels)
d) Naffcillin
Q3. Which of the following sets of vital signs is most compatible with diagnosis
of isolated head injury with increase intracranial pressure.?
A) B.p-80/60,p-50/min
B) B.p-80/60,p-130/min
C) B.p-170/80,p-50/min(cushing reflex)
D) B.P-170/80,p-130/min
Q4. Which of the following seizure patients requires electroencephalographic
(EEG) monitoring for optimal treatment?
(A) 35-year-old status post a witnessed tonic–clonic seizure with resolution of
the postictal period in 10 min
(B) 40-year-old alcoholic status post two witnessed seizures in the ED, with
lucid periods after each seizure
(C) 28-year-old with status epilepticus controlled with fosphenytoin
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

3. (D) 30-year-old with refractory status epilepticus requiring
vecuronium(motor paralysis may hamer seizure activity) Ans
• Q5. 18 year old girl is admitted with bilateral ptosis to the ward. She also
has double vision. Over the past few days she has some difficulty getting
out of a chair (reflecting proximal lower limb weakness) and while
combing her hair her arms get very fatigued. Which of the following is
the most sensitive and specific test for her condition?
a) Tensilon test
b) Acetylcholine receptor antibodies(ANS)( Ach-R-Ab test has a 85%
sensitivity and about 90% specificity for Myasthenia Gravis)
c)
d) Repetitive Nerve Stimulation
e) Muscle biopsy
Q6. Regarding weaning
1) Which one of the following criteria is necessary to initiate discontinuation
from mechanical ventilation?
a) Improvement in underlying condition(ans).
b) Positive end expiratory pressure of 10 cm of water or less.
c) Ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen
of more than 100.
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

4. d) Systolic Blood pressure greater than 120 mm of hg.
2) An unsuccessful spontaneous breathing trial would involve which one of the
following outcomes?
a) Heart rate of more than 110 beats per min.
b) oxygen saturation of less than 95%
C) Systolic blood pressure of more than 165 mm of hg.
d) Diaphoresis.(ans)
3) Which one of the following variables is considered to be risk factor for
unsuccessful discontinuation of mechanical ventilation?
a) Age Older than 60 yrs
b) APACHE 2 Score greater than 5 on the day of extubation.
C) Chronic obstructive pulmonary disease as a cause of respiratory failure.
D) Chronic heart failure(ans).
Q7. Which drug is most likely to cause hypotension, seizures, and
cardiac arrhythmia when taken in an overdose?
A. Acetaminophen
B. Diazepam
C. Methyl alcohol
D. Morphine
E.Amitryptiline(ans)
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

5. Q8. .All of the following are signs of acetylcholinesterase inhibitor toxicity
EXCEPT
(A)miosis (B) salivation(C) diarrhea (D) muscle fasciculations(E)
anhydrosis(ans)
Q9. Which of the following is First sign of compensated hypovolemic
shock?
A—pallor
B—wide pulse pressure
C—Narrow pulse pressure(ans)
D—tachycardia
D-weakened peripheral pulse
Q 10. In a teaching session you are discussing path physiology of ARF you are
Asked which part of kidney is most susceptible to hypoxia as a result of
decrease in blood flow.correct response will be
A) Inner medulla (ans) B)Cortex C)Outer medulla D)All of the above
Q.11)
While treating a patient of crush syndrome consultant advises you to achieve
airway control of the patient and ventilation,which of the following agent needs
to be avoided
A)Pancuronium B)Atracurium C)Succinyl choline(ans) D)Vecuronium
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

6. Q12. . A 60 yr old 10 days post clipping of ACOM aneurysm develops
change in mental status and lethargy .postoperative angiography reveals
excellent clip placement without evidence of cerebral vasospasm.
• Lab= Na- 119
• BUN-50mg%
• Ur ine spot Na- 65 CVP-2cm Of H20
• What is the most likely explanation for the hyponatremia?
A)SIADH B)Diabetes insipidus C)Renal failure
D)Cerebral salt wasting syndrome (ans)
Q13. With regards to non-variceal GI bleed, which of the following are true?
a) Approximately 20% of patients will stop bleeding spontaneously
without recurrence(False: 80%)
b) Low initial Hemoglobin is a clinical indicator of potential rebleeding
((True)
c)Onset of bleeding while being hospitalised for another reason is
associated with increased mortality risk (True)
d)Second look endoscopy is routinely recommended to ensure that
bleeding has stopped(false)
e)Patients at low-risk after endoscopy can be fed within 24 hours (True)
f)Increased risk of rebleeding has been noted with ulcers located in the
posterior lesser gastric curvature and posterior duodenal wall(True)
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

7. Q14. With regards to portal hypertension & variceal bleeding which of the
following are true
A) Beta-blockers have been proven to help reduce the incidence of ‘first
bleed’ in patients with portal hypertension .(true)
B)In patients who cannot tolerate beta blockers, nitrates may be used(true)
C) In patients with cirrhosis routine endoscopies every two years and
sclerotherapy when appropriate can prevent or delay ‘first variceal
haemorrhage’
D)Prophylactic antibiotics for seven days in patients with variceal bleeding
increases long term survival(False improves short term survival)
E)Variceal ligation is as effective as sclerotherapy in controlling acute
variceal haemorrhage (TRUE)
Terlipressin is superior to vasopressin in controlling bleeding and may be
given as bolus unlike vasopressin(true)
Q 15
A patient has the following arterial blood gas results on oxygen 15 litre/min of
oxygen flow Ph 6.9,Paco2 -54 mm of hg ,Pao2- 76 mm of Hg,HCO3- 10. m
mol/litre,BE- 8 ,His acid base abnormality is typical of
A) Diabetic ketoacidosis.
B) Severe acute pulmonary odema(answer)
C) Hepatic and renal failure
D) Patient with copd treated with diuretics.
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

8. Q 16. An 89-year-old woman suffers respiratory arrest at a nursing home.
She’s rushed to the ED, where she’s breathing on her own. The Registrar
knows that before this patient is treated, her ox hemoglobin dissociation
curve must
• :A. be normal. B. show a shift to the right.(ANSWER) C. show a shift to
the left. D. be flattened
• Q 17. Patient of stroke 3 day in ICU,starts with fever,Cough with
expectoration, breathlessness , TLC 18000, doctor on duty rings U up
and ask about which investigation to do as patient was not on DVT
prophylaxis ,thinks of P.E
a) CT pulmonary angio
b) 2D echo
c) D dimer(answer)
d) Chest X- RAY
Q 18. .Alcohol-based hand rubs have good antimicrobial activity against all of
the following except-
A)Viruses
B) Fungi
C) Mycobacteria
D) Bacterial spores (ANSWER)
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

9. Q19. 56 yr old male patient with IHD admited with chest
discomfort,palpitation and B.P-70Systolic
Rhythm as
shown
Treatment protocal as per ACLS would be,
A) Adenosine 6mg
B) Observe and monitor
C) Synchronized cardioversion(answer)
D) Call expert
Q20.Ninety six hours following admission to the trauma centre in ICU a
post splenectomy develops oliguric renal failure and progressive
pulmonary failure with rapidly increasing airway pressure, I AP
measured by foley catheter is 45 torr,which intervention will help.
A) H.D and HFJV
B) Laprotomy(ANSWER)
C) CAVHD
D) FLUID restriction and diuretics.
Q21.A 70 yr old 60 kg man with intracerebral bleed .He is obtuntded
and has NG tube in place.The resident found his abdomen to be some
what distended and peristalsis sounds were poor .He decided to start
him on parenteral nutrition.What you will prefer as the route/how
will you feed him.
A.Enteral(answer)
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

10. B.parenteral
C.no nutrition till gut settles
Q 22.Pt. Above was fed 80 gm of protien enterally and 1800 non
protien calories. His 24 hr UUN came back As 9 gm/day Does he have
adequate protien intake.
A.yes(Protien intake/6.25-24hUUN+4=nitrogen balance)
(protien calories/day/25-uungm/day-5g/day
B.No.
Q23.A 40 yr old 35 kg wt NHL patient is admitted for his sixth cycle of
chemo.he looks cachetic and has a serum albumin of 2 gm% .What
precaution you take while feeding him.
A.feed according to his ideal body weight.
B.feed according to his present body weight
C.feed him excess to normal requirement.
D.Feed him less than normal requirement.(ANS) refeeding syndrome)
Q 24.All of the following are correct regarding apnea test Except.
A.preoxygenate the pt with 100% oxygen.for 15 min
B.paco2 is allowed to be 20mmof hg above the normal base line
value
C.Visual observation for respiratory movement 5min.(ans)
D.should be terminated if pt becomes hemodynamically unstable.
• Q25. While shopping in a camp your friend suddenly c/o chest pain and
become unresponsive and gasping correct sequence of BLS you will
provide
A) Call for help, open airway ,give rescue breath ,get AED,give chest
compression 30:2
B)Activate EMS,Get AED,start chest compression,check rhythm after
2 min shock if indicated(ANS) c-a-b
C)Precordial thump,call for help,give rescue breath start compression
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

11. D)Open airway,look-listen-feel,give 2 breaths,check pulse,give
compression
Q26.
• As per ACLS 2010 capnography after advance airway placement helps in
all of the following except.
• A)Helps monitoring of resus efforts
• B)ROSC depicted by sustained increase in PetCo2 >40 mm of hg
• C) Confirmation of ETT placement if graph appears.2 breath(ANS) (6
breath)
• D)IF PetCO2<10 mm of hg attempt to improve CPR quaility
§ Q27
§ 42 yr old known case of asthma shifted from ER c/o Breathlessness,
silent chest, confusion bradycardia,decresed spo2 ventilated invasive
with following setting, as set by your registrar, which one you will ask
him to modify and why Sedation ± NMBA
§ Ventilator Mode CMV
§ Respiratory Rate 18/min
§ Tidal Volume 7-ml / kg
§ Inspiratory Flow Rate 80 L / mt
§ PEEP 4
§ FiO2 1.0
.
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.

12. .
Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark.