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Welcome to your Critical Care Test 5
Which of the following is the most common cause of hypokalemia in ICU patients?
Diuretics
Renal failure
Acidosis
Hyperaldosteronism
None
In a patient with severe hyponatremia, what is the recommended initial approach to correct the sodium level?
Rapid correction with hypertonic saline
Gradual correction over 48 hours
Fluid restriction only
Administer isotonic saline
None
Which of the following electrolyte abnormalities is most commonly associated with prolonged QT intervals?
Hyperkalemia
Hypokalemia
Hypercalcemia
Hypomagnesemia
None
Which of the following is the classic triad of thrombotic microangiopathy (TMA)?
Thrombocytopenia, hemolytic anemia, renal failure
Thrombocytopenia, leukopenia, renal failure
Hypertension, hyperkalemia, hemolytic anemia
Anemia, leukopenia, seizures
None
Which of the following is the treatment of choice for thrombotic thrombocytopenic purpura (TTP)?
Plasmapheresis
Steroids
Eculizumab
Heparin
None
In which of the following conditions is plasmapheresis most commonly used?
Guillain-Barré Syndrome
Acute myocardial infarction
Hyperkalemia
Acute respiratory distress syndrome (ARDS)
None
Which of the following is the most common complication of plasmapheresis?
Hypotension
Hyperkalemia
Hypercalcemia
Thrombocytosi
None
Which of the following is a major advantage of CRRT over intermittent hemodialysis in critically ill patients?
Faster fluid removal
Easier to perform
Less hemodynamic instability
More efficient solute clearance
None
Which of the following is a contraindication to CRRT?
Severe hypotension despite vasopressor therapy
Acute liver failure with renal involvement
Inability to access a large venous site
Severe metabolic acidosis
None
What is the most common indication for venovenous ECMO (VV-ECMO) in the ICU?
Acute respiratory failure
Cardiogenic shock
Sepsis
Acute kidney injury
None
Which of the following is the main complication associated with ECMO therapy?
Hypovolemia
Bleeding
Hyperkalemia
None
In the management of elevated intracranial pressure (ICP), which of the following interventions should be performed first?
Hyperventilation
Administration of mannitol
Placement of an external ventricular drain
Sedation and analgesia
None
Which of the following is the most appropriate first-line treatment for status epilepticus?
Phenytoin
Lorazepam
Levetiracetam
Phenobarbital
None
Which of the following is the most appropriate management for a patient with a massive pulmonary embolism and hemodynamic instability?
Heparin alone
Thrombolysis
Norepinephrine infusion
High-dose aspirin
None
Which of the following is a key parameter to monitor in patients on a nitroglycerin infusion for acute coronary syndrome (ACS)?
Blood pressure
Heart rate
Oxygen saturation
Serum potassium levels
None
A patient with severe hyperkalemia is being treated with calcium gluconate, sodium bicarbonate, and insulin. What is the primary mechanism of action of calcium gluconate in this setting?
Increases potassium excretion in the urine
Stabilizes the myocardial cell membrane
Decreases potassium release from the cells
Enhances potassium uptake into cells
None
Which of the following is a common cause of hypercalcemia in critically ill patients?
Tumor lysis syndrome
Hyperparathyroidism
Diuretic use
Acute kidney injury (AKI)
None
Which laboratory test is most useful for differentiating between TTP and HUS?
ADAMTS13 activity levels
Urine protein-to-creatinine ratio
Antinuclear antibody (ANA) test
Serum lactate dehydrogenase (LDH) levels
None
Which of the following is an early sign of thrombotic thrombocytopenic purpura (TTP)?
Hemolysis with schistocytes
Seizures
Fever
Hepatomegaly
None
What is the role of plasmapheresis in the management of myasthenia gravis crisis?
To remove acetylcholine receptor antibodies
To increase acetylcholine receptor availability
To correct electrolyte imbalances
To improve blood pressure and fluid balance
None
In which of the following conditions is plasmapheresis contraindicated?
Acute thrombotic thrombocytopenic purpura (TTP)
Guillain-Barré syndrome (GBS)
Hypovolemic shock with no venous access
Myasthenia gravis
None
Which of the following is the primary indication for CRRT in critically ill patients?
Severe hyperkalemia refractory to medical treatment
Acute kidney injury with hemodynamic instability
Chronic kidney disease
Acute respiratory failure
None
Which of the following is a potential complication of CRRT?
Hyperkalemia
Hypotension due to fluid shifts
Hypertension due to fluid overload
Pulmonary edema due to rapid fluid removal
None
Which of the following is the most appropriate initial management for a patient on ECMO who develops heparin-induced thrombocytopenia (HIT)?
Switch to warfarin
Start a direct thrombin inhibitor (e.g., argatroban)
Discontinue ECMO therapy
Increase the heparin dose
None
Which of the following ECMO configurations is most appropriate for a patient with severe refractory cardiac failure?
Veno-venous (VV) ECMO
Veno-arterial (VA) ECMO
Arteriovenous (AV) ECMO
Arterio-venous (AV) bypass
None
In the management of traumatic brain injury (TBI), which of the following is the most critical goal of care?
Rapid normalization of intracranial pressure (ICP)
Prevention of seizures
Correction of electrolyte imbalances
Maintenance of adequate cerebral perfusion pressure (CPP)
None
Which of the following is the most appropriate next step in the management of a comatose patient with suspected non-convulsive status epilepticus (NCSE)?
Start lorazepam infusion
Perform an EEG to confirm the diagnosis
Administer phenobarbital
Increase the dose of antiepileptic drugs (AEDs)
None
Which of the following is the most appropriate treatment for a patient with STEMI and persistent hypotension despite adequate fluid resuscitation?
Nitrates
Intra-aortic balloon pump (IABP)
Beta-blockers
Angiotensin-converting enzyme (ACE) inhibitors
None
A patient with acute decompensated heart failure develops a new murmur. Which of the following is the most likely cause of this murmur?
Aortic stenosis
Mitral regurgitation due to papillary muscle dysfunction
Tricuspid regurgitation due to volume overload
Atrial septal defect
None
A patient with diabetic ketoacidosis (DKA) presents with severe dehydration. What is the most important consideration when initiating fluid replacement in DKA?
Rapid administration of isotonic saline
Correction of sodium deficit before glucose normalization
Using hypotonic saline to correct hyperosmolarity
Gradual rehydration to avoid cerebral edema
None
Which of the following is the most likely cause of hypernatremia in a critically ill patient receiving intravenous fluids?
Hyperaldosteronism
Diuretic use
Excessive administration of sodium bicarbonate
Severe renal failure
None
Which of the following is the most common cause of hemolytic uremic syndrome (HUS) in children?
Streptococcus pneumoniae infection
Escherichia coli O157:H7 infection
HIV infection
Drug-induced hemolysis
None
What is the primary treatment for hemolytic uremic syndrome (HUS)?
Plasmapheresis
Antibiotic therapy
Dialysis
Corticosteroids
None
Which of the following is a major risk of performing plasmapheresis in critically ill patients?
Severe hyperkalemia
Infection due to central venous catheter
Electrolyte disturbances, particularly hypocalcemia
Acute renal failure
None
Which of the following autoimmune diseases can benefit from plasmapheresis therapy?
Rheumatoid arthritis
Systemic lupus erythematosus
Myasthenia gravis
Osteoarthritis
None
What is the primary advantage of continuous venovenous hemofiltration (CVVH) over other CRRT modalities?
Higher efficiency in removing waste products
Reduced risk of bleeding
More consistent fluid balance and hemodynamic stability
Faster fluid removal
None
Which of the following is the most common complication of CRRT?
Electrolyte disturbances
Infection
Thrombosis of the dialysis circuit
Hypertension
None
What is a key difference between venovenous (VV) ECMO and veno-arterial (VA) ECMO?
VA ECMO supports both the heart and lungs, while VV ECMO supports only the lungs
VV ECMO is used for cardiac failure, while VA ECMO is used for respiratory failure
VA ECMO requires a single cannula, while VV ECMO requires two separate cannulas
VV ECMO has a higher risk of clot formation than VA ECMO
None
What is the most common complication of ECMO related to anticoagulation?
Hemolysis
Thrombosis of the ECMO circuit
Bleeding
Infection
None
In patients with subarachnoid hemorrhage (SAH), what is the most common cause of delayed cerebral ischemia (DCI)?
Acute hydrocephalus
Cerebral vasospasm
Seizures
Acute brain swelling
None
What is the first-line treatment for intracranial hypertension in a patient with traumatic brain injury?
Hyperventilation
Osmotic therapy with mannitol
Corticosteroids
Anticonvulsants
None
Which of the following is the most appropriate pharmacological therapy for a patient with acute coronary syndrome (ACS) and no contraindications to anticoagulation?
Heparin
Enoxaparin
Warfarin
Clopidogrel
None
A patient with severe congestive heart failure (CHF) develops hypotension despite adequate fluid resuscitation. What is the most likely cause of hypotension in this patient?
Hyperkalemia
Acute coronary syndrome
Decreased cardiac output due to impaired ventricular function
Pulmonary embolism
None
Which of the following is the primary treatment for intracerebral hemorrhage (ICH)?
Surgical evacuation
Antihypertensive therapy
Corticosteroids
Anticonvulsant therapy
None
What is the most important management strategy in preventing secondary brain injury in patients with traumatic brain injury?
Aggressive glucose control
Prevention of hypoxia and hypotension
Early use of antibiotics
Induced hypothermia
None
A patient is diagnosed with hypercalcemia due to malignancy. Which of the following is the first-line treatment to lower calcium levels in this patient?
Furosemide
Furosemide
Calcium gluconate
Sodium bicarbonate
None
A critically ill patient develops severe hyponatremia. Which of the following is the most appropriate initial step in management?
Rapid administration of hypertonic saline
Administration of isotonic saline
Diuretic therapy
Restrict fluid intake only
None
A patient with a history of renal transplant presents with acute kidney injury, thrombocytopenia, and microangiopathic hemolytic anemia. What is the most likely diagnosis?
Hemolytic uremic syndrome (HUS)
Thrombotic thrombocytopenic purpura (TTP)
Disseminated intravascular coagulation (DIC)
Antiphospholipid syndrome
None
Which of the following is the most appropriate management for a patient with thrombotic thrombocytopenic purpura (TTP)?
Intravenous immunoglobulin (IVIG)
Plasma exchange (plasmapheresis)
Steroids
Blood transfusion
None
What is the primary mechanism by which plasmapheresis improves outcomes in patients with autoimmune hemolytic anemia (AIHA)?
Removal of circulating immune complexes
Restoration of platelet function
Restoration of platelet function
Decreased production of red blood cells in the bone marrow
None
Which of the following is an advantage of using continuous renal replacement therapy (CRRT) over intermittent hemodialysis in critically ill patients?
Faster fluid removal
Greater flexibility in anticoagulation
Less hemodynamic instability during therapy
Better clearance of urea
None
Which of the following patients would most likely benefit from veno-venous (VV) ECMO?
A patient with severe cardiogenic shock following a myocardial infarction
A patient with acute respiratory distress syndrome (ARDS)
A patient with profound hypotension and cardiac arrest
A patient with severe arrhythmia causing hemodynamic instability
None
Which of the following is a potential complication of ECMO therapy?
Pneumothorax
Pulmonary embolism
Heparin-induced thrombocytopenia
Hypertension
None
In the management of acute ischemic stroke, which of the following is the most important determinant of whether a patient is a candidate for thrombolysis?
Time of symptom onset
Blood glucose levels
Blood pressure control
Age of the patient
None
Which of the following is the most appropriate initial treatment for a patient with a suspected brain herniation syndrome due to increased intracranial pressure (ICP)?
Mannitol administration
Endotracheal intubation and hyperventilation
Administration of corticosteroids
Surgical decompression
None
A patient with acute heart failure presents with hypotension, a low cardiac output, and pulmonary edema. Which of the following interventions is most appropriate for this patient?
Increase preload with intravenous fluids
Administer nitroglycerin for afterload reduction
Use high-dose diuretics to decrease preload
Intubate and provide mechanical ventilation
None
Which of the following arrhythmias is most commonly seen in patients with acute myocardial infarction (MI)?
Ventricular fibrillation
Atrial fibrillation
Sinus bradycardia
Supraventricular tachycardia
None
A patient with a severe head injury develops a sudden decrease in Glasgow Coma Scale (GCS) score. What is the most appropriate next step?
Administer hypertonic saline
Reassess for new neurological deficits
Perform a CT scan of the brain
Initiate hyperventilation
None
Which of the following factors is most commonly associated with poor outcomes in patients with subarachnoid hemorrhage (SAH)?
Age over 50 years
Aneurysm size larger than 5 mm
Initial Glasgow Coma Scale (GCS) score less than 9
Female sex
None
In the management of acute myocardial infarction (MI), what is the primary benefit of using thrombolytics (e.g., tissue plasminogen activator)?
Reduces myocardial oxygen demand
Restores coronary blood flow
Prevents arrhythmias
Reduces the risk of heart failure
None
Time's up
