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Welcome to your Critical Care Test 6
Which of the following pharmacokinetic changes is most commonly observed in elderly patients receiving general anaesthesia?
Which of the following pharmacokinetic changes is most commonly observed in elderly patients receiving general anaesthesia?
Increased plasma protein binding
Decreased clearance of renal-excreted drugs
Increased hepatic metabolism of drugs
None
A pregnant patient undergoing general anaesthesia develops severe hypotension. Which of the following is the most appropriate treatment to restore blood pressure?
Increased doses of opioids
Administration of nitroglycerin
Left uterine displacement
Increased doses of volatile anaesthetics
None
Which of the following systemic effects can occur as a result of hepatorenal syndrome in critically ill patients?
Decreased renal perfusion due to vasoconstriction
Inhibition of platelet aggregation
Increased hepatic clearance of drugs
Enhanced release of insulin from the pancreas
None
During intubation of a patient with morbid obesity, which of the following is the most significant concern?
Difficult ventilation due to neck circumference
Decreased diaphragmatic excursion
Increased risk of gastric aspiration
Prolonged duration of drug action due to increased volume of distribution
None
In a patient with severe mitral stenosis, which of the following anaesthetic considerations is most important to avoid worsening the condition during general anaesthesia?
Maintenance of high systemic vascular resistance (SVR)
Avoidance of tachycardia
Use of high doses of opioids for pain control
Administration of large amounts of fluids
None
Which of the following mechanisms best explains oxygen desaturation in patients undergoing laparoscopic surgery?
Increased venous return leading to hypercarbia
Intra-abdominal pressure reducing lung compliance
Decreased central venous pressure
Decreased inspiratory flow due to air embolism
None
In acute porphyria, which of the following is the most appropriate anaesthetic agent to administer?
Thiopental
Etomidate
Propofol
Ketamine
None
Which of the following is the most important consideration in the management of anaesthesia in a patient with chronic kidney disease (CKD)?
Use of high-dose opioids for pain control
Increased risk of drug accumulation due to reduced renal clearance
Administration of high doses of fluids to maintain renal perfusion
Use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief
None
A patient with diabetes mellitus presents for surgery. Which of the following is the most appropriate approach to glucose management in the perioperative period?
Continue insulin therapy as normal, and withhold all food and fluids
Administer long-acting insulin preoperatively and hold all other medications
Administer a reduced dose of insulin with a glucose infusion during surgery
Give only oral hypoglycemics on the morning of surgery
None
In patients with traumatic brain injury (TBI), which of the following anaesthetic agents is most likely to increase intracranial pressure (ICP)?
Propofol
Sevoflurane
Ketamine
Isoflurane
None
Which of the following mechanisms of organ crosstalk best explains the development of acute lung injury (ALI) in a patient with sepsis?
Release of pro-inflammatory cytokines from the lungs
Systemic vasodilation leading to decreased perfusion pressure
Direct bacterial invasion of lung tissue
Release of pro-inflammatory cytokines from the liver
None
A 65-year-old patient with severe acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation with positive pressure ventilation. Which of the following strategies is most likely to reduce ventilator-induced lung injury (VILI)?
High tidal volumes (10-12 mL/kg)
High positive end-expiratory pressure (PEEP)
Low tidal volumes (6 mL/kg)
Increased respiratory rate to achieve normal PaCO2
None
Which of the following drug interactions is most likely to cause severe hypotension during the induction of anaesthesia in a patient receiving monoamine oxidase inhibitors (MAOIs)?
Propofol
Fentanyl
Nitroglycerin
Midazolam
None
In sepsis, renal dysfunction can be precipitated by systemic inflammation. Which of the following mechanisms is most likely responsible for acute kidney injury (AKI) during sepsis?
Renal vasodilation due to nitric oxide release
Tubular obstruction from necrotic cells
Increased filtration pressure due to systemic vasoconstriction
Renal vasoconstriction due to activation of the renin-angiotensin system (RAS)
None
A 70-year-old patient develops cardiogenic shock following a massive anterior myocardial infarction (MI). Despite adequate fluid resuscitation, the patient's blood pressure remains low. Which of the following is the most appropriate treatment to increase myocardial oxygen delivery and improve hemodynamics?
Administration of dobutamine
Administration of vasopressin
Increased volume expansion with crystalloids
Use of sodium nitroprusside to reduce afterload
None
A patient with severe acute respiratory distress syndrome (ARDS) is being mechanically ventilated. Which of the following ventilator settings has the potential to improve oxygenation while minimizing the risk of ventilator-induced lung injury (VILI)?
Low tidal volume (6 mL/kg), high PEEP
High tidal volume (12 mL/kg), low PEEP
Low tidal volume (6 mL/kg), low PEEP
High tidal volume (12 mL/kg), high PEEP
None
A patient with sepsis-induced multiorgan dysfunction syndrome (MODS) develops worsening liver and renal function. Which of the following cytokines is most likely to be implicated in the systemic inflammation that leads to this organ dysfunction?
Interleukin-1 (IL-1)
Tumor necrosis factor-alpha (TNF-α)
Interleukin-10 (IL-10)
Interferon-gamma (IFN-γ)
None
A 55-year-old patient is admitted to the ICU with metabolic acidosis after a prolonged episode of diarrhea. Blood gas results show a low pH, low bicarbonate (HCO3-), and an elevated anion gap. Which of the following is the most likely cause of the metabolic acidosis?
Lactic acidosis
Diabetic ketoacidosis
Renal failure
Diarrhea-induced loss of bicarbonate
None
In a patient with sepsis, which of the following is the primary mechanism by which microcirculatory dysfunction leads to organ failure?
Impaired endothelial function due to cytokine release
Impaired renal perfusion due to reduced cardiac output
Increased blood viscosity due to hemoconcentration
Increased oxygen demand leading to mitochondrial failure
None
In shock states (e.g., septic shock), which of the following pathophysiological mechanisms best explains the development of acute lung injury (ALI) due to systemic inflammation?
Systemic vasodilation and hypotension leading to poor tissue perfusion
Release of pro-inflammatory cytokines leading to pulmonary endothelial cell damage
Release of pro-inflammatory cytokines leading to pulmonary endothelial cell damage
Increased pulmonary vascular resistance due to catecholamine release
None
A 35-year-old patient is admitted with severe traumatic brain injury (TBI). Despite optimal management, the patient develops worsening intracranial pressure (ICP). Which of the following interventions is most likely to improve ICP by decreasing cerebral edema?
Hypertonic saline (3%)
Mannitol
Barbiturate coma
Furosemide
None
A 60-year-old patient with acute myocardial infarction (MI) is started on intra-aortic balloon pump (IABP) therapy. Which of the following best describes the mechanism of action of the IABP in improving hemodynamics in cardiogenic shock?
A 60-year-old patient with acute myocardial infarction (MI) is started on intra-aortic balloon pump (IABP) therapy. Which of the following best describes the mechanism of action of the IABP in improving hemodynamics in cardiogenic shock?
Enhances coronary artery perfusion during diastole
Increases myocardial oxygen consumption
Reduces preload by increasing venous return
None
In patients with acute kidney injury (AKI) and hemodynamic instability, which of the following types of Continuous Renal Replacement Therapy (CRRT) is most appropriate?
Continuous venovenous hemofiltration (CVVH)
Intermittent hemodialysis (IHD)
Continuous venovenous hemodialysis (CVVHD)
Peritoneal dialysis
None
Which of the following is the most important indication for initiating venovenous ECMO in a critically ill patient?
Acute respiratory failure refractory to mechanical ventilation
Severe cardiac arrest with no response to resuscitation
Chronic obstructive pulmonary disease (COPD) exacerbation
Severe sepsis with multiorgan failure
None
A 40-year-old patient with severe autoimmune hemolytic anemia is being considered for plasma exchange. Which of the following is the most important effect of plasma exchange in this condition?
Removal of circulating autoantibodies
Replenishment of clotting factors
Reduction of immune complex deposition
Decrease in red blood cell destruction
None
A 70-year-old patient requires urgent blood transfusion for acute blood loss. What is the most appropriate threshold for transfusing red blood cells (RBCs) in a patient without significant comorbidities?
Hemoglobin < 6 g/dL
Hemoglobin < 7 g/dL
Hemoglobin < 8 g/dL
Hemoglobin < 10 g/dL
None
A patient in cardiac arrest is being resuscitated using high-quality chest compressions. Which of the following is most likely to improve survival during resuscitation efforts?
Continuous compression without ventilation
Increased frequency of ventilations
Chest compression depth of less than 2 inches
Delaying defibrillation to optimize chest compressions
None
In a patient with acute ischemic stroke receiving thrombectomy, which of the following mechanisms is most important in preventing secondary brain injury during reperfusion?
Prevention of vasospasm
Optimization of blood pressure
Prevention of reperfusion injury
Monitoring of serum glucose levels
None
In a critically ill patient with acute kidney injury (AKI) and volume overload, which of the following therapies is most appropriate for continuous fluid removal?
Intermittent hemodialysis
Peritoneal dialysis
Continuous venovenous hemofiltration (CVVH)
Diuretics alone
None
A patient with severe trauma and ongoing blood loss is transfused with multiple units of packed red blood cells (PRBCs). Which of the following complications is most commonly associated with massive blood transfusion?
Hyperkalemia
Hypocalcemia
Hypermagnesemia
Hyperbilirubinemia
None
A 45-year-old patient with status epilepticus is unresponsive to initial benzodiazepine therapy. Which of the following medications is most likely to provide long-term seizure control in this patient?
Phenytoin
Propofol
Ketamine
Levetiracetam
None
A 50-year-old patient in septic shock is being managed with vasopressors and fluids. Which of the following hemodynamic parameters is most helpful in assessing adequate tissue perfusion in this patient?
Central venous pressure (CVP)
Mean arterial pressure (MAP)
Lactate levels
Pulmonary artery occlusion pressure (PAOP)
None
A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated. Which of the following strategies is most likely to reduce the risk of ventilator-associated lung injury (VILI)?
High tidal volumes (10-12 mL/kg)
Use of high-frequency oscillatory ventilation (HFOV)
Low tidal volumes (6 mL/kg) with appropriate PEEP
Prolonged inspiratory times
None
A 55-year-old patient with severe ARDS is being considered for venovenous ECMO. Which of the following is the most important consideration before initiating ECMO therapy?
Serum creatinine levels
Patient's age
Severity of hypoxemia despite conventional therapy
Presence of a family member for consent
None
A patient with severe thrombotic thrombocytopenic purpura (TTP) is being treated with plasma exchange. Which of the following is the primary goal of this therapy?
Removal of antibodies against ADAMTS13
Restoration of platelet count
Prevention of thrombosis
Replenishment of clotting factors
None
A 60-year-old patient undergoing a massive transfusion protocol (MTP) develops hypocalcemia. Which of the following is most likely the cause of this complication?
Citrate used as an anticoagulant in blood products
Overcorrection of acidosis
Excessive red blood cell transfusion
Hemolysis of transfused blood
None
After successful resuscitation from cardiac arrest, a patient is unconscious and has abnormal neurologic findings. Which of the following interventions is most likely to improve neurologic outcomes in this patient?
Therapeutic hypothermia
Hyperbaric oxygen therapy
Administration of corticosteroids
High-dose dopamine therapy
None
In a patient with traumatic brain injury (TBI) and elevated intracranial pressure (ICP), which of the following strategies is most likely to reduce ICP?
Administration of hypertonic saline
Administration of corticosteroids
Elevation of the head of the bed to 45 degrees
Sedation with propofol
None
A 50-year-old patient in cardiac arrest is being managed with advanced airway techniques. Which of the following is the most appropriate method to confirm correct endotracheal tube placement?
Chest rise with positive pressure ventilation
Detection of exhaled CO2 with capnography
Auscultation of breath sounds
Pulse oximetry
None
A 70-year-old patient with sepsis and hypotension is being managed in the ICU. After initial fluid resuscitation, the patient’s blood pressure remains low despite the use of norepinephrine. Which of the following interventions is most appropriate next?
Increase the norepinephrine dose
Initiate corticosteroids
Begin mechanical ventilation
Begin mechanical ventilation
None
A 55-year-old patient in the ICU with acute kidney injury (AKI) requires continuous renal replacement therapy (CRRT). Which of the following is a primary indication for initiating CRRT?
Hypotension unresponsive to vasopressors
Hypotension unresponsive to vasopressors
Mild azotemia with stable hemodynamics
Requirement for dialysis after acute toxic exposure
None
In a patient with suspected brain death, which of the following is a necessary criterion for confirming the diagnosis?
Absence of cranial nerve reflexes
Presence of a flat EEG for at least 30 minutes
Absent respiratory effort with a PaCO2 > 60 mmHg after 10 minutes of apnea
All of the above
None
A 30-year-old woman with severe hemorrhage requires a massive blood transfusion. Which of the following complications is most likely associated with the transfusion of stored blood?
Hyperkalemia
Iron deficiency
Coagulopathy
Thrombocytosis
None
In a patient with intracranial hypertension and elevated ICP, which of the following interventions is most likely to decrease ICP?
Administering mannitol
Hyperventilating the patient to a PaCO2 of 20 mmHg
Administering high-dose corticosteroids
Keeping the head of the bed flat
None
A 65-year-old patient presents with acute chest pain and ST-segment elevation on ECG. After initial stabilization with aspirin and heparin, the patient is scheduled for primary percutaneous coronary intervention (PCI). Which of the following is the most critical time window for PCI to achieve the best outcomes in STEMI?
Within 6 hours of symptom onset
Within 6 hours of symptom onset
Within 24 hours of symptom onset
Within 48 hours of symptom onset
None
A patient with severe AKI requires continuous renal replacement therapy (CRRT). Which of the following is the most common modality used in CRRT for hemodynamically unstable patients?
Continuous venovenous hemofiltration (CVVH)
Continuous venovenous hemodialysis (CVVHD)
Continuous venovenous hemodiafiltration (CVVHDF)
Intermittent hemodialysis
None
A patient with spinal cord injury presents with hypotension, bradycardia, and warm, dry skin below the level of injury. What is the most likely diagnosis?
Neurogenic shock
Hypovolemic shock
Cardiogenic shock
Anaphylactic shock
None
A patient with autoimmune hemolytic anemia (AIHA) is being treated with plasma exchange. What is the most important goal of plasma exchange in this condition?
Removal of autoantibodies
Replenishment of iron stores
Prevention of clotting disorders
Restoration of red blood cell mass
None
A 45-year-old patient with sepsis is receiving fluid resuscitation. Which of the following fluids is considered the first-line therapy for initial fluid resuscitation in sepsis?
0.9% saline
Ringer’s lactate
Albumin
Dextrose 5%
None
A 60-year-old patient has been successfully resuscitated from cardiac arrest. The patient remains unconscious, and the decision is made to initiate targeted temperature management (TTM). What is the most appropriate target temperature for this patient?
33°C
33°C
38°C
40°C
None
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