Welcome to your Critical Care Test 8 A 65-year-old male with a history of hypertension presents with severe chest pain, diaphoresis, and shortness of breath. His ECG shows ST-segment elevation in leads II, III, and aVF. What is the most likely diagnosis? Unstable angina Acute pericarditis Myocardial infarction (Inferior wall) Pulmonary embolism None Which of the following is the first-line treatment for acute decompensated heart failure with pulmonary edema? Norepinephrine Furosemide Dobutamine Amiodarone None A 50-year-old male is brought to the ICU following a myocardial infarction complicated by cardiogenic shock. Which of the following is the most appropriate initial management strategy? Immediate surgical revascularization Administration of thrombolytics Mechanical circulatory support (e.g., intra-aortic balloon pump) Initiation of high-dose corticosteroids None A 70-year-old female with a history of atrial fibrillation presents with hypotension, tachycardia, and a narrowed pulse pressure. Her heart rate is 140 bpm, and ECG shows rapid atrial fibrillation with a variable ventricular response. What is the next step in management? Digoxin Synchronized cardioversion Beta-blockers Anticoagulation therapy None A patient with a recent history of head trauma presents with a Glasgow Coma Scale (GCS) of 7. A CT scan shows a large right-sided epidural hematoma. What is the most appropriate next step in management? Intravenous mannitol Immediate craniotomy Observation and serial CT scans Hyperventilation to reduce intracranial pressure None Which of the following is the most common cause of non-traumatic subarachnoid hemorrhage (SAH)? Aneurysm rupture Arteriovenous malformation (AVM) Coagulopathy Brain tumor None A 45-year-old male with no prior neurological history presents with new-onset seizures. His MRI shows a ring-enhancing lesion in the right frontal lobe. What is the most likely diagnosis? Brain metastasis Glioblastoma multiforme Brain abscess Multiple sclerosis None A 60-year-old female with diabetes mellitus and hypertension presents with an acute-onset headache, vomiting, and papilledema. CT shows a hyperdense lesion in the posterior fossa. What is the most likely cause? Cerebellar infarction Cerebellar hemorrhage Meningitis Subdural hematoma None A 25-year-old woman presents to the ICU with severe anemia and jaundice. Her laboratory results show a low hemoglobin level, elevated reticulocyte count, and indirect hyperbilirubinemia. The most likely diagnosis is: Iron deficiency anemia Hemolytic anemia Acute blood loss anemia Anemia of chronic disease None A 60-year-old male with a history of prostate cancer presents with severe thrombocytopenia and signs of bleeding. He is found to have disseminated intravascular coagulation (DIC). What is the first step in managing DIC? Platelet transfusion Fresh frozen plasma (FFP) transfusion Heparin therapy Treat the underlying cause None 1. A 55-year-old female with metastatic breast cancer develops febrile neutropenia. Her absolute neutrophil count (ANC) is 300/µL. What is the most appropriate initial management? Antibiotics after blood cultures Immediate administration of granulocyte colony-stimulating factor (G-CSF) Administration of IV immunoglobulin Observation without antibiotics None A 45-year-old male with newly diagnosed leukemia presents with severe thrombocytopenia and widespread bruising. His fibrinogen level is 100 mg/dL, and his PT and aPTT are prolonged. What is the most likely diagnosis? Leukemia-induced coagulopathy Disseminated intravascular coagulation (DIC) Vitamin K deficiency Hemophilia None A 60-year-old male with acute kidney injury (AKI) due to prerenal causes (hypovolemia) develops worsening renal function despite adequate fluid resuscitation. His urine output remains low, and his urine sodium is 25 mEq/L. What is the next most appropriate step in management? Initiate hemodialysis Administer a diuretic Continue monitoring without intervention Evaluate for intrinsic renal pathology None Which of the following is the most common cause of acute kidney injury in critically ill patients? Postrenal causes (obstruction) Prerenal causes (hypoperfusion) Intrinsic renal causes (acute tubular necrosis) Glomerulonephritis None A 70-year-old female with a history of chronic heart failure presents with increasing shortness of breath, orthopnea, and bilateral lower extremity edema. Her blood pressure is 110/70 mmHg, heart rate 90 bpm, and her lungs are crackly on auscultation. Which of the following is the most appropriate next step in her management? Increase her diuretic dose Initiate a vasopressor Administer intravenous inotropes Administer beta-blockers None Which of the following ECG findings is most consistent with hyperkalemia in the setting of a patient with acute renal failure? Peaked T waves Prolonged QT interval ST-segment elevation U waves None A 60-year-old male presents with an acute ischemic stroke. His NIHSS score is 16. What is the most appropriate time window for intravenous thrombolysis with alteplase? Within 1 hour of symptom onset Within 3 hours of symptom onset Within 6 hours of symptom onset Within 12 hours of symptom onset None A 58-year-old female with a history of hypertension presents with an acute onset of severe headache, nausea, and vomiting. On examination, she is confused, and fundoscopy reveals papilledema. What is the most likely cause of her symptoms? Meningitis Brain tumor Hypertensive encephalopathy Acute ischemic stroke None A 40-year-old male with a history of sickle cell disease presents with acute chest syndrome. He has fever, chest pain, and hypoxia. What is the most appropriate initial treatment? Antibiotics, oxygen, and blood transfusion High-dose steroids Anticoagulation therapy Exchange transfusion None A 70-year-old male with chronic myelogenous leukemia (CML) presents with bleeding and a platelet count of 10,000/µL. Which of the following treatments would be most appropriate to correct his thrombocytopenia? Platelet transfusion Intravenous immunoglobulin Erythropoietin therapy Leukapheresis None A 65-year-old male with advanced non-small cell lung cancer (NSCLC) presents with hypercalcemia of malignancy (HCM). His calcium level is 15 mg/dL. What is the most appropriate initial management? Administer intravenous fluids and furosemide Administer bisphosphonates or denosumab Initiate corticosteroid therapy Chemotherapy None A 50-year-old female with metastatic breast cancer presents with confusion, headache, and nausea. CT of the head reveals multiple brain metastases. What is the next best step in managing her symptoms? High-dose corticosteroids Chemotherapy Whole-brain radiation therapy Surgical resection None A 70-year-old male with a history of diabetes and hypertension presents with acute kidney injury (AKI) after starting an ACE inhibitor. His serum creatinine has increased from baseline of 1.0 mg/dL to 3.0 mg/dL over the past 2 weeks. What is the most likely cause of his AKI? Pre-renal azotemia Acute interstitial nephritis Glomerulonephritis ACE inhibitor-induced acute kidney injury None A 55-year-old male with acute tubular necrosis (ATN) develops hyperkalemia and refractory acidosis. What is the most appropriate next step in management? Sodium bicarbonate therapy Intravenous insulin and glucose Initiate hemodialysis Administer calcium gluconate None A 68-year-old male with chronic kidney disease (CKD) presents with hyperkalemia. His serum potassium is 6.2 mEq/L, and he has ECG changes showing peaked T waves. Which of the following is the most appropriate immediate intervention? Sodium bicarbonate infusion Calcium gluconate infusion Calcium gluconate infusion Beta-blockers None A 60-year-old male with a history of chronic obstructive pulmonary disease (COPD) and coronary artery disease presents with severe chest pain. His ECG shows ST-segment elevation in V1-V4. His troponin levels are elevated. What is the most likely diagnosis? Acute pericarditis Anterior wall myocardial infarction Pulmonary embolism Non-ST elevation myocardial infarction (NSTEMI) None A 55-year-old male with acute myocardial infarction is receiving intravenous fibrinolytics. His blood pressure suddenly drops to 80/50 mmHg, and he becomes tachycardic. What is the most appropriate next step in management? Administer intravenous fluids and dopamine Perform percutaneous coronary intervention (PCI) Administer nitroglycerin Discontinue fibrinolytic therapy None A 72-year-old male presents with an acute ischemic stroke. He is within 4 hours of symptom onset and is a candidate for thrombolysis. His blood pressure is 185/100 mmHg. What is the most appropriate next step regarding blood pressure management? Administer intravenous labetalol to reduce blood pressure below 180/105 mmHg Administer antihypertensive medications to reduce blood pressure immediately to 120/80 mmHg No intervention is necessary if the patient is asymptomatic from a blood pressure perspective Increase blood pressure to maintain a perfusion pressure above 70 mmHg None A 58-year-old female presents with severe headache, nausea, and vomiting. A CT scan reveals an intraventricular hemorrhage. The patient's GCS is 7, and she is hemodynamically stable. What is the most appropriate management for this patient? Immediate craniotomy to evacuate the hemorrhage Placement of an external ventricular drain (EVD) Hypertonic saline infusion Intravenous corticosteroids None A 35-year-old woman with a history of systemic lupus erythematosus (SLE) presents with anemia, thrombocytopenia, and a positive direct antiglobulin test (DAT). What is the most likely diagnosis? Autoimmune hemolytic anemia Hemophilia A Thrombotic thrombocytopenic purpura Disseminated intravascular coagulation None A 50-year-old male with a history of chronic liver disease presents with easy bruising and prolonged bleeding. His PT and aPTT are markedly prolonged, and his fibrinogen level is normal. What is the most likely cause of his bleeding? Vitamin K deficiency Liver failure with coagulopathy Hemophilia A Disseminated intravascular coagulation (DIC) None A 40-year-old male with metastatic colorectal cancer presents with severe abdominal pain, nausea, and vomiting. A CT scan reveals bowel obstruction caused by tumor growth. What is the most appropriate next step in management? Initiate chemotherapy Perform bowel decompression via nasogastric tube Surgical resection of the obstructed segment Start total parenteral nutrition (TPN) None A 65-year-old female with breast cancer presents with confusion, lethargy, and increased calcium levels of 14 mg/dL. What is the first-line treatment for hypercalcemia of malignancy? Bisphosphonates Steroids Dialysis Parathyroidectomy None A 60-year-old male with diabetes and hypertension presents with an elevated serum creatinine of 3.0 mg/dL. His urine sodium is 20 mEq/L, and urine osmolality is 300 mOsm/kg. What is the most likely diagnosis? Acute tubular necrosis Pre-renal azotemia Post-renal obstruction Chronic kidney disease None A 70-year-old male with end-stage renal disease presents with acute-on-chronic kidney failure. His serum potassium is 6.5 mEq/L, and his ECG shows peaked T waves. What is the most appropriate next step in management? Administer sodium bicarbonate Initiate hemodialysis Administer calcium gluconate Start an ACE inhibitor None A 50-year-old male presents with a sudden onset of chest pain radiating to his back. His blood pressure is 190/120 mmHg, and his ECG shows nonspecific changes. CT of the chest reveals an aortic dissection. What is the most appropriate initial treatment? Immediate surgical repair Beta-blockers to lower heart rate and blood pressure Intravenous fibrinolytics Anticoagulation therapy None A 70-year-old male with a history of hypertension presents with an acute stroke. His CT scan is negative for hemorrhage, and he is eligible for thrombolysis. However, his blood pressure is 185/110 mmHg. What is the most appropriate management to lower his blood pressure before thrombolysis? Intravenous labetalol Oral amlodipine Intravenous nitroprusside Oral enalapril None A 56-year-old woman presents with altered mental status, fever, and a progressive decline in neurological function. A lumbar puncture reveals a markedly elevated white blood cell count with a predominance of neutrophils. What is the most likely cause? Meningitis Encephalitis Subarachnoid hemorrhage Brain abscess None A 68-year-old male with a history of diabetes and hypertension presents with sudden-onset focal neurological deficits and dysphagia. A CT angiogram reveals a large middle cerebral artery (MCA) infarction. What is the most appropriate acute management strategy? Administer tissue plasminogen activator (tPA) Administer aspirin Perform mechanical thrombectomy Start anticoagulation therapy None A 25-year-old woman with no significant medical history presents with severe shortness of breath, fatigue, and a hemoglobin level of 5 g/dL. Her peripheral blood smear shows microcytic hypochromic red blood cells. What is the most likely cause of her anemia? Iron deficiency anemia Vitamin B12 deficiency Hemolytic anemia Aplastic anemia None A 45-year-old male presents with a sudden onset of abdominal pain, fever, and confusion. His platelet count is 20,000/µL, and he has a history of colon cancer. A peripheral blood smear shows schistocytes. What is the most likely diagnosis? Disseminated intravascular coagulation (DIC) Thrombotic thrombocytopenic purpura (TTP) Hemolytic uremic syndrome (HUS) Acute leukemia None A 70-year-old male with advanced pancreatic cancer develops sudden-onset abdominal pain, nausea, and vomiting. His amylase and lipase are markedly elevated. What is the most likely cause of his symptoms? Pancreatitis Bowel obstruction Perforated gastric ulcer Mesenteric ischemia None A 50-year-old female with metastatic ovarian cancer presents with severe constipation, nausea, and vomiting. CT scan reveals a bowel obstruction secondary to tumor mass effect. What is the most appropriate next step in management? Surgical resection Chemotherapy Bowel decompression via nasogastric tube Initiate total parenteral nutrition (TPN) None A 65-year-old male with chronic kidney disease presents with a blood pressure of 170/100 mmHg, creatinine of 3.5 mg/dL, and proteinuria. What is the most likely cause of his worsening renal function? Acute interstitial nephritis Diabetic nephropathy Hypertensive nephrosclerosis Glomerulonephritis None A 70-year-old male with end-stage renal disease is on hemodialysis. He presents with fever, chills, and hypotension during dialysis. Blood cultures reveal Gram-positive cocci. What is the most likely diagnosis? Acute pericarditis Dialysis-related bacteremia Septic shock Catheter-related infection None A 58-year-old female with a history of systemic lupus erythematosus (SLE) presents with acute kidney injury, a positive urine dipstick for protein, and a negative urinalysis for blood. What is the most likely underlying cause? Acute tubular necrosis Acute interstitial nephritis Lupus nephritis Post-renal obstruction None A 62-year-old female with known coronary artery disease presents with acute chest pain, dyspnea, and diaphoresis. Her ECG shows ST-segment depression in the lateral leads. What is the most likely diagnosis? Non-ST elevation myocardial infarction (NSTEMI) Acute pericarditis Stable angina Unstable angina None A 75-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) presents with increased shortness of breath and orthopnea. His blood pressure is 100/60 mmHg, and his heart rate is 90 bpm. Which of the following medications would be most beneficial in improving his survival? Furosemide Metoprolol Spironolactone Nitroglycerin None A 55-year-old male presents with confusion, agitation, and a history of a recent head trauma. A CT scan reveals a subdural hematoma. His GCS is 10, and he is increasingly lethargic. What is the most appropriate next step in management? Observe and repeat CT scan in 24 hours Immediate craniotomy Hyperventilate to reduce intracranial pressure Administer corticosteroids None A 50-year-old male with a history of alcohol abuse presents with confusion and ataxia. His MRI shows bilateral thalamic lesions. What is the most likely cause? Thalamic stroke Wernicke’s encephalopathy Brain tumor Multiple sclerosis None Time's up
