Critical Care MCQ
Critical Care MCQ
Hemodynamics & Cardiology
Which arenot indications of temporary pacing in AMI?
a) Mobitz type II.
b) Alternating right and left bundle branch block (BBB).
c) Mobitz type I + normal BP.
c •??????
Indication of permanent pacemaker in MI:
a) Sinus brabycardia.
b) Lt Ant. Hemiblock.
c) Persistent Mobitz type II with BBB. (or with hemiblock)
d) Persistent Mobitz type II. ??????
c •
Rt heart failure PCWP 18, treatment:
a) Fluids.
b) Lasix.
c) Dobutamine.
d) Dopamine.
c •
Absolute contraindication to IABP:
a) Severe heart disease.
b) Unstable angina.
c) Acute mitral insufficiency.
d) Aortic insufficiency.
• Relative CI:
o Bilateral ilio-femoral peripheral artery disease.
o Aortic aneurysm.
o Iliac artery stent or prosthetic ilio-femoral graft
d
o Coagulopathy.
• Absolute CI: Aortic insufficiency , aortic dissection (risk to be inserted in in aneurysmal lumen),
PDA
• Confirm place of IABP by CXR (tip at carina)
1
,Critical Care MCQ
Which have the most effect on flow of fluids in IV catheters?
a) Diameter.
b) Length.
c) Viscosity of the fluid.
d) Site of insertion.
• Flow (Q) = k (ΔP/R)(L= Length, η = Viscosity, r = radius, P=pressure,R=Resistance)
• R= L.η/ r4
a • k =Л / 8,
• Q = ΔP. Л.r4/ 8 L.η
• Radius (diameter is raised to the fourth power so small change → significant effect)
All increase risk of pulmonary embolism during surgery except:
a) CRF (CKD).
b) Use of oral contraceptive pills (OCP).
c) Lupus (SLE).
d) Adenocarcinoma.
• Hypercoagulopathy: OCP, SLE(&APAS), malignancy
a
• CKD (platelet dysfunction
All are contraindication to CVC except:
a) Coagulation disorder.
b) Thrombocytopenia.
c) Scar at site of insertion.
d) Unconscious (or uncooperative) patient.
a •????? Marino 66
Test used to diagnose heart failure:
a) Troponin.
b) cK MB.
c) LDH.
d) B type Natriuretic Peptide (BNP).
• BNP >500 Pg/ml is diagnostic to HF &< 100 good negative value
d
• Not dependent test in RI or hemodialysis (false high)
2
,Critical Care MCQ
All are indications of CVC replacement except:
a) Purulent drainage from catheter site.
b) Percutaneously inserted is suspected to be a source of systemic
sepsis.
c) Catheter inserted emergently without strict aseptic technique.
d) Subclavian catheter inserted >48 h.
e) Femoral catheter inserted >48 h.
d •
Decompensated HF with (↑PCWP + ↓CO or CI + ↑BP); TTT of choice is:
a) Vasodilators.
b) Dobutamine.
c) Dopamine.
d) Milrinone.
a • Forrester classification
Decompensated HF with (↑PCWP + ↓CO or CI + normal BP); TTT of
choice is:
a) Milrinone.
b) Dobutamine.
c) Dopamine.
d) Norepinephrine.
b • Forrester classification
RT HF with (PCWP 12 + ↓BP); TTT of choice is:
a) Dobutamine.
b) Dopamine.
c) Norepinephrine.
d) IV fluid
• Need to increase preload
d
• To give inotropes PCWP >15
3
, Critical Care MCQ
Decompensated HF with (↑PCWP + ↓CO or CI + normal BP) + patient on
BB medication; TTT of choice is:
a) Milrinone.
b) Dobutamine.
c) Dopamine.
d) Norepinephrine.
• ??????Milrinone. PDI 3 → inodilator(VD+ inotrope)not depend on B receptors
• Patients treated with beta blockersbefore admission and requiringconcomitant inotropic therapy
a
should bepreferably treated with a PDE III inhibitororlevosimendan rather than a betaadrenergic
agonist such as dobutamine
Subclavian CVC, most common complication is:
a) VTE.
b) Pneumothorax.
c) Hemothorax.
d) Rupture of free wall of the heart.
• Subclavian CVC, most common complication is Pneumothorax (nearly no risk difference between
b jugular and Subclavian to Pneumothorax).
• Femoral catheter common complication VTE & infection.
Case: 72 years old exploratory laparotomy → remain elective
ventilation→ develops hypotension over several hours (BP = 110/70) →
develops manifestation of septic shock require high dose vasopressors →
evidence of hypoperfusion (pH = 7.24 + PCO2 = 28 + PO2 = 80 +
O2sat=97% + Hb = 8 ) → PAC is inserted giving this data (CVP = 10 +
PCWP = 18 + CI= 1.5 L/min/m2+ mixed venous O2 saturation 54%).
Which is most likely to increase O2 delivery?
a) 2L normal saline.
b) Blood transfusion to increase Hb to 10.
c) Vasopressor + inotropes to increase CI to 3.
• DO2 = CO x CaO2 x 10 as CaO2 = (1.34 x Hb x SO2) + 0.003 x PO2)
• DO2 = CO x [(1.34 x Hb x SO2) + 0.003 x PO2)] x 10 → so effect of Hb change is more than CO change
c
• To increase DO2 →↑CO or ↑Hb (but indication of BL transf is Hb<7 unless IHD or SaO2 – SvO2 >50)
• So increase CO is better choise
4
Critical Care MCQ
Hemodynamics & Cardiology
Which arenot indications of temporary pacing in AMI?
a) Mobitz type II.
b) Alternating right and left bundle branch block (BBB).
c) Mobitz type I + normal BP.
c •??????
Indication of permanent pacemaker in MI:
a) Sinus brabycardia.
b) Lt Ant. Hemiblock.
c) Persistent Mobitz type II with BBB. (or with hemiblock)
d) Persistent Mobitz type II. ??????
c •
Rt heart failure PCWP 18, treatment:
a) Fluids.
b) Lasix.
c) Dobutamine.
d) Dopamine.
c •
Absolute contraindication to IABP:
a) Severe heart disease.
b) Unstable angina.
c) Acute mitral insufficiency.
d) Aortic insufficiency.
• Relative CI:
o Bilateral ilio-femoral peripheral artery disease.
o Aortic aneurysm.
o Iliac artery stent or prosthetic ilio-femoral graft
d
o Coagulopathy.
• Absolute CI: Aortic insufficiency , aortic dissection (risk to be inserted in in aneurysmal lumen),
PDA
• Confirm place of IABP by CXR (tip at carina)
1
,Critical Care MCQ
Which have the most effect on flow of fluids in IV catheters?
a) Diameter.
b) Length.
c) Viscosity of the fluid.
d) Site of insertion.
• Flow (Q) = k (ΔP/R)(L= Length, η = Viscosity, r = radius, P=pressure,R=Resistance)
• R= L.η/ r4
a • k =Л / 8,
• Q = ΔP. Л.r4/ 8 L.η
• Radius (diameter is raised to the fourth power so small change → significant effect)
All increase risk of pulmonary embolism during surgery except:
a) CRF (CKD).
b) Use of oral contraceptive pills (OCP).
c) Lupus (SLE).
d) Adenocarcinoma.
• Hypercoagulopathy: OCP, SLE(&APAS), malignancy
a
• CKD (platelet dysfunction
All are contraindication to CVC except:
a) Coagulation disorder.
b) Thrombocytopenia.
c) Scar at site of insertion.
d) Unconscious (or uncooperative) patient.
a •????? Marino 66
Test used to diagnose heart failure:
a) Troponin.
b) cK MB.
c) LDH.
d) B type Natriuretic Peptide (BNP).
• BNP >500 Pg/ml is diagnostic to HF &< 100 good negative value
d
• Not dependent test in RI or hemodialysis (false high)
2
,Critical Care MCQ
All are indications of CVC replacement except:
a) Purulent drainage from catheter site.
b) Percutaneously inserted is suspected to be a source of systemic
sepsis.
c) Catheter inserted emergently without strict aseptic technique.
d) Subclavian catheter inserted >48 h.
e) Femoral catheter inserted >48 h.
d •
Decompensated HF with (↑PCWP + ↓CO or CI + ↑BP); TTT of choice is:
a) Vasodilators.
b) Dobutamine.
c) Dopamine.
d) Milrinone.
a • Forrester classification
Decompensated HF with (↑PCWP + ↓CO or CI + normal BP); TTT of
choice is:
a) Milrinone.
b) Dobutamine.
c) Dopamine.
d) Norepinephrine.
b • Forrester classification
RT HF with (PCWP 12 + ↓BP); TTT of choice is:
a) Dobutamine.
b) Dopamine.
c) Norepinephrine.
d) IV fluid
• Need to increase preload
d
• To give inotropes PCWP >15
3
, Critical Care MCQ
Decompensated HF with (↑PCWP + ↓CO or CI + normal BP) + patient on
BB medication; TTT of choice is:
a) Milrinone.
b) Dobutamine.
c) Dopamine.
d) Norepinephrine.
• ??????Milrinone. PDI 3 → inodilator(VD+ inotrope)not depend on B receptors
• Patients treated with beta blockersbefore admission and requiringconcomitant inotropic therapy
a
should bepreferably treated with a PDE III inhibitororlevosimendan rather than a betaadrenergic
agonist such as dobutamine
Subclavian CVC, most common complication is:
a) VTE.
b) Pneumothorax.
c) Hemothorax.
d) Rupture of free wall of the heart.
• Subclavian CVC, most common complication is Pneumothorax (nearly no risk difference between
b jugular and Subclavian to Pneumothorax).
• Femoral catheter common complication VTE & infection.
Case: 72 years old exploratory laparotomy → remain elective
ventilation→ develops hypotension over several hours (BP = 110/70) →
develops manifestation of septic shock require high dose vasopressors →
evidence of hypoperfusion (pH = 7.24 + PCO2 = 28 + PO2 = 80 +
O2sat=97% + Hb = 8 ) → PAC is inserted giving this data (CVP = 10 +
PCWP = 18 + CI= 1.5 L/min/m2+ mixed venous O2 saturation 54%).
Which is most likely to increase O2 delivery?
a) 2L normal saline.
b) Blood transfusion to increase Hb to 10.
c) Vasopressor + inotropes to increase CI to 3.
• DO2 = CO x CaO2 x 10 as CaO2 = (1.34 x Hb x SO2) + 0.003 x PO2)
• DO2 = CO x [(1.34 x Hb x SO2) + 0.003 x PO2)] x 10 → so effect of Hb change is more than CO change
c
• To increase DO2 →↑CO or ↑Hb (but indication of BL transf is Hb<7 unless IHD or SaO2 – SvO2 >50)
• So increase CO is better choise
4
