FULL TEST
BANK
A+
, CARDIORESPIRATORY ARREST
chapter
AND SHOCK
1 QUESTIONS
1. A 74-year-old man suffered a cardiorespiratory arrest on a surgical
ward four days after an elective sigmoid colectomy (with primary
anastomosis) for cancer. His past medical history included hypertension
and hypercholesterolaemia for which he took lisinopril, atenolol, and
atorvastatin.
He had been seen by the surgical foundation year 1 doctor (in the UK)
eight hours prior to his cardiorespiratory arrest after an episode of
nausea and vomiting. On examination at that time his temperature
was 38.0°C, pulse 105 beats per minute, blood pressure 95/40 mmHg,
and respiratory rate 28 breaths per minute, with peripheral oxygen
saturation of 94% on air. The doctor had noted abdominal tenderness,
prescribed intravenous fluids, paracetamol and ondansetron, and
performed peripheral blood cultures.
Which is the most likely cause of the cardiorespiratory arrest?
A. Anaphylaxis
B. Hyperkalaemia
C. Myocardial infarction
D. Peritonitis
E. Pulmonary embolus
2. A 69-year-old man was successfully defibrillated after an episode
of ventricular fibrillation secondary to an ST elevation myocardial
infarction (STEMI) and transferred to the cardiac catheter laboratory
for primary coronary intervention. After the procedure began he had a
further episode of ventricular fibrillation.
Regarding defibrillation, which is true?
A. A single direct current shock of 360 joules with a biphasic waveform is the most likely to
restore spontaneous circulation
B. Defibrillation is no more likely to be successful than a properly delivered praecordial thump
C. It is safe to continue with the coronary angiogram while the shock is delivered to the patient
D. Three shocks delivered with minimal interruptions should be given before any other intervention
E. Two minutes of chest compressions before defibrillation is recommended to optimize
coronary perfusion
,2 CARDIORESPIRATORY ARREST AND SHOCK | QUESTIONS
3. A 75-year-old man was admitted via the emergency department with
a two-day history of shortness of breath with a productive cough and
12 hours of nausea and vomiting. He had a history of chronic obstructive
pulmonary disease and usually took salmeterol and tiotropium inhalers.
His temperature was 39.3°C, heart rate 112 beats per minute, blood
pressure 116/72 mmHg, and respiratory rate 24 breaths per minute.
His oxygen saturation was 91% on 2 litres per minute of oxygen via nasal
cannulae.
A venous lactate was measured at 3.3 mmol per litre.
Which of the following is true?
A. Elevated lactate always represents tissue ischaemia
B. Elevated venous lactate identifies a high risk of death
C. Hyperlactataemia is diagnostic of severe sepsis
D. Venous and arterial lactate measurements are interchangeable
E. Venous lactate is not a suitable target for goal directed therapy
4. An 80-year-old woman was admitted to hospital for management of
chronic venous leg ulcers. While on the medical ward, she had an
asystolic cardiorespiratory arrest. Following resuscitation according
to Advanced Life Support guidelines ventricular fibrillation was seen
and defibrillation successfully restored spontaneous circulation after
15 minutes.
What is the patient’s chance of having a good neurological outcome?
A. 5%
B. 10%
C. 15%
D. 20%
E. 25%
5. A 49-year-old woman was admitted to the intensive care unit after
suffering a massive subarachnoid haemorrhage. One week after
admission she remained unresponsive and the decision to perform
brainstem death tests was made. What preconditions must be met
before the tests are performed?
A. Coroner’s approval, known irreversible aetiology of coma, exclusion of reversible causes
of apnoea
B. Exclusion of reversible causes of apnoea, known irreversible aetiology of coma, exclusion
of reversible causes of coma
C. Exclusion of reversible causes of coma, 48 hours since onset of coma, structural brain
damage on CT scan
D. Known irreversible aetiology of coma, coroner’s approval, evidence of absence of cerebral
blood flow (e.g. with angiography)
E. Twenty-four hours since onset of coma, exclusion of reversible causes of apnoea, absence
of contraindications to organ donation
, CARDIORESPIRATORY ARREST AND SHOCK | QUESTIONS 3
6. A 55-year-old man was admitted to the acute medical unit with a four-
day history of increasing shortness of breath and cough productive of
green sputum. He was a smoker who took amlodipine for hypertension.
On examination his temperature was 35.8°C, pulse rate 85 beats per
minute, blood pressure 112/50 mmHg, and respiratory rate 26 breaths
per minute. Bronchial breath sounds were heard at the base of his right
lung. His capillary refill time was 4 seconds.
Investigations:
haemoglobin 143 g/L (130–180)
white cell count 13.9 × 109/L (4–11)
neutrophil count 10.1 × 109/L (1.5–7.0)
platelets 122 × 109/L (150–400)
serum sodium 144 mmol/L (137–144)
serum potassium 3.9 mmol/L (3.5–4.9)
serum urea 10.5 mmol/L (2.5–7.0)
serum creatinine 119 μmol/L (60–110)
arterial PO2 (air) 9.9 kPa (11.3–12.6)
arterial PCO2 4.5 kPa (4.7–6.0)
pH 7.33 (7.35–7.45)
lactate 3.3 mmol/L (0.5–1.6)
Which clinical syndrome does he have?
A. Acute kidney injury
B. Acute lung injury
C. Sepsis
D. Septic shock
E. Severe sepsis
BANK
A+
, CARDIORESPIRATORY ARREST
chapter
AND SHOCK
1 QUESTIONS
1. A 74-year-old man suffered a cardiorespiratory arrest on a surgical
ward four days after an elective sigmoid colectomy (with primary
anastomosis) for cancer. His past medical history included hypertension
and hypercholesterolaemia for which he took lisinopril, atenolol, and
atorvastatin.
He had been seen by the surgical foundation year 1 doctor (in the UK)
eight hours prior to his cardiorespiratory arrest after an episode of
nausea and vomiting. On examination at that time his temperature
was 38.0°C, pulse 105 beats per minute, blood pressure 95/40 mmHg,
and respiratory rate 28 breaths per minute, with peripheral oxygen
saturation of 94% on air. The doctor had noted abdominal tenderness,
prescribed intravenous fluids, paracetamol and ondansetron, and
performed peripheral blood cultures.
Which is the most likely cause of the cardiorespiratory arrest?
A. Anaphylaxis
B. Hyperkalaemia
C. Myocardial infarction
D. Peritonitis
E. Pulmonary embolus
2. A 69-year-old man was successfully defibrillated after an episode
of ventricular fibrillation secondary to an ST elevation myocardial
infarction (STEMI) and transferred to the cardiac catheter laboratory
for primary coronary intervention. After the procedure began he had a
further episode of ventricular fibrillation.
Regarding defibrillation, which is true?
A. A single direct current shock of 360 joules with a biphasic waveform is the most likely to
restore spontaneous circulation
B. Defibrillation is no more likely to be successful than a properly delivered praecordial thump
C. It is safe to continue with the coronary angiogram while the shock is delivered to the patient
D. Three shocks delivered with minimal interruptions should be given before any other intervention
E. Two minutes of chest compressions before defibrillation is recommended to optimize
coronary perfusion
,2 CARDIORESPIRATORY ARREST AND SHOCK | QUESTIONS
3. A 75-year-old man was admitted via the emergency department with
a two-day history of shortness of breath with a productive cough and
12 hours of nausea and vomiting. He had a history of chronic obstructive
pulmonary disease and usually took salmeterol and tiotropium inhalers.
His temperature was 39.3°C, heart rate 112 beats per minute, blood
pressure 116/72 mmHg, and respiratory rate 24 breaths per minute.
His oxygen saturation was 91% on 2 litres per minute of oxygen via nasal
cannulae.
A venous lactate was measured at 3.3 mmol per litre.
Which of the following is true?
A. Elevated lactate always represents tissue ischaemia
B. Elevated venous lactate identifies a high risk of death
C. Hyperlactataemia is diagnostic of severe sepsis
D. Venous and arterial lactate measurements are interchangeable
E. Venous lactate is not a suitable target for goal directed therapy
4. An 80-year-old woman was admitted to hospital for management of
chronic venous leg ulcers. While on the medical ward, she had an
asystolic cardiorespiratory arrest. Following resuscitation according
to Advanced Life Support guidelines ventricular fibrillation was seen
and defibrillation successfully restored spontaneous circulation after
15 minutes.
What is the patient’s chance of having a good neurological outcome?
A. 5%
B. 10%
C. 15%
D. 20%
E. 25%
5. A 49-year-old woman was admitted to the intensive care unit after
suffering a massive subarachnoid haemorrhage. One week after
admission she remained unresponsive and the decision to perform
brainstem death tests was made. What preconditions must be met
before the tests are performed?
A. Coroner’s approval, known irreversible aetiology of coma, exclusion of reversible causes
of apnoea
B. Exclusion of reversible causes of apnoea, known irreversible aetiology of coma, exclusion
of reversible causes of coma
C. Exclusion of reversible causes of coma, 48 hours since onset of coma, structural brain
damage on CT scan
D. Known irreversible aetiology of coma, coroner’s approval, evidence of absence of cerebral
blood flow (e.g. with angiography)
E. Twenty-four hours since onset of coma, exclusion of reversible causes of apnoea, absence
of contraindications to organ donation
, CARDIORESPIRATORY ARREST AND SHOCK | QUESTIONS 3
6. A 55-year-old man was admitted to the acute medical unit with a four-
day history of increasing shortness of breath and cough productive of
green sputum. He was a smoker who took amlodipine for hypertension.
On examination his temperature was 35.8°C, pulse rate 85 beats per
minute, blood pressure 112/50 mmHg, and respiratory rate 26 breaths
per minute. Bronchial breath sounds were heard at the base of his right
lung. His capillary refill time was 4 seconds.
Investigations:
haemoglobin 143 g/L (130–180)
white cell count 13.9 × 109/L (4–11)
neutrophil count 10.1 × 109/L (1.5–7.0)
platelets 122 × 109/L (150–400)
serum sodium 144 mmol/L (137–144)
serum potassium 3.9 mmol/L (3.5–4.9)
serum urea 10.5 mmol/L (2.5–7.0)
serum creatinine 119 μmol/L (60–110)
arterial PO2 (air) 9.9 kPa (11.3–12.6)
arterial PCO2 4.5 kPa (4.7–6.0)
pH 7.33 (7.35–7.45)
lactate 3.3 mmol/L (0.5–1.6)
Which clinical syndrome does he have?
A. Acute kidney injury
B. Acute lung injury
C. Sepsis
D. Septic shock
E. Severe sepsis
