ABSITE CRITICAL CARE EXAM 2025 Questions With All
Correct Answers
All are potential causes of cardiogenic shock except:
- Myocardial infarction.
- Pericardial tamponade.
- Tension pneumothorax.
- Cardiac arrhythmias.
- Excessive preload. correct answer -Excessive preload.
(Excessive preload is typically not a cause of cardiogenic shock, but is a result
of cardiogenic shock.)
A 60-year-old man has an arterial PO of 60 mm Hg when the calculated
alveolar PO is 94 mm Hg. This difference is most commonly due to correct
answer -a ventilation-perfusion mismatch
oxygen delivery and consumption correct answer -- Under normal
circumstances, approximately 20% to 30% of the oxygen delivered to the
capillary bed is extracted by the tissues.
- In conditions of decreased delivery of oxygen, tissues are capable of
extracting up to 50% to 60% of the oxygen content in the capillary blood.
- When cellular oxygen supply does not meet demand, anaerobic respiration
results.
(The variables in the equation for the delivery of oxygen are cardiac output,
hemoglobin level, oxygen saturation of hemoglobin, and the partial pressure
of oxygen dissolved in blood. Increases in the first three variables all yield
significant increases in the total amount of oxygen carried by blood. The
partial pressure of oxygen is multiplied by a factor of 0.003, however, and
therefore has a miniscule contribution to the total oxygen content.)
Dopamine at doses of 5 to 10 μg/kg/min correct answer -has a largely
inotropic action profile
(Dopamine has a dose-dependent action profile. At 3 to 5 μg/kg/min, its
actions are largely to increase renal blood flow. At doses of 5 to 10
μg/kg/min, it largely acts to stimulate myocardial β receptors and has an
inotropic effect. At doses greater than 10 μg/kg/min, it stimulates α receptors
and has a chronotropic effect.)
,As oxygen delivery increases on the flat horizontal portion of the oxygen
consumption-delivery curve correct answer -Oxygen consumption
remains the same
(On the flat horizontal portion of the oxygen consumption-delivery curve,
oxygen delivery meets cellular demand of oxygen; as oxygen delivery
increases, oxygen consumption remains the same.)
Most disorganized ventricular arrhythmias (frequent PVCs, ventricular
fibrillation) are caused by correct answer -Metabolic derangements.
(Most disorganized ventricular arrhythmias are caused by some sort of
metabolic derangement such as ischemia or magnesium or potassium
deficiencies. These abnormalities are not well treated by antiarrhythmic
medications.)
The best management for a patient with a posterior knee dislocation correct
answer -Arteriogram.
(The patient may have fairly normal pulses and still have an intimal injury of
the popliteal artery that is similar to the intimal disruption that can be seen in
aortic isthmus injury.)
the possible etiologies of multiorgan failure correct answer -- Anticytokine
antibodies have shown therapeutic promise in animal studies.
- Evidence has shown that intestinal mucosa is made permeable by sepsis.
- The "two-hit" hypothesis postulates that after mounting an appropriate
response to some physiologic insult, the patient is left with a primed immune
system which manifests an exaggerated immune response to a second
challenge.
- The early stages after injury actually appear to consist of an immediate
proinflammatory state as the organism tries to address the physiologic insult.
When properly modulated, this is an appropriate function. When
overexpressed, this proinflammatory state leads to the systemic inflammatory
response syndrome. Later, anti-inflammatory and immunosuppressive
mechanisms are brought into play to bring the organism back to homeostasis.
If overmanifested, they can lead to a relative generalized immunosuppression
and late incidents of sepsis or multiorgan failure.
compensatory mechanisms in shock correct answer -Antidiuretic
hormone causes the reabsorption of free water by the kidney and has
vasoconstrictive properties.
,(Antidiuretic hormone is released from the posterior pituitary where it
stimulates free water retention by the kidney and acts as a powerful
vasoconstrictor.)
A 71-year-old man with colon cancer is in the intensive care unit following a
left hemicolectomy. His blood pressure is 72/38 mm Hg, pulse rate is
114/min, respiratory rate is 23/min, and oxygen saturation is 94% on 2 L of
oxygen by nasal cannulae. A pulmonary artery catheter shows a central
venous pressure of 8 cm H O, a pulmonary artery pressure of 22/8 mm Hg, a
pulmonary artery wedge pressure of 6 mm Hg, and a cardiac output of 3.4
L/min. The next step in management should be the intravenous
administration of correct answer -a fluid bolus
pulmonary artery catheters correct answer -Allow accurate approximation
of left atrial pressure.
The magnitude of a left-to-right shunt in the presence of an ASD is determined
by correct answer -Difference in compliance between left and right
ventricles.
(The blood will tend to fill the more compliant ventricle which will usually be
the right, until chronic pulmonary hypertension yields right ventricular
hypertrophy.)
Compared to conventional ventilation (endotracheal intubation), noninvasive
ventilation (mask, continuous positive airway pressure) is correct answer
-contraindicated in hemodynamically unstable patients
According to the American College of Chest Physicians/Society of Critical Care
Medicine Consensus Conference, which of the following are not part of the
diagnostic criteria for sepsis? correct answer -Hypotension defined as a
systolic blood pressure less than 90 mm Hg.
(Sepsis is defined as bacteriologic evidence of infection superimposed on a
clinical picture of SIRS. According to the ACCP/SCCM, by definition these
patients are hemodynamically stable. If they should become hemodynamically
unstable (defined as a systolic blood pressure <90 mm Hg), the name for the
condition changes to "severe sepsis.")
SIRS correct answer -- Temperature greater than 38°C or less than 36°C.
- Heart rate greater than 90 bpm.
, - Respiratory rate greater than 22 bpm
- White blood cell count greater than 12,000 or less than 4,000 and greater
than 10% bands.
abdominal compartment syndrome correct answer -Once diagnosed,
treatment consists of reopening the abdomen including doing so at the
bedside if necessary.
(The presence of an abdominal compartment syndrome requires
decompression of the abdomen. If the patient is too unstable to be
transported to the operating room, the abdomen should be promptly
reopened at the bedside.)
carotid bruit correct answer -a marker for generalized atherosclerosis
(In fact, studies have shown that a carotid bruit is a risk factor for coronary
artery disease and future myocardial infarction.)
alveolar ventilation correct answer -The alveolar gas equation
characterizes the potential for oxygen uptake and carbon dioxide removal.
(Tachypnea at a given minute ventilation increases anatomic dead-space
ventilation, not alveolar ventilation. Minute ventilation is the volume of gas
that is inspired and expired at the nasopharynx and is different than that
occurring at the alveolus by the anatomic dead-space volume. Although
arterial Pco is proportional to alveolar ventilation, arterial Po is not as it may
be affected by physiologic shunting, diffusion block, and so on. The RQ is
constant under normal physiological conditions at ± 0.8; however, it may
change substantially under conditions such as anaerobic metabolism,
overfeeding, and so on. Because the alveolar gas equation characterizes the
partial pressures of individual gases within the alveolus, which in turn
determine the individual gradients for diffusion, the equation does
characterize the potential for oxygen/carbon dioxide exchange. )
the following may constitute the physiological dead space of the respiratory
system correct answer -- Emphysematous lung.
- Lung involved with a pulmonary embolus.
- Proximal two thirds subsegmental bronchi.
- Zone one alveoli.
(The acinus, comprising the last seven generations of dividing subsegmental
bronchi, is composed of respiratory bronchioles, alveolar ducts, and alveolar
air sacs surrounded by the pulmonary capillary network and constitute the
Correct Answers
All are potential causes of cardiogenic shock except:
- Myocardial infarction.
- Pericardial tamponade.
- Tension pneumothorax.
- Cardiac arrhythmias.
- Excessive preload. correct answer -Excessive preload.
(Excessive preload is typically not a cause of cardiogenic shock, but is a result
of cardiogenic shock.)
A 60-year-old man has an arterial PO of 60 mm Hg when the calculated
alveolar PO is 94 mm Hg. This difference is most commonly due to correct
answer -a ventilation-perfusion mismatch
oxygen delivery and consumption correct answer -- Under normal
circumstances, approximately 20% to 30% of the oxygen delivered to the
capillary bed is extracted by the tissues.
- In conditions of decreased delivery of oxygen, tissues are capable of
extracting up to 50% to 60% of the oxygen content in the capillary blood.
- When cellular oxygen supply does not meet demand, anaerobic respiration
results.
(The variables in the equation for the delivery of oxygen are cardiac output,
hemoglobin level, oxygen saturation of hemoglobin, and the partial pressure
of oxygen dissolved in blood. Increases in the first three variables all yield
significant increases in the total amount of oxygen carried by blood. The
partial pressure of oxygen is multiplied by a factor of 0.003, however, and
therefore has a miniscule contribution to the total oxygen content.)
Dopamine at doses of 5 to 10 μg/kg/min correct answer -has a largely
inotropic action profile
(Dopamine has a dose-dependent action profile. At 3 to 5 μg/kg/min, its
actions are largely to increase renal blood flow. At doses of 5 to 10
μg/kg/min, it largely acts to stimulate myocardial β receptors and has an
inotropic effect. At doses greater than 10 μg/kg/min, it stimulates α receptors
and has a chronotropic effect.)
,As oxygen delivery increases on the flat horizontal portion of the oxygen
consumption-delivery curve correct answer -Oxygen consumption
remains the same
(On the flat horizontal portion of the oxygen consumption-delivery curve,
oxygen delivery meets cellular demand of oxygen; as oxygen delivery
increases, oxygen consumption remains the same.)
Most disorganized ventricular arrhythmias (frequent PVCs, ventricular
fibrillation) are caused by correct answer -Metabolic derangements.
(Most disorganized ventricular arrhythmias are caused by some sort of
metabolic derangement such as ischemia or magnesium or potassium
deficiencies. These abnormalities are not well treated by antiarrhythmic
medications.)
The best management for a patient with a posterior knee dislocation correct
answer -Arteriogram.
(The patient may have fairly normal pulses and still have an intimal injury of
the popliteal artery that is similar to the intimal disruption that can be seen in
aortic isthmus injury.)
the possible etiologies of multiorgan failure correct answer -- Anticytokine
antibodies have shown therapeutic promise in animal studies.
- Evidence has shown that intestinal mucosa is made permeable by sepsis.
- The "two-hit" hypothesis postulates that after mounting an appropriate
response to some physiologic insult, the patient is left with a primed immune
system which manifests an exaggerated immune response to a second
challenge.
- The early stages after injury actually appear to consist of an immediate
proinflammatory state as the organism tries to address the physiologic insult.
When properly modulated, this is an appropriate function. When
overexpressed, this proinflammatory state leads to the systemic inflammatory
response syndrome. Later, anti-inflammatory and immunosuppressive
mechanisms are brought into play to bring the organism back to homeostasis.
If overmanifested, they can lead to a relative generalized immunosuppression
and late incidents of sepsis or multiorgan failure.
compensatory mechanisms in shock correct answer -Antidiuretic
hormone causes the reabsorption of free water by the kidney and has
vasoconstrictive properties.
,(Antidiuretic hormone is released from the posterior pituitary where it
stimulates free water retention by the kidney and acts as a powerful
vasoconstrictor.)
A 71-year-old man with colon cancer is in the intensive care unit following a
left hemicolectomy. His blood pressure is 72/38 mm Hg, pulse rate is
114/min, respiratory rate is 23/min, and oxygen saturation is 94% on 2 L of
oxygen by nasal cannulae. A pulmonary artery catheter shows a central
venous pressure of 8 cm H O, a pulmonary artery pressure of 22/8 mm Hg, a
pulmonary artery wedge pressure of 6 mm Hg, and a cardiac output of 3.4
L/min. The next step in management should be the intravenous
administration of correct answer -a fluid bolus
pulmonary artery catheters correct answer -Allow accurate approximation
of left atrial pressure.
The magnitude of a left-to-right shunt in the presence of an ASD is determined
by correct answer -Difference in compliance between left and right
ventricles.
(The blood will tend to fill the more compliant ventricle which will usually be
the right, until chronic pulmonary hypertension yields right ventricular
hypertrophy.)
Compared to conventional ventilation (endotracheal intubation), noninvasive
ventilation (mask, continuous positive airway pressure) is correct answer
-contraindicated in hemodynamically unstable patients
According to the American College of Chest Physicians/Society of Critical Care
Medicine Consensus Conference, which of the following are not part of the
diagnostic criteria for sepsis? correct answer -Hypotension defined as a
systolic blood pressure less than 90 mm Hg.
(Sepsis is defined as bacteriologic evidence of infection superimposed on a
clinical picture of SIRS. According to the ACCP/SCCM, by definition these
patients are hemodynamically stable. If they should become hemodynamically
unstable (defined as a systolic blood pressure <90 mm Hg), the name for the
condition changes to "severe sepsis.")
SIRS correct answer -- Temperature greater than 38°C or less than 36°C.
- Heart rate greater than 90 bpm.
, - Respiratory rate greater than 22 bpm
- White blood cell count greater than 12,000 or less than 4,000 and greater
than 10% bands.
abdominal compartment syndrome correct answer -Once diagnosed,
treatment consists of reopening the abdomen including doing so at the
bedside if necessary.
(The presence of an abdominal compartment syndrome requires
decompression of the abdomen. If the patient is too unstable to be
transported to the operating room, the abdomen should be promptly
reopened at the bedside.)
carotid bruit correct answer -a marker for generalized atherosclerosis
(In fact, studies have shown that a carotid bruit is a risk factor for coronary
artery disease and future myocardial infarction.)
alveolar ventilation correct answer -The alveolar gas equation
characterizes the potential for oxygen uptake and carbon dioxide removal.
(Tachypnea at a given minute ventilation increases anatomic dead-space
ventilation, not alveolar ventilation. Minute ventilation is the volume of gas
that is inspired and expired at the nasopharynx and is different than that
occurring at the alveolus by the anatomic dead-space volume. Although
arterial Pco is proportional to alveolar ventilation, arterial Po is not as it may
be affected by physiologic shunting, diffusion block, and so on. The RQ is
constant under normal physiological conditions at ± 0.8; however, it may
change substantially under conditions such as anaerobic metabolism,
overfeeding, and so on. Because the alveolar gas equation characterizes the
partial pressures of individual gases within the alveolus, which in turn
determine the individual gradients for diffusion, the equation does
characterize the potential for oxygen/carbon dioxide exchange. )
the following may constitute the physiological dead space of the respiratory
system correct answer -- Emphysematous lung.
- Lung involved with a pulmonary embolus.
- Proximal two thirds subsegmental bronchi.
- Zone one alveoli.
(The acinus, comprising the last seven generations of dividing subsegmental
bronchi, is composed of respiratory bronchioles, alveolar ducts, and alveolar
air sacs surrounded by the pulmonary capillary network and constitute the
