ABSITE - CRITICAL CARE EXAM 2025
QUESTIONS AND ANSWERS
All are potential causes of cardiogenic shock except:
- Myocardial infarction.
- Pericardial tamponade.
- Tension pneumothorax.
- Cardiac arrhythmias.
- Excessive preload. - ANS 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 - ANS a ventilation-perfusion mismatch
oxygen delivery and consumption - ANS - 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.)
1Page
@COPYRIGHT FYNDLAY 2025/2026
, Dopamine at doses of 5 to 10 μg/kg/min - ANS 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 - ANS 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
- ANS 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 - ANS 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 - ANS - 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
2
Page
inflammatory response syndrome. Later, anti-inflammatory and immunosuppressive
@COPYRIGHT FYNDLAY 2025/2026
, 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 - ANS 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 - ANS a fluid bolus
pulmonary artery catheters - ANS Allow accurate approximation of left atrial pressure.
The magnitude of a left-to-right shunt in the presence of an ASD is determined by -
ANS 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 - ANS 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? -
ANS 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
3
Page
SIRS. According to the ACCP/SCCM, by definition these patients are hemodynamically stable. If
@COPYRIGHT FYNDLAY 2025/2026
, they should become hemodynamically unstable (defined as a systolic blood pressure <90 mm
Hg), the name for the condition changes to "severe sepsis.")
SIRS - ANS - 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 - ANS 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 - ANS 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 - ANS 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. )
4
Page
@COPYRIGHT FYNDLAY 2025/2026
QUESTIONS AND ANSWERS
All are potential causes of cardiogenic shock except:
- Myocardial infarction.
- Pericardial tamponade.
- Tension pneumothorax.
- Cardiac arrhythmias.
- Excessive preload. - ANS 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 - ANS a ventilation-perfusion mismatch
oxygen delivery and consumption - ANS - 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.)
1Page
@COPYRIGHT FYNDLAY 2025/2026
, Dopamine at doses of 5 to 10 μg/kg/min - ANS 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 - ANS 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
- ANS 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 - ANS 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 - ANS - 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
2
Page
inflammatory response syndrome. Later, anti-inflammatory and immunosuppressive
@COPYRIGHT FYNDLAY 2025/2026
, 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 - ANS 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 - ANS a fluid bolus
pulmonary artery catheters - ANS Allow accurate approximation of left atrial pressure.
The magnitude of a left-to-right shunt in the presence of an ASD is determined by -
ANS 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 - ANS 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? -
ANS 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
3
Page
SIRS. According to the ACCP/SCCM, by definition these patients are hemodynamically stable. If
@COPYRIGHT FYNDLAY 2025/2026
, they should become hemodynamically unstable (defined as a systolic blood pressure <90 mm
Hg), the name for the condition changes to "severe sepsis.")
SIRS - ANS - 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 - ANS 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 - ANS 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 - ANS 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. )
4
Page
@COPYRIGHT FYNDLAY 2025/2026
