ABSITE - Critical Care Updated 2025
Complete Exam Questions with
Elaborated Correct Answers||A+
GRADED||100% GUARANTEED
PASS!!!<<LATEST VERSION>>
What is preload? - ANSWER ✓ End-diastolic length of cardiac myocytes. Linearly
related to end-diastolic volume and filling pressure
What is afterload? - ANSWER ✓ Resistance against ventricular contraction (i.e.
SVR)
What is contractility? - ANSWER ✓ Force of myocardial contraction
ARDS - ANSWER ✓ Lung-protective ventilation has been shown to decrease
mortality across the spectrum in patients who develop ARDS; this includes patients
who sustain traumatic injury.
Corticosteroids may improve cardiopulmonary physiology, but they do not
decrease the risk of mortality in ARDS; if they are started too late, they may
instead increase the risk of death. Prone positioning does improve mortality, but
although the open abdomen is only a relative contraindication to prone positioning,
an unstable spine fractures is an absolute contraindication. The use of
extracorporeal membrane oxygenation has shown to improve mortality for acute
hypoxic respiratory failure/ARDS in several case series that focus on trauma
patients. However, exclusionary criteria include intracranial hemorrhage due to the
risk of bleeding on anticoagulation. High-frequency oscillatory ventilation has
been studied in several populations; it has not shown to decrease mortality in the
setting of ARDS.
Abdominal compartment syndrome - ANSWER ✓ Compartment syndromes were
originally described in the context of muscle compartments, the syndromes
reflecting the effect of increased pressure within the compartment that threatened,
by pressure-induced ischemia, the viability of the contents of that compartment.
,More recently, clinical problems arising from increased intra-abdominal pressure
have given rise to the concept of an "abdominal compartment syndrome" (ACS). A
critical difference between the ACS and other compartment syndromes is that its
consequences have critical extra-abdominal systemic consequences that may be
life-threatening if untreated. A number of recognized etiologies are responsible for
the pressure increases underlying ACS. The mechanisms are frequently multiple
for a given patient, and include mechanisms induced by the pathogenesis of a
disease process (eg, gaseous distention of bowel, ascites, intra-abdominal
hemorrhage, or a tumor mass) as well as treatment-related or iatrogenic
mechanisms (eg, tissue swelling due to massive crystalloid infusions, or pressure
induced by closure of an abdominal incision under tension or by hemostatic
packing of the abdomen). ACS manifests clinically mainly through an increase in
central venous pressure, interference with ventilatory function, and oliguria.
Confirmation of ACS relies on measurement of intra-abdominal pressure. Normal
intra-abdominal pressure is zero. Increased intra-abdominal pressure can be
measured on a scale ranging from mild (10 to 20 mm Hg) to severe (40 mm Hg or
higher). Intra-abdominal pressure is usually measured indirectly, based on
measurement of intravesical pressure of the urinary bladder, using water
manometry or a pressure transducer connected to an indwelling bladder catheter.
Intra-abdominal pressure can also be indirectly determined by measuring
intragastric pressure. Methods s
Contraindications to succs - ANSWER ✓ Succinylcholine is a short acting
paralytic agent that is often used for rapid sequence intubation (RSI), but there are
some important contraindications for the use of the drug. Succinylcholine
administration can lead to increases in serum potassium and thus is never
administered to patients who are hyperkalemic or at risk of hyperkalemia. Patients
at risk for hyperkalemia include those with prolonged immobilization, upper or
lower motor neuron disorders, and burn patients 24 hours after the burn out to 1
year status post burn. In all of these at risk populations, the mechanism behind the
hyperkalemia is the same: up-regulation of the nicotinic acetylcholine receptor that
leads to an exaggerated release of potassium after succinylcholine administration.
In patients with immobilization, the up-regulation of the receptors is seen within 6-
12 hours, while in burn patients, the up-regulation occurs as soon as 24 hours but is
reliably found at 48 hours. Thus, in this case, succinylcholine would not be used
and an alternative paralytic agent would be chosen.
PEG contraindications - ANSWER ✓ Long-term enteral access via PEG
placement has relatively few contraindications, but massive ascites and severe
,malnutrition are likely to result in ongoing fluid leaks. Life expectancy < 30 days is
a contraindication to placement, with NG tube access preferable in these patients.
Neither prior abdominal surgery nor inflammatory bowel disease are
contraindications to PEG placement; yet, careful abdominal transillumination
should be performed in such cases to minimize odds of injury to the colon or other
viscera.
gauging pressure in peripheral arteries - ANSWER ✓ The contour of the arterial
pressure waveform in the aorta differs from that in the peripheral arteries. As the
propagating pressure wave migrates from the aortic root to the periphery, the
systolic pressure gradually increases such that the peak systolic pressure in the
radial artery can be 20 mm Hg higher than that in the proximal aorta. Thus, the
propagation of blood into peripheral tissues is determined by the mean arterial
pressure, not the systolic pressure. This increased systolic pressure in the distal
arterial tree is due to less vascular elastic tissue and greater impedance, which is
transmitted in a retrograde direction from vascular bifurcations and the artery-
arteriolar junction. Such systolic amplification is especially prominent in more
diseased, less compliant peripheral arteries, which is the physiologic basis for
isolated systolic hypertension in the elderly. Amplification of peak systolic
pressure in peripheral arteries is counterbalanced by a narrowing of the systolic
waveform; the net result is that mean arterial pressure is unchanged. As a result,
when peripherally placed intra-arterial catheters are employed, mean arterial
pressure is the most accurate estimate of central arterial (i.e., aortic) pressure.
Pulmonary artery catheter - ANSWER ✓ Pulmonary artery catheters (PAC) are
prone to the same types of complications as other indwelling vascular devices,
such as catheter-related bloodstream infections and venous thromboembolism, as
well as additional unique complications. Arrhythmias are not uncommon with
PACs, often due to irritation of the endocardial surface as the catheter passes
through the right atrium and ventricle. While they may cause hemodynamic
instability and chest pain, hemoptysis would be unexpected. Catheter migration
may lead to misinterpretation of data as well as pulmonary emboli or infarction;
however, these complications would not be expected to be as hyperacute. Valvular
injury is uncommon and may occur as a result of catheter placement or removal.
Pulmonary artery rupture is a serious and highly morbid event and can occur
spontaneously or as a result of overdistension of the balloon during measurement
of the pulmonary artery occlusion pressure (i.e., "wedge pressure"). It is often
heralded by hemoptysis but may be asymptomatic and requires immediate
diagnosis and intervention. In this case, the close association of her symptoms with
, wedge pressure measurement and hemoptysis make pulmonary artery rupture the
most likely etiology.
most commonly inherited bleeding disorder - ANSWER ✓ Von Willebrand
disease (vWD) is the most common inherited disorder of coagulation associated
with bleeding, with a prevalence as high as 2%. vWD is characterized by a variety
of qualitative and/or quantitative abnormalities of von Willebrand Factor (vWF).
Certain types of vWD can lead to deficiencies in factor VIII which may mimic
hemophilia A. vWF factor levels of less than 30% are more likely to be associated
with clinically relevant bleeding events. Initial laboratory results may reveal a
normal aPTT and INR. Treatments of von Willebrand disease can include
administration of desmopressin, direct factor supplementation or cryoprecipitate
transfusion
improving outcomes for ARDS - ANSWER ✓ While use of nitric oxide (NO) in
patients with ARDS may improve oxygenation, a meta-analysis of seven
randomized trials showed the use of NO did not improve mortality in these
patients. Steroid therapy in ARDS is controversial - numerous studies have
attempted to answer this question, but due to a variety of methodological issues
and frequent selection biases, the definitive study regarding steroids and ARDS
mortality has not yet been accomplished. The BALTI-2 trial, which randomized
ARDS patients to receive IV salbutamol (albuterol) vs placebo, was terminated
early due to a higher mortality in the treatment arm. The OMEGA study showed
that twice-daily enteral supplementation of omega-3 fatty acids, γ-linolenic acid,
and antioxidants did not improve ventilator-free days or other clinical outcomes in
patients with acute lung injury and may be harmful. Answer B is correct. Papazain
et. al. performed a multi-center randomized controlled trial that found a significant
improvement in mortality for patients with severe ARDS who were treated with
early neuromuscular blocking agents for 48 hours.
Conservative fluid management strategies may improve ventilator-free days and
ICU-free days, but does not improve overall survival. Prone positioning has been
shown to improve mortality only in patients with moderate and severe ARDS
(PaO2/FiO2 ratio <150). While oxygen delivery is improved with increased
hemoglobin and cardiac output, unnecessary transfusions may increase the risk of
developing ARDS and may worsen outcomes. Restrictive transfusion strategies
(hemoglobin between 7-9 g/dL) have not been shown to worsen outcomes in
critically ill patients. The use of pressors to augment cardiac output and target
Complete Exam Questions with
Elaborated Correct Answers||A+
GRADED||100% GUARANTEED
PASS!!!<<LATEST VERSION>>
What is preload? - ANSWER ✓ End-diastolic length of cardiac myocytes. Linearly
related to end-diastolic volume and filling pressure
What is afterload? - ANSWER ✓ Resistance against ventricular contraction (i.e.
SVR)
What is contractility? - ANSWER ✓ Force of myocardial contraction
ARDS - ANSWER ✓ Lung-protective ventilation has been shown to decrease
mortality across the spectrum in patients who develop ARDS; this includes patients
who sustain traumatic injury.
Corticosteroids may improve cardiopulmonary physiology, but they do not
decrease the risk of mortality in ARDS; if they are started too late, they may
instead increase the risk of death. Prone positioning does improve mortality, but
although the open abdomen is only a relative contraindication to prone positioning,
an unstable spine fractures is an absolute contraindication. The use of
extracorporeal membrane oxygenation has shown to improve mortality for acute
hypoxic respiratory failure/ARDS in several case series that focus on trauma
patients. However, exclusionary criteria include intracranial hemorrhage due to the
risk of bleeding on anticoagulation. High-frequency oscillatory ventilation has
been studied in several populations; it has not shown to decrease mortality in the
setting of ARDS.
Abdominal compartment syndrome - ANSWER ✓ Compartment syndromes were
originally described in the context of muscle compartments, the syndromes
reflecting the effect of increased pressure within the compartment that threatened,
by pressure-induced ischemia, the viability of the contents of that compartment.
,More recently, clinical problems arising from increased intra-abdominal pressure
have given rise to the concept of an "abdominal compartment syndrome" (ACS). A
critical difference between the ACS and other compartment syndromes is that its
consequences have critical extra-abdominal systemic consequences that may be
life-threatening if untreated. A number of recognized etiologies are responsible for
the pressure increases underlying ACS. The mechanisms are frequently multiple
for a given patient, and include mechanisms induced by the pathogenesis of a
disease process (eg, gaseous distention of bowel, ascites, intra-abdominal
hemorrhage, or a tumor mass) as well as treatment-related or iatrogenic
mechanisms (eg, tissue swelling due to massive crystalloid infusions, or pressure
induced by closure of an abdominal incision under tension or by hemostatic
packing of the abdomen). ACS manifests clinically mainly through an increase in
central venous pressure, interference with ventilatory function, and oliguria.
Confirmation of ACS relies on measurement of intra-abdominal pressure. Normal
intra-abdominal pressure is zero. Increased intra-abdominal pressure can be
measured on a scale ranging from mild (10 to 20 mm Hg) to severe (40 mm Hg or
higher). Intra-abdominal pressure is usually measured indirectly, based on
measurement of intravesical pressure of the urinary bladder, using water
manometry or a pressure transducer connected to an indwelling bladder catheter.
Intra-abdominal pressure can also be indirectly determined by measuring
intragastric pressure. Methods s
Contraindications to succs - ANSWER ✓ Succinylcholine is a short acting
paralytic agent that is often used for rapid sequence intubation (RSI), but there are
some important contraindications for the use of the drug. Succinylcholine
administration can lead to increases in serum potassium and thus is never
administered to patients who are hyperkalemic or at risk of hyperkalemia. Patients
at risk for hyperkalemia include those with prolonged immobilization, upper or
lower motor neuron disorders, and burn patients 24 hours after the burn out to 1
year status post burn. In all of these at risk populations, the mechanism behind the
hyperkalemia is the same: up-regulation of the nicotinic acetylcholine receptor that
leads to an exaggerated release of potassium after succinylcholine administration.
In patients with immobilization, the up-regulation of the receptors is seen within 6-
12 hours, while in burn patients, the up-regulation occurs as soon as 24 hours but is
reliably found at 48 hours. Thus, in this case, succinylcholine would not be used
and an alternative paralytic agent would be chosen.
PEG contraindications - ANSWER ✓ Long-term enteral access via PEG
placement has relatively few contraindications, but massive ascites and severe
,malnutrition are likely to result in ongoing fluid leaks. Life expectancy < 30 days is
a contraindication to placement, with NG tube access preferable in these patients.
Neither prior abdominal surgery nor inflammatory bowel disease are
contraindications to PEG placement; yet, careful abdominal transillumination
should be performed in such cases to minimize odds of injury to the colon or other
viscera.
gauging pressure in peripheral arteries - ANSWER ✓ The contour of the arterial
pressure waveform in the aorta differs from that in the peripheral arteries. As the
propagating pressure wave migrates from the aortic root to the periphery, the
systolic pressure gradually increases such that the peak systolic pressure in the
radial artery can be 20 mm Hg higher than that in the proximal aorta. Thus, the
propagation of blood into peripheral tissues is determined by the mean arterial
pressure, not the systolic pressure. This increased systolic pressure in the distal
arterial tree is due to less vascular elastic tissue and greater impedance, which is
transmitted in a retrograde direction from vascular bifurcations and the artery-
arteriolar junction. Such systolic amplification is especially prominent in more
diseased, less compliant peripheral arteries, which is the physiologic basis for
isolated systolic hypertension in the elderly. Amplification of peak systolic
pressure in peripheral arteries is counterbalanced by a narrowing of the systolic
waveform; the net result is that mean arterial pressure is unchanged. As a result,
when peripherally placed intra-arterial catheters are employed, mean arterial
pressure is the most accurate estimate of central arterial (i.e., aortic) pressure.
Pulmonary artery catheter - ANSWER ✓ Pulmonary artery catheters (PAC) are
prone to the same types of complications as other indwelling vascular devices,
such as catheter-related bloodstream infections and venous thromboembolism, as
well as additional unique complications. Arrhythmias are not uncommon with
PACs, often due to irritation of the endocardial surface as the catheter passes
through the right atrium and ventricle. While they may cause hemodynamic
instability and chest pain, hemoptysis would be unexpected. Catheter migration
may lead to misinterpretation of data as well as pulmonary emboli or infarction;
however, these complications would not be expected to be as hyperacute. Valvular
injury is uncommon and may occur as a result of catheter placement or removal.
Pulmonary artery rupture is a serious and highly morbid event and can occur
spontaneously or as a result of overdistension of the balloon during measurement
of the pulmonary artery occlusion pressure (i.e., "wedge pressure"). It is often
heralded by hemoptysis but may be asymptomatic and requires immediate
diagnosis and intervention. In this case, the close association of her symptoms with
, wedge pressure measurement and hemoptysis make pulmonary artery rupture the
most likely etiology.
most commonly inherited bleeding disorder - ANSWER ✓ Von Willebrand
disease (vWD) is the most common inherited disorder of coagulation associated
with bleeding, with a prevalence as high as 2%. vWD is characterized by a variety
of qualitative and/or quantitative abnormalities of von Willebrand Factor (vWF).
Certain types of vWD can lead to deficiencies in factor VIII which may mimic
hemophilia A. vWF factor levels of less than 30% are more likely to be associated
with clinically relevant bleeding events. Initial laboratory results may reveal a
normal aPTT and INR. Treatments of von Willebrand disease can include
administration of desmopressin, direct factor supplementation or cryoprecipitate
transfusion
improving outcomes for ARDS - ANSWER ✓ While use of nitric oxide (NO) in
patients with ARDS may improve oxygenation, a meta-analysis of seven
randomized trials showed the use of NO did not improve mortality in these
patients. Steroid therapy in ARDS is controversial - numerous studies have
attempted to answer this question, but due to a variety of methodological issues
and frequent selection biases, the definitive study regarding steroids and ARDS
mortality has not yet been accomplished. The BALTI-2 trial, which randomized
ARDS patients to receive IV salbutamol (albuterol) vs placebo, was terminated
early due to a higher mortality in the treatment arm. The OMEGA study showed
that twice-daily enteral supplementation of omega-3 fatty acids, γ-linolenic acid,
and antioxidants did not improve ventilator-free days or other clinical outcomes in
patients with acute lung injury and may be harmful. Answer B is correct. Papazain
et. al. performed a multi-center randomized controlled trial that found a significant
improvement in mortality for patients with severe ARDS who were treated with
early neuromuscular blocking agents for 48 hours.
Conservative fluid management strategies may improve ventilator-free days and
ICU-free days, but does not improve overall survival. Prone positioning has been
shown to improve mortality only in patients with moderate and severe ARDS
(PaO2/FiO2 ratio <150). While oxygen delivery is improved with increased
hemoglobin and cardiac output, unnecessary transfusions may increase the risk of
developing ARDS and may worsen outcomes. Restrictive transfusion strategies
(hemoglobin between 7-9 g/dL) have not been shown to worsen outcomes in
critically ill patients. The use of pressors to augment cardiac output and target
