ABSITE - CRITICAL CARE QUESTIONS
WITH CORRECT ANSWERS 2025
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 differ
ence 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 b
ed 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, oxyg
en saturation of hemoglobin, and the partial pressure of oxygen dissolved in blood. Increases in th
e 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 min
iscule 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 inotr
,opic effect. At doses greater than 10 μg/kg/min, it stimulates α receptors and has a chronotropic e
ffect.)
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, oxyg
en 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 suc
h 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 th
at 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, t
he 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 t
he organism tries to address the physiologic insult. When properly modulated, this is an appropriat
e function. When overexpressed, this proinflammatory state leads to the systemic inflammatory res
ponse syndrome. Later, anti-
inflammatory and immunosuppressive mechanisms are brought into play to bring the organism bac
k to homeostasis. If overmanifested, they can lead to a relative generalized immunosuppression an
d 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 retenti
on 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 p
ressure 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 pre
ssure of 8 cm H O, a pulmonary artery pressure of 22/8 mm Hg, a pulmonary artery wedge pressu
re of 6 mm Hg, and a cardiac output of 3.4 L/min. The next step in management should be the in
travenous 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 chroni
c pulmonary hypertension yields right ventricular hypertrophy.)
Compared to conventional ventilation (endotracheal intubation), noninvasive ventilation (mask, conti
nuous 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 shou
ld 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 pro
mptly 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 fut
ure 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 a
nd 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 m
ay be affected by physiologic shunting, diffusion block, and so on. The RQ is constant under norma
l physiological conditions at ± 0.8; however, it may change substantially under conditions such as a
naerobic 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 gra
dients for diffusion, the equation does characterize the potential for oxygen/carbon dioxide exchang
e. )
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.
WITH CORRECT ANSWERS 2025
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 differ
ence 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 b
ed 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, oxyg
en saturation of hemoglobin, and the partial pressure of oxygen dissolved in blood. Increases in th
e 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 min
iscule 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 inotr
,opic effect. At doses greater than 10 μg/kg/min, it stimulates α receptors and has a chronotropic e
ffect.)
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, oxyg
en 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 suc
h 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 th
at 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, t
he 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 t
he organism tries to address the physiologic insult. When properly modulated, this is an appropriat
e function. When overexpressed, this proinflammatory state leads to the systemic inflammatory res
ponse syndrome. Later, anti-
inflammatory and immunosuppressive mechanisms are brought into play to bring the organism bac
k to homeostasis. If overmanifested, they can lead to a relative generalized immunosuppression an
d 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 retenti
on 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 p
ressure 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 pre
ssure of 8 cm H O, a pulmonary artery pressure of 22/8 mm Hg, a pulmonary artery wedge pressu
re of 6 mm Hg, and a cardiac output of 3.4 L/min. The next step in management should be the in
travenous 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 chroni
c pulmonary hypertension yields right ventricular hypertrophy.)
Compared to conventional ventilation (endotracheal intubation), noninvasive ventilation (mask, conti
nuous 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 shou
ld 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 pro
mptly 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 fut
ure 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 a
nd 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 m
ay be affected by physiologic shunting, diffusion block, and so on. The RQ is constant under norma
l physiological conditions at ± 0.8; however, it may change substantially under conditions such as a
naerobic 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 gra
dients for diffusion, the equation does characterize the potential for oxygen/carbon dioxide exchang
e. )
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.
