mock demo 2

Q1- All are indications for fibrinolytic therapy, except

Q2- Which of the following is true regarding the use of serum B-type natriuretic peptide (BNP) levels & the diagnosis of heart failure in patients who present with dyspnoea?

Q3- The following are causes of prolongation of the corrected QT interval (QTC), except: –

Q4- . A 62 years old man with dilated cardiomegaly develops cardiogenic shock while on waiting list for heart transplant. The shock is refractory to medical therapy and decision of VA ECMO has been considered. Which one of the following is incorrect regarding ECMO.

Q5- The most effective method of increasing carbon dioxide elimination on ECMO, is to increase which of the following parameters?

Q6- Reg Ventricular assist devices (VAD), false is:

Q7- Regarding temporary cardiac pacing:

Q8- A patient has developed acute chest pain in ICU while being treated for severe community-acquired pneumonia and acute kidney injury. An ECG has been done which shows ST-segment elevation. All except one should be included in differentials:

Q9- Cardiac enzymes like troponin I may be elevated in

Q10- Which of the following is not indicated in the management of car- diac tamponade?

Q11- All of the following are class I indications for permanent cardiac pacing EXCEPT:

Q12- A patient has been implanted with a pacemaker and DDI mode is selected. It means pacemaker will

Q13- The commonest area for acute aortic dissection is

Q14- In central venous pressure tracing, “c” wave is produced by

Q15- You are using a thermodilution technique with 10ml cold 5% (50mg/ml) glucose to assess the cardiac output of your patient. The thermistor indicates that the body temp of your patient is 38.3 C. at the end of the injection you obtain a thermodilution curve but no cardiac output measurement. You change the catheter, but the result of your injection is still the same.

Which one of the following do you do next?

Q16- When using intra-aortic balloon (IABP) counter-pulsation to treat cardiogenic shock, the intervention will achieve all of the following except?

Q17- Arterial pulse contours, all are true except,

Q18- This was the ECG of 60 year old male patient who presented to emergency room with complaints of headache & light headedness. He is having history of the pacemaker insertion done around 4 years back. What is your interpretation?

Q19- Which of the following is false:

Q20- Arterial pressure monitoring:

Q21- Regarding the IABP trace, all of the following are true, except

Q22- Regarding prognostication after resuscitation in adults, which ONE of the following reliably predicts poor outcome?

Q23- A 53 year old male with past history of mitral stenosis presented to emergency department with complaints of palpitations and mild dyspnea since 2-3days. On examination his vital parameters are as follows:            PR-143/min irregularly irregular, BP: 136/86 mmhg  , spO2 :95 % on room air, ECG is showing atrial fibrillation.

Cardiologist decided to DC cardiovert him. Which of the following statement is incorrect regarding DC cardioversion of this patient? :

Q24- Which of the following drugs cannot be given intra- tracheal in a patient with cardiac arrest

Q25- The following apply to levosimendan: –

Q26- Ventricular filling

Q27- One of the following is a finding in tension pneumothorax:

Q28- A 27-year old man is bought into the emergency department by ambulance complaining of shortness of breath. He has a history of asthma & takes salbutamol & beclometasone inhalers regularly which of the following examination findings would be the most worrying clinical sign?

Q29- You intubate a patient with acute severe asthma at Spo2 of 51%. Patient develops hypotension immediately after intubation. Regarding shock following intubation in such a scenario, which statement is false?

Q30 – A 19yr old male is admitted to the ICU with sudden onset severe dyspnoea. He is alert, anxious, and oriented but unable to complete a sentence in one breath. His respiratory rate is 42/min and peripheral oxygen saturation is 91% on 12L of oxygen via face mask. Diffuse wheeze but hardly audible breath sounds are the auscultatory findings.

Which one of the following treatments is NOT recommended by current guidelines?

Q31- A patient is admitted to ICU with hemoptysis, suspected to be due to diffuse alveolar hemorrhage. Which of the following would be the expected finding on bronchoalveolar lavage?

Patient is admitted to ICU with hemoptysis, suspected to be

Q32- Which one of the following statements regarding TRALI is correct?

Q33- All of the following features indicate a massive pulmonary embolism EXCEPT:

Q34- Which of the following patients with a CAP would you consider for admission to your ICU early after hospital admission?

Q35- In case of bronchopulmonary aspiration of gastric fluid (i.e. Mendelson syndrome) which management option is the most appropriate?

Q36- Pleural aspiration and chest drain management:

Q37- The following are recognised strategies in the prevention of ventilator-associated pneumonia (VAP)

Q38- Using the illustrations below, arrange the three bottles in correct sequence for pleural drainage and application of negative pressure (suction):

The correct sequence is:

Q39- Most appropriate statement regarding massive haemoptysis is

Q40- Which one of the following is true regarding Mendelson syndrome?

Q41- A 50-year-old woman has severe facial trauma following a motor vehicle crash. She is obtunded with a RR of 40/min. Arterial blood gas measurements reveal pH of 7.20, PaCO2 of 65 mm Hg and PaO2 of 60 mm Hg on high-flow face mask oxygen. The decision is made to intubate the patient for airway protection and mechanical ventilation.

Under these circumstances, which of the following is the best method for endotracheal intubation?

Q42- Some useful predictor of successful weaning include all of the following, except :

Q43- A patient with ARDS is supported by mechanical ventilation with the mode depicted in the figure below. What description best fits the mode?

Q44. A 75yr old severe COPD has been mechanically ventilated for 2 weeks due to bacterial pneumonia. His stay in ICU was complicated by an AMI and a VAP. Now he has failed a SBT for the 3rd consecutive day. Whilst on the ventilator the patient is not in respiratory distress. He is alert, moves all limbsto command and breath sounds are symmetrical.

Which one of the following is the most likely explanation of the weaning failure?

Q45- Regarding ventilation in prone position and impact on outcome of ARDS patients, which of the following is not true

Q46- A 64-year-old man with an exacerbation of COPD is on mechanical ventilator on: assist/control mode; RR, 16 breaths/min; VT, 600 mL; inspiratory flow rate (IFR), 60 L/min; PEEP, 0 cm H2O; and FiO2, 40%. He is in respiratory distress, his heart rate, 120 bpm; blood pressure, 80/40 mm Hg; RR, 36 breaths/min; and SaO2, 85%. Cardiac examination is normal; lung examination reveals bilateral expiratory wheezing with equal breath sounds. His venti graphics are shown below:

Despite intravenous fluids, bronchodilators, and sedation, the patient remains in respiratory distress and is hypoxic and hypotensive.

Which ventilator changes would be most beneficial?

Q47- Non-invasive ventilation (continuous positive airway pressure [CPAP]/bilevel positive airway pressure [BiPAP]) is contraindicated in:

Q48- An increased alveolar–arterial (A–a) gradient is not associated with:

Q49- A normal person, seated upright, begins to inspire from the residual volume. The first 100 mL of inspired gas is labeled with xenon 133. Most of this radioactive gas will probably be found:

Q50- 18 year old female, lean and thin, brought to the ER by her parents with c/o of generalized weakness and 1 episode of syncope while she got up from bed. The mother complained how she would not eat properly and trying to lose weight off late. On examination, she had features of orthostatic hypotension. No focal neurological deficits noted. Initial labs were as follows: sodium 142 mmol/L, potassium 3.0 mmol/L, chloride 90 mmol/L, bicarbonate 34mmol/L, urea -40.9 mg/dl, creatinine 1.0 mg/dl. ABG values showed Ph 7.49/ pco2 44 mmHg/ po2 86 mmHg / Hco3 34 mmol/L. Which acid-base disturbances are now present in this patient.

Q51-. A 56 year old patient, known case of COPD, presents with sudden onset breathlessness with severe right sided chest pain. Lung USG is done in the ER, which is shown below:

What is your diagnosis?

Q52- In which condition does the wedged PAOP remain unchanged?

Q53- The following radiological features are matched with the correct diagnosis EXCEPT:

Q54- 52 year old male, chronic smoker, brought to ER with altered sensorium & type-II respiratory failure. Patient requires endotracheal intubation & mechanical ventilation. Following is capnography trace after intubation. What does it indicate?

Q55- All of the following are true for D-dimer levels in assessment of pulmonary embolism EXCEPT:

Q56- Following drugs can precipitates myasthenia gravis except

Q57- CSF findings in Tubercular meningitis are:

Q58- A 75-year old man is admitted to the emergency department with confusion & photophobia. His family report that he has been generally unwell & lethargic for a week & has had diarrhoea. He is pyrexial at 38.9℃.His white cell count is 18.0 × 103 /ml. Lumber puncture is performed. Cerebrospinal fluid (csf) analysis revels a pleocytosis, & csf protein levels are moderately elevated at 0.80g/l. Csf glucose is 1.3mmol/L. The gram stain is negative. The most likely diagnosis is :-

Q59- All are inhibitor of P 450 enzyme system except

Q60- A 76-year old man is admitted with a short history of a dry mouth, diplopia & dysphagia. He develops a symmetrical descending weakness, initially affecting the trunk and proximal limb muscles, & spreading more peripherally. He has no sensory involvement. The most likely diagnosis is:-

Q61- The following are considered risk factors for intensive care unit-acquired weakness (ICUAW): –

Q62- Status Epilepticus (SE), which of the following is false:

Q63- A 67-year-old lady is seen in the emergency room with left arm weakness and right facial droop. Her blood pressure is 180/105 mm Hg. which of the following is the best management for the hypertension

Q64- 65 yr old man with known severe alcohol abuse has been on parenteral nutrition for 5 days because of perforated gastric ulcer. He complains of an impaired vision. Clinical examination reveals a bilateral nystagmus, an abducens paresis. Plasma electrolytes are normal.

Which is your most probable diagnosis?

Q65- 56 yr old gentleman is admitted to the ICU with suspected GB syndrome. He presented 4 days previously with history of back pain; paresthesia in both lower legs and has since developed a progressive symmetrical paralysis of both limbs.Which of the following features is not consistent with GB syndrome and should prompt a search for an alternative diagnosis?

Q66- Regarding SAH, true:

Q67- 52 yr old arrived with symptoms of stroke within 2hrs of onset. CT done and hemorrhage excluded. GCS=13/15, SpO2=94% in Room air. Following are the absolute contraindications for thrombolysis except:

Q68- A young patient presents to the emergency room with a GCS of 8 after suffering motor vehicle accident. On CT scan of head, an acute subdural hematoma is detected which is 8 mm in thickness with a mini- mal midline shift. One of the following is best statement:

Q69- In relation to nerve conduction study pattern:

Q70- All the following EEG patterns are associated with poor neurological outcome in post cardiac arrest patients except

Q71- True statement about Trans-Cranial Doppler:

Q72- Plasma apheresis is indicated as first-line therapy in all, EXCEPT:

Q73- Regarding hemophagocytic lymphohistiocytosis (HLH) following are true:

Q74- Red cell transfusion and critical care:

Q75- A 35yr old patient complains of dizziness, dysphagia and severe dyspnoea and marked stridor. On examination, he has facial oedema, peripheral (ear lobe) cyanosis, distended neck veins, distension of superficial veins of the chest wall, mild stridor and tachypnoea.the patient was recently diagnosed as suffering from malignant lymphoma. The management is:

Q76- Which one of the following complications in a patient of chemotherapy is attributed to tumor lysis syndrome?

Q77- 7 days after surgery, the patient developed acute swelling and tenderness of the right lower limb. The patient remained haemodynamically stable with no active respiratory distress. An USG Doppler for lower limbs revealed a proximal DVT in right femoral vein extending upto the common iliac vein. The best therapeutic option for this condition would be:

Q78- A 45-year-old patient on regular warfarin therapy for prosthetic heart valve for last 3 years, presents to you for follow up and is found to have an INR (international normalized ratio) of 10. He has no evidence of bleed- ing and has no recent history of trauma and surgery.

What is the next step of management?

Q79- All of the following parameters are used for disseminated intravascu- lar coagulation (DIC) scoring as per The International Society for Throm- bosis and Haemostasis (ISTH) DIC scoring system, EXCEPT:

Q80- Warming blood to 37°C during massive blood transfusion:

Q81- The most common bacteria causing transfusion-associated sepsis (TAS) through packed red cells is

Q82- Which one of the following is not a key principle of biomedical ethics?

Q83- A 62-year-old ex-smoker with COPD was transferred to the ICU because of progressively worsening hypercapnic respiratory failure. Two days before, he had been admitted to a general medical floor because of respiratory failure secondary to pneumonia. On admission, arterial blood gas measurements with the patient breathing room air were PO2 38 mm Hg, PCO2 64 mm Hg, and pH 7.28. Despite receiving intravenous corticosteroids and antibiotic, supplemental oxygen and noninvasive positive pressure ventilation, and inhaled bronchodilators, he was more short of breath, his PO2 had only improved to 52 mm Hg, and his respiratory acidosis had worsened to PCO2 80 mm Hg and pH 7.14. Past history was remarkable for the patient having only one contact with the medical profession in the past 10 years. One year ago, he saw a primary care physician for an insurance physical at which time spirometry revealed an FEV1 of 1.5 L, FVC 4 L, and FEV1/FVC 37%. At that time, he was working full time as a janitor in a capacity that was appropriate for his ninth-grade education. You recommend endotracheal intubation and mechanical ventilation. However, the patient, who is alert, refuses this intervention even after you predict a 95% chance of death without it and a 75% chance of survival with it. Which of the following courses of action is the most appropriate to take next?

Q84- A young man is involved in a high- speed motor vehicle collision while intoxicated. He is intubated in the emergency department with etomidate and succinylcholine. CT head is notable; it shows features consistent with Diffuse Axonal Injury, with scattered punctate hemorrhages. He is admitted to the ICU, where he is given midazolam and fentanyl infusion overnight. The next morning, while his sedation is held for an hour, his pupils are unreactive and he has no cough or gag reflexes. Which of the following is the next best course of action?

Q85- Apnoeic oxygenation test for the diagnosis of brain death has been under critique. Which one of the following issues is NOT correct?

Q86- Donation after cardiac death (DCD):

Q87- A 25 years old healthy male dies in a fatal road traffic accident; he has advance directives about his organ donations. Health care rationing of organs take multiple factors into account for deciding of who will be recipient of organ. Social utility, equity, equality, distributive justice, beneficence and expected life expectancy after organ transplantation,all perspectives play roles in allocating of scarce organs to recipients, as waiting lists are lengthy and decision is tough.

The most likely recipient of organ will be:

Q88- The most frequent cause of severe hypoxemia within the 72 hrs after a lung transplantation is

Q89- In acute graft versus host disease (AGVHD):

Q90- A group of patients in the ICU were exposed to a new drug for sepsis over a week. At the end of the week many of them were found to have

thrombocytopenia (platelets < 50000/cmm).

No thrombocytopenia        Thrombocytopenia

Drug given                             15                                          85

Drug not received                55                                          45

What is the relative risk of thrombocytopenia with the use of drug A?

Q91- Which of the following is the best indicator of a safe discharge policy of ICU patients?

Q92- Which is most commonly associated with burnout among critical care professionals?

Q93- A 200-bed regional hospital with a 14-bed mixed medical-surgical ICU is seeking to reduce patients’ length of stay and observed-to-expected mortality ratio, while saving costs. Their current structure includes a full-time nursing director and an unpaid, part-time medical director. Nurse-to-patient staffing is at a 1:2 ratio and a three-person pulmonary-critical care group either admits or comanages every patient. The critical care physicians are promptly available throughout the day to respond to questions and problems, but there is no in-house physician coverage at night.

Which of the following strategies offers the best chance of improving outcomes and lowering costs?

Q94- Concerning critical care outreach services, which of the following is incorrect:

Q95- Which of the following qualities is most essential when designing a scoring system to assess risk of mortality in critically ill patients

Q96- The APACHE II scoring system:

Q97- In relation to the Glasgow Coma Scale (GCS), which is false

Q98- The risk of refeeding syndrome is increased in all of the following EXCEPT:

Q99- A 78-year old man has collapsed several hours ago & been found on the floor by paramedics. He was found to be hypothermic at 32℃. His creatinine kinase is 10,000 IU. His serum potassium is 5mmol/l, urea is 20mmol/l and creatinine is 300μmol/l. The most important form of initial treatment should be:-

Q100- A 46-year old man’s house is on fire & he is brought into the emergency department with partial thickness skin burns. The ICU physician is asked to assess him in the emergency department resuscitation room. Fluid has been prescribed according to the parkland formula. Which of the following is the best endpoint for initial crystalloid titration?