Duration 2 hrs – Before you start kindly read the instructions carefully !
Attempt all questions. 50 questions within 2 hrs
Each Single choice Question carries 1 point.
Each True False question carries 4 point
There are no negative marking on wrong answer.
30 Single Choice Question: 1 out of 4 / 5 options is correct.
20 True & False Questions: qualify All the 4 statement as true or false, you will find “_” (dash) after each statement fill it with F or T (small & caps both accepted).
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Question 1 of 50
Q1. Which of the following conditions represents an absolute contraindication to fibrinolysis in a patient with acute ST-segment–elevation myocardial infarction?
Question 2 of 50
Q2. Which class of haemorrhagic shock should blood administration be part of the resuscitation?
Question 3 of 50
Q3. A 60 year old woman presents with new onset pancreatitis with a serum amylase of 4000, WBC of 16K, Glucose 210mg/dL and Calcium of 7.0 g/dL. The best management would be:
Question 4 of 50
Q4. 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?
Question 5 of 50
Q5. Which of the following represents the proper technique for mechanical zeroing of the system (to atmospheric pressure) before measurement of central venous or pulmonary artery pressure?
Question 6 of 50
Q6. Using the illustrations below, arrange the three bottles in correct sequence for pleural drainage and application of negative pressure (suction):
The correct sequence is:
Question 7 of 50
Q7. A 50-year-old female was admitted to the ICU with fever, cough and shortness of breath. She had non-insulin dependent diabetes mellitus and hypertension as her only other illnesses. Her medications included glyburide, hydrochlorthiazide, and ramipril. She had an elevated WBC count, and a lung infiltrate. She was started on Ceftriaxone 1gm 12 hourly and gatifloxacin 400mg daily. The glyburide was held and she was ordered insulin on a sliding scale but had received no insulin based on the sliding scale. It was noticed that she had a decreased level of consciousness on the third day. A CT scan of the head was negative but a blood glucose measurement was 30mg/dL. She was given 50ml of 50% dextrose intravenously and her level of consciousness improved. At this point, which of the following should you do?
Question 8 of 50
Q8. An unasssisted aortic pressure waveform and an intraaortic balloon counterpulsation – assisted waveform are depicted in the figure. The arrow on the IABC-assisted waveform corresponds to:
Question 9 of 50
Q9. A hemodynamically stable 40-year-old man, with height of 170 cm, is being mechanically ventilated for adult respiratory distress syndrome with the following settings: tidal volume = 400 mL, respiratory rate = 18/min, FiO2 = 0.80, I:E ratio = 1:2, PEEP = 8 cmH2O. ABG shows PaO2 = 50 mmHg, PaCO 2 = 40 mmHg, and pH = 7.42. The most appropriate change in ventilatory settings would be
Question 10 of 50
Q10. You are the consultant in your ICU and you initiate end of life care decisions, requesting limiting further life supporting treatment in all of the following patients, EXCEPT:
Question 11 of 50
Q11. Which of the following organisms is least likely to be susceptible to Imipenem?
Question 12 of 50
Q12. At age 14, a female patient was hospitalized, with flu- like symptoms including emesis, and then altered consciousness and unresponsiveness, treated with fluid resuscitation and oxygen. There were hypotension and mild hyperpigmentation, and after rehydration had commenced :
Which of the findings provides evidence against central cause for the low cortisol ( pituitary or hypothalamic )
Question 13 of 50
Q13. All of the following are class one indications for NIV EXCEPT:
Question 14 of 50
Q14. A 60-year-old man was involved in a high-speed automobile accident, sustaining multiple broken ribs and a fractured femur. He develops pneumonia and laboured breathing and so is intubated. His workup reveals the following: FiO2 = 1.0 on ventilator; pH = 7.14; PaCO2 = 58 mm Hg; PaO2 = 60 mm Hg; oxygen saturation = 88%. Although his admission ECG was normal, a monitor strip (see figure) now shows a change from sinus rhythm at 86/min to an irregular rhythm at 130/min, with no change in blood pressure. Which of the following next steps is most appropriate in the management of this new cardiac rhythm?
Question 15 of 50
Q15. What is the diagnosis on interpretation of this capnogram?
Question 16 of 50
Q16. Analyze the acid–base disorder in this patient:
Q17. What is the regimen of choice for Herpes simplex encephalitis in an immunologically normal 20 year old previously in good health?
Question 18 of 50
Q18. A reasonably well accepted recommendation to initiate nutrition in a critically ill patient is
Question 19 of 50
Q19. All of the following are indications for use of vaptans, EXCEPT:
Question 20 of 50
Q20. Low T3 with normal levels of T4 and TSH is most commonly seen in which condition?
Question 21 of 50
Q21. A 65-year-old man, recently diagnosed with lung carcinoma, now presents with acute confusional state. He is hemodynamically maintained, though has a reduced skin turgor. On investigations, he is found to have an
Ca++ = 14.6 mg/dL; S. albumin = 2 g/dL.
The next step in the management of this patient is
Question 22 of 50
Q22. All of the following patients, suspected of having meningitis, should undergo a CT or MRI brain evaluation before performing a lumbar puncture EXCEPT:
Question 23 of 50
Q23. Following methods are appropriate to reduce ICP in cases of acute liver failure, EXCEPT:
Question 24 of 50
Q24. An elderly gentleman has been admitted to ICU with history of burning micturition, decreased urine output, and generalized weakness for last 5 days. He was hypotensive on presentation and had lactate levels of 8 mmol/L. He was fluid resuscitated with about 1 L of crystalloids and his blood pressure rose to 110/60 mmHg. The following are appropriate for his further management EXCEPT:
Question 25 of 50
Q25. 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).
Drug not received
What is the relative risk of thrombocytopenia with the use of drug A?
Question 26 of 50
Q26. The most common bacteria causing transfusion associated sepsis (TAS) through packed red cells is
Question 27 of 50
Q27. The risk for developing cerebral vasospasm is greatest with
Question 28 of 50
Q28. Most important modality for the diagnosis of necrotizing soft tissue infections is
Question 29 of 50
Q29. One of the following is not a physiologic maternal adaptation in pregnancy:
Question 30 of 50
Q30. The risk of refeeding syndrome is increased in all of the following EXCEPT:
Question 31 of 50
Q31. Regarding the use of FAST scanning in emergency assessment of blunt abdominal trauma:
Visualisation of pericardium is a key view (T)
Free intraperitoneal fluid volume in excess of 500ml are reliably detected (T)
It is moderately sensitive for detecting encapsulated solid organ injury (T)
Hollow viscus injury is detected in 60-70% cases (F)
Question 32 of 50
Q32.In the ventilator graphic illustrated below, regarding the pressure being indicated by the arrows (upper graph) is:
If the patient is breathing spontaneously, it may mismeasure the underlying pathology (T)
It may increase the work of breathing when the patient starts to initiate breaths (T)
It is a clear indicator of increased lung elastance (F)
It may result in alveolar over-distension (T)
Question 33 of 50
Q33. Following statements is/are true for amniotic fluid embolism (AFE):
Disseminated intravascular coagulation may be the first manifestation of AFE (T)
Humoral factors are the mainstay of pathogenesis of AFE (T)
Hypoxia is secondary to cardiogenic as well as noncardiogenic pulmonary edema (F)
Question 34 of 50
Q34. Regarding the use of activated charcoal in poisoning, following are true:
It adsorbs toxins by van der Wall forces (T)
Frequent smaller doses are more effective than single large dose (F)
Presence of food in stomach reduces its efficacy (F)
It is superior to gastric lavage in preventing absorption of drug (T)
Question 35 of 50
Q35. A patient with COPD deteriorates with oxygen administration, due to all of the following:
Loss of hypoxic drive (F)
V/Q mismatch (T)
Haldane effect (T)
Bohr effect (F)
Question 36 of 50
Q36. In a comatose patient who has been successfully resuscitated after a cardio-respiratory arrest. Which of the following statements is/are TRUE
Electrophysiological testing (EEG/ evoked potentials) is necessary to predict neurological outcomes (F)
Clinical evaluation done immediately after the resuscitation predicts neurological outcome best (F)
Most patients who have had a return of spontaneous circulation will also have good neurological outcome (F)
Absence of motor function at 72 hours is associated with a very high likelihood of death or poor neurological outcome (T)
Question 37 of 50
Q37. A 58-year-old male, known diabetic since last 20 years has diabetic nephropathy with a serum creatinine level of 2.6, has presented with acute chest pain and is being taken up for coronary angiography. Which of the following will reduce the risk of further renal damage?
Oral N-acetyl cysteine (NAC) along with IV isotonic crystalloids (T)
Using biplanes during angiography when appropriate (T)
Using iso-osmolar contrast media (T)
Question 38 of 50
Q38. A 72-year-old patient presents with high-grade fever and dyspnea. He has a history of pacemaker implanted 2 years back. He is diagnosed to have endocarditis related to the device. Which of the following are appropriate statements in the management?
Most common organism is coagulase negative (T)
Appropriate antibiotics alone should be started and continued for 14 days (F)
Entire system should be removed and new one placed from contralateral site along with antibiotics (T)
Transesophageal echocardiography is diagnostic (T)
Question 39 of 50
Q39. For estimation of the area of burn which of the following is/are true?
The rule of nine is useful for both adults and children (F)
It is important to calculate the burnt area accurately (T)
First assessment calculations of burn area are most accurate (F)
The area of a child`s palm and the adducted fingers approximates 1% of body surface area (T)
Question 40 of 50
Q40. Regarding intra-arterial fibrinolysis of acute ischemic stroke following is/are true:
FDA has not approved r-tPA for intra-arterial use. (T)
Intra-arterial fibrinolysis is preferred over endovascular therapy with stent retrievers, for stroke <6 hours duration caused by occlusion of the middle cerebral artery. (F)
Clinical beneficial dose of intra-arterial r-tPA is 30% of intravenous dose. (F)
Intra-arterial fibrinolysis may be considered in patients within 6 hours of symptom onset, who have contraindications to use of IV r-tPA. (T)
Question 41 of 50
Q41. Following statements is/are true for candiduria:
Candiduria associated with a fungus ball in the urinary tract need antifungal therapy (T)
Patients with post catheterization candiduria usually require antifungal therapy (F)
Candiduria should be treated in renal transplant recipients (T)
Repeated, unexplained Candida isolates in the urinary tract are indicator of disseminated candidiasis (T)
Question 42 of 50
Q42. The following are true for cardiogenic shock (CS) due to right ventricular failure:
Shock due to isolated RV failure carries lower mortality risk than LV failure (F)
Patients in shock due to RV dysfunction should be aggressively given fluids (F)
5% of patients presenting with cardiogenic shock have isolated RV failure (T)
RV end-diastolic pressure of > 20 mmHg should be targeted for optimal RV function (F)
Question 43 of 50
Q43. Regarding hemophagocytic lymphohistiocytosis (HLH) following are true:
Not a hereditary disease (F)
Laboratory findings reveal increase in triglycerides and ferritin levels (T)
Etoposide is an inciting agent (F)
Steroids are ineffective (F)
Question 44 of 50
Q44. The following are true for inotropes and vasopressors in shock:
Phenylephrine can cause bradycardia. (T)
Isoproternol has neutral effect on cardiac output. (T)