Regarding drug-receptor interactions, which one is CORRECT:

β-receptor blockers are reversible antagonists.

An antagonist has receptor affinity and intrinsic activity.

Increasing the dose of a partial agonist can elicit a maximal effect.

Flumazenil is an inverse agonist.

Phenoxybenzamine is an reversible antagonist at α-adrenoceptors.

A 4 year old boy presented with road traffic accident. A FAST scan showed huge pericardial tamponade. Clinically, the patient showed signs of hemodynamic instability. The most sensitive finding in a pericardial tamponade that will alert the physician towards impending course of hemodynamic collapse is

Collapse of Right Ventricle during systole

Collapse of Right Atrium during systole

Collapse of Left Ventricle during diastole

Collapse of Right Ventricle during diastole

Distended Vena cavae with no phasic variation with respiration

You are called to intubate a 15-year-old 85 Kg patient for respiratory failure. You have an anesthetist who can come in and help you in case of a difficult airway. You don’t find any facial dysmorphism. Among the options provided below, which one of the following would be the best predictor that he can be difficult to ventilate and intubate?

Abnormal dentition/dental malocclusion

A 7 year old child is being treated for Burkitts Lymphoma with Rasburicase in an effort to reduce the risk of acute kidney injury secondary to tumour lysis syndrome. Metabolic acidosis with raising lactate develops acutely. Which of the following would explain the pathophysiology involved in this scenario?

Impaired renal ammonium synthesis

Pulmonary hypertension with right to left intracardiac shunt

Uncontrolled uric acid production

Which of the following is TRUE regarding acute kidney injury?

A fixed acute renal insult is characterized by a loss of glomerular filtration rate(GFR) or tubular function

The net effect of impaired perfusion is low urine sodium concentration and low urine osmolarity

In the hypovolemic patient, the fractional excretion of sodium(FENa) is >1

Urine studies are a poor reflection of tubular damage due to the inability to distinguish impairment of both concentration and dilution

When seen, granular casts, RBC casts and WBC casts indicate hypovolemia

Patient has a serum albumin of 2.0g/dl. How would you expect this to affect calculation of anion gap?

Falsely decreases the anion gap

Albumin does not affect anion gap

You would have to calculate delta/delta ratio to know

Following statement is most accurate regarding prescription for starting acute peritoneal dialysis for an 8-month infant with Acute Kidney Injury with fluid overload.

Initial exchange duration including inflow, dwell and drain times should generally be limited to 60-90 minutes. The cycle duration may need to be reduced to achieve adequate ultrafiltration.

Initial fill volume is limited to 3 ml/kg to minimize the risk of dialysate leakage

In cases of hyperkalemia, the dwell time needs to be prolonged to accomplish quick solute removal.

To increase the net ultrafiltrate, Hypertonic dialysis solutions is made by increasing the concentration of sodium in dialysate fluid

Drug dosage adjustment is not necessary during peritoneal dialysis.

Master V, a 2-year-old male, background of Hirschsprung disease and duhamel procedure at 1 year of life, admitted with perforation peritonitis in a decompensated state. He was admitted at another hospital for 10 days before getting admitted to this hospital. Postoperatively he was transferred to PICU intubated. His admission electrolytes were Na 143.2, K 2.2. He was started on 70% maintenance IV fluids with added potassium. He had a urine output of 0.8-1 ml/kg/hour for first 2 days postoperatively, when his Na increased to 154 meq/L; and then started passing huge amounts of urine around 8-9 ml/kg/hour from post operative day 3. His electrolytes demonstrated a drop in Na which reached 124 meq/L on POD 5. His Serum osmolality at this point was 293 mOsm/kgH2O, U osmolality 435 mOsm/kgH2O, Urine Na 168. What immediate treatment option would you consider?

Replace urinary losses with isotonic fluids

Restrict fluids to 50% maintainance

hypothyroidism. His admission weight was 4 kg. He underwent VSD closure at 5 months of age. He had post-op PHT crises, required prolonged ventilation, twice re-intubation in view of worsening distress & LV dysfunction. He was discharged to ward after 3 weeks of ICU stay on furosemide, enalapril, thyroxine & sildenafil. Weight on ICU discharge was 3.8 kg. Which of the following factor would have contributed to weight loss in this child?

It’s an expected and acceptable weight loss

Post-surgical improvement in heart function

3-year-old female child with recurrent respiratory tract infections & failure to thrive was admitted with history of one-week cough, 4 days fever & 2 days of fast breathing. As per parents, she has some baseline tachypnoea at rest & she was diagnosed to have cystic fibrosis by gene testing. They have planned to meet the pediatric pulmonologist a week later at a different place. As she had more problems, she was brought to you for further management. On examination, she is tachypnoeic with bilateral crepitations, SpO2 88% in Room air & 96% with 1 liter oxygen nasal cannula. CXR shows bilateral perihilar & right lower lobe infiltrates. Her weight is 8 kg. Which of the following is the RIGHT statement regarding malnutrition in critically ill children.

Preservation of lean body mass during critical illness is associated with better ICU outcomes

Prevalence of malnutrition in children admitted to the ICU has decreased over the years

Assessment of nutritional status in critically ill children is not essential

Malnutrition is not associated with increased mortality & poor outcomes

Dual energy X ray absorptiometry is useful in determining lean body mass in pediatric patients & can be used in the PICU.

In acute pancreatitis the following is true EXCEPT

Insert NG, keep the child NPO and start early antibiotics

High protein, low fat, semi-elemental feeding formulas may be used

Early enteral nutrition is preferred

Antibiotics are given empirically when there is evidence of necrotising pancreatitis

Abdominal compartment syndrome is a recognised complication

A known case of ALL on induction therapy develops tumor lysis syndrome (TLS). Which of the following statement is CORRECT?

Clinical TLS can be diagnosed in a patient with seizures, hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia and azotemia

High dose IV steroids is a reasonable initial treatment option

TLS is most commonly associated with solid organ malignancies

An increase in serum Calcium and potassium levels by >25% is the hallmark of TLS

Allopurinol is the treatment of choice for preventing acute kidney injury in TLS

With regard to bleeding and coagulopathy in the critically ill patient, which statement is FALSE

A suggested dose of fresh frozen plasma in the bleeding trauma patient with coagulopathy is 30ml/kg.

If a platelet transfusion is indicated, 1 unit will raise the count by approximately 20 x 109/L.

The principal constituents of cryoprecipitate include Factors VIII, XIII, vWF, fibronectin and fibrinogen.

Desmopressin at a dose of 0.3µg/kg is a useful treatment in patients with coagulopathy related to uremia, cirrhosis and aspirin use.

At temperatures of 33-35°C, altered enzyme kinetics equate to a 33% reduction in normal clotting factors.

A 4 month old baby is admitted to the PICU with pneumonia in respiratory distress for which he is started on HFNC with 50% FiO2 and 2L/kg flow. This is the second severe infection and PID workup revealed severe combined immunodeficiency. Baby is started on broad spectrum IV antibiotics. Initial lab investigations revealed Hb 5.8 g/dl and a packed cell transfusion was planned. Which of the following is the MOST appropriate option?

Irradiated Packed red blood cells

Leucoreduced Packed red blood cells

Leucodepleted Packed red blood cells

Identify the statement regarding thrombocytopenia in the critically ill child that is TRUE

Hemolytic uremic syndrome is uncommon in children

Infection associated thrombocytopenia is treated with intravenous immunoglobulin

Patients with trauma and bleeding may develop refractory hemorrhage due to a collection of factors EXCEPT

Hypercalcemia-induced coagulopathy

Hypothermia from transfusion of products.

1 year old boy is admitted after being rescued from a house fire. On admission, he is crying but consolable, has intermittent stridor, RR 40/min, chest is clear with bilateral breath sounds with Sat O2 97% on room air. His heart rate is 130/min, peripheral pulses well felt, with warm peripheries, CRT

Intubation and mechanical ventilation

Non-rebreathing mask Oxygen at 10 L/min

Nebulised adrenaline and IV dexamethasone

A 2-year-old boy was brought to the ER unresponsive with history of fall from the second floor. He was only pain responsive with a GCS of 7. He had bruising on the face and chest wall and bleeding from the nose and ear. His vitals were HR 120, BP 70/60, RR 35/min with saturation 98% on oxygen by mask and has stridor. All of the following should be considered while intubating the child EXCEPT

Inline stabilization of the cervical spine has to be done by an assistant, while securing the airway

Consider use of video laryngoscope to intubate

Ketamine can be used as an intubating agent

Call for anesthetist back up before intubation

With respect to the Organ donation, the recommended time period that would be required for repeat testing of brainstem reflexes in this child so that organ donation can be done is:

Second testing is not required.

Regarding a patient with a penetrating neck injury, which one of the following is TRUE?

Multi detector CT imaging is very sensitive for the detection of clinically significant vascular injury.

The platysma may or may not be breached.

The patient should be immediately immobilized in a hard collar.

Dysphonia is an indication for urgent surgical exploration.

A negative CT effectively excludes aerodigestive tract injury.

You are treating a child with suspected iron toxicity. Your colleague wants you to discuss the management of Iron toxicity. Regarding Iron overdoses which is TRUE?

Deferoxamine is indicated for serum iron levels >500mcg/dl

95% of ingested tablets are seen on plain x-ray

Systemic toxicity occurs at a dose of 40mg/kg

Activated charcoal is the recommended method of GIT decontamination in the first hour

It has no local GIT irritating effects

A 2 year old presented with history of ingestion of a household detergent liquid 30 mins back. He has drooling of saliva, odynophagia and is refusing to eat or drink anything. His vitals are stable and has no respiratory distress. His parents inform you that they gave him a glass of water immediately after the exposure. What is the MOST appropriate next step in his management?

IV fluids and plan endoscopy within 24 hrs

Give him another 250 ml of warm water to drink

Gastric lavage with activated charcoal administration

IV fluids, IV antibiotics and steroids

IV fluids, start PPI and antibiotics

A 3-year-old Rani ingested an unknown amount of her brother's phenytoin tablets. All of the following are true regarding phenytoin overdose EXCEPT:

The elimination half-life increases with higher plasma concentrations

Manifested by ataxia, nystagmus, lethargy and extrapyramidal signs

A 3 year old presented with acute ingestion of a ‘Bottle’ of a blue sanitizer at his home. Parents rushed to your hospital within one hour of ingestion. He was drowsy but arousable and had normal vital parameters. During your secondary survey, he had one episode of hematemesis following which his sensorium worsened. His blood gas was normal, blood glucose was normal but blood ketone levels were elevated. What is the appropriate therapy for this kid?

Symptomatic management, IV fluids and monitoring for hypoglycemia

Gastric lavage and activated charcoal administration

All of the following statements are true regarding organophosphate poisoning, EXCEPT:

Characterized by increased serum cholinesterase levels

Characterized by increased airway secretions, vomiting and diarrhea

Treated with pralidoxime and atropine

Avoid succinylcholine to intubate

Can see delayed symptoms due to metabolism to active substance

Routine blood toxicology studies are useful in detecting all of the following substances EXCEPT:

Lysergic Acid Diethylamide (LSD)

Regarding the principles of invasive blood pressure monitoring, which one is a FALSE statement:

Overdamping has no effect on the reading of mean arterial pressure.

The risk of thrombus formation is greater with a wide-bore arterial cannula.

The flush system infuses continuously at about 1-3ml/hr.

The addition of extra tubing and three-way-taps to the system cause an increase in damping.

The transducer must be at the level of the heart when the system is zeroed.

Regarding the use of humidification and nebulizers on the intensive care unit, which one of the following is TRUE:

A hot water humidifier can achieve a relative humidity of 100% at 37°C.

When air is inhaled it is fully humidified and warmed by the patient’s nasopharynx by the time it enters the trachea.

Heat and moisture exchangers typically deliver air with a relative humidity of 90%.

The use of an ultrasonic nebulizer in a ventilated patient may impair ventilator triggering.

In a ventilated patient approximately 50% of the nebulizer charge is lost due to aerosol deposition in the ventilator circuit, endotracheal tube and large conducting airways.

With regard to intracranial pressure (ICP) monitoring, which statement is FALSE:

On a standard intracranial pressure waveform, P3 represents cerebral compliance.

Ocular nerve sheath diameter >6mm measured with ultrasound reliably predicts raised intracranial pressure of >20mmHg.

ICP monitoring through an external ventricular drain allows therapeutic intervention.

Cerebral hypoxia results in hypoxic vasodilatation and increased cerebral blood flow, thus causing a temporary rise in ICP.

Lundberg Type A waves are always pathological.

The following may be used to reduce the incidence of clotting in the haemofilter circuit: EXCEPT

Reduce the pre-dilution to a post-dilution ratio.

All of the following are true regarding care of post of care of tracheostomy in children EXCEPT:

Tracheostomy wound is considered to be clean and non-contaminated.

Delayed Tracheal Hemorrhage after 48 hours of the procedure is most commonly caused by Tracheo-Innominate fistula when Tracheostomy tube is placed below the third tracheal ring.

Introduction of high volume low pressure tracheostomy cuff may reduce the incidence of cuff site stenosis post decannulation

Presence of Subcutaneous emphysema may signify another underlying complication such as a pneumothorax or tracheal injury

Tracheostomy tract is usually well formed in a week.

The Charter on Medical Professionalism is best described as:

A set of principles guiding ethical and professional behavior in medicine.

A legal document outlining patient rights only.

A code of conduct for hospital administrators.

A guideline for medical billing procedures.

What factor most specifically impacts the development of burnout in pediatric critical care providers?

Open visitation in the Pediatrician ICU

Pediatric resident and fellow rotation schedules

Number of ventilated patients in PICU

A 12 year old is admitted in the PICU for septic shock. She has been diagnosed to have Acute lymphocytic leukemia. She had febrile neutropenia for which she was treated with antibiotics (Piperacillin-tazobactum and Vancomycin). Her current ANC were 530cells/cumm. She had a central line in situ. In view of septic shock her antibiotics were escalated to Meropenem and Vancomycin. Fluid resuscitation was done using normal saline boluses and she was started on Dopamine (7.5mcg/kg/min). She had persistent fever spikes and so temperature monitoring was done. Temperature monitoring of the child was done using the oesophageal probe. With respect to the oesophageal probe the best placement of the probe would be:

In the middle 1/3rd of the oesophagus

In the mouth at the junction of tongue and pharynx

In the upper 1/3rd of the oesophagus

In the lower 1/3rd of the oesophagus

In the junction of upper 1/3rd and middle 1/3rd of the stomach.

A 6-year-old girl who weighs 30 kg is admitted to the pediatric intensive care unit with ataxia and progressive weakness of the lower extremities. She had an upper respiratory tract infection approximately 2 weeks ago. Physical examination reveals paresthesias of the lower extremities and loss of deep tendon reflexes. There is no bulbar dysfunction. Pulse oximetry demonstrates a saturation of 98% on room air, bedside pulmonary function tests reveal a vital capacity of 400 mL and a negative inspiratory pressure of -14 cm H2O. Which of the following is the LEAST appropriate next management step?

Sedation only intubation is preferable

Consider elective tracheal intubation

Close observation, chest physiotherapy and serial PaO2 measurement is the preferred management strategy

Child needs to be admitted to PICU

A 3-month-old child is brought in by his mother who noticed abnormal jerking movements of his extremities associated with eye deviation. Following a dose of lorazepam, the movements stop. On examination, you see bruising and bogginess behind his right ear. The tympanic membrane is intact but appears purplish. His anterior fontanelle is tense. He has some old and new bruises over his body. Examination of the cardiovascular and respiratory system and the abdomen, genitourinary system, and musculoskeletal system is unremarkable. Which of the following is FALSE about this condition?

Has better prognosis than Traumatic brain injury in this age group.

Retinal haemorrhages are very likely to be present

Serum and/or CSF concentrations of NSE and MBP may be useful as a screening test to identify infants who are at increased risk for this condition

Subdural bleed is more indicative of this condition than intra-parenchymal bleeds

A 4-year-old boy with diarrhoea and vomiting developed generalised seizures. When he came to hospital, he was drowsy with dehydration. He was given dehydration correction after which signs of dehydration improved but child continued to be drowsy with no neck stiffness with right hemiparesis and extensor plantar response. CT scan was done. What is the most likely diagnosis?

Cerebral infarct due to cerebral venous thrombosis

Acute disseminated encephalomyelitis

Regarding the effect of PaCO2 on cerebral perfusion, which of these is LEAST accurate?

PaCO2 effect on cerebral perfusion remains constant over the first 24 hours

Decrease in PaCO2 causes vasoconstriction

Short hyperventilation can be used to rapidly lower the intracranial pressure

PaCO2 affects cerebral perfusion by pH changes in the extracellular fluid

PaCO2 should be targeted between 35-40 mm Hg in suspected raised intracranial pressure

A 5-year-male admitted in PICU with the diagnosis of acute respiratory distress syndrome and mechanically ventilated for 10 days. After a failed spontaneous breathing trial, he was noted to have generalised weakness and hypotonia. Regarding ICU acquired weakness, which of the following is TRUE?

Critical illness neuropathy is more common cause of ICU acquired weakness than critical illness myopathy

The recovery is rapid and complete

Motor neuropathy is more common than sensory

Prognosis of critical illness neuropathy is good when compared to critical illness myopathy

The use of steroids is protective for development of ICU acquired weakness

Regarding the use of mannitol for raised intracranial pressure, which of the following is a FALSE statement:

The viscosity-mediated reflex vasoconstriction last for 4-6 hours

At a higher bolus dose of 1 g/kg, mannitol reduces blood viscosity which produces viscosity-mediated reflex vasoconstriction leading to reduction in cerebral blood volume and ICP

At all doses, mannitol reduces ICP by an osmotic effect on brain parenchyma leading to gradual movement of water from the brain parenchyma into the systemic circulation

The osmotic action last for up to 6 hours

The dose of mannitol is 0.25-0.5 gm/kg

A 5-year unimmunized male child came with history of lock jaw and generalised rigidity since last 3 days. There was history of trauma over left foot 2 weeks back. The wound is currently unhealthy. Which of the following is FALSE while managing this child?

Penicillin G is more effective than metronidazole

Administer human tetanus immunoglobulin

Muscle relaxants are often needed

Magnesium sulphate is useful in this situation

IDPCCM MCQ Paper Jan 2022

Authored by sandeep reddy

Health Sciences

University

AI Actions

Add similar questions

Adjust reading levels

Convert to real-world scenario

Translate activity

More...

Content View

Student View

65 questions

Show all answers

MULTIPLE CHOICE QUESTION

1 min • 1 pt

1. 4 year old male child was admitted to the ICU with pneumonia & septic shock. Child was intubated & started on adrenaline & noradrenaline infusion after fluid boluses. He had catecholamine refractory shock with metabolic acidosis. Child was also started on broad spectrum antibiotics. The consultant on call arrived & asked the fellow to start stress dose steroids for the child. The fellow asked the consultant about the reasoning for starting steroids in this child. The consultant explained the physiological basis for use of stress dose steroids in shock. Which of the following statement about physiological role of glucocorticoids in septic shock is WRONG?

Glucocorticoids suppress the inflammatory process by predominantly decreasing B lymphocytes

Glucocorticoids improve LV function due to positive inotropic effect

Glucocorticoids inhibit pro-inflammatory cytokines like TNF α, IL 6 etc

Glucocorticoids increase the sensitivity of catecholamines

None of the above

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

An 11-yr-old boy complains of increasing headaches and recent visual changes affecting his lateral fields of vision. MRI of the brain reveals a midline mass measuring 2 cm in diameter in the region of the anterior pituitary gland. He undergoes transsphenoidal resection of the mass and is transferred to the pediatric intensive care unit for postoperative care. Six hours later he is noted to have a brisk urine output of 4-6 mL/kg/hr. Vital signs are stable: heart rate 120/min, blood pressure 120/75 mm Hg. He appears well hydrated. His serum osmolality is 310 mOsm/kg and urine osmolality is 100 mOsm/kg.

SIADH

Cerebral salt wasting

Normal postoperative diuresis

Central diabetes insipidus

Nephrogenic diabetes insipidus

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A 15-day old infant underwent arterial switch procedure for transposition of great arteries. On POD 2, child was stable on low dose milrinone infusion & was extubated to NIV. The fellow on duty had sent thyroid profile for the child. The T3 levels were decreased in the report. The fellow wanted to start thyroxine replacement. The consultant on call said that there is no need for thyroxine replacement. Which of the following is WRONG pertaining to sick euthyroid syndrome?

Thyroxine replacement is not necessary

T4 levels will be low

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A 3-year-old girl with new-onset T1DM is admitted to the hospital with a diagnosis of DKA. On initial evaluation in the emergency department she was assessed to be severely dehydrated. Her parents report that she has been ill for a week. Laboratory studies show PH of 7.2, high urine specific gravity, glucosuria, and ketonuria. Which of the following factors is least likely to place this patient at risk for cerebral edema?

Age of 3 years.

PH of 7.2

New onset of T1DM.

Prolonged nature of her illness.

Severe dehydration

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

9-month-old child was admitted with polyuria & polydipsia since 3 weeks & increasing sleepiness for 2 days. On examination, child was crying on stimulation but preferring to sleep. There is minimal tachypnoea with good air entry on both sides. There is tachycardia with low volume pulses & normal BP. Blood sugar level was 865 mg/dl, Urine sugar was positive & ketones were 1+. VBG sent for analysis is yet to come. Which of the following is CORRECT statement regarding hyperglycemic hyperosmolar state.

Insulin should be started early

Arterial pH should be < 7.25

Ketosis will be minimal

Fluids should be restricted in view of high incidence of cerebral edema

none of the above

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

Which of the following statements is FALSE with regards to Dexmedetomidine?

Dexmedetomidine acts by inhibiting norepinephrine release in the ventrolateral preoptic nucleus in the hypothalamus

Dexmedetomidine infusions for sedation have been associated with a lower incidence of withdrawal than benzodiazepine infusions

Bradycardia due to Dexmedetomidine can be prevented by pretreatment with glycopyrrolate

Bolus doses of Dexmedetomidine are associated with significant risk of hypotension

Coadministration of ketamine bolus with a Dexmedetomidine bolus reduces the risk of bradycardia

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

Which of the following antibiotics will not provide anti-toxin effect in a child with suspected Staphylococcal septic shock?

Linezolid

Rifampicin

Teicoplanin

Clindamycin

Gentamicin

Access all questions and much more by creating a free account

Create resources

Host any resource

Get auto-graded reports

Continue with Google

Continue with Email

Continue with Classlink

Continue with Clever

or continue with

Microsoft

Apple

Others

Already have an account?

Similar Resources on Wayground

65 questions

test 3

Quiz

•

University

62 questions

NSG1211 Content Review 1

Quiz

•

University

60 questions

MTQM P1 14 Juni - Pretest

Quiz

•

University

60 questions

Chemical Kinetics and Drug Stability

Quiz

•

University

60 questions

Hypothalamic & Pituitary Medications and Endocrine Disorders

Quiz

•

University

Popular Resources on Wayground

10 questions

5.P.1.3 Distance/Time Graphs

Quiz

•

5th Grade

10 questions

Fire Drill

Quiz

•

2nd - 5th Grade

20 questions

Equivalent Fractions

Quiz

•

3rd Grade

22 questions

School Wide Vocab Group 1 Master

Quiz

•

6th - 8th Grade

20 questions

Main Idea and Details

Quiz

•

5th Grade

20 questions

Context Clues

Quiz

•

6th Grade

20 questions

Inferences

Quiz

•

4th Grade

12 questions

What makes Nebraska's government unique?

Quiz

•

4th - 5th Grade

Discover more resources for Health Sciences

18 questions

Informative or Argumentative essay

Quiz

•

5th Grade - University

20 questions

Disney Trivia

Quiz

•

University

5 questions

Human Impacts: How Do People Disrupt Ecosystems?

Interactive video

•

4th Grade - University

7 questions

Human Body Systems Overview (Updated 2024)

Interactive video

•

11th Grade - University

20 questions

Context Clues

Quiz

•

KG - University

7 questions

Comparing Fractions

Interactive video

•

1st Grade - University

20 questions

10.4 Exponential Functions

Quiz

•

8th Grade - University

30 questions

PSYCH 250: Exam 3

Quiz

•

University