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WorksheetsIDPCCM MCQ Paper Jan 2022
Total questions: 65
Worksheet time: 36mins
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
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
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
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
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
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
Which of the following antibiotics will not provide anti-toxin effect in a child with suspected Staphylococcal septic shock?
Linezolid
Rifampicin
Teicoplanin
Clindamycin
Gentamicin
Regarding drug-receptor interactions, which one is CORRECT:
An antagonist has receptor affinity and intrinsic activity.
Increasing the dose of a partial agonist can elicit a maximal effect.
β-receptor blockers are reversible antagonists.
Flumazenil is an inverse agonist.
Phenoxybenzamine is an reversible antagonist at α-adrenoceptors.
You have an infant in your PICU with liver and kidney failure. You decide to intubate the child in view of his respiratory failure due to fluid overload. Your consultant wants to assess the sensorium shortly and so he wants you to pick a combination of sedative and muscle relaxant whose elimination is not prolonged by the underlying condition. His Blood pressure is stable and is not on any hemodynamic supports.
Propofol and pancuronium
Ketamine and Vecuronium
Midazolam and Atracurium
Fentanyl and Vecuronium
Propofol and Atracurium
You have a 2-year-old child admitted in your PICU with traumatic brain injury and was on neuroprotection for 5 days. He is being weaned off his ventilation slowly. While weaning, he is not adequately waking up. You and your consultant check the list of the drugs he was getting and you find the following list - morphine infusion now, fentanyl infusion till last morning, thiopentone infusion till two days ago, propofol infusion now and lorazepam enterally till last night. Your consultant says that it could be due to prolonged context sensitive half time of the drugs previously used. To which of the following options, does this term ‘context sensitive half time’ prolonged apply the best?
Propofol and Fentanyl
Morphine and Fentanyl
Thiopentone and Fentanyl
Thiopentone and Morphine
Lorazepam and Propofol
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 Atrium during systole
Collapse of Right Ventricle 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?
Medication history
History of Snoring
Abnormal dentition/dental malocclusion
BMI > 25
Hypertension
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
Methemoglobinemia
Pulmonary hypertension with right to left intracardiac shunt
Renal bicarbonate wasting
Uncontrolled uric acid production
Which of the following is TRUE regarding acute kidney injury?
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
A fixed acute renal insult is characterized by a loss of glomerular filtration rate(GFR) or tubular function
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?
Albumin does not affect anion gap
Falsely elevates anion gap
Falsely decreases the anion gap
You would have to calculate delta/delta ratio to know
None of the above
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 fill volume is limited to 3 ml/kg to minimize the risk of dialysate leakage
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.
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?
Restrict fluids to 50% maintainance
Increase free water intake
Replace urinary losses with isotonic fluids
Start Fludrocortisone
Plan a MRI screening
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?
Inadequate thyroxine dose
It’s an expected and acceptable weight loss
ICU related catabolism
Post-surgical improvement in heart function
Pre-existing malnutrition
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.
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
Preservation of lean body mass during critical illness is associated with better ICU 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
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
Insert NG, keep the child NPO and start early antibiotics
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?
High dose IV steroids is a reasonable initial treatment option
TLS is most commonly associated with solid organ malignancies
Clinical TLS can be diagnosed in a patient with seizures, hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia and azotemia
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
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.
A suggested dose of fresh frozen plasma in the bleeding trauma patient with coagulopathy is 30ml/kg.
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?
Packed red blood cells
Leucoreduced Packed red blood cells
Leucodepleted Packed red blood cells
Irradiated Packed red blood cells
Any of the above can be
Identify the statement regarding thrombocytopenia in the critically ill child that is TRUE
Hemolytic uremic syndrome is uncommon in children
Children with platelet count <25,000/cmm should be transfused irrespective of the presence of bleeding
Infection associated thrombocytopenia is treated with intravenous immunoglobulin
Patients with trauma and bleeding may develop refractory hemorrhage due to a collection of factors EXCEPT
Dilution of clotting factors
Hypothermia from transfusion of products.
Hypercalcemia-induced coagulopathy
Acidosis.
Thrombocytopenia
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 < 3 sec and BP 100/60 mm Hg. He has singing of nasal hairs and visible soot on his palate. His ABG on room air is as follows: pH 7.31, pCO2 48, PaO2 95, HCO3 22, SatO2 95%. The MOST appropriate management is:
Non-rebreathing mask Oxygen at 10 L/min
High flow nasal cannula
Nebulised adrenaline and IV dexamethasone
Non Invasive ventilation
Intubation and mechanical ventilation
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
Nasal intubation is preferable
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:
48 hours
24 hours
12 hours
6 hours
Second testing is not required.
Regarding a patient with a penetrating neck injury, which one of the following is TRUE?
The platysma may or may not be breached.
Multi detector CT imaging is very sensitive for the detection of clinically significant vascular injury.
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?
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
Deferoxamine is indicated for serum iron levels >500mcg/dl
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?
Give him another 250 ml of warm water to drink
IV fluids and plan endoscopy within 24 hrs
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:
Manifested by ataxia, nystagmus, lethargy and extrapyramidal signs
The elimination half-life increases with higher plasma concentrations
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
Hemodialysis
Fomepizole
All of the above
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:
Acetaminophen
Lithium
Lysergic Acid Diethylamide (LSD)
Cocaine
Salicylic Acid
Regarding the principles of invasive blood pressure monitoring, which one is a FALSE statement:
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.
Overdamping has no effect on the reading of mean arterial pressure.
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:
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%.
A hot water humidifier can achieve a relative humidity of 100% at 37°C.
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:
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.
On a standard intracranial pressure waveform, P3 represents cerebral compliance.
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.
Fondaparinux.
Heparin.
Citrate.
Epoprostenol.
All of the following are true regarding care of post of care of tracheostomy in children EXCEPT:
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
Tracheostomy wound is considered to be clean and non-contaminated.
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.
Which aspect of simulation in an interdisciplinary teaching model is particularly effective?
Critical event debriefing
Role playing
Systems thinking
Didactic teaching
Stress management
What factor most specifically impacts the development of burnout in pediatric critical care providers?
Dealing with dying children
ICU shift length
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 mouth at the junction of tongue and pharynx
In the upper 1/3rd of the oesophagus
In the middle 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?
Consider BiPAP
Consider elective tracheal intubation
Sedation only intubation is preferable
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?
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
Has better prognosis than Traumatic brain injury in this age group.
Perform skeletal survey
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
Bacterial meningitis
Hypoglycemic encephalopathy
Acute disseminated encephalomyelitis
Regarding the effect of PaCO2 on cerebral perfusion, which of these is LEAST accurate?
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 effect on cerebral perfusion remains constant over the first 24 hours
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?
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
Critical illness neuropathy is more common cause of ICU acquired weakness than critical illness myopathy
Regarding the use of mannitol for raised intracranial pressure, which of the following is a FALSE statement:
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
The viscosity-mediated reflex vasoconstriction last for 4-6 hours
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?
Wound debridement is needed
Administer human tetanus immunoglobulin
Penicillin G is more effective than metronidazole
Muscle relaxants are often needed
Magnesium sulphate is useful in this situation
Identify the EEG pattern
Left focal spikes
Triphasic waves
Periodic lateralized epileptiform discharges
Burst suppression
Diffuse slowing
A 16 year old boy is brought to Emergency department after Road Traffic Accident. He makes incomprehensible sounds, withdraws to painful stimuli and opens eyes to painful stimuli. What is his Glasgow Coma Scale (GCS) score?
10
7
8
A 10-year-male admitted to the PICU with diagnosis of traumatic brain injury and raised intracranial pressure. An intraparenchymal catheter was inserted to monitor the intracranial pressure. What is the objective definition of raised intracranial pressure?
Elevation of intracranial pressure >20 mm Hg for >2 min
Elevation of intracranial pressure >10 mm Hg for >2 min
Elevation of intracranial pressure >20 mm Hg for >5 min
Elevation of intracranial pressure >10 mm Hg for >5 min
Elevation of intracranial pressure >20 mm Hg for >10 min
A 5 year old child with prolonged submersion event is managed in PICU. He is intubated and managed with neuroprotective care. His neuroimaging done shows bilateral basal ganglia infarcts. Which of the following is the best course of action:
Administer Dexamethasone to decrease cytotoxic edema
Insert ICP catheter and start ICP monitoring
Consider total whole body cooling
Prepare the parents for the likelihood of poor prognosis
Start the child on Aspirin
A 15 year old boy is on chemotherapy for ALL, drugs includes Vincristine, L-asparaginase, Methothrexate and steroids. He is also had CSF analysis done which is suggestive of meningitis for which he is been started on Meropenem and Vancomycin. On Day 5 of antibiotic therapy he develops diarrhea. Examination of stool done by cytotoxic assay as well as ELISA and PCR reveals the organism. As a treating doctor which one of the following would be MOST APPROPRIATE protocol for ensuring hand hygiene after leaving the patient's room?
No further action is necessary because double gloves were used
Sanitize hands with alcohol gel
Sanitize hands with soap and water
Sanitize hands with chlorhexidine
Sanitize hands with 10% povidone-iodine
A 7 year old girl presented to the PICU with severe respiratory distress, pallor and tachycardia. Her hemoglobin (Hb) was 3gm/dl. Her Chest X-ray showed lobar consolidation and thin rim of pleural effusion on left side. Her peripheral smear showed features of hemolysis like fragment cells, burr cells and other features of microangiopathic hemolytic anemia. Her DIC screen was negative. Blood culture and diagnostic tap of the left pleural effusion showed growth of streptococci pneumonia. Her renal parameters were mildly elevated: Urea=58mg/dl and creatinine=1.2mg/dl. Hematologist diagnosed this
Condition as streptococcal induced thrombotic thrombocytopenic purpura. She was started on 1-1/2 volumes of plasmapheresis/plasma exchange (PE) and initiated on ceftriaxone. With respect to ceftriaxone in this scenario the dosing would be:
Need to administer another dose of ceftriaxone after PE due to high Volume of distribution(Vd) and low protein binding.
Need to administer single dose ceftriaxone daily on PE as it has low Vd and high protein binding.
Need to administer another dose of ceftriaxone after PE due to low Vd and high protein binding.
Need to administer single dose ceftriaxone daily on PE as it has high Vd and low protein binding.
Antibiotics should be changed to carbapenem as it does not have penicillin ring.
A 15 year old girl undergoes box-osteotomy for her hyperteleorism and is shifted to ward with a drain in-situ. Four days after the surgery she continues to have high grade fever. She is empirically started on Meropenem and Vancomycin suspecting post-surgical meningitis. On Day 7 after surgery despite the fever reducing in intensity she has a generalized tonic–clonic convulsions. She undergoes emergency drainage of the collection. The pus is send for culture the report of which is given below: The pus has grown Enterococcus fecalis and sensitivity pattern Penicillin - sensitive Amoxicillin - sensitive Ampicillin - sensitive Ceftriaxone - sensitive Cefotaxime - sensitive Vancomycin - sensitive Tigecycline - sensitive
Deescalate to Ampicillin as it is the drug of choice for Enterococcal meningitis
Ignore the report as this organism is an enteric organism and cannot cause meningitis
Continue Meropenem and stop Vancomycin
Deescalate to Vancomycin alone as it is the drug of choice for Enterococcus meningitis.
Add Amoxicillin along with Vancomycin as dual therapy is required for Enterococcus.
Among the following drugs given below one of the drug has maximum and excellent CSF penetration. This drug is:
Penicillin
Chloramphenicol
Ceftriaxone
Meropenem
Vancomycin
A 14 year old boy is admitted in the PICU with septic shock. He was intubated for increased requirement of fluid and for respiratory failure. He is currently on Nor-adrenaline (0.1mcg/kg/min) and Dobutamine (7.5mcg/kg/min). He was admitted in the hospital previous week for appendicitis surgery and was discharged. He currently is stable on the above measures. On day 3 of admission his blood culture grows the following organism and the culture and sensitivity report is given below: The aerobic blood culture has grown Pseudomonas aeruginosa and sensitivity pattern is given below. Given the current classification of the organisms based on the sensitivity pattern this organism will be classified as:
Pan-drug resistant organism(PDR)
Multi-drug resistant organism(MDR)
Extensively-drug resistant organism(XDR)
Sensitive organism as hospital acquired Pseudomonas will be sensitive only to Colistin
Cannot be decided on the given data as MIC of each antibiotic will be required.
Regarding fluid therapy on the intensive care unit, which one of the following statements is TRUE?
Colloids have not shown a clear mortality benefit over crystalloids in most ICU patients.
Crystalloids are always contraindicated in septic shock.
Fluid therapy is unnecessary in patients with hypovolemia.
Only hypertonic saline should be used for all ICU patients.
One of the following is NOT a component of CPIS (Clinical Pulmonary Infection Score) and that is used for diagnosing Ventilator associated pneumonia(VAP):
Temperature (°Celsius)
Leukocytes in blood (cells/mm3)
Tracheal secretions (subjective visual scale)
Oxygenation index(OI)
Oxygenation status (defined by PaO2:FiO2)
One of the following conditions given below DOES NOT require anti-fungal prophylaxis which is:
High risk Patients hospitalized in the ICU units that have a high incidence of invasive candidiasis.
Chemotherapy-induced neutropenia.
Stem cell transplant recipients with neutropenia.
Solid-organ transplant recipients
Severe septic patient with central line in-situ.
Regarding the use of antibiotics in the ICU, which one of the following statement is TRUE:
It is better to use longer duration of antibiotics to prevent the emergence of resistant strains.
The initial empiric choice of antibiotics in a patient with shock should be as narrow spectrum as possible to prevent the emergence of resistant organisms.
Antibiotics whose action is time dependent should be given as infusions over a few hours.
Aminoglycosides are bacteriostatic antimicrobials.
Vancomycin has no activity against anaerobic organisms.
