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HPIM Part 8: Critical Care 50

Total questions: 49

Worksheet time: 25mins

Name
Class
Date
1.

Sepsis-3 defines sepsis as:

a)

Infection + ≥2 SIRS criteria

b)

Organ dysfunction due to infection

c)

Life-threatening organ dysfunction from a dysregulated host response to infection

d)

Lactate >2 mmol/L

2.

qSOFA includes:

a)

HR >100

b)

SBP ≤100, RR ≥22, altered mentation

c)

Fever + leukocytosis

d)

SBP ≤90 only

3.

Most common source of sepsis:

a)

Respiratory tract

b)

Urinary tract

c)

Skin

d)

CNS

4.

A warm shock state with wide pulse pressure suggests:

a)

Cardiogenic shock

b)

Distributive shock

c)

Obstructive shock

d)

Hypovolemic shock

5.

First-line vasopressor in septic shock:

a)

Dopamine

b)

Vasopressin

c)

Norepinephrine

d)

Epinephrine

6.

Most important initial step when septic shock suspected:

a)

CT abdomen

b)

Start steroids

c)

Give antibiotics

d)

Start vasopressors immediately

7.

Transfusion threshold in sepsis:

a)

Hgb <9

b)

Hgb <8

c)

Hgb <7

d)

Hgb <6

8.

Cytokines in sepsis-associated encephalopathy include:

a)

IL-10

b)

IL-2, IL-6, TNF, IL-1

c)

IFN-γ

d)

IL-5

9.

DIC laboratory pattern:

a)

↑ Platelets, ↑ fibrinogen

b)

↓ Platelets, ↓ fibrinogen, ↑ PT/INR

c)

Normal PT/PTT

d)

High platelets + prolonged PTT

10.

Definitive sign of cardiogenic shock:

a)

Warm extremities

b)

S3 gallop and pulmonary rales

c)

Tachypnea only

d)

Hypertension

11.

Lactate is measured in shock because it reflects:

a)

Renal perfusion

b)

Hepatic failure

c)

Tissue hypoperfusion

d)

Respiratory alkalosis

12.

Tension pneumothorax signs include all EXCEPT:

a)

Tracheal deviation

b)

Absent breath sounds

c)

Hypertension

d)

Subcutaneous emphysema

13.

Target tidal volume in lung-protective ventilation:

a)

4 mL/kg IBW

b)

6 mL/kg IBW

c)

8 mL/kg IBW

d)

10 mL/kg IBW

14.

In volume-control ventilation, which is dependent?

a)

Tidal volume

b)

Flow rate

c)

Respiratory rate

d)

Plateau pressure

15.

SBT duration recommended:

a)

5 minutes

b)

10–15 minutes

c)

30–120 minutes

d)

4 hours

16.

Most reliable indicator of extubation success:

a)

Negative inspiratory force

b)

Respiratory muscle ultrasound

c)

Passing SBT

d)

FiO2 1.0

17.

Risk factor for extubation failure:

a)

Age <40

b)

BMI >30

c)

No secretions

d)

Short duration of ventilation

18.

Best method to reduce VAP incidence:

a)

Routine bronchoscopy

b)

Prophylactic antibiotics

c)

Early removal of invasive devices

d)

High PEEP

19.

Standard ICU DVT prophylaxis:

a)

DOACs

b)

Aspirin

c)

SQ heparin + SCDs

d)

IV heparin infusion

20.

Sedative with lower delirium risk:

a)

Midazolam

b)

Diazepam

c)

Propofol

d)

Dexmedetomidine

21.

First-line treatment for anaphylactic shock:

a)

Fluids

b)

Hydrocortisone

c)

Epinephrine

d)

Antihistamines

22.

High lactate in sepsis is due to:

a)

Renal injury

b)

Anaerobic metabolism

c)

Hyperventilation

d)

Hyperkalemia

23.

Most common gram-negative organism in sepsis:

a)

E. coli

b)

H. influenzae

c)

Salmonella

d)

Bacteroides

24.

Early goal-directed therapy emphasizes:

a)

High CVP

b)

Immediate antibiotics

c)

High-dose steroids

d)

Immediate CT scan

25.

In sepsis, fluid of choice for initial resuscitation:

a)

3% saline

b)

LR or normal saline

c)

Albumin only

d)

D10W

26.

Which shock shows low CVP and cool extremities?

a)

Distributive

b)

Cardiogenic

c)

Obstructive

d)

Hypovolemic

27.

All indicate septic shock EXCEPT:

a)

Lactate >2

b)

Need for vasopressors to maintain MAP ≥65

c)

Normal mentation

d)

Persistent hypotension after fluids

28.

Typical cause of obstructive shock:

a)

Sepsis

b)

Tension pneumothorax

c)

Dehydration

d)

MI

29.

ARDS hallmark:

a)

Pulmonary embolism

b)

Non-cardiogenic pulmonary edema

c)

Cardiomegaly

d)

Pleural effusion

30.

ARDS tidal volume strategy reduces mortality by preventing:

a)

Hyperoxia

b)

Barotrauma and volutrauma

c)

Atelectasis

d)

Pleural effusion

31.

PEEP is used to:

a)

Reduce FiO2

b)

Prevent alveolar collapse

c)

Increase tidal volume

d)

Reduce respiratory rate

32.

Early septic shock vasopressor adjunct:

a)

Vasopressin

b)

Dopamine

c)

Dobutamine

d)

Isoproterenol

33.

Best diagnostic marker of shock severity:

a)

HR

b)

BP

c)

Lactate

d)

SpO2

34.

Antibiotic delay in sepsis increases mortality by:

a)

No change

b)

2x

c)

5–10% per hour

d)

50%

35.

Definition of refractory septic shock:

a)

Hypotension responsive to fluids

b)

Hypotension needing only one vasopressor

c)

Persistent hypotension despite fluids and vasopressors

d)

Sepsis with fever

36.

Most common cause of death in the ICU:

a)

MI

b)

Stroke

c)

Sepsis

d)

Trauma

37.

DIC in sepsis results from:

a)

Hyperfibrinolysis

b)

Coagulation activation and consumption

c)

Increased platelet production

d)

Liver failure only

38.

Sepsis-associated encephalopathy pathogenesis:

a)

Direct bacterial invasion

b)

Cytokine-mediated dysfunction

c)

Stroke

d)

Hepatic failure

39.

ICU-acquired weakness associated with prolonged use of:

a)

Antipsychotics

b)

Neuromuscular blockers

c)

Steroids only

d)

Opioids

40.

Daily sedation interruption helps reduce:

a)

Fever

b)

Hypotension

c)

Delirium and ventilation duration

d)

Hypoxia

41.

Most common nosocomial infection in the ICU:

a)

UTI

b)

VAP

c)

CLABSI

d)

C. difficile

42.

Ideal SpO2 target in shock:

a)

100%

b)

95–100%

c)

92–95%

d)

85–90%

43.

Early sign of hypoperfusion:

a)

Hypertension

b)

Warm skin

c)

Prolonged capillary refill

d)

Bradycardia

44.

Most common cause of cardiogenic shock:

a)

Arrhythmia

b)

Acute MI

c)

Hypothyroidism

d)

Pericarditis

45.

In hypovolemic shock, JVP is typically:

a)

Normal

b)

Elevated

c)

Reduced

d)

Indeterminate

46.

Shock with large pulse pressure:

a)

Hypovolemic

b)

Cardiogenic

c)

Distributive

d)

Obstructive

47.

First-line treatment for adrenal crisis causing shock:

a)

Epinephrine

b)

Hydrocortisone

c)

Insulin

d)

Fludrocortisone only

48.

ARDS P/F ratio for severe ARDS:

a)

>300

b)

200–300

c)

100–200

d)

<100

49.

Best ventilatory mode when patient is deeply sedated and unstable:

a)

Pressure support

b)

CPAP

c)

Assist-control ventilation

d)

High-flow nasal cannula

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