Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine--->Brain Death and Degenerative Diseases
Page: 1

Question 1#Print Question

An 84-year-old man with coronary artery disease and atrial fibrillation had a ST-segment elevation myocardial infarction that was complicated by a ventricular fibrillation cardiac arrest with 45 minutes of pulselessness. His initial management included evaluation in the cardiac catheterization lab with placement of a bare metal stent into the right coronary artery. He underwent 24 hours of cooling post cardiac arrest, but following this he has had limited neurologic recovery. Post arrest day 6, neurology is consulted.

Which of the following is MOST correct?

a. The most accurate prognostic test for poor neurologic outcome is electroencephalography
b. If there are no corneal responses 6 days post cardiac arrest, there is no anticipated neurologic recovery
c. Neuron-specific enolase is not affected by cooling and can be used for prognosis at 6 days post cardiac arrest
d. A magnetic resonance imaging (MRI) can assist with prognosis, and the most commonly affected area of the brain is the cortical region

Question 2#Print Question

A 54-year-old woman is admitted to the intensive care unit (ICU) with a subarachnoid hemorrhage due to a left middle cerebral artery aneurysm rupture. Early external ventricular drain was placed because of a poor neurological examination. Over the course of 7 days, there have been ongoing issues with refractory elevated intracranial pressure and poor neurologic examination, progressing to no cranial nerve responses. Her examination is as follows: pupils 5 mm and nonreactive, absent oculocephalic reflexes, absent corneal reflexes, absence of facial grimace, absent gag, and absent cough. The only evoked motor response is minimal triple flexion in the bilateral legs. An apnea test was completed and there were no spontaneous respirations with an increase in pCO2 20 mm Hg more than baseline.

Which of the following is MOST true? 

a. Because of the motor response present, the patient does not meet criteria for brain death
b. An ancillary test (EEG, cerebral angiogram, nuclear scan) should be completed to diagnose brain death
c. We need to repeat the apnea test
d. The current examination is consistent with brain death

Question 3#Print Question

A 28-year-old previously healthy male is admitted to the ICU with altered mental status and hypoxic respiratory failure following a traumatic brain injury. There is limited history of his actual injury, but the night before his admission, he was intoxicated with friends when he got in an altercation and was hit on left side of his head and did have a brief loss of consciousness. His friends took him home, and at that time he was confused, complaining of a headache but was still talking and walking. He went to bed and he was checked on 10 hours later and was unresponsive. Emergency medical services (EMS) was called, and on arrival he was unresponsive with fixed, dilated pupils and no movements to painful stimulation and was intubated without sedation or paralytic.

A head computed tomography (CT) was completed on arrival to the emergency department and demonstrated a 1.4 cm left-sided holocephalic subdural with 1.2 cm of left-to-right midline shift including uncal herniation and midbrain compression. His examination demonstrates lack of brain stem responses, no spontaneous breathing, and no movement to painful stimulation. An apnea test was attempted to evaluate for brain death but was unable to be completed because of hemodynamic instability. A whole brain positron emission tomography (PET) scan was completed and showed no activity in the brain stem and cortex.

What is the MOST correct statement regarding the patient? 

a. The patient does not meet brain death criteria because the ancillary study does not support the diagnosis of brain death
b. The patient does not meet brain death criteria because he was unable to complete an apnea test
c. The patient does meet brain death criteria because his clinical examination is consistent with this and did not need an ancillary study
d. The patient does meet brain death criteria because his clinical examination is consistent with this and the ancillary study supports this diagnosis

Question 4#Print Question

A 58-year-old woman with amyotrophic lateral sclerosis (ALS) presents to the emergency department complaining of increased weakness and difficulty with feeding herself. Her daughter inquires if there are any interventions which have been proven to increase life expectancy in ALS patients.

Which of these is the MOST appropriate answer?

a. Amantadine
b. Noninvasive ventilation
c. Colostomy
d. Prophylactic antibiotics
e. Indwelling nasogastric tube

Question 5#Print Question

A 74-year-old man with hypertension, coronary artery disease, and Parkinson disease is admitted to the ICU for management of pneumonia. He is intubated and started on broad-spectrum antibiotics. Six days after admission, he is found to have worsening fever, rigidity, and is no longer following commands.

What is the MOST likely etiology for his condition?

a. Status epilepticus
b. Meningitis
c. Serotonin syndrome
d. Neuroleptic malignant syndrome (NMS)
e. Infective endocarditis

Category: Critical Care Medicine--->Brain Death and Degenerative Diseases
Page: 1 of 1