Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine--->Clinical Syndromes
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Question 1#Print Question

You are called to evaluate a 64-year-old man who is 3 days into his postoperative course from a heart transplant. The patient’s spouse is at bedside and describes 2 minutes of seizurelike activity, followed by persistent confusion. Vital signs are unremarkable, and a neurologic examination reveals left hemianopsia but otherwise no focal deficits. Reviews of basic laboratory studies from the day are also unremarkable. Magnetic resonance imaging (MRI) of the brain is obtained and resulted below:

Which of the following is the most likely diagnosis?

a. Hypomagnesemia
b. Posterior reversible encephalopathy syndrome
c. Subarachnoid hemorrhage
d. Progressive multifocal leukoencephalopathy
e. Viral encephalitis

Question 2#Print Question

A 42-year-old woman is transferred to the intensive care unit (ICU) from the floor. The primary team was concerned about deteriorating mental status and the potential for loss of airway protection. Her records show that she was admitted two days prior with diffuse abdominal swelling. Computed tomography (CT) demonstrated ascites, as well as an ovarian mass concerning for malignancy. On initial examination, she is visibly irritable but appropriately responsive to voice.

Vital signs:

  • temperature of 38.8°C
  • heart rate of 124 bpm
  • blood pressure (BP) of 135/75 mm Hg
  • respiratory rate (RR) of 20 breaths/min
  • pulse oximetry of 98% on room air

Further history obtained from her husband reveals a 2-week history of hallucinations and lip smacking leading up to admission. She takes only sertraline for depression.

Which of the following are the most appropriate next step in management?

a. Baseline transthoracic echocardiogram, initiation of doxorubicin
b. Therapeutic paracentesis, initiation of lactulose
c. Administer haloperidol, discontinue sertraline
d. Lumbar puncture, initiation of methylprednisolone

Question 3#Print Question

A 32-year-old man presents to the ICU after coiling of the anterior communicating artery aneurysm for subarachnoid hemorrhage. He is placed on cefazolin for external ventricular drain prophylaxis. On the sixth postoperative day he develops frequent loose stools and a temperature of 38.8°C.

Which of the following is INCORRECT regarding fever?

a. Early administration of acetaminophen to treat fever due to probable infection reduces the number of ICU-free days
b. Fever may enhance immune cell function, inhibit pathogen growth, and increase the activity of antimicrobial drugs
c. The ability to develop fever in older adults is impaired, and baseline temperature in older adults is lower than in younger adults
d. For every increase of one degree above 37°C, there is a 13% increase in O2 consumption
e. Acetaminophen is oxidized in the brain by the p450 cytochrome system, and the oxidized form inhibits cyclooxygenase activity

Question 4#Print Question

A 50-year-old man was involved in a motorcycle accident over July 4th weekend. He received cardiopulmonary resuscitation (CPR) on the scene until arrival of emergency medical services, with return of spontaneous circulation in transit to the hospital. He underwent decompressive craniectomy and subdural hematoma evacuation for which he has been recovering in the intensive care unit for 2 weeks. He remains intubated and under continuous electroencephalography (EEG) monitoring. Despite being off sedative medications, he has yet to regain consciousness. The neurologist consulted is leaving for vacation and asks you to perform an examination and document an assessment for coma today. The patient intermittently opens his eyes, moves bilateral upper extremities without purpose, and has a strong cough and gag reflex. EEG demonstrates delta waves with no evidence of sleep patterns.

Which of the following is the most likely diagnosis?

a. General anesthesia
b. Coma
c. Brain death
d. Vegetative state
e. Minimally conscious state

Question 5#Print Question

A 71-year-old woman presents with a 2-week history of progressive numbness, tingling, and weakness in bilateral lower extremities. An MRI is obtained and reveals the findings below:

Which of the following regarding diagnosis and treatment of this lesion is TRUE?

a. Dexamethasone reduces neurologic impairment and spinal pain
b. Radiotherapy is very effective for renal, thyroid, non–small-cell lung, and gastrointestinal cancers
c. Surgery is contraindicated in the presence of spinal instability
d. CT myelography should be performed if allergy to gadolinium is present
e. Cervical segments are most commonly involved with cord compression due to spinal metastasis

Category: Critical Care Medicine--->Clinical Syndromes
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