Multiple Choice Questions (MCQ)

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Category: Gastrointestinal, Nutrition and Genitourinary Disorders--->Diagnostic and Management Modalities
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Question 1#Print Question

A 55-year-old male is brought to the intensive care unit (ICU) after an exploratory laparotomy because of a motor vehicle collision where he suffered a liver laceration. He is intubated with an open abdomen and a negative pressure abdominal wound dressing. He remains hypotensive on norepinephrine infusion of 1 µg/kg/min and was transfused 16 units of packed RBCs, 8 units of fresh frozen plasma, 8 packs of platelets, 2 bags of cryoprecipitate. Repeat laboratory tests show a stable hemoglobin postoperatively. However, his urine output starts to decline, and his pressor requirements start to rise. On examination, the abdomen is distended and tight. In the case of intra-abdominal hypertension (IAH), what is the minimum ideal abdominal perfusion pressure (APP) correlating to improved survival? 

A. 90 mm Hg
B. 80 mm Hg
C. 70 mm Hg
D. 60 mm Hg

Question 2#Print Question

A 48-year-old male who is 1 month status postorthotopic liver transplant for NASH Cirrhosis is transferred to the ICU with abdominal distention, pain, and septic shock. He has a known history of duodenal ulcer. A computed tomography (CT) of the abdomen and pelvis does not show any obvious free air or perforation. Sepsis guidelines are followed, and the decision is to proceed with a diagnostic paracentesis. The fluid drained does not contain any bile staining.

Which one of the answers below supports a spontaneous bacterial peritonitis rather than a secondary bacterial peritonitis?

A. Ascites protein concentration of less than 1 g/dL
B. Glucose concentration of 25 mg/dL
C. LDH level of 200 units/L
D. Elevated Amylase in the fluid

Question 3#Print Question

An 85-year-old male who was recently treated for an upper respiratory tract infection presented 2 days ago with abdominal pain. On abdominal examination, he has tenderness to palpation with mild distention but no signs of peritonitis. On admission, the WBC was 25 cell/mL and now it is 18 cell/mL. Urinalysis does show bacteria and the initial diagnosis is a UTI. Cultures have been sent. Chest X-ray does not show any evidence of pneumonia. He starts to develop hypotension on the floor with oliguria requiring 2 L of crystalloid. A request is made to transfer the patient to the ICU. The nurse notes that in the past 24 hours, he has had four episodes of diarrhea. Stool was sent for GDH (glutamate dehydrogenase) and Toxin A and B. GDH was negative, but the Toxin A/B was positive. She asked the intern on the floor to start IV Flagyl for a presumed Clostridium difficile infection, but the intern has not started it yet. Aside from the sepsis guidelines and ICU care, what is the NEXT step to address a possible C. difficile infection?

A. Hydration, bowel rest, continuing current empiric antibiotics, and monitoring her symptoms
B. Start IV Flagyl because the patient is positive for Toxins and obtain a KUB
C. Send stool for nucleic acid amplification testing then start IV Flagyl and obtain a KUB
D. Start IV Flagyl and PO Vancomycin and obtain a KUB

Question 4#Print Question

Which one of the following immunosuppressants is in the macrolide family?

A. Mycophenolate
B. Tacrolimus
C. Sirolimus
D. Cyclosporine

Question 5#Print Question

A 35-year-old otherwise healthy female status post Roux-en-Y gastric bypass surgery presents to the ICU with abdominal pain mainly in the epigastric region with temperature of 101.5°F, blood pressure of 84/60 mm Hg with altered mental status after 4 L of crystalloid in the ED. A CT scan that does not demonstrate any bowel obstruction or internal hernia however a mildly dilated common bile duct with gallstones is visualized without signs of cholecystitis. On examination, she is jaundiced with epigastric tenderness to palpation. She has a slight elevation in her AST and ALT and direct bilirubin of 5 mg/dL. Aside from appropriate intensive care resuscitation, what is the next BEST step in the management of this patient? 

A. IV antibiotics and emergent surgical and gastroenterology consultation
B. IV antibiotics, MRCP, and consult to interventional radiology
C. Stat bedside right upper quadrant ultrasound
D. Stat head CT for altered mental status and ammonia laboratory test results

Category: Gastrointestinal, Nutrition and Genitourinary Disorders--->Diagnostic and Management Modalities
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