Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pharmacology and Toxicology--->Adverse Effects of Drugs
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Question 1# Print Question

A 55-year-old woman undergoes elective ventral hernia repair. Past medical history is significant for hypertension and asthma. She had uneventful induction of anesthesia. Five minutes after cefazolin was started for perioperative prophylaxis, the patient becomes hypotensive and progressively hypoxic with high peak airway pressures. Diphenhydramine, steroids, a H2-blocker, bronchodilators, and epinephrine are administered, with clinical improvement. A decision is made to postpone surgery, and she is transferred to the intensive care unit (ICU) for further management.

Which of the following laboratory levels can help determine whether the episode was related to anaphylaxis as compared to asthma exacerbation?

A. Pseudocholinesterase
B. Tryptase
C. Lipase
D. Amylase

Question 2# Print Question

A 33-year-old woman is admitted to ICU s/p motor vehicle accident with traumatic brain injury, and CT scan of the head showed subdural hematoma without midline shift and bilateral frontal contusions. On day 2 of admission, she starts having seizures. She is given 1000 mg phenytoin and started on a maintenance dose. She remains in the ICU due to waxing and waning mental status. On day 5 as you are examining the patient, red-purple macules and papules are noticed on chest and abdomen, as well as on the bilateral upper and lower extremities. Similar lesions are also seen in mouth and genital area.

Which of the following will help to differentiate Stevens-Johnson syndrome (SJS) from toxic epidermal necrolysis (TEN)?

A. Presence of Nikolsky sign in SJS as compared to TEN
B. Involvement of more than two mucosal surfaces in TEN as compared to two or less in SJS
C. They are spectrum of same disease process; SJS is defined as affecting less than 10% body surface area (BSA), and TEN affects more than 30% BSA
D. SJS occurs within 1 week of triggering factor, while TEN occurs more than 4 weeks after triggering agent

Question 3# Print Question

A 48-year-old woman with a history of poorly controlled hypertension, coronary artery disease, and chronic renal failure is admitted to ICU after presenting to emergency room (ER) with hypertensive emergency. Her blood pressure was controlled with sodium nitroprusside. After 32 hours of treatment, the patient develops agitation, confusion, and metabolic acidosis.

Which of the following is used for the prevention/treatment of this adverse effect of nitroprusside?

A. Thiocyanate
B. Cyanocobalamin
C. Thiosulfate
D. Methylene blue

Question 4# Print Question

A 28-year-old woman presents to the emergency department with sudden onset of generalized fatigue, fever, chills, and blurry vision. She was recently diagnosed with urinary tract infection and started on Bactrim 2 days ago. On physical examination, her skin is mildly jaundiced. She has multiple purpura over her extremities. Laboratory tests reveal: Hemoglobin 8.0 g/dL, platelet count 57/mm3 , and creatinine of 2.8 mg/dL. Of note, renal function was normal 4 days ago. On peripheral smear, multiple schistocytes are present (∼2%). She is admitted to ICU due to metabolic disarray and for additional workup. She reports no history of illicit drug use, recent diarrhea, or no other significant past medical history. Vitals are:

  • heart rate 90 beats/min
  • blood pressure 130/74 mm Hg
  • temperature 38.7°C
  • respiratory rate 18 breaths/min

Serum lactate dehydrogenase (LDH) is elevated. Serum ADAMTS13 level was send from emergency department, showed a mild reduction.

Based on these findings what is most probable diagnosis?

A. Immune thrombocytopenic purpura
B. Thrombotic thrombocytopenic purpura
C. Drug-induced thrombotic microangiopathy (DITMA)
D. Disseminated intravascular coagulation

Question 5# Print Question

A 58-year-old woman is admitted to hospital with fever, productive cough, and shortness of breath. Chest x-ray is consistent with right lower lobe consolidation. She was treated as an outpatient for community-acquired pneumonia with oral ciprofloxacin, without improvement in symptoms. Medical history is significant for hypertension, gastroesophageal reflux disease (GERD), bipolar disorder, and depression. Her medications include carvedilol, omeprazole, aripiprazole, and amitriptyline. An ECG at time of admission shows normal sinus rhythm with prolonged QT interval.

Which of the following medications should be discontinued FIRST based on patient’s ECG findings?

A. Aripiprazole
B. Carvedilol
C. Omeprazole
D. Amitriptyline

Category: Critical Care Medicine-Pharmacology and Toxicology--->Adverse Effects of Drugs
Page: 1 of 2