Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pharmacology and Toxicology--->Metabolism and Drug Interactions
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Question 1# Print Question

Which of the following correctly pairs the pharmacodynamics with the antibacterial agents?

A. Oxacillin (time dependent), moxifloxacin (concentration dependent)
B. Vancomycin (concentration dependent), cefazolin (time dependent)
C. Daptomycin (time dependent), amikacin (concentration dependent)
D. Levofloxacin (time dependent), meropenem (time dependent)

Question 2# Print Question

A 49-year-old male with a past medical history significant for hypertension and end-stage renal disease on hemodialysis is admitted to the ICU in septic shock from pneumonia. He is intubated and mechanically ventilated, and requires vasopressor support. Blood cultures grew multidrug–resistant Acinetobacter baumannii. You begin appropriate treatment. Over the course of several hours you begin to notice increasing vasopressor requirements and increasing peak airway pressures.

Which of the following antimicrobial choices could adequately explain this scenario?

A. IV polymyxin B without renal adjustment
B. Meropenem allergy
C. Inhaled colistin hypersensitivity
D. IV tobramycin-induced bronchospasm

Question 3# Print Question

A 54-year-old man with a past medical history of cirrhosis is in the ICU 4 days after suffering severe burns to >40% of his body while at work. His respiratory status has been rapidly declining, and he is currently requiring BiPAP; however his P:F ratio is now <200 and his last chest radiograph supports your concern for acute respiratory distress syndrome. You make the decision to intubate and suspect that he will need continuous neuromuscular blockade.

Which of the following neuromuscular blocking drugs will be most appropriate in this patient for intubation and continuous blockade?

A. Succinylcholine (intubation), vecuronium (continuous)
B. Rocuronium (intubation), rocuronium (continuous)
C. Succinylcholine (intubation), atracurium (continuous)
D. Rocuronium (intubation), cisatracurium (continuous)

Question 4# Print Question

A 48-year-old, male, liver transplant recipient is readmitted 4 months postsurgery because altered mental status. On examination, he is confused and agitated; the rest of the examination is unremarkable. A review of his medications indicates that he in on lisinopril, prednisone, and tacrolimus. Laboratory tests show:

  • Na 136
  • K 6.1
  • HCO3 17
  • Cl 108
  • blood urea nitrogen 42
  • creatinine 4.4

The results of his complete blood count and the rest of the chemistry profile are normal. CT scan of the brain is normal.

What is the most likely cause of this patient’s current presentation?

A. Normal pressure hydrocephalus
B. Meningitis
C. Acute graft rejection
D. Tacrolimus toxicity

Question 5# Print Question

A 19-year-old female with a past medical history of sensorineural deafness and mitochondrial encephalomyopathy lactic acidosis and strokelike episodes (MELAS) presented to the emergency room with slurred speech, tremor, and unsteady gait. Her physical examination revealed nystagmus, dysarthria, gait and limb ataxia. While in the ER, she had a generalized tonic-clonic seizure for which she was intubated. Phenytoin was also administered and an MRI was obtained that showed bilateral occipitotemporal lesions. She was transferred to the ICU. Phenytoin is discontinued and sodium valproate started. Laboratory results are unremarkable except for elevated lactate levels. EEG confirms seizure activity.

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

A. Fluid resuscitation with ringer lactate @ 30 mL/kg
B. Sodium valproate should be discontinued
C. tPA should be administered emergently
D. Empiric broad-spectrum antibiotics should be initiated

Category: Critical Care Medicine-Pharmacology and Toxicology--->Metabolism and Drug Interactions
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