Mock Exam Part 1, #31-60 Reviewer

Question 1

The air remaining in the chest at the end of exhalation and does not contribute to gas exchange is the ___

Answer 1

Functional Residual Capacity

Dead space and FRC do not contribute to gas exchange

Physiologic dead space - non perfused areas of the lung
functional residual capacity - The air remaining in the chest at the end of exhalation

Question 2

A mountaineer started his climb at sea level when he experienced dyspnea. The first responder gave him 80% oxygen supplementation. What would be the expected PaO2 that the mountaineer is getting?

Answer 2

400 mmHg

Five times Rule

expected Pao2 from supplemental oxygen can be roughly estimated by multiplying the actual Fio2 by 5

Question 3

A cyclist who reportedly bike a distance of 130km was brought to the ED due to weakness and fatigue. On diagnostics, the serum phosphate was noted to be 5.5 mg/dL. What could be the possible cause of the cyclist presentation?

Answer 3

There is a shift of phosphate from ICF to ECF possibly due to rhabdomyolysis

Shift of PO4 from ICF to ECF
Hemolysis
Rhabdomyolysis
Tumor lysis syndrome
Respiratory acidosis
Diabetic ketoacidosis

Question 4

A patient was brought to the ED due to generalized weakness. Upon attaching to the cardiac monitor, there was a note of heart block. Magnesium was also noted to be elevated. What is the best management that can be done for this patient?

Answer 4

Start with 10mL of 10% calcium chloride IV over 2 to 3 minutes

Mg level 12-15 meq/L - Hypotension, heart block, cardiac arrest

TX:
- If renal failure not evident - dilution by IV fluids followed by furosemide
- Severe symptomatic - 10 mL of 10% calcium chloride IV over 2 to 3 minutes
- Renal Failure - Dialysis

Question 5

Which of the following is an ECG feature of premature ventricular contractions

Answer 5

Abnormally widened QRS complex with different morphology from SA node-initiated QRS complex

Question 6

Which of the following can be given as pericardioversion anticoagulation for unstable patients with mechanical prosthetic valve or rheumatic mitral stenosis?

Answer 6

Enoxaparin 1mg/kg SC

Nonvalvular atrial fibrillation: Onset >48H or unknown OR Stroke or TIA <6mon OR CHA2DS2VASc score >/= 2
- Dabigatran
- Rivaroxaban
- Apixaban

Question 7

The following belongs to Class III Vaughan-Williams Classification of antiarrhythmic medication

Answer 7

Amiodarone

Mnemonic: Some Block Potassium Channels

Class I: Na channel blockers (1a, 1b, 1c)
Class II: Beta blockers
Class III: K channel blockers (Sotalol)
Class IV: Calcium channel blockers

Question 8

Which of the following is a significant adverse effect of dronedarone, a noniodinated, less lipophilic derivative of amiodarone

Answer 8

New-onset or worsening heart failure

Question 9

Which of the following vasopressor is dose-dependent in increasing the heart rate, blood pressure, cardiac output and systemic vascular resistance

Answer 9

Dopamine

5-10 mcg/kg/min - Inc RENAL blood flow, HR, contractility and CO
>10mcg/kg/min - vasoconstriction and increased blood pressure

1-5 mcg/kg/min - no longer recommended

Question 10

This inotrope is indicated for the short-term management of patients with acute cardiac decompensation, particularly in patients presenting with cardiogenic shock

Answer 10

Dobutamine

Question 11

Which of the following is an indication for hyperbaric oxygen therapy

Answer 11

Central Retinal Artery Occlusion

see table 21-2

Question 12

What is the most common adverse effect of hyperbaric oxygen therapy

Answer 12

Middle ear barotrauma

Question 13

It is believed that conventional chest compressions can generate approximately how much of physiologic cardiac output

Answer 13

25-30%

CPR generates 1/4 to 1/3 of physiologic cardiac output

Question 14

maneuver that is NOT RECOMMENDED to relieve foreign body obstruction

Answer 14

Blind finger sweep

Question 15

Appropriate energy level for synchronized cardioversion of wide irregular rhythms

Answer 15

Not for synchronized cardioversion, needs defibrillation

SYNCHRONIZED CARDIOVERSION
narrow regular rhythm - 50-100J
narrow irregular rhythm - 120-200J

wide regular rhythm - 100J
wide irregular rhythm - FOR DEFIBRILLATION

Question 16

Appropriate energy level for synchronized cardioversion of ventricular tachycardia in children

Answer 16

1 J/kg

V Tach w/ pulse – 1 J/kg (sync cardioversion)
V Fib – 2-4 J/kg (defib)

Question 17

Dose of lidocaine for refractory VF/ pulseless VT

Answer 17

1-1.5 mg/kg

1-1.5mg/kg – initial IV bolus
0.5-0.75mg/kg – 2nd IV bolus
1-4mg/min – infusion upon ROSC

Question 18

In patients who are eligible for therapeutic hypothermia, what is the targeted temperature during the 1st 24 hrs after ROSC

Answer 18

32-36 ⁰C

Question 19

Which of the following physiologic changes occurs in pregnancy:
a) Decreased central venous pressure
b) Decreased respiratory rate
c) Increased tidal volume and minute ventilation
d) Increased lower esophageal tone and gastric emptying

Answer 19

Increased tidal volume and minute ventilation

a) Decreased central venous pressure - May be increased up to 10mmHG
b) Decreased respiratory rate - No change
d) Increased lower esophageal tone and gastric emptying - DECREASED

Question 20

Which of the following drugs used in resuscitation is Pregnancy Risk Category D?
a) Adenosine
b) Amiodarone
c) Atropine
d) Lidocaine

Answer 20

Amiodarone

a) Adenosine - Class C
c) Atropine - Class C
d) Lidocaine - Class B

Question 21

A primigravid 36 weeks AOG patient came in the ED with the chief complaint of persistent vomiting for the past 2 days. How much of resuscitative fluid will you give to accommodate the demand in increase in blood and plasma volume for this type of patient?

Answer 21

Give volume of resuscitative fluids by 50% above that is required by the nonpregnant patient

Question 22

The most common cause of septic shock in pregnancy

Answer 22

Pyelonephritis

Question 23

Which among the physiologic parameters will not increase during pregnancy that will affect resuscitation process in an Emergent gravid patient?
a) Cardiac output
b) Blood pressure
c) Tidal volume
d) Central venous oxygen saturation

Answer 23

Blood pressure

Peripheral resistace - DECREASE

a) Cardiac output - increased by 30-50%
c) Tidal volume - Increase
d) Central venous oxygen saturation - Increase as high as 80%

Question 24

A G3P2 was currently managed with resuscitative fluids at the ED en route to the operating room. Patient was already stabilized however hypotensive 15 minutes after spinal anesthesia induction. What medication of choice is appropriate for this patient?

Answer 24

Ephedrine

Hypotension related to spinal anesthesia or unresponsive to fluids

Question 25

Noninvasive positive-pressure ventilation ( NIPPV ) is most commonly used for patients with

Answer 25

cardiogenic pulmonary edema

Question 26

An inducting agent during rapid sequence intubation preserving respiratory drive and often used in patients with refractory status asthmaticus

Answer 26

Ketamine

Question 27

A 39 year old chronic kidney disease patient came in the ED with chief complaint of persistent difficulty of breathing. Initial laboratory result revealed hyperkalemia. What will be the appropriate neuromuscular agent that can be used for this patient

Answer 27

rocuronium

NOTE: succinylcholine -> Do not use in patients with sus
pected preexisting significant hyperkalemia (especially renal failure), myopathies, or myasthenia gravis

Question 28

The parameter to be used in calculating ideal body weight for patients having acute respiratory distress syndrome

Answer 28

height

Question 29

Which of the following is appropriate In assessing difficulty establishing a traditional tracheal airway
a) Mallampati score >2
b) hyoid-mental distance of 2 fingerbreadths
c) thyroid-to-mouth distance of 3 fingerbreadths
d) incisor opening distance of 3 fingerbreadths

Answer 29

incisor opening distance of 3 fingerbreadths

LEMON Airway Assesment Method:
L - Look externally (facial trauma, large incisors, beard, large tongue)
E - Evaluate the 3-3-2 rule
* Incisor opening distance: 3 fingerbreadths
* Hyoid-mental distance: 3 fingerbreadths
* Thyroid-to-mouth distance: 2 fingerbreadths
M - Mallampati score ≥3
O - Obstruction
N - Neck mobility (limited neck mobility)

Question 30

Possible source of bleeding as acute complication in patients undergoing emergency cricothyrotomy

Answer 30

bleeding from the thyroidea ima artery