ASIPP Critical Care Questions Flashcards
1
Q
1825. A patient with a score of 4 on the Riker Sedation – Agitation scale can be best described as: A. Very agitated B. Very sedated C. Unarousable D. Sedated E. Calm and cooperative
A
- Answer: E
Source: Day MR, Board Review 2005
2
Q
- All of the following are true regarding the use of opioids
in patients with altered hepatic function except:
A. Smaller clearance of the opioid
B. Volume of distribution is increased
C. Prolonged elimination half-time
D. Relatively normal initial distribution
E. Accumulation of drug will occur
A
- Answer: B
Explanation:
Ref: Murphy. Chapter 16. Opioids. In: Clinical
Anesthesia, 2nd Edition. Barash, Cullen, Stolling;
Lippincott, 1992, pg 431
Source: Day MR, Board Review 2003
3
Q
- What is the mode of action of cocaine in the central
nervous system?
A. increasing the reuptake of norepinephrine
B. blocking dopamine receptors
C. activating GABA receptors
D. mediating its rewarding effect through dopamine cells
in the ventral tegmentum area that projects to the
basal ganglia
E. inhibiting acetylcholine esterase in the central nervous
system
A
- Answer: D
Explanation:
Cocaine acts by blocking reuptake of neurotransmitters
(norepinephrine, dopamine, and serotonin) at the synaptic
junctions, resulting in increased neurotransmitter
concentrations. Because norepinephrine is the primary
neurotransmitter of the sympathetic nervous system,
sympathetic stimulation results and leads to
vasoconstriction, tachycardia, mydriasis, and
hyperthermia. Central nervous system stimulation may
appear as increased alertness energy talkativeness,
repetitive behavior, diminished appetite, and increased
libido. Psychological stimulation by cocaine produces an
intense euphoria that is often compared to orgasm.
Pleasure and reward sensations in the brain have been
correlated with increased neurotransmission in the
mesolimbic or mesocortical dopaminergic tracts (or
both). Cocaine increases the functional release of
dopamine, which activates the ventral tegmental-nucleus
accumbens pathway, which seems to be major component
of the brain reward system. Activation of this pathway is
essential for the reinforcing actions of psychomotor
stimulants
Source: Laxmaiah Manchikanti, MD
4
Q
- Which of the following is true regarding the use of Midazolam
for ICU sedation?
A. Rapid onset
B. Long duration of action
C. No tolerance of CNS effects after prolonged infusion
D. Will not cause hypotension even with high doses
E. Metabolites are inactive
A
- Answer: A
Source: Day MR, Board Review 2005
5
Q
1829. The heart rate response to the infusion of a moderate dose of phenylephrine in conscious patients is not blocked by A. Atropine B. Hexamethonium C. Phenoxybenzamine D. Reserpine E. Scopolamine
A
- Answer: D
6
Q
- Which of the medical community, active euthanasia is
best defi ned as:
A. The withdrawal of life-sustaining measures
B. The provision by a physician of the means by which
patients can end their own lives
C. The intentional termination of a patient’s life by a
physician
D. The withholding of life-sustaining measures
E. The act of ending a patients life by a health care professional
A
- Answer: C
Explanation:
Ref: Breitbant, Possik, Rosenfeld. Chapter 46. Cancer,
Mind, and Spirit. In: Textbook of Pain, 4th Edition. Wall
and Melzack, Churchill Livingstone, 1999, pg 1082
Source: Day MR, Board Review 2003
7
Q
1831. Intravenous administration of norepinephrine in a patient already taking an effective dose of atropine will often A. Increase heart rate B. Decrease total peripheral resistance C. Decrease blood sugar D. Increase skin temperature E. Reduce pupil size
A
- Answer: A
8
Q
- A patient in the coronary care unit has been receiving
warfarin for 2 weeks. As a result of this therapy, the
patient will probably have
A. Reduced plasma factor II activity
B. Reduced plasma factor VIII activity
C. Reduced plasma plasminogen activity
D. Increased tissue plasminogen activator
E. Increased platelet adenosine stores
A
- Answer: A
9
Q
- True statements regarding the apnea test used to diagnose
brain death include all of the following except:
A. Absence of spontaneous breathing during disconnection
from the ventilator
B. Arterial pH below 7.30 at the end of the test
C. PaCO2 > 60 torr at the end of the test
D. Core body temperature higher than or equal to 35 degrees
Celcius at the start of the test
E. PaO2
A
- Answer: D
Explanation:
Ref: Grenick. Chapter 111. Brain Death and Permanently
Lost Consciousness. In: Textbook of Critical Care.
Shoemaker, Thompson, Holbrook; W.B. Sanders, 1984, pg
969
Source: Day MR, Board Review 2003
10
Q
- A patient is admitted to the emergency room 2 hours
after taking an overdose of phenobarbital. The plasma
level of the drug at time of admission is 100 mg/L, and
the apparent volume of distribution, half-life, and
clearance of phenobarbital are 35 L, 4 days, and 6.1 L/d,
respectively. The ingested dose was approximately
A. 1 g
B. 3.5 g
C. 6.1 g
D. 40 g
E. 70 g
A
- Answer: B
11
Q
- Following a very large overdose of a benzodiazepine, a
patient is admitted to hospital. Which one of the following
is not likely to be of therapeutic value in the
management of this patient?
A. Administration of naloxone
B. Gastric lavage if an endotracheal tube is in place
C. Intravenous fl umazenil
D. Protection of the airway
E. Ventilatory support
A
- Answer: A
12
Q
- Which of the following is not true regarding continuous
epidural infusion of medication versus intermittent
bolus technique?
A. Easier to titrate medication via a continuous infusion
B. There are fewer fl uctuations in cerebral spinal fl uid
concentrations of drug with a continuous infusion
C. Tachyphylaxis is less common with the intermittent
bolus technique
D. Continuous epidural infusion provides better analgesia
than intermittent bolus
E. Higher risk for respiratory depression with the intermittent
bolus technique
A
- Answer: C
Explanation:
Ref: Anderson. Chapter 16. Continuous Regional
Analgesia. In: Textbook of Regional Anesthesia. Raj et al,
Churchill Livingstone, 2002, pg 239
Source: Day MR, Board Review 2003
13
Q
- A patient is admitted to the emergency department for
treatment of a drug overdose. The identity of the drug
is unknown, but it is observed that when the urine pH
is acidic, the renal clearance of the drug is less than the
glomerular fi ltration rate and that when the urine pH
is alkaline, the clearance is greater than the glomerular
fi ltration rate. The drug is probably a
A. Strong acid
B. Weak acid
C. Nonelectrolyte
D. Weak base
E. Strong base
A
- Answer: B
14
Q
1838. Which of the following opioids do not evoke the release of histamine? 1. Sufentanil 2. Alfentanil 3. Fentanyl 4. Meperidine
A
- Answer: A (1,2, & 3)
Explanation:
Ref: Murphy. Chapter 16. Opioids. In: Clinical
Anesthesia, 2nd Edition. Barash, Cullen, Stolling;
Lippincott, 1992, pg 416
Source: Day MR, Board Review 2003
15
Q
- A post-op patient with intraabdominal bypass presents
with new complaints of back pain with bilateral leg
weakness, altered refl exes: knee left 1+, right 2+. The
patient is on heparin and Plavix with epidural catheter.
Next step in management of this patient is: - To stop infusion and reassess after 4 hours
- To obtain surgical consult
- To increase infusion
- Order MRI of thoracic & lumbar spine
A
- Answer: D (4 Only)
16
Q
- Which of the following criteria can be used to support
the diagnosis of brain death in the intensive care unit? - Light-fi xed pupils
- An isoelectric electroencephalogram recorded in part
at full gain - No evidence of decerebrate or decorticate posturing
or shivering - Heart rate increase of less than 5 beats per minute after
intravenous atropine 0.04 mg/kg
A
- Answer: E (All)
Explanation:
(Shoemaker, pp 968-969.)
The defi nition of brain death is the permanent loss of all
integrated brain functions. The patient is not experiencing
pain or suffering. As such, it is extremely important to
elimate all medications and correct hemodynamic
variables that may be contributing to the comatose
conditions before one declares the patient brain dead. The
patient should have adequate blood pressure and
temperature above 34°C ( 93.2°F) and be free of alcohol,
toxins, and medications that could depress brain function.
A detailed and thoroughly documented clinical
examination should be performed and then repeated no
sooner than 2 h after the initial examination. Body
temperature, blood ethanol level, and toxicology screens
should be documented. In the absence of muscle relaxants,
there should be no spontaneous movement and no
evidence of decerebrate to decorticate posturing or
shivering and there should be no spontaneous breathing
for 3 min ( at Paco2 > 60 torr at the end of the test).
If the patient has pulmonary disease, the Pao2 must be
less than 50 torr at the end of the test. The patient must
have light-fi xed pupils and the absence of corneal
refl exes, response to painful stimuli, response to upper
and lower airway stimulation, ocular response to head
turning, and ocular response to ear irrigation
with 50 mL of ice water. Intravenous atropine
0.04 mg/kg should fail to increase the heart rate by more
than 5 beats per minute. An isoelectric
electroencephalogram recorded in part at full gain should
also be obtained. The ultimate criterion of brain death is
the complete absence of cerebral blood fl ow, which can be
documented by bilateral internal carotid and vertebral
anteriography or by radionuclide cerebral imaging.
Source: Kahn and Desio
