Basic skills module (Class Qs)

Question 1

Which of the following do not affect oxygen transfer from air to blood?
1. Diffusing capacity
2. Alveolar partial pressure of oxygen
3. Cardiac output
4. Ventilation
5. Ventilation-perfusion matching
6. Perfusion

Answer 1

3

Question 2

Which of the following do NOT affect the alveolar partial pressure of oxygen?
1. Alveolar pressure
2. Ventilation
3. Inspired oxygen concentration
4. Alveolar partial pressure of carbon dioxide
5. Perfusion

Answer 2

5

Question 3

Carbon dioxide elimination is NOT affected by
1. Respiratory rate
2. Deadspace
3. Inspired oxygen concentration
4. Tidal volume

Answer 3

3

Question 4

A patient is admitted to a hospital at sea level with a saturation of 85%. By the time you see him he is receiving low flow (2L/min) oxygen through nasal cannulae and his saturation has risen to 98%. Based on his response what is the most likely mechanism underlying his respiratory failure?
1. Hypoventilation
2. Diffusion abnormality
3. Low inspired oxygen concentration
4. Shunting

Answer 4

1

Question 5

VQ mismatch and shunting are the same thing
1. False
2. True

Answer 5

1

Question 6

Which of the following can cause hypoventilation
1. Guillain Barre syndrome
2. Upper airway obstruction
3. Respiratory alkalosis
4. Myasthenia gravis
5. Cervical spinal cord lesion
6. Pleural fibrosis
7. Decreased lung compliance

Answer 6

1,2,4,5,6,7

Question 7

You are treating a patient with severe pneumonia who has a saturation of 85% on room air. He is likely to need:
1. High concentration of supplemental oxygen because the main pathophysiological mechanism is diffusion abnormality
2. A low supplemental concentration of oxygen because the primary pathophysiological mechanism is hypoventilation
3. High concentration of supplemental oxygen because the main pathophysiological mechanism is shunting

Answer 7

3

Question 8

You are looking after a patient with respiratory failure. Which of the following would be useful signs to monitor?
1. Altered mental state
2. Respiratory rate
3. Recession
4. Blood pressure
5. Urine output
6. Cyanosis
7. Body temperature
8. Heart rate

Answer 8

1,2,3,4,6,8

Question 9

What physical signs of respiratory failure is this patient demonstrating?
1. Subcostal recession
2. Tachypnea
3. Tracheal tug
4. Intercostal recession
5. Use of accessory muscles

Answer 9

1,4,5

Question 10

You should titrate the patient’s oxygen therapy to an oxygen saturation of at least
1. 97%
2. 90%
3. 85%
4. 95%

Answer 10

2

Question 11

The video shows the patient’s bedside monitor. The top (green) waveform is his ECG, the middle (red) waveform is his arterial pressure and the bottom (yellow) waveform is his pulse oximetry. On the basis of what you can see the patient is hypoxic.
1. True
2. False (The pulse oximeter only works if there is detectable pulsation.)

Answer 11

2

Question 12

You see a patient with stridor, respiratory rate 30/min, intercostal recession and using accessory muscles. His saturation on 2 L/min oxygen is 99%. His upper airway obstruction is unlikely to be severe because his saturation is normal.
1. False
2. True

Answer 12

1

Question 13

Which of the following suggest that a patient with respiratory failure has severe respiratory failure?
1. Confusion
2. Respiratory rate 34/min
3. Inability to speak 1⁄2 a sentence without pausing
4. SpO2 94%
5. Respiratory rate 6/min
6. Deterioration despite treatment

Answer 13

1,3,5,6

Question 14

You are asked to see a patient with COPD who was admitted to hospital with pneumonia. He is now becoming drowsy. His SpO2 is 94% on oxygen 4l/min via nasal cannulae and he has developed hypercapnia. The appropriate treatment is:
1. Increase oxygen flow rate to 6L/min
2. Refer for non-invasive ventilation
3. Decrease oxygen flow rate to 2L/min

Answer 14

2

Question 15

You are asked to see a patient who has a saturation of 88% and respiratory rate of 30/min despite oxygen 15 l/min via a reservoir facemask. You should:
1. Apply a bag-valve-mask resuscitator with oxygen 15 l/min and let the patient continue to breath spontaneously
2. Apply a bag-valve-mask resuscitator with oxygen 15 l/min and ventilate the patient at 30 breaths/min
3. Use high flow nasal cannulae to give oxygen
4. Call for help. There is nothing else that be done until someone else arrives to help
provide non-invasive ventilation or to intubate the patient
 

Answer 15

1

Question 16

Although hypotension need not be present in shock it is, perhaps, simplest to think of the pathophysiology in terms of blood pressure. Which of the following are determinants of mean arterial pressure?
1. Heart rate
2. Preload
3. Total peripheral resistance
4. Contractility
5. Afterload

Answer 16

1,2,3,4,5

Question 17

Which of the following investigations and monitoring modalities are useful for detecting early shock?
1. Arterial blood gas
2. Heart rate
3. Colour of skin
4. Central venous pressure
5. Altered mental state
6. Lactate
7. Temperature of peripheries
8. Blood pressure
9. Urine output

Answer 17

2,5,6,9

Question 18

Which of the following statements about automated blood pressure devices is/are true?
1. Over-read at low pressure (ie the displayed pressure is higher than the actual pressure)
2. Accurate during arrhythmias
3. Over-read at high pressures (ie displayed pressure is higher than actual pressure)
4. Under-read at low pressures (ie displayed pressure is lower than actual pressure)
5. Cuff width is a major determinant of accuracy
6. Under-read at high pressure (ie displayed pressure is lower than actual pressure)

Answer 18

1,5,6

Question 19

The cuff width should be approximately what percentage of the circumference of the arm? (enter a number without the % sign)

Answer 19

40

Question 20

If the blood pressure cuff is too narrow it will
1. Overestimate the blood pressure
2. Underestimate the blood pressure

Answer 20

1

Question 21

If the blood pressure cuff is too wide it will
1. Overestimate the blood pressure
2. Underestimate the blood pressure

Answer 21

2

Question 22

The patient’s blood pressure has now fallen to 70/50. What three components of the clinical examination would you carry out to rapidly determine the likely type of shock (ie cardiogenic, distributive, obstructive or hypovolaemic)?
1. Heart rate
2. Jugular venous pressure
3. Position of trachea
4. Measure temperature
5. 12 lead ECG
6. Palpate peripheries to determine whether they are warm or cold

Answer 22

1,2,6

Question 23

The patient’s pulse is 114/min, regular, small volume. JVP 4 cm above sternal angle
Peripheries are cold
What is/are the likely type(s) of shock
1. Hypovolaemic
2. Obstructive
3. Cardiogenic
4. Distributive

Answer 23

2,3

Question 24

An above normal CVP or JVP indicates that the patient should not be given more fluid
1. True
2. False

Answer 24

2

Question 25

Which of the following indicate that a shocked patient should be given more fluid? 1. A rise in pulse pressure of 5% on passive leg raising 2. A rise in CVP of 5 mmHg after a fluid bolus 3. A low CVP or JVP 4. A rise in pulse pressure of 15% on passive leg raising 5. A rise in CVP of 1 mm Hg after a bolus of fluid

Answer 25

3,4,5

Question 26

CVP measurement is used to assess right ventricular end diastolic pressure. In what situation(s) will CVP measurement not correspond to left ventricular pressure. 1. Severe pulmonary disease 2. Uni-ventricular failure 3. Reduced preload 4. Severe mitral regurgitation 5. Reduced afterload

Answer 26

1,2,4

Question 27

If the blood pressure falls soon after a central venous catheter is inserted to monitor CVP, what would you look for? 1. Central line infection 2. Local anaesthetic toxicity 3. Vascular injury 4. Haemothorax 5. Chylothorax 6. Pneumothorax 7. Progressive shock from underlying condition 8. Venous thrombosis 9. Arrhythmia

Answer 27

3,4,6,7,9

Question 28

Which of the following statements concerning the passive leg raising test are correct? 1. It simulates the effects of administering a fluid bolus to the patient 2. The blood pressure should be measured before and after the test 3. Lift the legs so that they are elevated to 45 degrees without changing the position of the rest of the body 4. The manoeuvre increases the afterload. 5. Start with the upper body 45 degrees head up and legs flat then rapidly adjust the bed position so that the upper body is supine and the legs are elevated to 45 degrees

Answer 28

1,2,5

Question 29

Returning to our patient with probable cardiogenic shock. His pulse pressure rises by 12% on passive leg raising. How should we resuscitate him initially? 1. Inotrope 2. Vasopressor 3. Fluid

Answer 29

3

Question 30

What fluid would you give him? 1. 0.9% saline 2. 20% albumin 3. 5% albumin 4. Hetastarch 5. Hartmann’s solution

Answer 30

1

Question 31

What is the appropriate initial volume (in ml) of saline or Hartmann's solution?

Answer 31

100

Question 32

What is the appropriate volume (in ml) of saline or Hartmann's solution?

Answer 32

500

Question 33

Despite giving him fluid his blood pressure falls to 50/30 over a few minutes. What treatment would you give? 1. Epinephrine infusion starting at 0.05 mcg/kg/min 2. Epinephrine 0.5mg IM 3. Dopamine infusion starting at 5mcg/kg/min 4. Epinephrine 1mg IV 5. Epinephrine 0.1mg IV bolus

Answer 33

5

Question 34

His blood pressure rises to 80/50. Passive leg raising suggests he is no longer likely to be fluid responsive. What would be the optimal vasoactive agent in this setting? 1. Dopamine 2. Dobutamine 3. Norepinephrine

Answer 34

3

Question 35

If the initial infusion rate does not increase the blood pressure sufficiently the infusion should rate should be increased after how many minutes?

Answer 35

10

Question 36

If the initial infusion rate does not increase the blood pressure sufficiently the infusion should rate should be increased after how many half-life?

Answer 36

4.5 or 5

Question 37

50 year old male smoker Right hemicolectomy for colon cancer Day 5 post-op Temperature 37.2°C WCC 15.2 Respiratory rate 30/min HR 110/min Is this patient likely to be infected? 1. Likely 2. Unlikely

Answer 37

1

Question 38

He is confused and oliguric with a blood pressure of 80/40. Is this simple infection or sepsis? 1. Sepsis 2. Simple infection

Answer 38

1

Question 39

Following resuscitation the patient has BP 110/50 (mean 65 mm Hg), urine output of 50 ml/h and is no longer confused. His pulse pressure rose by 5% on passive leg raising. Is he adequately resuscitated? 1. No 2. Yes

Answer 39

2

Question 40

In general, the most common anatomical sources of sepsis are: 1. Upper respiratory tract infection 2. Intra-abdominal 3. Artificial devices 4. Dental infection 5. Skin and soft tissue infection 6. Urinary tract infection 7. Sinus infection 8. Central nervous system 9. Lower respiratory tract 10. Ear infection

Answer 40

2,3,6,9

Question 41

You see a man who appears to be unconcious lying on the ground. Your first response should be to: 1. Ensure the safety of the patient, yourself and bystanders 2. Shout for help 3. Check for breathing 4. Check his responsiveness 5. Check his pulse

Answer 41

1

Question 42

The patient is not breathing, you are alone and you do not have a mobile phone. You should: 1. Give 30 chest compressions and then leave the patient to call an ambulance 2. Leave the patient to call for an ambulance immediately 3. Start chest compressions and breaths in a 30:2 ratio and wait for someone to come past 4. Give one cycle of 30 compressions: 2 breaths and then leave the patient to call an ambulance 5. Give 5 rescue breaths and then leave the patient to call an ambulance

Answer 42

2

Question 43

After calling for an ambulance you should: 1. Start chest compressions at 100 compressions/minute 2. Give two rescue breaths 3. Open the airway and check for foreign bodies 4. Start chest compressions at 80 compressions/minute

Answer 43

1

Question 44

With regard to chest compressions: 1. The rescuer's fingers should be interlocked to keep them off the chest 2. The compression:recoil ratio should be 2:1 3. The chest should be compressed slightly to the left of the lower half of the sternum 4. You should keep your shoulders above the patient's sternum 5. The rescuer should compress the chest by repetitive extension and flexion of his/her elbows 6. The chest should be compressed by 5-6 cm

Answer 44

1,4,6

Question 45

Which of the following actions are required in mouth to mouth ventilation 1. Pinch patient’s nostrils closed 2. Keep airway open during both inspiration and expiration 3. Ensure a good seal between your mouth and the patient’s 4. Head-tilt chin lift 5. Blow into the patient’s mouth over 2 sec 6. Watch for chest rise of at least 5 cm 7. Take a breath 8. Allow patient’s mouth to open 9. Triple airway manoeuvre 10. Allow passive exhalation 11. Look for normal chest rise 12. Place your lips around patient’s mouth 13. Blow into the patient’s mouth over 1 sec 14. Place your lips around patient’s mouth and nose

Answer 45

1,2,3,4,7,8,10,11,12,13

Question 46

The appropriate sequence of actions during mouth-mouth ventilation is 1. Head-tilt-chin-lift 2. Pinch the patient’s nostrils shut 3. Allow mouth to open 4. Take a breath 5. Seal your lips around patient’s mouth 6. Blow into patient’s mouth 7. Allow passive exhalation 8. Repeat

Question 47

If the chest does not rise properly this is usually because 1. The seal around the patient's mouth is inadequate 2. The airway is obstructed 3. The patient has obstructive airways disease 4. You are not blowing hard enough

Answer 47

1

Question 48

If you think the patient's upper airway is obstructed you should 1. Perform a Heimlich manoeuvre 2. Check the patient's mouth and remove any visible obstruction 3. Keep attempting ventilation until you achieve two successful breaths 4. Re-check the head tilt and chin-lift and if adequate consider other manoeuvres (eg jaw thrust) 5. Re-attempt mouth-mouth ventilation after relieving obstruction

Answer 48

4

Question 49

You find a patient lying unconscious in his hospital bed. There is no suggestion of trauma. The first thing you should do is: 1. Insert a nasal airway 2. Insert an oral airway 3. Call for help 4. Check for breathing 5. Perform a head-tit chin-lift 6. Check for a pulse

Answer 49

3

Question 50

You have called for help. Your next action should be: 1. Insert a nasal airway 2. Do a head-tilt, chin-lift 3. Check for breathing 4. Check for a pulse 5. Do a modified jaw thrust 6. Insert an oral airway

Answer 50

4

Question 51

There is a palpable pulse. What would you do next? 1. Bag mask ventilation 2. Check breathing 3. Check BP

Answer 51

2

Question 52

How would you check for breathing? 1. Look 2. Listen 3. Capnometry 4. Feel 5. Pulse oximetry 6. Arterial blood gas

Answer 52

1,2,4

Question 53

What should you do next? 1. Bag mask ventilation 2. Head-tilt chin-lift 3. Modified jaw thrust 4. Insert nasal airway 5. Insert oral airway

Answer 53

2

Question 54

If there was a history of trauma what would you do? 1. Insert a nasal airway 2. Refer the patient for intubation 3. Modified jaw thrust 4. Insert an oral airway 5. Still do a head-tilt chin-lift

Answer 54

3

Question 55

To perform a modified jaw thrust you should 1. Grasp the chin with your fingers and pull the jaw anteriorly 2. Place your fingers posterior to the angle of the jaw and lift the mandible anteriorly 3. Open the mouth with your thumbs 4. Tilt the head first

Answer 55

2,3

Question 56

You have performed a head tilt chin lift but the patient is making no respiratory efforts. What should you do next? 1. Call an anaesthetist to intubate the patient 2. Insert oral airway 3. Bag-mask ventilation 4. Insert nasal airway

Answer 56

3

Question 57

What is the problem here? 1. Excessive ventilation 2. Insufficient ventilation 3. No chest movement

Answer 57

1

Question 58

How much should the bag be compressed by? 1. One quarter 2. One half 3. Three quarters 4. Completely

Answer 58

1

Question 59

What should you do about this problem? (bag-mask ventilation with no chest rise) 1. Insert an oral airway 2. Re-position the head, jaw and neck position to re-open the airway 3. Squeeze the bag harder 4. Insert a nasal airway

Answer 59

2

Question 60

What should you do if re-positioning doesn't work? 1. Insert a nasal airway 2. Call for an anaesthetist to intubate the patient 3. Insert an oral airway

Answer 60

3

Question 61

What should you do if you still can't ventilate the patient 1. Insert a nasal airway 2. Call for an anaesthetist to intubate the patient 3. Use a two person technique

Answer 61

3

Question 62

In the story described in the lecture, which of the following categories of factors were important in contributing to the patient being harmed? Select one or more: 1. Patient factors 2. Context factors 3. Medical factors 4. Task factors 5. Personal factors

Answer 62

2,4,5

Question 63

When considering your fitness to work you should consider the effects of: Select one or more: 1. Illness 2. Stress 3. Hunger 4. Sleep deprivation 5. Medication 6. Alcohol 7. None of the above

Answer 63

1,2,3,4,5,6

Question 64

Context related factors that can contribute to mistakes include: Select one or more: 1. Poor lighting 2. Hierarchical staff structure 3. Incompetence 4. Unfamiliar patient 5. Excessive protocols 6. Busy units 7. Unfamiliar environment 8. Laziness 9. Unfamiliar equipment 10. Distractions

Answer 64

1,24,5,6,7,9,10

Question 65

The most effective way to prevent harm to patients is to eliminate mistakes Select one: 1. True 2. False

Answer 65

2

Question 65

Distractions during one’s work are inevitable and cannot be reduced. Select one: 1. True 2. False

Answer 65

2

Question 66

The best strategy to avoid mistakes is maintain high vigilance at all times Select one: 1. True 2. False

Answer 66

2