Intensive Care Unit (ICU) (Textbook) MCQs

Question 1

Total parenteral nutrition for an average adult should include:

a) magnesium
b) 14 grams of nitrogen daily
c) 1mL water for each kcal
d) fat solutions in hepatic failure
e) glucose.

Answer 1

ALL answers are correct!

Question 2

In carbon monoxide poisoning the following are seen:

a) arrhythmias
b) hypotension
c) extensor plantars
d) cyanosis
e) hyperventilation

Answer 2

a) arrhythmias
b) hypotension
c) extensor plantars
e) hyperventilation

Question 3

Pulmonary oxygen toxicity during oxygen therapy is associated with:

a) prolonged exposure
b) high altitude
c) increased muscle activity
d) increased carbon dioxide tension
e) anaemia.

Answer 3

a) prolonged exposure

Question 4

Oxygen toxicity to the lung is due to:

a) inspired oxygen (FIO2) above 0.6
b) prolonged exposure
c) increased arterial partial pressure of oxygen
d) the effect of oxygen on pulmonary vessels
e) unhumidified oxygen.

Answer 4

a) inspired oxygen (FIO2) above 0.6
b) prolonged exposure
d) the effect of oxygen on pulmonary vessels

Question 5

At 30°C:

a) Oxygen consumption is one-third that at 37°C
b) Oxygen solubility is raised
c) J-waves might appear on the ECG
d) Active rewarming should be commenced
e) Carbon dioxide solubility is reduced.

Answer 5

b) Oxygen solubility is raised
c) J-waves might appear on the ECG

Question 6

A thyrotoxic crisis should be immediately treated by:

a) Radioactive iodine
b) Propranolol
c) Diazepam
d) Lugol’s iodine
e) Adrenaline

Answer 6

b) Propranolol
c) Diazepam

Question 7

Appropriate management of an acute head injury includes:

a) Naloxone
b) Methylprednisolone 30mg/kg
c) Hyperventilation to a Pa
CO2 of 3.3–4kPa
d) Mannitol 2mg/kg
e) Burr holes.

Answer 7

c) Hyperventilation to a Pa CO2 of 3.3–4kPa
e) Burr holes.

Question 8

Helium:

a) is useful in treating bronchospasm
b) is stored as liquid in brown cylinders
c) has a lower viscosity than oxygen
d) causes an alteration in voice
e) supports combustion.

Answer 8

b) is stored as liquid in brown cylinders
c) has a lower viscosity than oxygen
d) causes an alteration in voice

Question 9

A poor prognosis in tetanus is associated with:

a) a long incubation period
b) minimal muscle damage
c) distal injury
d) severe muscle spasm
e) previous immunisation.

Answer 9

d) severe muscle spasm
e) previous immunisation.

Question 10

In patients with haemorrhagic shock:

a) physiological dead-space is increased
b) renal blood flow is decreased
c) antidiuretic hormone (ADH) secretion is increased
d) the oxygen dissociation curve is shifted to the left
e) oxygen delivery is decreased.

Answer 10

a) physiological dead-space is increased
b) renal blood flow is decreased

c) antidiuretic hormone (ADH) secretion is increased

e) oxygen delivery is decreased.

Question 11

Recognised effects of PEEP include:

a) sodium retention
b) fall in cardiac output
c) rise in closing volume
d) rise in FRC
e) fall in CVP

Answer 11

a) sodium retention
b) fall in cardiac output
d) rise in FRC

Question 12

Raised left ventricular end-diastolic pressure (LVEDP) implies:

a) increased left ventricular compliance
b) decreased left ventricular systemic work index (LVSWI)
c) decreased oxygen flux
d) decreased myocardial oxygen demand
e) decreased myocardial oxygen supply.

Answer 12

c) decreased oxygen flux
e) decreased myocardial oxygen supply.

Question 13

Pulmonary capillary wedge pressure (PCWP) is a reliable parameter:

a) in mitral stenosis
b) after anterior myocardial infarction
c) in pulmonary stenosis
d) in aortic stenosis
e) in pulmonary fibrosis.

Answer 13

b) after anterior myocardial infarction
c) in pulmonary stenosis
d) in aortic stenosis

Question 14

In septic shock:

a) peripheral hypothermia is associated with a good prognosis

b) the patients usually have an increased cardiac output

c) the patients usually have a depleted circulating volume

d) the causative organisms are always Gram-negative

e) antibiotics should not be given before blood culture results are available

Answer 14

b) the patients usually have an increased cardiac output

c) the patients usually have a depleted circulating volume

Question 15

An 8-year-old child is rescued 20 minutes after drowning and has a core temperature of 30°C and fixed dilated pupils. Further appropriate treatment includes:

a) phenobarbitone
b) rapid rewarming
c) hypoventilation
d) steroids
e) cardiopulmonary resuscitation.

Answer 15

b) rapid rewarming
e) cardiopulmonary resuscitation.

Question 16

The following findings occur with a large pulmonary embolus:

a) an increase in pulmonary artery pressure
b) an increase in right ventricular pressure
c) an increase in left atrial pressure
d) an increase in physiological dead-space
e) a decrease in right atrial pressure.

Answer 16

a) an increase in pulmonary artery pressure
b) an increase in right ventricular pressure
d) an increase in physiological dead-space

Question 17

Increased left ventricular end-diastolic pressure:

a) causes increased compliance of the left ventricle
b) causes decreased tension in left ventricular wall
c) causes decreased left ventricular stroke work index
d) occurs in mitral stenosis
e) is associated with raised pulmonary artery pressure.

Answer 17

NONE of the answers are correct!

Question 18

In the oxygen dissociation curve, causes of a right shift include:

a) low-molecular-weight dextran
b) digitalis
c) metabolic acidosis
d) respiratory alkalosis
e) hypoxia

Answer 18

c) metabolic acidosis
e) hypoxia

Question 19

An increased alveolar–arterial (A–a) gradient is associated with:

a) an increased FI O2
b) a decreased FI O2
c) a decreased FRC
d) an increased V/Q ratio
e) an increased shunt

Answer 19

a) an increased FI O2
c) a decreased FRC
d) an increased V/Q ratio
e) an increased shunt

Question 20

Complications of PEEP include:

a) alteration of the alveolar–arterial (A–a) gradient
b) decreased cardiac output
c) increased renal output
d) pneumothorax in an emphysematous patient
e) hypercarbia.

Answer 20

a) alteration of the alveolar–arterial (A–a) gradient

b) decreased cardiac output
d) pneumothorax in an emphysematous patient

Question 21

PEEP added to intermittent mandatory ventilation (IMV) is indicated:

a) to hasten weaning
b) if it has already been used for IPPV
c) if FI O2>0.6 and Pa O2 < 10kPa
d) if respiratory rate is greater than 30 breaths per minute
e) if PCWP > 8mmHg

Answer 21

a) to hasten weaning
b) if it has already been used for IPPV
c) if FI O2>0.6 and Pa O2 < 10kPa

Question 22

PEEP:

a) decreases cardiac output
b) increases CVP
c) increases closing volume
d) increases FRC
e) decreases PvO2.

Answer 22

a) decreases cardiac output
b) increases CVP
d) increases FRC

Question 23

Pulmonary artery capillary wedge pressure can be increased:

a) after myocardial infarction
b) in mitral stenosis
c) in aortic regurgitation
d) in pulmonary fibrosis
e) in pulmonary stenosis.

Answer 23

a) after myocardial infarction
b) in mitral stenosis
c) in aortic regurgitation

Question 24

In early sepsis syndrome:

a) cardiac output is normal
b) a decreased white cell count is a poor prognostic sign
c) ACTH levels are low
d) insulin is raised
e) Pa O2 is lowered.

Answer 24

a) cardiac output is normal

b) a decreased white cell count is a poor prognostic sign

d) insulin is raised

e) Pa O2 is lowered.

Question 25

Features of dissemated intravascular coagulation include:

a) a lowered fibrinogen level

b) a normal prothrombin time and activated partial thromboplastin time

c) heparin a reasonable treatment following placental abruption

d) may occur secondary to malaria

e) may have a compensated phase with no bleeding

Answer 25

a) a lowered fibrinogen level

d) may occur secondary to malaria

e) may have a compensated phase with no bleeding

Question 26

Gram-negative septicaemic shock is associated with:

a) urine output < 0.5mL/kg per hour
b) disseminated intravascular coagulation
c) hypotension unresponsive to fluid loading
d) high fever
e) diminished cardiac output

Answer 26

a) urine output < 0.5mL/kg per hour
b) disseminated intravascular coagulation
c) hypotension unresponsive to fluid loading
e) diminished cardiac output

Question 27

An increased alveolar–arterial (A–a) oxygen difference is caused by:

a) a decreased FRC
b) increased inspired oxygen
c) nitrous oxide absorption
d) hepatic failure
e) increased V–Q mismatch.

Answer 27

ALL answers are correct!

Question 28

Essential criteria for the diagnosis of brainstem death are:

a) equal pupils
b) absent doll’s head response
c) absent limb movements
d) patient’s temperature must exceed 35°C
e) Pa CO2 must exceed 6.5kPa at completion of apnoea testing

Answer 28

b) absent doll’s head response
d) patient’s temperature must exceed 35°C
e) Pa CO2 must exceed 6.5kPa at completion of apnoea testing

Question 29

An adult breathing 100% oxygen at sea level may suffer from:

a) retrosternal chest pain
b) convulsions
c) dizziness
d) atelectasis
e) permanent visual damage.

Answer 29

a) retrosternal chest pain
d) atelectasis