2013 critical care board review (board certific steve marvel

Explanations: Radiation intensity decreases with the square of distance Go to the next page if you knew the correct answer, or click the link imagesbelow to further research the concepts

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KnowledgeTesting Book ID: MD_CRITICAL_CARE

Introduction

Section 1 ( Questions 1 - 200 )

Section 2 ( Questions 201 - 400 )Section 3 ( Questions 401 - 600 )Section 4 ( Questions 601 - 800 )Section 5 ( Questions 801 - 1000 )Section 6 ( Questions 1001 - 1200 )Section 7 ( Questions 1201 - 1400 )Section 8 ( Questions 1401 - 1600 )Section 9 ( Questions 1601 - 1800 )Section 10 ( Questions 1801 - 2000 )About Knowledge Testing

Question 1: How is radiation intensity related to distance? Choices:

1 Directly proportional

2 Inverse proportional

3 Half

4 Inversely related to the square

Explanations:

Radiation intensity decreases with the square of distance

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Research Concepts:

Radiation Physics:

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Question 2: What is the least important assessment immediately afterlaminectomy?

Laminectomy:

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Question 3: Caregivers usually prescribe total parenteral nutrition for whattime period:

Total Parenteral Nutrition:

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Question 4: What is not a feature on an ECG in a patient with atrialfibrillation?

Question 5: Spherules are commonly associated with: Choices:

1 Histoplasmosis

2 Coccidioidomycosis

3 Nocardia

4 Candida

Explanations:

Coccidioidomycosis is a dimorphic fungus endemic to southern areas ofArizona and Central America The organism grows in soil and when

inhaled can transform into multinucleated spherules

Filipinos have the highest risk of C immitis primarily because they workoutside in the gardens The majority of infections in healthy people areasymptomatic

Typical findings are pulmonary nodules cavitary lesions and

pneumothorax Direct examination of specimen for spherules is the mostrapid method of diagnosis

In general, only symptomatic patients need treatment Those who haveweight loss, night sweats, lung infiltrates or adenopathy need to be treatedwith an anti fungal agent

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Research Concepts:

Coccidioidomycosis:

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Question 6: What is the most common cause of bronchiectasis in NorthAmerica?

Explanations:

CF occurs with a prevalence of 1 in 2,500 births

CF is the largest cause of chronic lung infection and bronchiectasis inNorth America

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Question 7: Which of the following is NOT an emergent treatment of acuteMI?

Explanations:

Lipid profiles drawn during the acute event do not alter treatment

Intranasal oxygen, beta-blockers, and chewable aspirin are measures thatare needed urgently

Immediate actions are aimed to reduce the degree of ischemia

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Research Concepts:

Acute Myocardial Infarction:

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Question 8: Which of the following lung diseases can be associated withfinger clubbing?

Explanations:

The exact mechanism of finger clubbing is unknown

Lung diseases associated with finger clubbing include COPD, lung cancer,cystic fibrosis, and bronchiectasis

Cyanotic congenital heart diseases are also associated with clubbing

GI disorders such as celiac disease, Crohn's disease and cirrhosis can causeclubbing

Question 9: Therapy for hyperglycemic coma involves all of the following,except:

Explanations:

Fluid, insulin and IV glucose are all essential in managing such patientsBicarbonate is rarely needed unless severe acidosis occurs

Hyperglycemic coma patients do not have ketoacidosis

IV glucose is started when the glucose is normalized to avoid

hypoglycemia

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Research Concepts:

Hyperosmolar Coma:

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Question 10: Which of the following topical antibiotics has been associatedwith the highest rate of hypersensitivity?

Explanations:

Neomycin has been reported to cause the highest rate of allergic reactionswhen applied topically

Polymyxin B and muciprocin are less common cause of allergies

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Question 11: What is the most frequently hollow organ injured in blunttrauma:

Explanations:

The majority of duodenal injuries are due to penetrating trauma and

commonly occur in the 2nd or 3rd portion of the duodenum where theorgan is compressed against the spine

Duodenal injures can be hematomas, or wall ruptures CT scan is the idealtest to assess duodenal injures Other findings on CT may include freeretroperitoneal gas, fluid, pancreatic edema or abscess collection

At surgery, it is important to perform a Kocher maneuver and visualize allfour segments of duodenum Simple duodenal injuries can be managed byprimary repair but complex injuries may mean resection or reconstructionThe role of ERCP and MRCP is not clear in duodenal injuries These

studies should only be considered in stable patients

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Research Concepts:

Abdomen, Blunt Trauma:

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Question 12: Leprosy is usually treated with rifampin and: Choices:

1 Doxycycline

2 Levaquin

3 Dapsone

4 Gentamycin

Research Concepts:

Leprosy:

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Question 13: What does it mean when you are reviewing a Tc99m-labeledaerosol lung ventilation scan and notice gastric activity

Answer: 3 - Inadvertent radiopharmaceutical ingestion (droplet swallowing) Explanations:

This finding is common as a result of aerosol droplet swallowing

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Research Concepts:

Ventilation Scan:

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Question 14: Which of the following is not appropriate in a patient whoarrives in an unconscious state?

Explanations:

In all patients who are unconscious, blood sugar levels must be obtained.Hypoglycemia is a common cause of coma in diabetics Hyperglycemiacan also cause a hyperosmolar state with diuresis and loss of electrolytesAlways suspect raised intracranial pressure in patients who are in a coma.Perform a lumbar puncture and check for meningitis

Other causes of coma include use of drugs like paracetamol and liverenzymes may be elevated CT scan may help patients who are in a comaMany hospitals have a protocol of administering glucose, thiamine andnaloxone to people who are in a coma Flumazenil, a benzodiazepine

antagonist, is not a routine protocol

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Research Concepts:

Coma:

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Question 15: For a patient on a mechanical ventilator who is fighting themachine and has elevated peak airway pressures, the best drug of choice todecrease the agitation is:

Explanations:

When a patient fights the ventilator despite being sedated, a neuromuscularblocker can be used

There are many neuromuscular blockers that can be used in the ICU

Vecuronium is a long acting non-depolarizing neuromuscular blockingagent

It binds competitively at the nicotinic receptors lof the motor end-plate ofstriated muscle

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Explanations:

Biguanides, such as metformin, act primarily in the liver by decreasinggluconeogenesis

Metformin also has some effect on insulin resistance

Metformin has less associated weight gain since it does not primarilyincrease the level or the action of insulin

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Research Concepts:

Metformin:

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Question 17: Which is not true regarding adrenal crisis? Choices:

1 May present with illness or surgery

2 Has a risk of cardiovascular collapse and death

3 Hypertension is a principal feature

4 May occur with abrupt withdrawal of corticosteroids

Explanations:

Hypotension is a principal feature

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Research Concepts:

Adrenal Crisis:

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Question 18: A patient suspected of having a hemolytic transfusion reactionshould be managed by?

Explanations:

Whenever a blood transfusion reaction is suspected, the blood transfusionmust be stopped immediately

All blood include the rubber tubing must be sent back to the laboratory foranalysis

The patient should be hydrated and furosemide should be administered.Diuretics can help maintain renal blood flow and preserve urine outputSometimes low dose dopamine may be required to maintain renal bloodflow and blood pressure

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Research Concepts:

Transfusion Reactions:

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Question 19: What is the correct location of a chest tube placement? Choices:

1 Second intercostal space

2 Third intercostal space

3 Fourth intercostal space

4 Fifth intercostal space

Explanations:

Proper chest tube placement is the fifth intercostal space at the midaxillaryline

They are indicated for pneumothorax, hemothorax, pleural effusions,

empyema, and chylothorax

The patient should be placed supine or at a 45° angle

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Research Concepts:

Chest Tube:

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Explanations:

It is defined as air space enlargement distal to the terminal non-respiratorybronchiole

Emphysema is a chronic obstructive pulmonary disease

It often coexists with chronic bronchitis

Emphysema can be centriacinar, panacinar, or paraseptal

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Research Concepts:

Emphysema, Pathology:

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Question 21: Which of the following is the best treatment of Pneumocystisjiroveci pneumonia (PCP) ?

Drug of choice is Trimethoprim sulfamethoxazole but IV Pentamidine may

be required in severe cases It is important to watch for QT prolongationand blood glucose levels while on this therapy

appropriate in the management of a 91-year-old male nursing home resident who

is admitted with pneumonia while sputum gram stain and culture are pending?Choices:

1 Respiratory fluoroquinolone and aminoglycoside

2 Third generation cephalosporin and macrolide

3 Anti-pseudomonal cephalosporin, anti-pseudomonal fluoroquinolone, andvancomycin

4 Anti-pseudomonal carbapenem and vancomycin

fluoroquinolone, and vancomycin

Explanations:

Nosocomial pneumonia refers to hospital acquired pneumonia as well ashealthcare associated pneumonia as would occur with a resident of a longterm care facility

Empiric antibiotic therapy for nosocomial pneumonia needs to cover

Pseudomonas aeruginosa, Klebsiella, MRSA and E coli Pseudomonasrequires double coverage due to the high risk of resistance in this

population

Community acquired pneumonia empiric therapy would be choice 2 orwith a fluoroquinolone

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Research Concepts:

Nosocomial Pneumonia:

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Question 23: Heat stroke is a serious condition that can have end-organdamage Which of the following are not considered possible complications ofheat stroke?

Explanations:

Heat stroke can result in extensive end organ damage and have irreversibleneurologic defects

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Research Concepts:

Heat Stroke:

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