2.

Which of the following statements is/are TRUTH about the effects of mechanical ventilation on left
ventricular preload, afterload and cardiac output?

(A) . Increase preload ,decreased afterload, increase cardiac output.

(B) Increase preload, increase afterload, increase cardiac output.

(C) Decreased preload , decreased afterload, increased cardic output.

(D) Decreased preload, decreased afterload, decreased cardiac output.

(E) Decreased preload, decreased afterload, variable effect on cardiac output.

3. In volume preset assist control ventilation which of the following is/are affected by changing the I:E
ratio

(A) Absolute expiratory time

(B) Inspiratory flow

(C) Inspiratory time

(D) Inspiratory pause time

(E) Gas trapping

4. Guillain-Barre’ Syndrome (GBS);

1) Affects more females than males

2) Is a disease of the middle-aged

3) When secondary to a respiratory illness, the majority of cases present within a month.

4) The presence of cranial nerve signs effectively rules out the diagnosis.

5) The most common associated pathogen is Clostridium perfringens

5.You have performed a rapid sequence induction but are unble to intubate or ventilated patient. The
appropriate course of action is/are;

(A) perform a cricothyrotomy

(B)Give a second dose of muscle relaxant and attempt intubation again

(C) Allow the patient to breath 100% oxygen spontaneously

(D) Insert a laryngeal mask and ventilate the patient

(E) Perform a fibreoptic intubation

6. Which of the following is /are correct?

(A) airway pressure= Flow/Resistence+Volume Compliance +PEEP

(C) airway pressure= Inspiratory time Resistence +Volume/Compliance +PEEP

(D) AP = Flow Compliance + Volume/ Resistence + PEEP

(E) AP = Flow Resistence + Volume / Compliance

8. A patient has just been intubated following a rapid sequence induction. Which the following modes
is/are contraindicated?

(A) SIMV

(B) Pressure preset assist control

(C) Volume presset assist control

(D) Pressure support

(E) CPAP

9. In pressure support mode the patient has no control cover ;

(A) RR

(B) Tidal volume

(C) Inspiratory time

(D) Respiratory pattern

(E) Inspiratory pressure

10. An asthmatic patient becomes hypotensice shortly after intubation. She remains hypotensive(BP
80/50) after rapid infusion of 250ml of colloid. The following are appropriate course of action:

(A) give adrenaline 0.1 mg IV

(B) insert bilateral chest drains

(C) disconnect the patient from the ventilator or bag

(D) start a dopamine infusion

(E) perform bilateral needle thoracostomies

11. In volume preset assist control ventilaton which of the following is/are affected by changing the
I:E ratio;

(A) Absolute expiratory time

(B) Inspiratory flow

(C) Inspiratory time

(E) Gas trapping

12.These are the results from a 25 year old 70 kg patient with pneumonia: BP 100/50 (mean

(A)

(B)

(C)

(D)

(E) Dobutamine infusion

13. An adequate preload is indicated by ;

(A) CVP 10 mmHg

(B) Large variation in pulse pressure with ventilation

(C) Change in pulse pressure of 5% on passive leg raising

(D) CVP 14 mmHg

(E) CVP 7mmHg

14. Haemodynamic support of a hypotensive patient with a massive pulmonary embolus should
include;

(a) Large volume fluid resuscitation

(b) Intrvenous nitrate infusion

(c) Norepinephrine infusion

(d) Dobutamine infusion

(e) Isoprenaline infusion

15. A post-operative patient with a blood pressure of 70/40 has warm peripheries and a normal
jugular venous pressure. The most likely cause of shock is/are;

(a) Septic shock

(b) Cardiogenic shock

(c) Massive pulmonary embolus

(d) Tension pneumothorax

16. Which of the following is/are potentially reversible causes for cardiac arrest?

(a) Hypovolemia

(b) Hypoxia

(c) Tension pneumothorax

(d) Pulmonary embolus

(e) Entensive myocardial infarction

17. Following is/are appropriate initial treatment of rapid atrial fibrillation in a shocked patient;

(a) DC cardioversion with 100J(monophasic), 50J (biphasic)

(b) DC cardioversion with 200J (monophasic or biphasic)

(c) Amiodarone 150mg over 10 minutes

(d) Procainamide 10-15mg/kg

(e) Amiodarone 300 mg over 10 minutes

18. The following are the drugs that can cause acute renal failure

(a) Amikacin

(b) Vancomycin

(c) Lisinopril

(d) Amphotericin B

(e) N- acetylcysteine

19. Confirmed deep venous thrombosis (DVT) in the left leg of a 54 year old patient with an underlying
diagnosis of pneumonia is treated with

(a) Unfractionated heparin 5000U daily SC

(b) Low molecular weight heparin at a dose of 4000-6000 IU daily( equivalent of nardroparine or
Fraxiparine 0.3 ml SC daily)

(c) Full anticoagulation with low molecular weight heparin (eg. Enoxiparine 1mg/kg q 12 hourly)

(d) Graded compression stockings on the left leg

(e) Intermittent pneumatic compression boots applied to both legs

20. The following pharmacological agents achieves prevention of stress ulcer bleeding (stress ulcer
prophylaxis) in intensive care patients?
(a) Histamine 2 receptor antagonists such as Ranitidine

(b) Soluble antacids such as sodium bicarbonate

(c) Agents with cytoprotective effects such as sucralfate

(d) Agents that decrease gastro-intestinal secretions such as octreotide

(e) Proton pump inhibitor

21. A patient with septic shock has a mean arterial pressure 60 mmHg , HR 120 /min ,oxygen
saturation 97% (in FiO2 0.3). His BP rises from 80/50 to 90/55 on passive leg raising. He is acidotic,
oliguric and confused. He Is in positive fluid balance of 3L over the first 12 h of his ICU admission. The
appropriate step in his resuscitation is/ are;

(a) No further resuscitation is required

(b) 1000 ml crystalloid over 30 minutes

(c) Start norepinephrine infusion

(d) Start dopamine infusion

(e) Start dobutamine infusion

22. A patient has the following arterial blood gas result; pH 7.34, PaCO2 8.0(60mmHg), PaO2 7.5kPa
( 56mmHg) , HCO3 32.1mmol/l, BE 8.His acid-base abnormality is diagnosed as;

(a) metabolic acidosis

(b) metabolic alkalosis

(c) Respiratory acidosis

(d) Chronic compensated respiratory acidosis

(e) Mixed metabolic acidosis and respiratory alkalosis

23. The following statements regarding interhospital transport of critically ill patients is/are TRUE;

(a) At least three appropriately trained staff should accompany each patient

(b) A self-inflating bag valve resuscitator with PEEP valve should be considered essential equipment

(c) End- tidalCO2 monitoring should be used for all ventilated patients

(d) Intravenous glucose should be available

(e) Epinehrine should be available

24. A 63 year old man develops a recurrence of upper GI bleeding from a stress ulcer. He is
pharmacologically treated with;

(a) Ranitidine 50 mg 8 hourly

(c) Omeprazole 80 mg IV followed by 8 mg/h

(d) Omeprazole 40 mg IV 12 hourly

(e)

25.A 75 yr old patient is admitted with an isolated head injury. His GCS is 3/15 ,BP 100/60, HR
100/min. Following intubation and ventilation he is noted to have a 5 min unrespone left pupil. He
can be managed immediately with;

(a) Transfer to the operating theatre for insertion of a burr hole

(b) CT scan of brain

(c) Infusion of thiopentone

(d) induction of hypothermia

(e) infusion of mannitol and hyperventilation

26. A 36 yr old male presents following a fight in which he sustained a knife wound to the abdomen.He
has signs of peritonism. The following investigation should be performed;

(a) laparotomy

(b) upper GI endoscopy

(c) FAST

(d) CT abdomen

(e) Diagnostic peritoneal lavage

27. A patient admitted following a benzodiazepine overdose has noisy breathing, associated with
increase inspiratory effort and see-saw thoracoabdominal movements. She starts to desaturate
despite oxygen 4 L/min via nasal cannulae. The appropriate immediate intervention is to increase the
oxygen flow rate and;

(a) Change nasal cannulae to a facemask

(b) Insert a laryngeal mask

(c) insert a nasopharyngeal airway

(d) Head- tilt Chin- lift

(e) insert oropharyngeal airway

30. In a patient with severe pneumonia the major pathophysiological mechanism lead to hypoxaemia
is/are ;

(a) Hypoventilation
(b) Decreased diffusing capacity

(c) Increased physiological dead space

(d) Intrapulmonary shunting

(e) Decreased inspired oxygen concentration

31. The following drugs undergo non-organ metabolism;

(a) Esmolol

(b) Atracurium

(c) Inhaled nitric oxide

(d) Propofol

(e) Adrenaline

32.With regard to bleeding and coagulopathy in the critically ill patient;

(a) If a platelet transfusion is indicated, 1 unit will raise the count by appropriately 20 109/L

(b) The principal constituents of cryoprecipitate include Factors 8,13,vWF , Fibronectin and fibrinogen

(c) A suggested dose of fresh frozen plasma in the bleeding trauma patient with coagulopathy is 30ml/kg

(d) Desmopressin at a dose of 0.3ug/kg is a useful treatment in patients with coagulopathy related to
uraemia , cirrhosis and aspirin use.

(e) At temperature of 33-35’C, altered enzyme kinetics equate to a 33% reduction in normal clotting
factors.

33. Regarding the hepatorenal syndrome (HRS);

(a) It is commonly over-diagnosed in patients with cirrhotic liver disease

(b) HRS Type 1 has the poorest outcome

(c) Kidneys from patients with HRS are suitable for transplantation.

(d) The condition is associated with splanchnic vasodilatation.

(e) Terlipressin must be given by infusion

34. With regard to a patient with a neuromuscular disorder on the critical care unit;

(a) Potassium-sparing diuretics should be avoided in patients with hypokalaemic periodic paralysis.

(b) Suxamethonium use should be avoided in patients with myasthenia gravis.

(c) patients with motor neurone disease typically require double the standard dose of suxamethonium
to provide optimum intubating conditions.
(d)

(e)

35.A 67 yr old male has a diagnosis of myasthenia gravis (MG) . Which of the following medications
should be avoided to reduce the risk of exacerbation?

(a) Gentamicin

(b) Paracetamol

(c) Trimethoprim

(d) Ciprofloxacin

(e) Aspirin

36.A 59 yr old male is admitted with a gradual onset of peripheral oedema and forthy urine. He is
subsequently diagnosed with nephrotic syndrome. The condition is associated with ;

(a) Hypercalcaemia

(b) Venous thrombosis

(c) Hyperlipidaemia

(d) Risk of myocardial infarction

(e) Hypervolaemia

37. The following have been demonstrated to be useful prognostic variables in moderate to severe
traumatic brain injury;

1. Age

2. Pupillary reaction

3. Sensory neurological deficit

4. The presence of non-evacuated haematoma on CT brain scan

5. Serum glucose

38. Regarding the mechanics of positive pressure ventilation;

1. Setting an extrinsic PEEP less than intrinsic PEEP will reduce elastic work of the respiratory system.

2.One risk of applying PEEP is a reduction in oxygen delivery (DO2)

3. A decelerating flow pattern is seen in volume-controlled ventilation

4. The difference between peak and plateau pressures is greater with volume –controlled ventilation
than pressure-controlled ventilation.
5. Dynamic compliance equals the tidal volume divided by (peak pressure minus total positive end-
expiratory pressure.

39. The following are examples of severity scoring systems in the intensive care unit;

1. Acute Physiology and chornic health evaluation 3(APACHE 3)

2. CT Calcium Score.

3. Sequential Organ Failure Assessment(SOFA)

4. Mortality Prediction Model(MPM)

5. Glasgow-Blatchford Score.

40.Regarding Diabetic Ketoacidosis(DKA);

1. DKA can be diagnosed if a known diabetic patient presents with hyperglycaemia (plasma glucose
>10mmol/l) and a serum bicarbonate of <15mmol/l.

2. A high serum ketone level indicates more severe disease.

3. DkA should be treated with a fixed rate insulin infusion .

4. when managing a patient with DKA , their usual insulin regime should be stopped but oral antidiabetic
medication should be continued.

5. DKA is deemed to have resolved when urinary ketones are no longer detectable.

41.Regarding the pre-operative assessment of exercise capacity;

1. 1 metabolic equivalent (MET) is roughly equivalent to climbing one flight stairs.

2. The anaerobis threshold (AT) is the point at which oxygen supply exceeds demand .

3. patients with AT of >15ml/min O2 have a high relative risk of cardiopulmonary morbidity following
major non-cardiac surgery.

4. Cardiopulmonary exercise testing is relatively contraindicated in the presence of severe aortic

5. Oxygen consumption = cardiac output (arterial –mixed venous oxygen content).

42. A patient presents with a paracetamol overdose. The following factors would increase the chances
of severe hepatotoxicity;

1. high body mass index

2. regular consumption of ethanol in excess of remommended amounts.

3. use of hepatic enzyme inhibitors

4. malnourishment
5. St John’s Wort.

43. The following are diagnostic features of submassive pulmonary embolism(PE);

1. Dilated right ventricle on echocardiography

2. systolic blood pressure < 90 mmHg.

3. Elevated troponin.

4. B- natriuretic peptide (BNP) level of < 10 pg/ml.

5. SpO2 <94% on room air.

44. Regarding the diagnosis of brainstem death;

1. Fixed and dilated pupils must be present.

2. the absence of corneal reflex indicates no function in the midbrain region.

3. the visual evoked responses must be demonstrated to be absent.

4. Motor response to a sternal rub excludes the diagnosis.

5. A cough reflex respone to bronchial stimulation by a suction catheter placed down the trachea to the
carina excludes the diagnosis.

45. The following factors cause inaccuracy in pulse oximetry;

1. Methaemoglobinaemia

2. carbon monoxide poisoning

3. vasopressors

4. Acrylic nails

5. Hyperbilirubinaemia

46. Giving your patient a FAST-HUG meas paying strict attention to the following;

1. Airway concerns

2. Falls prevention

3. Humidification of ventilatory support

4. Tracheostomy care

5. stress ulcer prophylaxis

47. With regards to the use of vasopressin in patients with septic shock;

1. vasopressin is synthesized in the posterior pituitary

3. it increases smooth muscle intracellular calcium

4. vasopressin infusion is effective in reducing noradrenaline requirements in patients with septic shock.

5. vasopressin should be infused at a rate of between 1-3 units/ min.

48. Regarding the anatomy of larynx and trachea;

1. the cricoid cartilage is situated at the level of C4.

2. the crictracheal membrane is the preferred site for cricothyrotomy.

3. An aortic aneurysm can cause paralysis of the left vocal cord.

4. In an adult the trachea is approximately 10 cm long.

5. the anterior jugular vein is at increased risk of damage if a tracheostomy is not performed in the
midline.

49. When performing a lumbar puncture;

1. in an adult a lumbar puncture can safely be performed at the level of L2/3.

2. cerebrospinal fluid is located in the epidural space.

3. when performing a lumbar puncture in the sitting position , a normal opening pressure is 20-40 cm of
cerebrospinal fluid.

4. cerebrospinal fluid is formed by the arachnoid villi in the lateral , third and fourth ventricles.

5. cerebrospinal fluid has an osmolality of approximately 280mOsm/kg.

50.Which of the following are true regarding arterial pressure waveform analysis?

1. the dicrotic notch represents aortic valve closure.

2. vasoconstriction is suggested by a steep slope of systolic decay.

3. the rate of rise in pressure per unit time (dP/dt) is an index of contractility.

4. a large delta ( ) down in a ventilated patient suggests hypovolaemia.

5. the stoke volume is derived from the area under the arterial waveform.

51. Regarding arterial blood gas analysis;

1. the pH of a gas sample is directly measured.

2. all arterial bood gas samples are measured at 37’C+/- 0.1’C.

3. the blood gas analyser will underestimate the ture in vivo PaCO2 of a hypothermic patient.
4. bubbles of air in the gas syringe will affect the measured PaO2.

5. Leukopaenia can cause pseudohypoxaemia.

52.During a respiratory wean, the following numerical indices suggest a spontaneous breathing trial is
likely to br followed by successful extubation;

1. Rapid Shallow Breathing Index(RSBI)

2. respiratory rate <35/ min.

3. vital capacity >5 ml/kg

4. PO2 >10kPa

5. ETCO2 < 5kPa.

53.The application of continuous positive airway pres(CPAP) or positive end- expiratory pressure
(PEEP) typically leads to ;

1. increased functional residual capacity.

2. a reduction in preload in patients with acute cardiogenic pulmonary oedema.

3. Redistribution of extravascular lung water.

4. increase cardiac output.

5. decreased intracranial pressure.

54. In the patient with major burns;

1. Selective decontamination of the digestive tract has been demonstrated to reduce th incidence of
burn wound infection.

2. the first half of the fluid requirement as calculated by the Parkland formula shoubld be administered
over 12hours.

3. Pre-hospital fluid should be subtracted from the fluid requirement as calculated by the Parkland
formula.

4. Erythematous areas should be included in the total body surface area (TBSA) calculation.

5. the modified Baux score can be used to predict mortality.

55. A 56 yr old male is admitted with severe sepsis,. His blood cultures have grown Gram-positive
bacteria . Which of the following are examples of Gram-positive bacteria?

1.Bacillus

2. Streptococci

3. Clostridium
4. Haemophilus

5. Listeria.

56. Regarding the diagnosis and management of hypertension;

1. Diagnosis requires elevated blood pressure measurement on three separate occasions.

2. Stage 2 hypertension id defined as a systolic BP >159mmHg and /or a diastolic BP >99mmHg.

3. Resistant hypertension is defined as a blood pressure greater than 140/90 mmHg despite optimal
doses of three antihypertensive agents.

4. Hypertensive urgency describes severe hypertension with evidence fo end-organ damage.

5. patients with severe, asymptomatic hypertension should have their BP quickly lowered to less than
140/90 mmHg.

58.Regarding non- invasive ventilation (NIV) in critically ill patients;

1. It has a clear mortality in patients with Type 1 respiratory failure due to chronic obstructive
pulmonary disease (COPD)compared with standard medical therapy.

2. it is contraindicated in patients with thoracic wall deformities.

3. it is an effective treatment for severe community-acquired pneumonia.

4. it should be first-line therapy for asthmatic patients with worsening respiratory acidosis.

5. it is effective rescue therapy following failed extubation.

59.Causes of hyperalcaemia include;

1. loop diuretics

2. multiple endocrine neoplasia (MEN) Types 2b.

3. theophylline toxicity.

4. hyperthyroidism

5. immobilization

60.A man is admitted to your ICU with acute liver failure. The following criteria must be met to fulfill a
diagnosis of acute liver failure;

1. illness duration <28 days.

2. presence of chronic liver disease.

3. jaundice.

4. coagulopathy with an INR > 1.5.

4. An adult with a one-day history of sore throat and stridor is tachypnoeic (respiratory rate 40
breaths/min , sweaty, anxious and drooling. He is using accessory muscles of respiration and is
beginning to show signs of exhaustion . The appropriate immediate course of action is/are;

1. Rapid sequence induction, direct laryngoscopy and intubation.

2. cricothyrotomy.

3. sedation and insertion of a laryngeal mask.

4. Bag-valve mask ventilation with 100% oxygen.

5.spontaneous breathing of 100% oxygen via bag-valve resuscitator, call for specialist help and prepare
equipment for intubation.