Neg dovmee~ ref) | \ Che £0x Sve Fundamental Criticallpare Support Post Te Instructions: + Please print your name on the accompanj|ng answer sheet. + Read each item carefully. + Select the best answer to each question. * Write the letter preceding your selected oftion on the answer sheet next to Bxb= fe re that question number. pMpec4 ard 56 7 Aae-yearold male admitted tothe hospitel ve frock develops acute respiratory istess SW + 42 ‘ syndrome. His predicted-body is 80 kG. Currell| ventilator settings are assist control . 1 entation et erate of T2inin Gs SB0TRL, postive enqpperirtory pressure (PEEP) 8 em ¥,0 and ny Fie festa Srenpetement ore hod If 730, pec 42m Ho, Pee Bt Ha }EST at this time? , yy! s4 vied feep b ast Je oy Fi0, 0.45, Alt pressure is now 1:0. Arterial blood gas sho ich of the folowing ventitor adjustments would b Decrease rate by 2imin to 10min. Decrease Ve by 1 milskg to 480 rl Desrease PEEP by 2.0m HO 106 em HO Br Increase inepratory time perverse ‘Which of the following statements is MOST CORRE} patient? @ pepe is usually an early sign of erica ling ~2 (8) Tachypnes is the single MOST important indicatolf critical itness. ‘Tachycardia is commonly seen in the elderly popustion. D> Pulsus paradoxus fs seen with hypervoleria and of breath end an altered level of neck dissection, Which of the following italy? 3. You are called to see 2 42-year-old female with shorts . consciousness an the first postoperative day following} statements is MOST CORRECT in assuring her irwa A” Hyperextend the jaw and neck, B. Visualize mouth and throat for alrway obstruction. G. Stimulate protective airway reflexes (Le., cough, © Perform the triple erway maneuver. 4, A72 year-old male with recent stroke is admitted to tht level of consciousness and hypotension. His blood pt \is 150 mmol/L. What is the MOST eppropriate fluid toh = 8% dextrose in water intravenously —> 9 (65) 0.9% sodium chloride intravenously NaC | te 5% slbumin intravenously DS Water enterally Intensive Care Department with decreesed sure is 64/42 mm Hg and his serum sodivm ved orpispatey teh nogemen? SO Ge weetel /L Lenerctynoveaiel be ser 8. Which of the following statements BEST reflects chro 6 ‘Tachypnes,-pH 7.48, PaCd, 28.mmlig. HCO, 24-mi Techypnea, HZ S7.PaC0s 28H, Hs 16 ‘Fachypnee; pIF7-28; Pao, S0'inmiig: HOO tr { -TocnfpnesspH 46, Poses St ml, HODES a pid norroab(G, se-4? Ha, w-w Febrary 4, 2008ote) ZZ via high-low reservoir mask, the patient 40. Despite continued administration of supplemental oxy ig measured SpO> falls to 81%, Which of remains tachypneic and develops significant agitation '2 following statements is LEAST,CORRECT? i] Control agitation and tachypnea with intravenous » Performa STAT high resolution (spiral) CT scan td felure. \@ Begin noninvasive posiiive-pressure ventilation, 7 Switch to an air-entrapment face (Ventur) mask tq from 50 to 90%. prphine administration. ule out a PE es the cause of respiratory eran /cp ae prove the fraction of inspired oxygen (FiO2) 11. Which of the follawing statements ls TRUE regarding tient? : ‘Metabolic acidosis is one of the MOST important ffi Dine easing sefum carbon dioxide (CO) andlor a fidened ation gap octe=te metabolic alkalosis, C. Anarterial blood gas (ABG) is rarely helpful in ety il patient. D. Lactic acidosis occurs only with severe sepsis oO Questions 12 end 13 are based on this patient scenario. dfonic lung disease, and a recent upper implaint of progressive dyspnea over the last ind in moderate respiratory distress with has audible expiratory wheezes with & ZELCIAL in the initial management of this patient? the [psven sk Cheese By reets tare Oa ‘A62-year-old female with a long history of tobacco use, respiratory tract infection fs admitted to tie hospital with “2 hours, On exaininations she is noted to be awake, eccessory muscle use diiring inspiration and expiration. respiratory rate of 30/min and is afebrile. - 42. Which pharmacologic edjunct would be MOST BEN' A Arosolized racemic epinephrine — OVS ‘Trenstrachea! lidocaine Inhaled By-agonist (albuterol) f. Acetyloysteine 1s progressive respiratory fallure and het Oxygen. Vital éigns are respiratory rate i iormin. An arterial blood gas is obtained with {6.2 kPe), PaGO, 65 mm Ho (7 kPa) and ARRECT regarding the initiation of noninvasive gi i regarding the inflation of nomenneap 43. Despite significant medical therapy, the patient de oxygen saturation (SpO2) is now 85% with suppleme 34/min, blood pressure 475/80 fam Hg, end heart pt 32, PaCO2 | ‘65 mm Hg (8.7-kPa), PaO; 52. HCO; 34 ‘mmol, Whict of the following is MOST nostive pressure ventilation (NPPV) in this patient? aay De required if ventilatory goals 2 not reached within the first 4- to 6-hours of be adjusted to obtain a tidel volume (Vr) of lott Liy to improve in the next 48-to 72-hours43, The pravious ABG is MOST CONSISTENT with afan: dA, Acute metabolic acidosis 8” Chronic metabolic alkalosis 5. Sheonec respiratory acidosis nie respiratory alkalosis ge tayprCRN I cle crash. He was ejected from his cer ‘of an open femur fracture, the patient ming the change in patient mestal old intoxicated male is admitted after a motor v4 Jd transient loss 6? consciousness. During stabilizaty Vomits nnd suddenly becomes unconsciousness. After co i, which is the MOST immediate action to take? Valuate blood pressure and peripheral pulses. Repoat pupillary exam. Reassess the scalp for additional injuries. Reassess patency of the airway, went s 21. Adecrasses sevar CoH affect which of the folowing? A Stureased delivery oF oxygen! Dacréased consumption © ig increased delivety of oxygen’ Increased consumption © sineryfncreesed consumation creased delivery/Decreesed consumption 22-26 are based on this patient scenario, uiin-cepondent diabetes metitus is Im swelling after cutting her hand while right arm is noted tohaveeninema, sy § pirtory rate 32/min, blood pressure etrate 132imin. er oxygen saturation 7 1-9 er laboratory workup reveals glucose of a aid old 90 kg, female with a history of poory controled i ‘mitted tothe hospital with a fever, altered mental satus anc! siiking outsiee 24-hours pricr to admission. On examination, nd air in the soft tissue. Viel signe are Se SEF aitenal pressure (MAP) 44 mm Hg, and hy Spo) 6 2224 on 200m ale. She appears to be disorientod and 2p migiet (13 8 rimoldl, wile blend cell (WBC) count 23.4 22, Whict of the following stetements regarding her immecia «A Wirnholé antbiatic therapy untl e MAP of 60 mm Hg perfusion a ® Forus on soune exfire! and perfusion enhancement ( {CvP} monitoring ane measuroment of SovO3). © Gogin a vacopressor such as norepinephrine or dopa Jeniniter 100 mom hydrocortisone IV within 1 mine anagementt is TRUE? piained ensuring adequate tissue fasciitis garding her management is TRUE? J5 fiactam/S-lactamase mhibitor romptly initiated prior to surgical ‘A surgicel consultation is obtained and 2 presumptive diag| javolving the right arm, Which of the following statements E:npicic antibiotic selection could include vancomycin ‘Antifungal therapy including amphotericin B shoul be Aubridement ‘Gan alternative consultation should be sought since ne Hus patient 5. Appropriate antibictic therapy should be initiated imme 10 48-hours. Jing fascitis is untikely to be present in ately and surgical debridement delayed ebay 6 20087 and 28 are based on this patient scenario, Questions: A 22-year-old male is edmitied to the hospital after a mot sustained obvious dernage. Cn examination he will no of incomprehensible sounds and withdraws but does not loc: deformity of his left thigh. Vital signs are respiratory rate yycle accident, He was wearing a helmet that n his eyes to painful stimuli, but makes fe. In addition, he is noted to have 2 imin, heart rate 88/min and blood pressure high-flow oxygen by facemask & oNby

determine the patient's preference 9 Jo of the “worst headache cf his life” with hnoid hemorrhage (SAH). Which of tl compiications with SAH? le treated aggressively. 5o,h P-yonras ale asta to the hoa compia © computes mograpy (Cl) sean deroratat #50 ‘Shown sstartria MOST CORRECT regen A fypematariaeconmony encountered and sel 6 Scere, “4 burysm is clipped or o: Rebloeding is a major early Complication url he Htively igins cerebral blood flow pre op: Hypertension is ter falling from a roof. On admission, he Jed tomography (CT) scan. No intubsa the unit, he is observed to have a MOST CORRECT regarding his seizure’? istered as rapidly as possible if seir ves 31, A 24-year-old male is admitted to the intensive care uni was found to have a lef frontal lobe contusion on com] p (ICP) exceeds 20 mm Hg. b, administered at the onset of seu i No drug therapy indicated unless intracranial pressi =) intravenous benzodiazepine, such as lorazepam 2 | XS setivity may terminate the seizure On 9] Df Intravenous neuromuscular relaxant, such as vecurfifium 10 mg, shduld béadiMnisterod de cerebral oxygen requirement 32, Which ofthe following statements is MOST CORRECT [garding the presentation of the imure Jood loss of 30-40% of total biooxt va 40% tote blood vou jen Giron eft cad shock, typically with} The anrious petent ypiclly has messive Bows Ios © Early doath ater jury is yploaly due to severe hy D. The an: d ihe ansigus patient Woieglv hes veda el Febnumny 4, 2008following are expected changes in physiology during Decreased blood pressure in the fipst trimester 2° increased cardiac output by 28% in third trimester SY - 1 ©} Decreased functional residual capacity of 25% 78. bp systolic murmurs 39. An 18-year-old healthy female university student is admit ish ie ‘olen statements MOST CORRECT ce Ae Spins coverage th vancomycin fo Staphieeoccu 2 [Bbipi meningidesin the CSF cutee shout be tested vf ‘lisera mopocylogenes frosted wih arp oi PAP raiercic. * 3 Bier ray mute tite survival benef ]with 2 history consistent with meningitis, ding antibiotic therapy? ureus ts indicated. high-dose penicillin G. ler. phoprim-sulfarnetnoxazole if penicilin- o the iumbar gincture and gram stain to obtain the best 140. A 76-year-old female with past history of hypothyroidism a] Jeepartment with hypothermia and altered mental status Sees er iig. respiratory rate t2iminute, HR 42iminute, Pe patient has not filed her levothyrox Sresenption for 2 months and is manifesting signs and syrgjtoms of exacerbated hypothe idism. i Semon to tnyrorine 1V, intravenous flué resuscitation andjkassive r@-werming measures, he Pak should receive as Mannitol 80 gms, IV STAT G® Hydrocortisone 100 mg IV every 8 hours ‘Temporary trensvenous pacemaker Narcan 1 mg IV slowly | ciabetes is brought to the emergency cial temperature is 92° F (33° C), BP 4+, A So-year-old femate with a histery of major depression pr a Mian othor sizes they had 2 fight two hours ago anc} Seeils and he will be somn.” Fe found two empty acetam sogpitalst aocepted the patient 2s a direct admit four houg noseieeion fre which action wit NOT be considered 8&4] ‘pa. Unie crug sereen with acetaminophen and saliyiste Nesogestic tube insertion with gastric lavage ate the patient for alnvay and hemodynamic compromise __ D. Use ofn-acelyleysteine for possible acetaminophen tg ts with @ possible sutct "ewig him that she would “take a bunch bohen bottles on the bathroom floor. [siier the ingestion. Because of the delsy « following are laboratory features of preeclampsia EXG AlTsou ong, NCC Normat glucose increased fibrinogen level ‘V/T Normal bifrubin Ny/ # — is yn owen 43. 4.30 year-old female, pregnant, 40 weeks gestatio ‘ltered mental status and seizures. Her vital signs 2 “Saturation is 88%. The MOST LIKELY diagnosis is ©, A. Postpartum cardiomyopathy for the last 14 hours, suddenly dev 0/40 mm Hg, heart rate +20/mnia, and B Preeclampsia G. Venous air embolisi BY Amniotic embolism / eeu 4, 2008fered an acute NSTEMI and Lon the ventilator for over 1 week. After he Bost pin wih ambulation and wes fund 0 ibcutaneous heparin for prophylaxis prior to normal renal function and platelet count. ment option for this patient? 49, An elderly male with a histony of prostate cancer who s cardiopulmonary arrest developed severe ARDS and was extubated, he complained of sudden onset pleurit have a pulmonary embolism on helical CT. He wes on] developing the PE and was hemodynamically stable ‘Which of the following would NOT be an acceptable tre Full dose unfractionated heparin Prophylactic dose low molecular weight heperin & Taferior vera cava (IVC) fier high risk for bleed D, Full dose low molecular weight heparin with @ subarachnoid hemorrhage after @ ‘rato’ vehicle crash. On exam his initial Glasgow Con Score (GCS) was 8 with labored Tapirations. He was Infubated in the emergency depgjgment and nowie on rechanical ventietory 7 Sunpom. Shorty efter atvel tothe unt, his pulse oxiigter (SpOz) réads 57% heart rate of Aire SVERe patent fs pulseless. Which ofthe folowing stalments is the safest and MOST immediate wethod to verify CORRECT endotracheal tube placergnt?? ‘Auscuttation . Manual bag mask breathis Oper Eialed 002 monte ng GDB 'D: Portable chest radiograph 4 50, A 27-year-old male is admitted to the intensive care