1. Which Enzyme is found orly in myocardium?

A LDH
8 Myogoibin
Trooonin T
Srooonin
of the following evaluation
2. ATter a car accident a patient with muitiple injuries is brought to ER, which
Findings demandrapic intervention

irreguiar apical ouise

Unequa pupiis
1Deviated Trachea
O. Ecchymosis in the flank area

3. Features of wet gangrene

A. Most commoniv seen in the bowel
invariabiv foliowed bv severe burns and frost bite
venous obstruction
nAlof the above

4. Normai or elevated biood sugar at night decrease at around 2-3 am and then a subsequent increase is
calied
Somogyi effect
Dawn effect
C. Cushing effect
D. Menmory effect

5. Tvpesof insulin rapid acting. short acting,intermeciate acting, icng acting

True Jnsulins
B. False

6. Accumuiation of pus in pleurai cavity is known as

A. Chylothorax
B. Pneumothorax
YEmoyema
D. None of the above

fluid is
7. The cause of amber coiored pleural

hubercuiosis
Cardiac failure
Acute pancreatitis
D Obstruction of thoracic duct
 8. Acute hypoxemia presents as

Restlessness and confusion

Hyper ventilation
C. Tachycardia or Bradycardia
e All of the above

9. Advantages of oxygen therapy

Optimize cardiac output

improve lung condition
Recuce oxygen demand
D. All of the above
10. ECMO serves as bridging therapy and not a curative therapy

Yes
8. No

11. The goals of initiaf resuscitation are all except

A CVP 8-12 mm Hg/12-15 mm Hg intubated patients

B. MAP> 65 mm Hg
C. Urine output> 0.5ml/kg
Hematocrit< 30 %
sepsis except
12. The following measures are useful in managing SEPS13
A. Measurement of lactate
spectrum antibiotic
B. Fariy initiation of adequate broad
IV vitamin Cadministration
D. Sourcecontroi

13. The newBy added standard

precaution is
Slondood peccauhong
A. Biomed wastage management
B. Handling of sharps
Respiratory hygiene &cough etiquette
D. PPE and hand washing
environmental cieaning
E Equipment and

14.Purpose of patient record is

A
Communication/ Education
3 Care plan
C. Auditing
D. Re- imbursement
 Lega!document
All of the above

15. Which of the foliowing statement is false

pakene
Lioics provide 4 Kcalenergy /gm
Energv requirement is 25-55 Kcal/kg/day Raisotans
Protein requirement 1gm/kg
Water reauirement 1ml/cal

16. Life threatening emergencies are

A Hypotension
Hypoxia
Arrnythmias
Severe Hynokalemia
All of the above

17. Errors in medical practices are all except

Single person is responsible for any error

Critica! decisions are coliective mind applications of care givers
Fauity action is a product of flawed thinking across the systems
system
identify and evaiuate the vulneratbilities and flaws in the

18. in a 12 lead ECG al! are the true except

leads
A 3 imb leads, 3 Augmented leads, 6 Precordial
a rate of 25 mm/sec
ECG is recorded onto standard papes travelting at
measuring Smm wide, equivalent to 0.25 second
Paper is divided into large squares , each
each small square is 1 mm wide and equivalent
Each large square has 5 smallsquares in width,
to 0.04 second

physical restraint
19.Which of the following is not considered a
Sedation meditation
pAYOICA RESTROT CHENICEÐ} RESIE)NT
Generic chair
Side raiis
Vest restrain

every
who is in iong restraints at least
20. You should check a patient

A Shift
2 hours
C. Hour
D. 15 mins
 21. Nursing management and assessment of dengue patients includes
A Evaluation of vitals
Evaluation of skin color
OENGOk
Measurement of urine output
Evaluation of bleeding manifestations
Al! of the above

22. Fire, Expiosions, Minor spill is CLoUR

Co DES
A Code Blue
Code Brown
Code Orange
D. Code Black

23. Which of the foliowing is not a component of FAST HUG

A Feeding P8T HUG B)D.

B. Analgesia
Secretion handling
Head end elevation
E. Ulcer prophylaxis

24. Allof the folowing practices are used to prevent bed sores

A Use of Nimbus bed ’ BED B0RES

B Frequent position change
C. Keeping skin clean as dry
Inadequate nutrition

pain in
25. Behavioralpain scale is used for assessment of

Awake non ventilated patients ’BcAES FOR POIN

A.
Ventilated patients
C. Can be used on both patients
D. None

assessment is used for

26. Modified Morse risk

A Sedation assessment
Pain
C Fal! risk
Pressure ulcer risk
D.

antibiotic is renal safe

27. Which of the following

A Vancomycin
Clindamycin
 Amikacin
D. Metronidazole

28. Claustrophobia is
phechiat,.
Fear of pain
Fear of darkness
Fear of heaith
Fear of closedspaces

29. Which is the first medical treatment for type 2diabetes

A insulin
8. Suifonylurea
Metformin
D Glitazones

30. Which of the foBiowing is false

A. Life spam of RBC- 120 days

B

D.
M
Life spam of WBC- 10-15 days
Smallest WBC- Monocyte
increased RBC count- poiycythemia
kaukoye
31. Pinpoint pupils are seen in except

Diabeies
Miotic drops
Pontine hemorrhage
Batoptib
Atropine

32. Beil's Paisy is paraiysis of

A Cranial nerve !! Crartia Newes

B Cranial nerve iV
Crania nerve V
Crania! nerve iH

33. Which statement is false in Hypothermia

A Stupor Coma
B Lethargy
Arrhythmia
Seizures

34, infat emboiism allare true except

A. Fat in urine
 History of fractured long bones
C Hypercholesterolemia
D Bat wings in CXR PA

35. Infection detected by PAP smear are all except

A HPV, HSV
B Bacterial vaginitis
Trichomonal vaginitis
D. Candida
E Armoctriasis ?

36. Vaccine types

A. Subunit
B. Toxoid
Live-attenuated
D Recombinant
E Killed inactivated
F Allof the above

37. Following organisms cross except

A Syphilis
B Toxoplasmosis
C HIV
D. CMV
E. Herpes
F. Hepatitis B

38. PCOD causes all except

A. Hirsutism
B Infertility
Resistance to insulin
C
Decreased production of androgen

39. E-coli causes all except

F-Cot.
A. Diarrhea
B. UTI
C. Synovitis
Gram negative sepsis
D. Neonatal meningitis
E.
 40. Which of the following is aíalse statement
A Avoid use of neuro muscular blocking agents in patients at risk for seizures
in the abserce of papiledema and íocal neurological signs lumber puncture can be done without prior
CT scan for detection of meningitis
C. Anterior myocardial infections are more tikely to Bead to cardiogenic shock
D. Hypothermia is a good prognostic signs in infections

41. Which of the foiowing statement is false

Hyperkalemia with ECGchanges is an emergency

Causesof Hyperkalemia is Hyper Ventilation
Rapid correction of sodium causes myelinolysis
D. Eariy uses of antibiotics will reduce mortality
42. Beta blockers protect the myocardium and reduce myocardial infections

A. True
3. Faise

43. Anterior Mi more likely to lead to cardiogenic shock

A. Yes
B. No

44. Amikacin causes renai failure

Yes
3. No

45. Raised Intra Cranial Tension is a contraindication for prone ventilation

A Yes
B. No

46. Assessment of deep vein thrombosis is done with which score

A. CURB 65
Well's Score
C. Q
SOFA
D. RIFLE criteria

47. Which ofthe following is nota anticoagulant

A. Dalteparin
B. Aspirin
C. Recombinant tissue piasminogen activato:
D. Apixaban
 except
48. Medicines used for Anxiety and agitation

A Benzodiazepines
B. Propofol
C. Dexmedetomidine
D. Ketamine

49. First choice of vascular access for dialysis

A7Rignt internal jugular

B Femoral
C. Subciavian
D. Left internal jugular
patients resting energy expenditure
50. Which of these conditions does not increase a

A. Infection
B. COPD
C. Starvation
D Burn

should be monitored for

51. Patients who have had resection of the ileum

A Iron deficiency anemia ucr

B. Deficiency of fat soluble vitamins
C. Calcium and phosphorus deficiency
D. Vitamin B12 deficiencyTem
52. The intake from food is not monitored in renal patients

A Vitamin D
B. Fluids
C. Protein
D. Sodium

statemntjs false
53.Which of the following
hormone
A. Adrenalin is a constriction
causes broncho
B. Adrenalin
increases blood sugar
C. Adrenalin duration of action of xylocaine
D. Adrenalin is used
to increase the
is
importance stage of the nursing process
54. The most

A. Evaluation
B
Assessment
C. Planning
 implementaton

55. Which of the following cells of the body are in almost corstant mitosis
(division)
Nerve cel!
Stemach cell
C Muscle cel!
Renal cel!

56. Asthma is caused by

A Virus
Bacteria
Fungus
Nonof the above

57. Troponin is a

Cardiac enzyne
Bacterium
Fungus
Type of x-ray

58. Whnat is the most important test for iron stores

A Serum calcium
Serum ferritin
Serum iron
None of the abce

59. Plateiets are produced in

A. Large intestine
Liver
Bone marrow
D. Small intestine

60. A50 year oidwoman is brought to the hospital for abnormai mental status change during the past 6
nours. initiaily she felt dizzy andnauseated and feit asieep. The husband then called the ambulance as she
was not waking up. She received fluids, naloxone, thiamine and dextrose enroute to the emergency
department without improvement. Her temperature is 37C, BP 150/102 mm Hg, HR 110/min and RR 10
i4/min and oxygen saturation 92% on 2L 0; by nasal prongs. The patient is lethargic with GCS of 8.
Abnormai asynchronous fast tonic movements of the arms andlegs are also noted, The patient is intubated
and ventilated. CT scan shows hyperdense signal at the level of the basilar artery. b l e o d

Which of the foliowing interventions is the most appropriate at this point?

s t r f a s

itypesens

y p r k r t s e
 Systemic thrombolytics

immediate IV antibiotics

N phenytoin

D Local thrombolytics
E intracranial pressure monitor

61. A 72-year old man was admitted to the ICU2 weeks agowith a left basal gargia hyoerten$ve
nemorrhage without intraventricular extension. The gatient has a medical history for COPD, HT3nd
hyperiipidemia He remains in the CU on MV. On examination, he remains hemiparetic over hs gt sce
Lower extremity USG reveals a right femoral DVT.

Which of the following interventions is most aopropriate in this patient?

o Nb
omu )

A. IVC filter
v e i o

Localized thrombolytics

IV heparin (goal APTT 1.5-2 times baseline)

D Antipiatelet theragy
E Warfarin (goal INR 2-3)
62. An 18-year old male is brought to the emergency department after a motor vehice
crash. He was
intubated in the field with cervical spine in-ine immobilization and given iV fiuics. On arrval to the
emergency department, he was hypotensive and received another 4L of iV fuics with marked imorovement
in hemodynamics. On arrival to ICU, his GCS is 6.

For which of the following intervention is there the strongest evicence for reducing this patent's mcra
risk?

Avoidance of hypotension

B Decompressive hemicraniectomy

Hyperosmolar therapy

D. Induced hypothermia

E. Intracranialpressure monitoring

63. A 48-vear oid man was admitted to the trauma KU after multiorgan truma. He had a iractured temur
with "open book hip fracture and severe traumatic brain tnury. he ortopedic surgeons have recared bis
 receiving
inserted an intraparenchymai 1CP monitor. Currently he is
have
injuries and the neurosurgeons temperature is 37 C, BP 155/104 mm Hg, HR
110/min and is Cver
midazolam and fentanyl infusions. His symmetrically with
ventlator. His pupils are 3 mm bilaterally and reactive and he withdraws
breathing the H,0. ABG reads pH
remains elevated at 30 degrees but the ICP monitor is reading 35 cm
both arms. His head
7.38, PaCO,43 mm Hg, PaO, 110 mm Hg
decrease his iCP is:
The next step to attenpt to

Ainmmediately give bolus of 20% mannitolsolution,

0.25-1g/kg over 5 mins <J5anH,0
hypertonic saline solution, 20miover 10mins
B. Immediateiy give abolus of 23.4%
and increase sedation and analgesia
C. Immediately give a bolus of fentanyl 50ug

D. Target PaC02 to 28-35 mm Hg

E. Start mild induced hypothermia to 33-35 C

characterizes the appropriate method of measuring CVP?
64. Which of the following statements best
wave
A. CVP should be measured from the base of v
end-inspiration if
end-expiration if mechanically ventilated and
CVP should be measured at
soontaneously breathing
measured distension of jugular veins reiative
. 2.\ CVP can be estimated by adding 5cm H0 to the
to the sternal angle
are
reference levelfor CVPmonitoring, measurements
D. If the midpoint of the right atrium is used as
oniy reiiable when the patient is supine

contraindication for Intra-aortic balloon pump?

65.Which of the following is a reiative
A. Aortiçdissection

.Severe peripheral vascular disease

C. Aortic vaive insufficiency

D. Patent ductus arteriosus

for
in the calculations of appropriate tidal volume
66.Which of the following patient date are utilizedrecommendations?
ARDSnet
apatient with ARDS in accordance with
A. Body mass index
 Height
D. Age

A50-year old woman intubated 7 days for pneumonia and sever

sepsis is being evaluated for
67.
with a tidal volume
weaning from ventilation. Current ventilator settings include volume-assist mode
sedative or vasoactive
of 450ml, rate of 14/min, FiO, 0.35, PEEP 5cm H,0.She has stable vital signs off
drips and is awake and able to follow simple commands. Her hand gria is weak bilaterally, lungs are
25/min with an
clear and HR is regular. She is placed on CPAP for 3 minutes during which time her RR is
average TV of 350ml and a negative inspiratory force measured at -30cm H,0. An ABG study is
pending.

Which of the following is the most appropriatecourse of action regarding this patients's weaning trom
mechanicalventilation?
A. Patient should not be extubated as she is likely to failextubation
tshould be placed on pressure support ventilation of 5 cm H,0 for 120 minutes
C. Patient should be extubated at this point without further action

D. Patient should be extubated andplaced on noninvasive ventilation

E. Patient should be extubated based on ABG results

68. A60-year old man presents to the emergency department with acute onset shortness of bçeath and
chest pain. The patient has a recent diagnosis of colonic cancer and had a colectomy &days ago. He
has amedical history of hypertension and type 2 DM. On physicalexamination, he is alert with mild
respiratory distress, temperature 38C, HR 122/min, RR 24/min, BP 130/80 mm Hg. Patient is 120 kg in
weight. Oxygen saturation is 90% on oxygen support. Lung auscultation is normal. ECG shows sinus
tachvcardia with no signs of cardiac ischaemia. CXR is non contributory. Serum creatinine is 2.5 mg/d!
(pre-op was 1.2 mg/dl)
Which of the following is the most appropriate initial management?

A. CTangiography prior to initiating treatment

B. IV unfractionated heparin, 80 U/kg bolus followed by 18 U/kg/hr infusion
C. Subcutaneous enoxaparin 120 mg/kg every 12 hours
D. IV argatroban 2mg/kg/min 2100 U/h
E. IV unfractioned heparin 9600 U bolus foilowed by

followinga collision of his motorcycle with

69. A25-vear old man is admitted to the lCUfor observation
workup is in progress.
atree. His GCS is 10. His neurologic
posttraumatic seizures are contraindicated in which
Anticonvulsants to prevent the occurrence of early
situations?
of the following clinical
 A. Deoressed skull fracture
8. Suboural hemorrhage

C.SAH

D Penetrating brain injury

E. Cortical contusion

70. Which one of the foiiowing wii increase

plateau pressure in a patient receiving continous
ventilation for pneumonia? mandatory
A. increasing tE ratio to 2:1

B. A decelerating flow pattern

C. An acceierating fiow pattern
D. increasing the inspiratory fiow rate
E. Increasing the set tidal volume

71. You are asked to evaiuate a 52-year-old diabetic who is admitted with 2
days of fever, cough and
diarrhea. On admission, the pulse is 132/minute, the blood pressure 80/60 mm Hg, and the
respirations
32/minute. The mucous nembranes are dry, and there are crackles throughout the right iower lung
field. The following iaboratory studies are reported: Arterial biood gas measurements:

pH 7.38, PaCO, 40 mm Hg, PaO> {room air) 54 mm Hg - 35 pt.

36by5
Na140 mEq/t, K2.8 mEq/t, C! 100 mEq/L, HCO3 13 mEq/L
Which of the foilowing is the correct interpretation of this acid-base disorder? HCog 22 tozb.

inconsistent and uninterpretable data

B. Norma! acid-base status
Metabolic acidosis with appropriate respiratory compensation
D. Metabolic acidosis with respiratory aikalosis
E. Respiratory acidosis with metabolic acidosis

72. Whicih ONE of the foilowing is the most useful indicator when considering a diagnosis cf
massive puimonary embolism?
A Afall in end-tidal CO2 to 9.75 mm Hg
Apuimonary artery pressure of 20/10 mm Hg aitom.
C. An oxygensaturation of 85% onroom air
An arterial blood gas showing a Pa0, of 46 mm Hg on room air
 E S;Q:Tspattern on the ECG

73. identify the ECGrhythm

A. Asystole
B. Ventricular fibrillation

CTorsades de pointes
D. Puleseless electrical activity
E. Ventricular tachycardia

74. A 43-year old man ingests approximately 20 grams of acetaminophen in a suicidal attempt and is
treated with NAC. inthe hospital, he develops acute liver failure, becoming stuporous within 2 days of
admission. Hisammonia level is 150 mg/dl. AnEEG is performed sinowing diffuse slowing but no seizure
activity.

Apart from liver transplantation, which of the following interventions is most likely to prevent
neurologicaldeterioration?

A. Prophylactic antiepileptic drug

fetanicoman NS
Broar
B. IV corticosteroids

C. Hyperosmolar therapy

YAriose for correction of hyperammonemia Arencorio

Nesmal hluo y G-45,
75. A 60-year old man is admítted to the iCUafter cardiac Surgery. Findings of physical examination and
chest radiography are consistent with pulmonary edema. A vasoactive drug is administered.
I)-32ym)1
 Paramneters On admission After therapy
BP 100/64 88/50

Mean right atrial pressure 23 15

Pulmonary Artery pressure 48/26 40/20

PÁOP 26 18

C 1.6 2.8

HR 110 119

Which of the following drugs was administered?

A. Nitroglycerine
irinone
Adherale
C. Dopamine

D. Norepinephrine pobutarirg
T9oprengro
Ropekamine
76. Which of the foiiowing patients best meets criteria for sepsis-3?
cholecystectomy for acute
A. 59-year old man hospitalized for 2days following laparoscopic culture positive for
cholecystitis who deveiops fever to 38.5C, WBC count of 14,000/uL and a urine
E.Coli

B. 41-vear oid woman with diabetes and perineal pain,

fever to 38.9Cand a biood glucose level
above 400mg/d!
108/min, BP 105/70 mm Hg, RR 22/min,
C. 70-year old man admitted with pneumonia with HR of
urine output of 10ml/h after normal saiine
positive sputum cuiture for klebsiella pneumonia and
3litres

. p4s-year old man with gram-positive bacteremia and persistent hypotension despite 5
norepinephrine infusion
itres of lactated ringer so!ution and high dose

Kaprortyén.
pre-eclampsia (BP 190/120) at 30 weeks' gestation.
77. A 29-year old presents with severe platelets 87,000, SGOT 115, SGPT 93, ALP
Pertinent laboratory values are : hemoglobin 10.1,
and she is admitted to the ICU.
55. A magnesium infusion is started with iV hydration
further management of this patient?
Which of the foBlowing is the best approach for
systolic BP is greater than 160 mm Hg
A. iV hydralazine as needed whie
 BP is greater than 160 mm Hg
B. IV enalapril as needed while systolic
systolic BP less than 160 mm Hg
C. IV labetalol infusion to keep
section
D. Emergent cesarean

and requires
year old man is admitted to the ICU for sepsis and multisystenm organ failure
78. A S2-
output.
a urinary catheter for accurate monitoring of urine
infections?
prevent catheter-associated urinary tract
Which ofthe following strategies help to
ASterile equipment and aseptic technique for catheter insertion
with antiseptic solution after catheter insertion
B. Routine cleaning of the urethral meatus
promote reflux of urine into
C.Keeping the collecting bag above the levelof the bladder to
the bladder and not emptying it routinely
agents into the collecting bag
D. Bladder irrigation and instilling antiseptic or antimicrobial

type 2 DM and HT is admitted to the

79. A 63-year old woman with a past medical history of and
Initially she is hypotensive
ICUwith a diagnosis of community acquired pneumonia. of normal saline.
hyperglycemic. However her blood pressure normalizes with a bolus
and mechanical
Unfortunately her respiratory status declines, requiring intubation
showing many white
ventilation. Shortly after intubation, BAL 0s performed, with gram stain
most appropriate initial
yeasts. The
blood cells, many gram-positive cocci in pairs and few
therapy for this patient is: QPC
A. Vancomycin and piperacillin/tazobactum
penfai
B. Ceftriaxone and azithromycin
C. Ceftriaxone and fluconazole
Vettorys.
D. Levofloxacin and fluconazole
qecoplonth
optoieyh.
acute
generally healthy, 64 year old man presents to the emergency department with
80. A
hypotension. Due to ankle sprain, he has been taking ibuprofen. After initial
hematenmesis and and
and initiation of an lV proton pump inhibitor, the patient is stabilized
resuscitation hours reveals a
esophagogastroduodenoscopy performed within 24
admitted to the ICU. An clot on the lesser curve of stomach. This
visible vessel and adherent
1.5cm gastric ulcerwith a cautery. Two days later, the patient develops
epinephrine and heater probe
istreated with hematocrit and melena.
tachycardia, a drap in
acute hypotension,
stabilization, which ofthe following is the best next step in
After resuscitation and
management?
 Urgent surgicalintervention
immediate CT of abdomen and pelvis
C. IVoctreotide
Repeat EGD
E Angiography

81. A 50-year oid man with alcoholic cirrhosis and MELD SCore of 20 is admitted to ICU for
management ofunexplained hypoxemia. His ABG onroom airshows pH 7,43, PaCO236 mm
Hgand Pa02 55 mm Hg. The patient describes dyspnea when he is moved from supine to an
upright position. His CXR is normal and a low probability ventilation-perfusion scan.
The next diagnostic test for the evaluation of his hypoxemia should be

A. Transthoracic echocardiography with a bubble study

BVcontrast enhanced chest CT ABy ches) Srogg
C. Dobutamine stress echo chest x*ay
) PCoz
) Cardiac MRi Rop mechanicg 3) PH
E. Bronchoscopy pinoTthy venoien
Respnus,do piSUg NUy-Na vdutey
Vantibin
HIp(Ha Ep
folEP(ar Thsp
bro&i.
82. Which of the folowing ia an advantage of using CVVHDF rather than IHD in criticaly ill
patient with acute renal faiiure?
CWHDF-e Vertovertou
A. Lower cost
B. Improved mortality henodeaftaYor
C. Reliabie antibioticdosing CUVHDE:
D Hemodynamic toBerance
E. Effective solute removal
ylhahalien
adeosphèr critically ill patient?
83. Which of the following is required before initiation of enteral nutrition in
LAPresence of bowe! sounds
,B Bowel movements
C. Hemodynamic stability
D. Placement of jejunal feeding tube

documented history of alcoholic cirrhosis

84. A65-year-old alcoholic with a previous
ascites, low-grade
presented with a 2-day history of increasing confusion, tense
noted]Paracentesis indicated
temperature, and malaise, Renal insufficiency was
After the initiation of therapy with a third
evidence of spontaneous bacterial peritonitis.
wouldyou do?
generation cephalosporin, which of the following
 A. perform a therapeutic paracentesis
B. initiate therapy with albumin
C. start diuretics
D. begin dopamine
E. search for a liver donor

oedema and
35. A30 year old pregnant women at 34 weeks gestation presents with pedal
5mg/dl; ammonia 70mg/di
hypertension. Laboratory data include BUN 22mg/di.ALT 3500/L;BILIRUBIN
slightiy lethargiC
;WBC 19,000/cmm ;PT 20.2 sec;and PTT 45 sec. On physical exam she is noted to be
withfew basilar rales bilaterally and a small liver on percussion.
Which one of the following is the most likely diagnosis?
(Pnam)
A. Viral hepatitis

B. Severe pre-eclampsia
HELP H - Hetdys
C. HELLP syndrome
1P- too phelat Counb
D. Acetaminophen overdose

Miornastuo
E. Acute fatty liver of pregnancy

statements
86. According tothÇ 2012 surviving sepsis campaign guidelines, which of the following
about interventions to be completed within 6 hours of triage is correct?
atleast 50mm Hg
A. Use vasopressors as needed to maintain mean arterial pressure of

,BMeasure CVP and central Scv02 for patients with persistent arterial hypotension despite
resuscitation or initial lactate levels of at least 4 mmol/L
should be at least 6 mm Hg
C. CVP target for quantitative resuscitation
resuscitation should be at least 60%
D.ScvO2 target forquantitative

a critically ill patient is

87. Non caloricprotein requirement in
A. 0.8g/kg/day
B 1.0g/kg/day
C. 1.5 g/kg/day
D 2.0 g/kg/day
E. 2.5 g/kg/day

CD4 count of 150-200 (x 106/1)

risk of infection in an HIV positive patient, a
88 In assessing the EXCEPT:
to the following infections
predisposes
 A Tuberculosis
.B. Bacterial pneumonia
Oral candidiasis
CMV
E Kaposi sarcoma CAA tounks
orcoHo
USualy CHvR deuclera
89. A50- year old man is brought to the emergency department bparamedics after collapsing at a
tennis club. Abystander provided CPR and on arrival to the scene the paramedics successfully
cardioverted the patient from ventricular fibrillation, Patient is now unresponsive to stimuli and
receiving mechanical ventilation. His temperature is 37.4 C, HR 110/min, BO 140/82 mm Hg and RR
20/min.

Which of the following interventions is most likely to improve neurologic outcome in this patient?
A. Amiodarone

B. Normothermia

CPrimary seizure prophyiaxis with fosphenytoin

D. Hypothermia (32-34 C)
E. Beta blockade

preceding 24
90. A40-year old man is admitted to the ICU with progressive inability to walk during the
hours.His BP is 140/80mm Hg, HR 88/min, RR 20/min and afebrile. He is alert and oriented but reports
in the
cramping pain in his iegs bilaterally with paraesthesia. Neurologic examination shows 2/5 strength
and knee deep tendon
proximal and distal muscie groups of the lower extremities and absent ankle
extremities and cranial
reflexes. Rectal sphincter tone is normal. He has normal strengthof his upper
nerves are normal.

neurologic
Which of the following interventions is the most appropriate initial therapy to improve
outcome with the ieast adverse effects?

A Plasmapheresis with concomitant IV immunog!obulin

B. Piasmapheresis foliowed by IV immunoglobulin
Yimmunogiobulin alone
D High dose corticosteroids

65-year old man has suffered adevastating iCH.AnEV

91 A was inserted forhydrocephalus<and he
receiving norepinephrine at maximum doses to keep a
remained in iCUfor 12 hours. He is cufrently
is 300ml/h. On physical
mean arterial pressure greater than 65 mm Hg and his urine output
Sp02 98% and temp is 36.2
examination, his BP is 98/58 mm Hg, HR 118/min, RR 16/min on ventilator,
ocuiocephalic reflexes. Gag and cough reflex are
C. His pupils are 5mm nonreactive with no corneal or results but at this time
after 6 hours and finds similar
aiso absent. The team repeats the examination
 Malooitehes
Jneuntey

tasciculations are present in upper andlower extremities On the basis of his neurological examinaton
findings, the team should
A. Perform an
apnea test
B. Continue ongoing therapy and have a family
discussion
C Declare him brain dead
D. Activate organ
donation network
ERewarm the patient to 37 C and repeat examination

92.Thegersistent vegetative statejs characterized by:

wsleep and awake cycies
B. Organized EEG patterns

CAbsent N20 responses on SSEP testing

Poy outtoe q
D. State of

E.
awareness
Purposeful motor function
SoNATOSENGORY EvoRED
PeTENTA"

93) An otherwise healthy 17 year old boy who tripped and fell into a fire arrives at your hospital
Tauma centre. On arrival in the ICU, physical examination reveals temperature of 35 C, HR 120/min,
BP 88/48 mm Hg on noradrenaline, and SpO2 90% on 60% oxygen by face mask.
Neurologic
examination reveals a somnolent patient able to follow simple commands and to withdraw from
painfui stimulus. Lung examination showS coarse rhonchi in all fields.

He has partial and fullthickness burns involving the entire abdomen and chest, both upper and right
iower extremity. The physician who initiated the transfer gave the following information:
The patient's burn occurred 6 hours ago. He has two 18-gauge IV and has received 800 ml of 0.9%
normalsaline.
Which of the foliowing is the best immediate intervention?

A. Placement of a central venous line for monitoring of central venous pressure and
administration of fluid and drugs
B. Placement of an arterial line for beat-to beat measurement of blood pressure and serial blood gas
sampling
C Endotracheal intuation, mechanical ventilation, and placement of a pulmonary artery catheter to
guide carefui administration of IV fluids
 D. Endotracheal intubation, mechanical ventilation and rapid IV
warmed crystaloid solution administration of multipie litres of

94. A 22-vear old woman with acute

iver failure due to acetaminophen toxicity.
stabie. On examinatíon, grade 2 Her vital signs are
encephalopathy
are noted and hemogiobin is stable.
is found and the INR is 7.0. No signs of
active bieeding
The most appropriate next step in the management of her severe
coagulopathy is:
A. Administration of FFP

B. Administration of recombinant factor Vi

eplasmapheresis
D. Monitoring without intervention
E. Administration of factor !X
complex

95. A 62-year old woman with hypertension and

hyperlipidemia was diagnosed with Graves disease 1
year ago. She presents with palpitations, dizziness,
shortness of breath and intermittent chest pain
for the past 2 days. She admits to having not taking
propylthiouracil for the last 2 weeks.
On examination, she is confused and diaphoretic with
irregular pulse,
tachypneic Physical examination is remarkabie for restlessness, tremornormotensive, febrile and
of both hands and warm skin.
She is admitted to CU. VWhich of thefollowing is the most
appropriate first intervention?
A.Oral propyithiouracil
B Oral saturated solution of iodine
C Orai aspirin
D IV diitiazem .

96. A 22-year old male is involved in a house fire. He is found

unconscious by fire rescue and brought
to the hospitai. He has partial thickness burns to his face, upper extremities and chest. His
GCS is 6. HR
140/min, BP 110/56 mm Hg, RR 34/min,carboxyhemogiobin is 40% and Sp02 is 98% on 100% oxygen
rebreather mask. He has soot in his nares and mouth and his lips have a parched appearance.
The most immediate care of this patient should include:

A. igh-flow oxygen therapy with immediate bronchoscopy

B intubation, bronchoscopy and hyperbaric oxygen therapy
C. immediate hyperbaric therapy, bronchoscopy and intubation only if the patient does
D. not improve
E Immediate treatment with amyl nitrate followed by bronchoscopy
F. Intubation followed by bronchoscopy and plasma exchangé therapy