ABSITE CRITICAL CARE EXAM 2024 ACTUAL EXAM
COMPLETE 130 QUESTIONS WITH DETAILED
VERIFIED ANSWERS (100% CORRECT ANSWERS)
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All are potential causes of cardiogenic shock except:
- Myocardial infarction.
- Pericardial tamponade.
- Tension pneumothorax.
- Cardiac arrhythmias.
- Excessive preload. - ANSWERExcessive preload.
(Excessive preload is typically not a cause of cardiogenic shock, but is a result of
cardiogenic shock.)
A 60-year-old man has an arterial PO of 60 mm Hg when the calculated alveolar PO is
94 mm Hg. This difference is most commonly due to - ANSWERa ventilation-perfusion
mismatch
oxygen delivery and consumption - ANSWER- Under normal circumstances,
approximately 20% to 30% of the oxygen delivered to the capillary bed is extracted by
the tissues.
- In conditions of decreased delivery of oxygen, tissues are capable of extracting up to
50% to 60% of the oxygen content in the capillary blood.
- When cellular oxygen supply does not meet demand, anaerobic respiration results.
(The variables in the equation for the delivery of oxygen are cardiac output, hemoglobin
level, oxygen saturation of hemoglobin, and the partial pressure of oxygen dissolved in
blood. Increases in the first three variables all yield significant increases in the total
amount of oxygen carried by blood. The partial pressure of oxygen is multiplied by a
factor of 0.003, however, and therefore has a miniscule contribution to the total oxygen
content.)
Dopamine at doses of 5 to 10 μg/kg/min - ANSWERhas a largely inotropic action profile
(Dopamine has a dose-dependent action profile. At 3 to 5 μg/kg/min, its actions are
largely to increase renal blood flow. At doses of 5 to 10 μg/kg/min, it largely acts to
stimulate myocardial β receptors and has an inotropic effect. At doses greater than 10
μg/kg/min, it stimulates α receptors and has a chronotropic effect.)
As oxygen delivery increases on the flat horizontal portion of the oxygen consumption-
delivery curve - ANSWEROxygen consumption remains the same
(On the flat horizontal portion of the oxygen consumption-delivery curve, oxygen
delivery meets cellular demand of oxygen; as oxygen delivery increases, oxygen
consumption remains the same.)
,Most disorganized ventricular arrhythmias (frequent PVCs, ventricular fibrillation) are
caused by - ANSWERMetabolic derangements.
(Most disorganized ventricular arrhythmias are caused by some sort of metabolic
derangement such as ischemia or magnesium or potassium deficiencies. These
abnormalities are not well treated by antiarrhythmic medications.)
The best management for a patient with a posterior knee dislocation -
ANSWERArteriogram.
(The patient may have fairly normal pulses and still have an intimal injury of the popliteal
artery that is similar to the intimal disruption that can be seen in aortic isthmus injury.)
the possible etiologies of multiorgan failure - ANSWER- Anticytokine antibodies have
shown therapeutic promise in animal studies.
- Evidence has shown that intestinal mucosa is made permeable by sepsis.
- The "two-hit" hypothesis postulates that after mounting an appropriate response to
some physiologic insult, the patient is left with a primed immune system which
manifests an exaggerated immune response to a second challenge.
- The early stages after injury actually appear to consist of an immediate
proinflammatory state as the organism tries to address the physiologic insult. When
properly modulated, this is an appropriate function. When overexpressed, this
proinflammatory state leads to the systemic inflammatory response syndrome. Later,
anti-inflammatory and immunosuppressive mechanisms are brought into play to bring
the organism back to homeostasis. If overmanifested, they can lead to a relative
generalized immunosuppression and late incidents of sepsis or multiorgan failure.
compensatory mechanisms in shock - ANSWERAntidiuretic hormone causes the
reabsorption of free water by the kidney and has vasoconstrictive properties.
(Antidiuretic hormone is released from the posterior pituitary where it stimulates free
water retention by the kidney and acts as a powerful vasoconstrictor.)
A 71-year-old man with colon cancer is in the intensive care unit following a left
hemicolectomy. His blood pressure is 72/38 mm Hg, pulse rate is 114/min, respiratory
rate is 23/min, and oxygen saturation is 94% on 2 L of oxygen by nasal cannulae. A
pulmonary artery catheter shows a central venous pressure of 8 cm H O, a pulmonary
artery pressure of 22/8 mm Hg, a pulmonary artery wedge pressure of 6 mm Hg, and a
cardiac output of 3.4 L/min. The next step in management should be the intravenous
administration of - ANSWERa fluid bolus
pulmonary artery catheters - ANSWERAllow accurate approximation of left atrial
pressure.
The magnitude of a left-to-right shunt in the presence of an ASD is determined by -
ANSWERDifference in compliance between left and right ventricles.
(The blood will tend to fill the more compliant ventricle which will usually be the right,
until chronic pulmonary hypertension yields right ventricular hypertrophy.)
, Compared to conventional ventilation (endotracheal intubation), noninvasive ventilation
(mask, continuous positive airway pressure) is - ANSWERcontraindicated in
hemodynamically unstable patients
According to the American College of Chest Physicians/Society of Critical Care
Medicine Consensus Conference, which of the following are not part of the diagnostic
criteria for sepsis? - ANSWERHypotension defined as a systolic blood pressure less
than 90 mm Hg.
(Sepsis is defined as bacteriologic evidence of infection superimposed on a clinical
picture of SIRS. According to the ACCP/SCCM, by definition these patients are
hemodynamically stable. If they should become hemodynamically unstable (defined as
a systolic blood pressure <90 mm Hg), the name for the condition changes to "severe
sepsis.")
SIRS - ANSWER- Temperature greater than 38°C or less than 36°C.
- Heart rate greater than 90 bpm.
- Respiratory rate greater than 22 bpm
- White blood cell count greater than 12,000 or less than 4,000 and greater than 10%
bands.
abdominal compartment syndrome - ANSWEROnce diagnosed, treatment consists of
reopening the abdomen including doing so at the bedside if necessary.
(The presence of an abdominal compartment syndrome requires decompression of the
abdomen. If the patient is too unstable to be transported to the operating room, the
abdomen should be promptly reopened at the bedside.)
carotid bruit - ANSWERa marker for generalized atherosclerosis
(In fact, studies have shown that a carotid bruit is a risk factor for coronary artery
disease and future myocardial infarction.)
alveolar ventilation - ANSWERThe alveolar gas equation characterizes the potential for
oxygen uptake and carbon dioxide removal.
(Tachypnea at a given minute ventilation increases anatomic dead-space ventilation,
not alveolar ventilation. Minute ventilation is the volume of gas that is inspired and
expired at the nasopharynx and is different than that occurring at the alveolus by the
anatomic dead-space volume. Although arterial Pco is proportional to alveolar
ventilation, arterial Po is not as it may be affected by physiologic shunting, diffusion
block, and so on. The RQ is constant under normal physiological conditions at ± 0.8;
however, it may change substantially under conditions such as anaerobic metabolism,
overfeeding, and so on. Because the alveolar gas equation characterizes the partial
pressures of individual gases within the alveolus, which in turn determine the individual
gradients for diffusion, the equation does characterize the potential for oxygen/carbon
dioxide exchange. )
the following may constitute the physiological dead space of the respiratory system -
ANSWER- Emphysematous lung.
