Exam 1 Questions

1. Which of the following is the most common form of incomplete spinal cord injury? A. Central cord syndrome. B. Cauda equina syndrome. C. Anterior spinal cord syndrome. D. Posterior spinal cord syndrome. E. Brown-Sequard lesion. 2. A 64-year-old male with a history of chronic alcohol abuse and congestive heart failure is currently recovering from excision of a large right shoulder lesion suspicious for melanoma. Postoperatively, he is experiencing bleeding and oozing from his surgical site that has persisted despite suture repair and direct pressure for an extended period of time. His labs are drawn, and are as follows: platelets 141 × 10(3)/mL, INR 1.2, fibrinogen 90 mg/dL. Which of the following blood products should be administered next? A. Fresh frozen plasma. B. Cryoprecipitate. C. Prothrombin complex concentrate. D. Recombinant activated factor VII. E. Aminocaproic acid. 3. A 75-year-old, 90 kg male with a history of peripheral vascular disease, coronary artery disease, and epilepsy following a recent cerebral infarction presents to the emergency department after having three witnessed seizures at home. He was intubated at the scene by the paramedics, and received 8 mg of intravenous lorazepam and 1 g of phenytoin. While you are evaluating him, he has another generalized tonic-clonic seizure, and the nurse asks if you would like to initiate a continuous propofol infusion. His blood pressure is 94/42 mmHg, and he is having numerous premature ventricular contractions (PVCs) on the electrocardiographic monitor. He has no history of platelet or liver dysfunction. Which of the following should be performed next? A. Complete the phenytoin load to attain 20 mg/kg, then start propofol infusion. B. Complete the phenytoin load to attain 20 mg/kg only C. Administer valproate, 30 mg/kg over 10 min, as well as midazolam 0.2 mg/kg. D. Start immediate midazolam infusion at 2 mg/kg/h. E. Give a 1 L normal saline bolus, and start a norepinephrine infusion to normalize blood pressure. 4. A 38-year-old male is brought to the emergency department after a motor vehicle accident. He is found to have significant ecchymoses on his chest and face, with multiple apparent rib fractures. He is in mild respiratory distress, with an oxygen saturation of 89% on room air, and hypotensive, with a systolic blood pressure of 88 mmHg. He has absent breath sounds on the right side. There is currently a delay in obtain a bedside portable chest x-ray. Which of the following should be performed next? A. 28-French chest tube placement. B. 16-French chest tube placement. C. Obtain computed tomography (CT) of the chest. D. Administer 30 cc/kg crystalloid. E. Obtain urgent cardiothoracic surgery consult. 5. Stress ulcer prophylaxis is often undertaken to prevent clinically important upper gastrointestinal (GI) bleeding. Which of the following factors puts patients at highest risk for such bleeding episodes? A. Respiratory failure. B. History of alcohol abuse. C. NPO status. D. Diverticulitis. E. All of the above. 6. In an intact heart, the Frank-Starling mechanism describes contractility increases in responses to: A. Decreased preload. B. Increased afterload. C. Decreased left ventricular end-diastolic pressure. D. Increased left ventricular end-diastolic volume. E. Increased pulmonary vascular resistance. 7. A 68-year-old female with a history of hyperlipidemia, hypothyroidism, and gastric cancer on total parenteral nutrition is currently in the ICU following a small traumatic subdural hemorrhage. On hospital day 5, the patient begins to spike fevers that persist despite broad spectrum antibiotic coverage with vancomycin and piperacillin-tazobactam. She is otherwise hemodynamically stable. The lab calls you to notify you that multiple sets of blood cultures display budding yeast forms and pseudohyphae. Which of the following should be administered next? A. Fluconazole. B. Posaconazole. C. Anidulafungin. D. Caspofungin. E. Amphotericin B. 8. A 56-year-old male with a past medical history of hypertension, hyperlipidemia, and morbid obesity is currently intubated in the ICU following a left middle cerebral artery infarct. The respiratory therapist alerts you the fact that the patient has become markedly dysynchronous with the ventilator, including breath holding episodes, breath stacking, and resisting ventilator-delivered breaths. A variety of pressure- and volume-regulated ventilator modes have been attempted without improvement, as well as boluses of both fentanyl and midazolam. The most recent arterial blood gas is as follows: pH 7.19, PaCO(2) 78 mmHg, PaO(2) A. Prone the patient. B. Administer nitric oxide at 10 parts per million. C. Administer 10 mg of cisatracurium. D. Administer a mixture of 60% helium/40% oxygen. E. Administer a continuous infusion of phenobarbital. 9. Compared to lactulose for the treatment of hepatic encephalopathy, polyethylene glycol (PEG) has been shown to: A. Decrease in-hospital mortality. B. More rapidly improve symptoms. C. Increase the rate of gastrointestinal complications. D. Increase the incidence of major electrolyte abnormalities. E. None of the above. 10. Which of the following neurologic insults is the least likely to cause central (non-infectious) fever in the ICU? A. Intracranial neoplasm. B. Intraventricular hemorrhage. C. Normal pressure hydrocephalus. D. Subarachnoid hemorrhage. E. Traumatic brain injury. 11. A 57-year-old male with a history of epilepsy and medication noncompliance is admitted to a small community hospital after a brief tonic-clonic seizure. A non-contrast head CT on admission is normal. On the second hospital day, the patient begins to complain of severe substernal chest pressure, and an urgent bedside EKG shows evidence of an acute inferior myocardial infarction (MI). The nearest percutaneous coronary intervention (PCI) capable center is approximately 150 min away by the fastest transport method available. Which of the following is the most appropriate next step in this patient’s care? A. Arrange for transport to the closest PCI center with anticipated balloon time within 30 min of arrival. B. Prepare to administer fibrinolytic therapy. C. Consult cardiothoracic surgery for possible coronary artery bypass grafting (CABG). D. Place the patient on a continuous nitroglycerine infusion and administer aspirin, clopidogrel, and heparin. E. Await serum cardiac biomarkers and repeat EKG in 1 h. 12. A 62-year-old male with unknown past medical history who recently immigrated from El Salvador is currently in the stroke unit after suffering from an acute left middle cerebral artery infarction. The patient is aphasic; his wife states that he been in his usual state of health lately, and denies any recent weakness, dizziness, chest pain, cough, shortness of breath, or fevers. On reviewing this patient’s belongings, the nurse discovers a bottle of isoniazid, as well as paperwork demonstrating a positive quantiferon gold test performed at a local clinic approximately 3 weeks ago. He does not appear to be on any other medications. A bedside portable chest x-ray is performed, which preliminarily appears normal. Which of the following should be performed next? A. Move the patient to a negative pressure isolation room, continue isoniazid. B. Isolate the patient, continue isoniazid, add rifampin. C. Isolate the patient, continue isoniazid, add rifampin and pyrazinamide. D. Isolate the patient, continue isoniazid, add rifampin, pyrazinamide and ethambutol. E. None of the above. 13. A 56-year-old, 70 kg female patient in oliguric renal failure would be expected to have a daily urine output of: A. No more than 50 mL. B. No more than 400 mL. C. No more than 800 mL. D. Less than 70 mL/h. E. Less than 35 mL/h. 14. A 37-year-old female with a history of epilepsy is admitted to the ICU with status epilepticus. She required several doses of lorazepam in the emergency department in addition to fosphenytoin, intubation, and a continuous propofol infusion. There was concern for aspiration in the prehospital setting. Approximately 3 days after being admitted to the hospital, her respiratory status has worsened; she is increasingly hypoxic, and her chest x-ray demonstrates diffuse bilateral interstitial infiltrates. The patient is afebrile with minimal secretions. Her most recent arterial blood gas is as follows: pH 7.21, PaO(2) 107 mmHg, PCO(2) 55 mmHg, 100% FiO(2), and a positive end-expiratory pressure (PEEP) of 8 cm H(2)O. According to the Berlin criteria, how would you categorize this patient’s acute respiratory distress syndrome (ARDS)? A. Acute lung injury (ALI). B. Mild ARDS. C. Moderate ARDS. D. Severe ARDS. E. None of the above. 15. An 80-year-old male presents to the emergency department with multiple episodes of bright red blood per rectum. He is on aspirin and clopidogrel for a history of coronary artery disease and a previous transient ischemic attack. He underwent aortic graft surgery for repair of an abdominal aortic aneurysm 2 years ago. A complete blood count and coagulation profile are all within normal limits. His vital signs are as follows: blood pressure 102/58 mmHg, heart rate 98 beats/min, respiratory rate 18 breaths/min, oxygen saturation 98% on room air, and temperature 98.3 °F. Which of the following is the next best step in the care of this patient? A. Transfuse platelets, fresh frozen plasma, and recombinant factor VIIa. B. Consult gastroenterology for emergent upper endoscopy. C. Consult gastroenterology for emergent colonoscopy. D. CT angiogram of the abdomen and pelvis. E. Expectant management with fluids and blood transfusions. 16. A thrombus in which of the following veins would not be considered a deep vein thrombosis (DVT)? A. Popliteal vein. B. Soleal vein. C. Femoral vein. D. Gastrocnemius vein. E. Greater saphenous vein. 17. After partial resection of the pituitary stalk, secretion of which of the following hormones will be most affected? A. Oxytocin. B. Adrenocorticotrophic hormone. C. Melanocyte-stimulating hormone. D. Thyroid-stimulating hormone. E. All will be equally affected. 18. A 58-year-old female with a history of hypertension, rheumatoid arthritis, metastatic ovarian cancer, and bilateral deep venous thrombosis status post recent inferior vena cava filter placement presents to the emergency department with right flank pain. She states the pain began approximately 1 h ago when bending down to pick something off the floor, and that it is constant and severe in nature. She denies dysuria or hematuria. Her vital signs are as follows: blood pressure 108/62 mmHg, heart rate 121 beats/min, respiratory rate 20 breaths/min, oxygen saturation 99% on room air, and temperature 99.6 °F. A CT scan of the abdomen is obtained (see Image 1). Which of the following is the next best step in this patient’s management? A. Administer vancomycin and cefepime, and draw two sets of blood cultures. B. Urgent vascular surgery consult. C. Immediately place the patient on her left side. D. Rapid sequence intubation with mechanical ventilation. E. Perform bedside diagnostic peritoneal lavage;