BASIC pre-course MCQs

1. A confused patient is receiving oxygen 4 L/min via a simple facemask. Which of the
following would suggest that the patient is NOT critically ill.
a) Pulse oximetry 97%
b) Respiratory rate 15/min
c) Heart rate 115/min
d) Blood pressure 110/60
e) pH 7.3, PaCO2 2.1 kPa (15.8 mmHg), PaO2 10 kPa (75 mmHg)
2. The most common mechanism underlying hypoxaemic respiratory failure in the
critically ill is:
a) Increased dead space
b) Hypoventilation
c) Diffusion abnormality
d) Shunting
e) Low inspired oxygen concentration
3. Which device delivers an inspired oxygen of close to 100%:
a) Reservoir oxygen mask with oxygen flow rate of 15L/min
b) Bag valve mask resuscitator with reservoir bag and oxygen flow rate of 15L/min
c) 60% Venturi mask with oxygen flow rate of 30L/min (instead of usual 15L/min)
d) nasal cannulae with oxygen flow rate of 15L/min
e) simple face mask with oxygen flow rate of 15L/min
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 most appropriate
immediate course of action is:
a) Rapid sequence induction, direct laryngoscopy and intubation
b) Cricothyrotomy
c) Sedation and insertion of a laryngeal mask
d) Bag-valve-mask ventilation with 100% oxygen
e) Spontaneous breathing of 100% oxygen via bag-valve resuscitator, call for
specialist help and prepare equipment for intubation
5. You have performed a rapid sequence induction but are unable to intubate or ventilate
the patient. The most appropriate course of action is to:
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 correct?

Flow
+ Volume Compliance + PEEP
Resistance
Volume
b) Airway pressure = Flow Resistance +
+ PEEP
Compliance
Volume
c) Airway pressure = Inspiratory time Resistance +
+ PEEP
Compliance
Volume
+ PEEP
d) Airway pressure = Flow Compliance +
Resistance
Volume
e) Airway pressure = Flow Resistance +
Compliance

a) Airway pressure =

7. Which of the following statements most accurately describes the effects of mechanical
ventilation on left ventricular preload, afterload and cardiac output?
a) Increase preload, decreased afterload, increased cardiac output
b) Increased preload, increased afterload, increased cardiac output
c) Decreased preload, decreased afterload, increased cardiac output
d) Decreased preload, decreased afterload, decreased cardiac output
e) Decreased preload, decreased afterload, variable effect on cardiac output
8. A patient has just been intubated following a rapid sequence induction. Which of the
following modes is contraindicated?
a) Time cycled assist control
b) Pressure control
c) Volume cycled assist control
d) Pressure support
e) Synchronized intermittent mandatory ventilation
9. In pressure support mode the patient has no control over
a) Respiratory rate
b) Tidal volume
c) Inspiratory time
d) Respiratory pattern
e) Inspiratory pressure
10. A patient with bilateral pneumonia is being ventilated in pressure control mode with
the following settings. Set inspiratory pressure=22 cmH2O above PEEP=2 cmH2O (ie
total inspiratory pressure = 24 cmH2O), FiO2=0.8, respiratory rate=30, inspiratory
time=50%. This results in an oxygen saturation of 85%. He is haemodynamically stable.
The most appropriate way of increasing the oxygen saturation is to:
a) Increase the set inspiratory pressure
b) Increase the respiratory rate
c) Increase the inspiratory time
d) Increase the FiO2
e) Increase the set PEEP

11. In assist control ventilation which of the following is NOT affected by changing the
I:E ratio
a) Absolute expiratory time
b) Inspiratory flow
c) Inspiratory time
d) Inspiratory pause time
e) Gas trapping
12. These are the ventilator settings for a patient with atypical pneumonia. Volume
control ventilation, tidal volume 270 ml, respiratory rate 20/min, PEEP=10 cmH2O,
FIO2=0.4, inspiratory time 65%. This results in airway pressure of 30 cmH2O,
inspiratory pause pressure of 25 cmH2O, PEEPtotal=15. The alveolar pressure is
approximately
a) 30
b) 25
c) 15
d) 10
e) 5
13. An asthmatic patient becomes hypotensive shortly after intubation. She remains
hypotensive (BP 80/50) after rapid infusion of 250 ml of colloid. The most appropriate
course of action is to:
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
14. A 60 kg patient with ARDS is being ventilated in assist control mode with a tidal
volume of 480 ml, respiratory rate 35/min, PEEP 10 cmH2O, I:E ratio 1:2, FiO2 0.8. This
results in an oxygen saturation of 100%, pH 7.31, PaCO2 7.9 kPa (59 mmHg), PaO2 13.5
kPa (101 mmHg), intrinsic PEEP 12. The most appropriate course of action is:
a) decrease FiO2
b) leave settings unchanged
c) increase tidal volume
d) increase respiratory rate
e) decrease inspiratory time
15. A 60 kg asthmatic patient is being ventilated in assist control mode with a tidal
volume of 400 ml, respiratory rate 12/min, PEEP 0 cmH2O, I:E ratio 1:3 and FiO2 0.4.
This results in pH 7.04, PaCO2 12.5 kPa (94 mmHg), PaO2 18 kPa (135 mmHg), peak
airway pressure 55 cmH2O, inspiratory pause pressure 18 cmH2O, PEEPi 8 cmH2O. The
most appropriate course of action is:
a) leave settings unchanged
b) increase tidal volume
c) decrease tidal volume

d) decrease FiO2
e) increase respiratory rate
16. These are the results from a 25 year old 70 kg patient with pneumonia: BP 100/50
(mean 65) mmHg, CVP 0 mmHg, urine output 50 ml/hr, pH 7.4. The patient is alert and
has warm peripheries. The most appropriate haemodynamic intervention is:
a) IV bolus of 250 ml colloid
b) No intervention is required
c) IV bolus of 250 ml 5% glucose
d) Low dose dopamine infusion
e) Dobutamine infusion
17. An adequate preload is indicated by:
a) CVP 10 mmHg
b) Large variation in systolic pressure with respiration
c) Rise in CVP of 4 mmHg after a fluid challenge
d) CVP 14 mmHg
e) CVP 7 mmHg
18. Haemodynamic support of a hypotensive patient with a massive pulmonary embolus
should include:
a) Large volume fluid resuscitation
b) Intravenous nitrate infusion
c) Norepinephrine infusion
d) Dobutamine infusion
e) Isoprenaline infusion
19. 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:
a) Septic shock
b) Cardiogenic shock
c) Massive pulmonary embolus
d) Tension pneumothorax
e) Hypovolaemic shock
20. Which of the following is/are potentially reversible causes for cardiac arrest?
a) Hypovolemia
b) Hypoxia
c) Tension pneumothorax
d) Pulmonary embolus
e) all of the above

21. A 53 year old man with a VF cardiac arrest is undergoing advanced cardiopulmonary
resuscitation in the Accident & Emergency department. He has received epinephrine 1

mg (1 minute ago), and has just received DC shock 360J (monophasic). He is unintubated
and remains in VF. What is the next step in his management?
a)
b)
c)
d)
e)

Recommence cardiac compressions and ventilation at a ratio of 5:1

Recommence cardiac compressions and ventilation at a ratio of 30:2
DC shock 360J
Epinephrine 1 mg IV
Intubation

22. The appropriate initial treatment of rapid atrial fibrillation in a shocked patient is:
a) DC cardioversion with 100J
b) DC cardioversion with 200J
c) Amiodarone 150 mg over 10 minutes
d) Procainamide 10-15 mg/kg
e) Amiodarone 300 mg over 10 minutes
23. Pacing is NOT indicated for:
a) Bilateral bundle branch block
b) Mobitz type II second degree heart block
c) Newly acquired bifascicular block with 1st degree AV block (trifascicular block)
d) Third degree heart block
e) Mobitz type I second degree heart block
24. Which of the following statements is false
a) Oliguric renal failure in adults can be defined as urine output of less than 400
mls/day
b) The part of the kidney that is most susceptible to hypoxia is the renal cortex
c) Urea and creatinine are insensitive markers of glomerular filtration rate
d) Patients undergoing abdominal aortic aneurysm surgery are at increased risk of
developing acute renal failure
e) Loop diuretics do not increase creatinine clearance
25. Which of the drugs below can cause acute renal failure
a) Amikacin
b) Vancomycin
c) Lisinopril
d) Amphotericin B
e) All of the above
26. Confirmed deep venous thrombosis (DVT) in the left leg of a 54 year old patient with
an underlying diagnosis of pneumonia is best treated with which of the following?
a) Unfractionated heparin 5000U daily SC
b) Low molecular weight heparin at a dose of 4000-6000 Axa U daily (equivalent to
nardroparine or Fraxiparine 0.3ml SC daily)
c) Full anticoagulation with low molecular weight heparin (e.g. Enoxiparine 1mg/kg
q12 hourly)

d) Graded compression stockings on the left leg

e) Intermittent pneumatic compression boots applied to both legs
27. Which of the following pharmacological agents best 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 inhibitors such as omeprazole
28. A 70kg man who has developed sepsis after multiple trauma and is ventilated in the
ICU. He requires the following rate of a standard enteral nutrition formula such as Isocal
to provide adequate calorie intake.
a) Approximately 100 ml/hour.
b) Approximately 40 ml/hour.
c) Approximately 200 ml/hour.
d) Approximately 1000 ml/day.
e) Approximately 20 ml/hour.
29. A patient with septic shock has a mean arterial pressure 60 mmHg, CVP 4 mmHg,
heart rate 120/min and oxygen saturation 97% (on FiO2 0.3). He is acidotic, oliguric and
confused. He is in positive fluid balance of 3L over the first 12 h of his ICU admission.
The most appropriate next step in his resuscitation is:
a) No further resuscitation is required
b) 500 ml colloid over 30 minutes
c) Start norepinephrine infusion
d) Start dopamine infusion
e) Start dobutamine infusion
30. Dual antibiotic therapy is recommended for:
a) Methicillin resistant Staphylococcus aureus pneumonia
b) Penicillin sensitive Streptococcus pneumoniae pneumonia
c) E. coli bacteraemia
d) Enterobacter pneumonia
e) Meningococcal meningitis
31. Rear impact motor vehicle accidents are particularly associated with:
a) Aortic dissection
b) Flail chest
c) Head injury
d) Acetabular fracture
e) Cervical spine injury

32. A 24 year old trauma victim has cold pale peripheries, ashen grey face, blood
pressure 90/40 mmHg and respiratory rate 22/min. He is confused. His estimated blood
loss is:
a) 10%
b) 15%
c) 20%
d) 30%
e) 45%
33. The first priority in managing a severely head injured patient is:
a) Reduce the intracranial pressure with mannitol
b) Perform a CT scan of the brain
c) Exclude cervical spine injury
d) Restore a normal blood pressure and oxygen saturation
e) Sedate the patient to prevent a rise in intracranial pressure due to agitation or
coughing
34. In a patient with status epilepticus and a normal blood glucose concentration, the drug
of choice to terminate the fits is:
a) Sodium Valproate 400 mg IV
b) Lorazepam 0.1 mg/kg
c) Diazepam 0.2 mg/kg
d) Phenytoin 15-20 mg/kg
e) Midazolam 0.1 mg/kg
35. A patient on oxygen 15L/min via reservoir facemask has the following arterial blood
gas result: pH 6.9, PaCO2 7.2 kPa (54 mmHg), PaO2 10 kPa (75 mmHg), HCO3- 10
mmol/L. His acid base abnormality is typical of:
a) Diabetic ketoacidosis
b) Severe acute pulmonary oedema
c) Hepatic and renal failure
d) Renal tubular acidosis
e) A patient with chronic obstructive pulmonary disease who has been treated with
diuretics
36. A patient has the following arterial blood gas result: pH 7.34, PaCO2 8.0 (60 mmHg),
PaO2 7.5 kPa (56 mmHg), HCO3- 32.1 mmol/L, BE 8. His acid-base abnormality is:
a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis
e) Mixed metabolic acidosis and respiratory alkalosis
37. The optimal level of sedation corresponds to a Richmond Agitation Sedation Score
of:
a) 0

b)
c)
d)
e)

1
+1
4
depends on the patients clinical condition

38. The intravenous dose of suxamethonium for rapid sequence induction is:
a) 0.1 mg/kg
b) 0.5 mg/kg
c) 10 mg/kg
d) 1 mg/kg
e) 0.2 mg/kg
39. When a mechanical ventilator is employed during patient transport which of the
following must be in continuous use
a) minute ventilation display
b) tidal volume alarm
c) flow volume loop
d) high airway pressure alarm
e) pressure volume loop
40. Which of the following statements regarding interhospital transport of critically ill
patients is INCORRECT?
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-tidal CO2 monitoring should be used for all ventilated patients
d) Intravenous glucose should be available
e) Epinephrine should be available
41. A treated hypertensive patient presents with an acute confusional state. Results of
investigations were: plasma sodium 112 mmol/l, potassium 3.5 mmol/l, serum osmolality
245 mOsm/l, urine osmolality 302 mOsml/l, urine sodium 72 mmol/l. Her jugular venous
pressure was 8 cm above her sternal angle. The most appropriate treatment is:
a) Hypertonic saline infusion
b) Normal saline infusion
c) Arginine vasopressin
d) Fluid restriction
e) Steroid replacement