Critical Care Medicine Practice Questions

Q: Which of the following statements given below is incorrect regarding CPR?

Ventilation 22-25/ min. ***Ventilation 22-25/ min*** - A ventilation rate of 22-25 breaths/min is **too high** for CPR, which typically recommends 10-12 breaths/min, corresponding to 2 breaths after every 30 compressions. - Excessive ventilation can lead to **hyperventilation**, increasing intrathoracic pressure and reducing venous return, thus decreasing cardiac output. *Chest compression rate 100-120/min* - The recommended chest compression rate for adults in CPR is **100-120 compressions per minute**, ensuring adequate blood flow to vital organs. - Maintaining this rate is crucial for maximizing the effectiveness of chest compressions by providing sufficient circulation. *Depth of chest compression up to 5-6 cm* - The recommended depth for adult chest compressions is at least 5 cm (2 inches), but no more than **6 cm (2.4 inches)** to prevent injury. - This depth ensures that enough pressure is exerted to circulate blood effectively without causing excessive trauma. *Allow adequate chest recoil* - Complete chest recoil is essential to allow the heart to **fully refill with blood** between compressions. - Leaning on the chest between compressions prevents adequate recoil, which can reduce pulmonary and coronary perfusion and **decrease the effectiveness of CPR**.

Q: In CPR, number of chest compressions per minute in an adult:

100-120 per minute. ***100-120 per minute*** - The **American Heart Association (AHA)** and other international resuscitation guidelines recommend a compression rate of **100 to 120 beats per minute** for adults. - This rate ensures adequate blood flow to vital organs while minimizing rescuer fatigue. *30-50 per minute* - This rate is **too low** and would be ineffective in maintaining adequate cerebral and coronary perfusion during cardiac arrest. - Insufficient compressions per minute significantly **reduce the chances of survival** and positive neurological outcomes. *50-72 per minute* - While better than 30-50, this rate is still **below the recommended range** for effective CPR in adults. - It would likely result in **inadequate blood flow** to the brain and heart, diminishing the effectiveness of resuscitation. *120-200 per minute* - While aiming for higher compression rates might seem beneficial, rates **above 120 per minute** can be counterproductive. - Excessively fast compressions can **reduce chest recoil** and ventricular filling time, actually decreasing cardiac output and perfusion.

Q: A patient in shock requires rapid fluid resuscitation. If intravenous (IV) cannulation is not possible, within what time frame should an intraosseous (IO) line be placed?

1.5 minutes. ***1.5 minutes*** - The goal for intraosseous (IO) line placement in a patient in shock when IV access is difficult is within **90 seconds** (1.5 minutes) to ensure rapid fluid resuscitation and drug delivery. - This timeframe is crucial for minimizing the duration of inadequate perfusion and improving patient outcomes in critical situations. *2.5 minutes* - This timeframe is generally considered too long for establishing emergency vascular access in a patient in shock. - Delays beyond **90 seconds** can lead to significant morbidity and mortality due to prolonged hypoperfusion. *1 minute* - While a faster placement time is always desirable, **1 minute** may be a challenging target to consistently achieve, especially for less experienced operators or in difficult situations. - The established guideline aims for a balance between speed and realistic attainability. *2 minutes* - This timeframe is still longer than the recommended maximum for IO access in shock. - Every additional second of delay can negatively impact the patient's condition, making **2 minutes** less ideal than the recommended 1.5 minutes.

Q: Hypothermia is used in all except:

Arrhythmia. ***Arrhythmia*** - While sometimes used in specific cardiac procedures or to protect organs during cardioplegia, **therapeutic hypothermia** is not a primary treatment for general cardiac arrhythmias due to its potential to exacerbate certain rhythm disturbances. - **Hypothermia** can paradoxically induce **arrhythmias** itself, particularly bradycardia and ventricular fibrillation, making it unsuitable for general arrhythmia management [1]. *Hyperthermia* - **Therapeutic hypothermia** is used to reduce high body temperatures in conditions like **malignant hyperthermia** and **heatstroke** to prevent organ damage [2]. - By actively cooling the body, hypothermia counteracts the harmful effects of sustained, extreme elevations in body temperature. *Neonatal asphyxia* - **Therapeutic hypothermia** is a standard treatment for **neonatal hypoxic-ischemic encephalopathy** (HIE) to reduce brain injury. - Cooling the infant's body temperature helps to slow down damaging metabolic processes after oxygen deprivation. *Cardiac surgery* - **Hypothermia** is commonly employed during **cardiac surgery** to protect organs, especially the brain and heart, from ischemia during periods of reduced blood flow. - **Moderate to deep hypothermia** can significantly reduce metabolic demands, extending the safe duration of cardiopulmonary bypass and aortic cross-clamping [3].

Q: A 55-year-old woman was admitted to the intensive care unit with severe lobar pneumonia and septic shock. She remained hypoxemic despite intubation, a high fraction of inspired oxygen, and positive end-expiratory pressure (PEEP). When PEEP was increased further, she paradoxically became more hypoxemic and her blood pressure and central venous hemoglobin saturation fell. What would be your approach?

Initiate dobutamine and reduce PEEP to 5cm H2O. ***Initiate dobutamine and reduce PEEP to 5cm H2O*** - The patient is experiencing negative hemodynamic effects from **excessive PEEP**, indicated by falling blood pressure and central venous hemoglobin saturation. Reducing PEEP will improve **venous return** and **cardiac output**. - **Dobutamine** is a positive inotrope that will help support cardiac output and improve oxygen delivery to tissues, addressing the shock state. *Increase PEEP further* - Increasing PEEP would worsen the patient's **hemodynamic compromise** by further increasing intrathoracic pressure, reducing venous return, and potentially decreasing cardiac output, leading to more profound shock. *Keep PEEP at the highest and give adrenaline* - Maintaining high PEEP would continue to suppress cardiac output. While **adrenaline** is a potent vasopressor and inotrope, it would be treating the symptoms (hypotension) without addressing the root cause of the hemodynamic instability (excessive PEEP-induced reduced venous return and cardiac output). *Increase FiO2* - The patient is already on a **high fraction of inspired oxygen** and remains hypoxemic, suggesting that the primary problem is not lack of oxygen in the inspired air but rather impaired oxygen delivery due to hemodynamic compromise or significant intrapulmonary shunting. Increasing FiO2 further is unlikely to resolve the issue and may expose the patient to **oxygen toxicity**.

Q: According to current CPR guidelines, the immediate first action when encountering an unresponsive patient should be:

Airway maintenance. ***Airway maintenance*** - **Airway maintenance** is the immediate priority in an unresponsive patient to ensure adequate oxygenation and ventilation [1]. - Establishing an open airway (e.g., head tilt-chin lift or jaw thrust) is crucial before assessing breathing or circulation [1]. *Intracardiac atropine* - **Intracardiac atropine** is not a recommended intervention in modern CPR guidelines and carries significant risks with no proven benefit. - Atropine is typically used intravenously for symptomatic **bradycardia**, not as a first-line agent for unresponsive patients in cardiac arrest. *Hysterectomy* - **Hysterectomy** is a surgical procedure to remove the uterus and is completely irrelevant to the immediate management of an unresponsive patient. - This option is medically absurd and demonstrates a clear misunderstanding of emergency medical care. *IV adrenaline* - **Intravenous (IV) adrenaline** is a crucial drug in cardiac arrest, but it is typically administered *after* establishing an airway, initiating chest compressions, and assessing the cardiac rhythm. - It is not the *immediate first action* upon encountering an unresponsive patient, as securing the airway precedes drug administration [1].

Q: Which of the following statements is true or false regarding the CPR technique? 1. Can be given irrespective of rib fracture. 2. An adult chest compression : breath remains 30 : 2 and does not change to 15 : 2 even if 2nd rescuer present. 3. In infants ratio change from 30 : 2 to 15 : 2 when 2nd rescuer arrives. 4. Chest compression at rate of 100 - 120 / min on adults and 90 per minute in infants.

b, c are true & a, d are false. ***b, c are true & a, d are false*** - Statement 'b' is true because the **compression-to-ventilation ratio for adult CPR remains 30:2** regardless of the number of rescuers, focusing on minimal interruptions to chest compressions [1]. - Statement 'c' is true as the ratio for infant CPR changes from **30:2 for a single rescuer to 15:2 with two rescuers** to improve ventilation effectiveness in a smaller patient. *a, b are true & c, d are false* - Statement 'a' is false because **rib fractures are a known complication of CPR** and should be managed, but CPR should still be administered to save a life, even if fractures occur. - Statement 'd' is false because the recommended **chest compression rate for both adults and infants is 100-120 compressions per minute**, not 90 per minute for infants [1]. *a, c, d are true & b is false* - Statement 'a' is false; although rib fractures can occur during CPR, it's not a reason to withhold compressions. - Statement 'd' is false; the chest compression rate for infants is the same as adults, **100-120 compressions per minute** [1]. *a is false and b, c, d are true* - Statement 'a' is false because chest compressions should still be performed even if rib fractures are suspected or occur during CPR, as the priority is life-saving circulation. - Statement 'd' is false as the **recommended compression rate for infants is 100-120 per minute**, consistent with adult guidelines, not 90 per minute [1].

Q: During cardiopulmonary resuscitation, cardiac massage is given over:

Lower third of sternum. ***Lower third of sternum*** - Correct hand placement for **cardiac compressions** is on the **lower half of the sternum**, approximately at the junction of the middle and lower thirds. - Position: **Center of the chest**, 2 finger breadths above the xiphoid process, which corresponds anatomically to the lower third area. - This placement ensures optimal compression of the heart between the sternum and spine, maximizing **cardiac output** during CPR according to **AHA and ERC guidelines**. *Mid third of sternum* - Compressing only the mid-third (middle of sternum) is **too high** for optimal cardiac compression. - This placement is above the ideal position and results in **less effective blood flow** during resuscitation. *Upper third of sternum* - Compressing the upper third of the sternum is **highly ineffective** for cardiac compression. - Can lead to injuries such as **fractures of the clavicle** or upper ribs without achieving adequate cardiac compression. *Precordium* - **Precordium** refers to the general area over the heart, but it is **not precise enough** for effective CPR hand placement. - This vague anatomical term doesn't provide the specific landmark needed for proper compression technique.

Q: The ideal parameters for cardiac massage in cardiopulmonary resuscitation are all EXCEPT:

Ratio of compression to ventilation should be 15:2. ***Ratio of compression to ventilation should be 15:2*** - The currently recommended **ratio of chest compressions to ventilations** for adult cardiopulmonary resuscitation (CPR) by a single rescuer or two rescuers is **30:2**. - A 15:2 ratio was used in older guidelines but is **no longer ideal for adult CPR**; it is still used in pediatric CPR with two rescuers. *Compressions to be given over lower third of sternum* - Proper hand placement for chest compressions is on the **lower half of the sternum**, avoiding the xiphoid process. - This position ensures effective compression of the heart while minimizing the risk of injury to abdominal organs. *Force should depress sternum approximately 1/3 of chest wall diameter* - The recommended depth of chest compressions for adults is at least **2 inches (5 cm)**, but no more than 2.4 inches (6 cm). - This depth corresponds to approximately **one-third of the anterior-posterior diameter** of the adult chest, ensuring adequate blood flow. *Force should depress sternum by 1½ inches* - A compression depth of **1½ inches (approximately 3.8 cm)** is **insufficient** for effective adult CPR. - This depth would result in **inadequate blood circulation** to vital organs, reducing the chances of successful resuscitation.

Q: What is the ratio of chest compressions and breaths when a lone person is giving cardiopulmonary resuscitation?

30:2. ***30:2*** - For **adults**, the recommended ratio for solo CPR is **30 chest compressions** followed by **2 rescue breaths**. - This ratio aims to maximize blood flow to vital organs while ensuring some oxygenation. - This is the standard for **single-rescuer adult CPR** per AHA/ERC guidelines. *10:1* - This ratio is highly **ineffective** and does not provide adequate circulation or ventilation. - A single breath for ten compressions is insufficient for oxygen delivery. *30:1* - This ratio provides good compressions but **inadequate ventilation** for adults. - Giving only one breath after 30 compressions does not ensure sufficient oxygen delivery. *15:1* - This ratio is typically recommended for **two-person CPR in infants and children**. - For adults, it would lead to too many interruptions in chest compressions, reducing perfusion.

Question 1

Which of the following statements given below is incorrect regarding CPR?

Accepted Answer

Ventilation 22-25/ min

Answer

Chest compression rate 100-120/min

Answer

Depth of chest compression up to 5-6 cm

Answer

Allow adequate chest recoil

Question 2

In CPR, number of chest compressions per minute in an adult:

Accepted Answer

100-120 per minute

Answer

30-50 per minute

Answer

50-72 per minute

Answer

120-200 per minute

Question 3

A patient in shock requires rapid fluid resuscitation. If intravenous (IV) cannulation is not possible, within what time frame should an intraosseous (IO) line be placed?

Accepted Answer

1.5 minutes

Answer

2.5 minutes

Answer

1 minute

Answer

2 minutes

Question 4

Hypothermia is used in all except:

Accepted Answer

Arrhythmia

Answer

Hyperthermia

Answer

Neonatal asphyxia

Answer

Cardiac surgery

Question 5

A 55-year-old woman was admitted to the intensive care unit with severe lobar pneumonia and septic shock. She remained hypoxemic despite intubation, a high fraction of inspired oxygen, and positive end-expiratory pressure (PEEP). When PEEP was increased further, she paradoxically became more hypoxemic and her blood pressure and central venous hemoglobin saturation fell. What would be your approach?

Accepted Answer

Initiate dobutamine and reduce PEEP to 5cm H2O

Answer

Increase PEEP further

Answer

Keep PEEP at the highest and give adrenaline

Answer

Increase FiO2

Question 6

According to current CPR guidelines, the immediate first action when encountering an unresponsive patient should be:

Accepted Answer

Airway maintenance

Answer

Intracardiac atropine

Answer

Hysterectomy

Answer

IV adrenaline

Question 7

Which of the following statements is true or false regarding the CPR technique?

1. Can be given irrespective of rib fracture.
2. An adult chest compression : breath remains 30 : 2 and does not change to 15 : 2 even if 2nd rescuer present.
3. In infants ratio change from 30 : 2 to 15 : 2 when 2nd rescuer arrives.
4. Chest compression at rate of 100 - 120 / min on adults and 90 per minute in infants.

Accepted Answer

b, c are true & a, d are false

Answer

a, b are true & c, d are false

Answer

a, c, d are true & b is false

Answer

a is false and b, c, d are true

Question 8

During cardiopulmonary resuscitation, cardiac massage is given over:

Accepted Answer

Lower third of sternum

Answer

Mid third of sternum

Answer

Upper third of sternum

Answer

Precordium

Question 9

The ideal parameters for cardiac massage in cardiopulmonary resuscitation are all EXCEPT:

Accepted Answer

Ratio of compression to ventilation should be 15:2

Answer

Compressions to be given over lower third of sternum

Answer

Force should depress sternum approximately 1/3 of chest wall diameter

Answer

Force should depress sternum by 1½ inches

Question 10

What is the ratio of chest compressions and breaths when a lone person is giving cardiopulmonary resuscitation?

Accepted Answer

30:2

Answer

10:1

Answer

30:1

Answer

15:1

Critical Care Medicine — MCQs

Critical Care Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?