Critical Care Practice Questions

Q: Which of the following are components of SOFA scoring system? I. PaO_2 / FiO_2 ratio II. Mean arterial pressure III. Glasgow coma scale IV. Prothrombin Time with INR Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - The **Sequential Organ Failure Assessment (SOFA) score** evaluates organ dysfunction based on six systems: respiration, coagulation, liver, cardiovascular, central nervous system, and renal. - **PaO2/FiO2 ratio** assesses respiratory function, **Glasgow Coma Scale (GCS)** assesses central nervous system function [1], [3], and **Prothrombin Time with INR** assesses coagulation function, all of which are included in the SOFA score calculation. *I, II and IV* - This option incorrectly includes **Mean Arterial Pressure** as a primary component for calculating the cardiovascular SOFA score, though it is indirectly considered when evaluating the use of vasopressors [2]. - The SOFA cardiovascular component primarily relies on **vasopressor dosage** required to maintain blood pressure, rather than absolute mean arterial pressure alone. *II, III and IV* - This option omits the **PaO2/FiO2 ratio**, which is a crucial parameter for assessing respiratory organ dysfunction within the SOFA scoring system. - It incorrectly focuses on **Mean Arterial Pressure** as a direct component instead of the vasopressor requirement. *I, II and III* - This choice omits **Prothrombin Time (PT) with INR**, which is a vital indicator for assessing the **coagulation system** within the SOFA score. - It incorrectly includes **Mean Arterial Pressure** as a direct, standalone component rather than vasopressor support for the cardiovascular system.

Q: Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)? 1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria. 2. It is same as bacteraemia. 3. It results in Multiple Organ Dysfunction Syndrome (MODS). 4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **SIRS** can be caused by the release of **lipopolysaccharide endotoxin** from the cell wall of dying **Gram-negative bacteria** like *E. coli*, triggering a systemic inflammatory response [1]. - One of the major complications of **SIRS** is the progression to **Multiple Organ Dysfunction Syndrome (MODS)**, where organs begin to fail due to uncontrolled inflammation [1]. - A component of the **SIRS criteria** is a white blood cell count greater than 12 x 10^9/L or less than 4 x 10^9/L, or the presence of more than 10% immature band forms [1]. *2, 3 and 4* - **Bacteremia** refers specifically to the presence of **viable bacteria** in the bloodstream, while **SIRS** is a broader inflammatory response that can be triggered by various causes (infectious or non-infectious). - While bacteremia can lead to SIRS, SIRS can also occur without bacteremia (e.g., pancreatitis, trauma). *1, 2 and 3* - **Bacteremia** is not the same as SIRS; bacteremia is a potential cause of SIRS, but SIRS can arise from non-infectious conditions as well. - The presence of bacteria in the blood (bacteremia) is a specific finding, whereas SIRS describes a *syndrome* of systemic inflammation. *1, 2 and 4* - This option incorrectly states that **SIRS is the same as bacteremia**, which it is not. - Also, while bacteremia can lead to SIRS, **MODS** is a crucial and often fatal consequence of advanced SIRS, which is omitted in this option.

Q: Consider the following statements : Systemic Inflammatory Response Syndrome is characterised by 1. Temperature either above 38°C or below 36°C. 2. Heart rate less than 80/minute. 3. Tachypnoea > 20/min. 4. Leucocyte count > 4 x 109/L. Which of the statements given above are correct ?

3, 4 and 1. ***3, 4 and 1*** - **SIRS criteria** include a temperature above 38°C or below 36°C [1], and tachypnea with a respiratory rate greater than 20 breaths/minute. - Additionally, a white blood cell count greater than 12,000 cells/mm³ (12 x 10⁹/L) or less than 4,000 cells/mm³ (4 x 10⁹/L), or the presence of more than 10% immature band forms, are part of the criteria. *1 and 3* - This option correctly identifies **temperature** [1] and **tachypnea** as SIRS criteria but omits the leukocyte count, which is also a key component. - It is an incomplete set of correct criteria, missing one crucial element. *1, 4, 3 and 2* - This option incorrectly states a heart rate **less than 80/minute** as a SIRS criterion; the correct criterion for SIRS is a heart rate **greater than 90/minute**. - While it includes other correct criteria, the inclusion of an incorrect heart rate makes this option wrong. *2, 4 and 3* - This option incorrectly states a heart rate **less than 80/minute** as a SIRS criterion. The correct criterion for SIRS is a heart rate **greater than 90/minute**. - It also misses the **temperature** criterion, which is a fundamental component of SIRS [1].

Q: Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except

White cell count 12,000/mm³ or 10% **immature (band) forms**. [2] - This option correctly states a **WBC count below 4000/mm³**, which is indeed a criterion for SIRS. *Temperature > 38°C or < 36°C* - This is a correct criterion for SIRS, indicating a significant deviation from normal body temperature. [1] - Both **fever (hyperthermia)** and **hypothermia** are signs of systemic inflammation. *Tachycardia with a heart rate of more than 90/min.* - This is a correct criterion for SIRS, reflecting the increased metabolic demand and sympathetic activation during systemic inflammation. [2] - A persistent **heart rate above 90 bpm** is considered indicative of such stress. *Tachypnoea with a respiratory rate of > 20/min.* - This is a correct criterion for SIRS, showing the body's attempt to compensate for metabolic disturbances or increased oxygen demand. [2] - A **respiratory rate greater than 20 breaths per minute** or a PaCO2 less than 32 mmHg are both SIRS criteria.

Q: Which of the following is NOT a feature of Systemic Inflammatory Response Syndrome?

Bradycardia. ***Bradycardia*** - **Bradycardia** (a slow heart rate) is **not** a typical diagnostic criterion for **Systemic Inflammatory Response Syndrome (SIRS)**. - SIRS is usually associated with **tachycardia** (heart rate >90 beats/min) due to the body's increased metabolic demand and stress response [2]. *Hypothermia (less than 36°C)* - **Hypothermia** ( 38°C) is a common and primary diagnostic criterion for **SIRS**, reflecting the body's inflammatory response to infection or injury [2], [3]. - This elevated core temperature is part of the systemic response to pathogens or tissue damage. *Leucocytosis* - **Leucocytosis** (white blood cell count >12,000 cells/mm³) is a key diagnostic criterion for **SIRS**, indicating a robust innate immune response [1], [2]. - A WBC count 10% immature neutrophils ("bands") also fulfills this criterion.

Q: A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:

Systemic inflammatory response syndrome. ***Systemic inflammatory response syndrome*** - The patient's presentation with **tachycardia** (pulse 106/min), **tachypnea** (respiratory rate 26/min), and **leukocytosis** (TLC 14000/µL) meets at least two criteria for **Systemic Inflammatory Response Syndrome (SIRS)** following a significant surgical stressor. - SIRS is a generalized inflammatory response to various insults, including major surgery, trauma, and infection, occurring in the absence of a confirmed infection. *Sepsis syndrome* - **Sepsis syndrome** is defined as SIRS with a **confirmed or suspected infectious source**. While the patient had a bowel injury, there is no definitive evidence of active infection provided (e.g., positive cultures, purulent discharge). - Although the bowel injury could lead to infection, the current information only confirms a systemic inflammatory response, not necessarily a microbial cause. *Multisystem organ failure (MSOF)* - **Multisystem organ failure (MSOF)** involves the failure of two or more organ systems. While the patient has elevated **BUN** and **creatinine**, indicating **acute kidney injury**, there's no evidence of failure in other systems required to diagnose MSOF. - MSOF is a more severe progression of SIRS or sepsis, characterized by severe organ dysfunction, which is not fully met by the current presentation. *Wound infection* - **Wound infection** is a localized infection and would typically present with signs like **erythema**, **purulent discharge**, **tenderness**, or **warmth** at the surgical site. None of these specific local signs are mentioned. - While a wound infection could be a potential source of SIRS or sepsis, the clinical picture provided describes a systemic response rather than a localized one.

Q: Systemic Inflammatory Response Syndrome (SIRS) is characterized by all of the following EXCEPT:

Platelet count ( 38˚C)* - **Fever** is a classic sign of inflammation and infection, and a temperature greater than 38°C is one of the key diagnostic criteria for SIRS. [2] - This indicates the body's systemic inflammatory response to a perceived insult. [3] *Tachypnoea (>20/min)* - An increased **respiratory rate**, or **tachypnea**, is another important criterion for SIRS, reflecting increased metabolic demand or respiratory compensation. - This criterion helps identify patients with a significant physiological response to inflammation. *Hypothermia (<36˚C)* - While less common than fever, **hypothermia** (temperature less than 36°C) can also be a sign of a severe systemic inflammatory response, particularly in immunocompromised or severely ill patients. - It signifies a dysregulated thermoregulatory response in SIRS.

Q: All the following are criteria for SIRS, except

Systolic blood pressure 90/min* - An elevated **heart rate** (tachycardia) is a common physiological response to systemic stress and inflammation. - This criterion fulfills one of the four clinical parameters to diagnose **SIRS**. *Respiratory rate >20 bpm* - An increased **respiratory rate** (tachypnea) reflects the body's attempt to compensate for metabolic acidosis or increased oxygen demand during a systemic inflammatory response. - This criterion is one of the four clinical parameters used to diagnose **SIRS**. *Temperature >38 degree Celsius or 38°C) and **hypothermia** (<36°C) are indicators of a systemic inflammatory response, as the body's thermoregulation is affected [1]. - This criterion is one of the four principal parameters used to diagnose **SIRS** [1].

Q: Refractory Septic shock is defined as?

Shock persisting despite adequate fluid resuscitation and vasopressor support. ***Shock persisting despite adequate fluid resuscitation and vasopressor support*** - This is the **standard definition** of refractory septic shock according to current **Surviving Sepsis Campaign Guidelines** and critical care literature. - It specifically refers to the failure of **both fluid resuscitation and vasopressor therapy** to restore adequate mean arterial pressure and tissue perfusion. *Shock that does not respond to initial fluid bolus within 1 hour* - This describes **early non-response** to fluid therapy, which is concerning but not the complete definition of refractory shock. - Refractory shock requires failure of **comprehensive standard therapy** (fluids AND vasopressors), not just initial fluid bolus failure. *Shock requiring mechanical ventilation and inotropic support* - This describes a patient in **severe septic shock** with multi-organ support but does not define its **refractory nature**. - The need for these interventions indicates **organ dysfunction** and severity, not necessarily refractoriness to standard resuscitation efforts. *Shock with lactate levels >4 mmol/L despite treatment* - **Elevated lactate** indicates tissue hypoperfusion and ongoing shock, but it is a **severity marker**, not the definition of refractoriness. - High lactate levels can occur even in shock that is **responsive to standard therapy** and doesn't specifically indicate failure of resuscitation efforts.

Q: All of the following can cause Pulseless Electrical Activity (PEA) except

Pulseless VT. Detailed Analysis: ***Pulseless VT*** - **Pulseless VT** is a cardiac arrest rhythm where an electrocardiogram shows ventricular tachycardia, but no pulse is detectable [1]. This is itself a type of cardiac arrest, not a *cause* of PEA [1], [2]. - While it's a life-threatening arrhythmia, PEA refers to organized electrical activity (other than VT) without a palpable pulse. *Massive pulmonary embolism* - A **massive pulmonary embolism** can lead to sudden right ventricular failure and obstruction of pulmonary blood flow, causing profound hypotension and PEA. - The heart has electrical activity but cannot generate a pulse due to the severe mechanical obstruction. *Tension pneumothorax* - A **tension pneumothorax** causes significant intrathoracic pressure, which impedes venous return to the heart and compresses the great vessels and heart. - This leads to a drastic reduction in cardiac output, resulting in PEA despite ongoing electrical activity. *Cardiac tamponade* - **Cardiac tamponade** involves accumulation of fluid in the pericardial sac, compressing the heart and preventing adequate ventricular filling [3]. - The inability of the ventricles to fill sufficiently leads to a severe drop in cardiac output and subsequent PEA.

Question 1

Which of the following are components of SOFA scoring system?
I. PaO_2 / FiO_2 ratio
II. Mean arterial pressure
III. Glasgow coma scale
IV. Prothrombin Time with INR

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Answer

I, II and III

Question 2

Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)?

1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria.
2. It is same as bacteraemia.
3. It results in Multiple Organ Dysfunction Syndrome (MODS).
4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 3

Consider the following statements : Systemic Inflammatory Response Syndrome is characterised by

1. Temperature either above 38°C or below 36°C.

2. Heart rate less than 80/minute.

3. Tachypnoea > 20/min.

4. Leucocyte count > 4 x 109/L. Which of the statements given above are correct ?

Accepted Answer

3, 4 and 1

Answer

1 and 3

Answer

1, 4, 3 and 2

Answer

2, 4 and 3

Question 4

Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except

Accepted Answer

White cell count < 4000/mm³

Answer

Temperature > 38°C or < 36°C

Answer

Tachycardia with a heart rate of more than 90/min.

Answer

Tachypnoea with a respiratory rate of > 20/min.

Question 5

Which of the following is NOT a feature of Systemic Inflammatory Response Syndrome?

Accepted Answer

Bradycardia

Answer

Hypothermia (less than 36°C)

Answer

Hyperthermia (more than 38°C)

Answer

Leucocytosis

Question 6

A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:

Accepted Answer

Systemic inflammatory response syndrome

Answer

Sepsis syndrome

Answer

Multisystem organ failure (MSOF)

Answer

Wound infection

Question 7

Systemic Inflammatory Response Syndrome (SIRS) is characterized by all of the following EXCEPT:

Accepted Answer

Platelet count (<1,00,000/mm3)

Answer

Hyperthermia (>38˚C)

Answer

Tachypnoea (>20/min)

Answer

Hypothermia (<36˚C)

Question 8

All the following are criteria for SIRS, except

Accepted Answer

Systolic blood pressure <90 mmHg

Answer

Heart rate >90/min

Answer

Respiratory rate >20 bpm

Answer

Temperature >38 degree Celsius or <36 degree Celsius

Question 9

Refractory Septic shock is defined as?

Accepted Answer

Shock persisting despite adequate fluid resuscitation and vasopressor support

Answer

Shock requiring mechanical ventilation and inotropic support

Answer

Shock with lactate levels >4 mmol/L despite treatment

Answer

Shock that does not respond to initial fluid bolus within 1 hour

Question 10

All of the following can cause Pulseless Electrical Activity (PEA) except

Accepted Answer

Pulseless VT

Answer

Massive pulmonary embolism

Answer

Tension pneumothorax

Answer

Cardiac tamponade

Critical Care — MCQs

Critical Care — MCQs

On this page

Practice by Chapter

Want unlimited practice?