CCM practice test 1
72 yo man, admitted to the ICU for COPD flare. On the third day, he is found to be quiet, calm, and confused. Which of the following is not a characteristic feature of ICU delirium?
Inattention
Hypertension
Waxing/waning mental status
Disorganized thinking
Altered consciousness
A 47 yo woman with alcoholic cirrhosis is brought to your ER with fevers, confusion, shortness of breath, and worsening ascites. SBP is 50 mmHg, HR 150 bpm, RR 40/min, and O2 sat 80%. CXR shows diffuse infiltrates, and peritoneal fluid returns with a leukocyte count of 1000/mL (95% polys). Initial management of hemodynamics should entail use of:
Vasopressin
Norepinephrine
Norepinephrine + Lasix
Intravenous fluids
Dobutamine
Which one of the following is most likely to be associated with hypovolemia?
Increased central venous pressure
Decreased ventricular end-diastolic volume
Increased pulmonary artery occlusion pressure
Decreased heart rate
Normal heart rate
Hemodialysis is most effective at removing drugs/toxins with which of the following characteristics?
Highly protein bound
Low volume of distribution
Lipid soluble
Slowly equilibrates between blood and tissue compartments
Metabolized by Hofmann elimination
Which of the following does not help predict the outcome of a critically ill cancer patient?
The status of the cancer
Institution of renal replacement therapy on Day 5
The reason for their respiratory failure
Whether or not they have been delirious
Neutropenia
Which of the following steps has been shown to reduce mortality in patients with myocardial infarction complicated by cardiogenic shock?
Intra-aortic balloon counterpulsation
Percutaneous left ventricular assist device
Early cardiac catheterization and revascularization
Pulmonary Artery Catheterization
Early cardiac surgical consultation
Approximately how many adults develop ARDS per year in the US?
50,000
100,000
200,000
400,000
600,000
What is the most appropriate length for a spontaneous breathing trial?
5-10 minutes
30-120 minutes
3-6 hours
8-12 hours
3 hours
What is the most practical cerebral imaging study within 3 hours of stroke signs and symptoms?
CT of brain
CT of brain/CT angiogram of head and neck
MRI of brain
MRI of brain/MRA of head and neck
Which portion of the ventricular waveform represents the preload state?
Systolic preak
Dichrotic nothc
End diastolic pressure
The ventricular upstroke
The mid-systolic peak
Which of the following statements about ScvO2 is most correct?
ScvO2 values < 60% indicate vulnerable tissue oxygenation
ScvO2 values > 80% indicate adequate or increased tissue oxygenation
ScvO2 values < 60% indicate low oxygen consumption
ScvO2 values > 80% indicate increased oxygen consumption
ScvO2 values < 60% correlate well with cyanide intoxication
Which of the following is the most correct PCWP pressure value shown in the tracing?
35 mm Hg
25 mm Hg
44 mm Hg
38 mm Hg
45 mm Hg
What percentage of Total Blood Volume loss is correlated with hypotension?
10%
20%
25%
30%
35%
A 19 year-old man arrives to the ED after sustaining gunshot to left lower quadrant. His pulse is 140 and blood pressure is 80/40. FAST is positive for intra-abdominal fluid and the patient is taken to the operating room. Current evidence most strongly supports the following approach to blood component therapy:
Early administration of prothrombin complex concentrate (PCC)
Administration of crystalloid and albumin
Transfusion of blood components in a fixed ratio
Minimize use of platelets
Goal directed component transfusion based on PT/PTT and platelet count
A 60 year-old man presents with 2 hours of crushing substernal chest pain radiating to his left arm, nausea, and diaphoresis. On examination his BP is 80/40, pulse is 110, and oxygen saturation is 95% on 4L NC. He is in severe respiratory distress and has marked jugular venous distention, bilateral rales, and S3 gallop, and cold clammy extremities. An ECK reveals sinus tachycardia, ST elevation in anterolateral leads and ST depression in the inferior leads. The patient is given aspirin, clopidogrel, nitroglycerin, heparin, and iV fluids. He remains hypotensive despite dopamine. Urgent coronary angiography is planned. Which of the following additional steps is most appropriate?:
Start low dose beta-blocker
Add a phosphodiesterasse inhibitor
Insert an intra-aortic balloon pump
Administer thrombolytic therapy
Edmomyocardial biopsy
You are called to the CCU to see a 47 year-old man being supported with and IABP following an acute myocardial infarction with cardiogenic shock. The nurse notes a change in the IABP waveform. What manipulation should be made to correct the timing?:
Nothing
Increase the inflation delay
Increase the inflation time
Reduce the inflation time
Give a fluid bolus
30 year-old female at 37 weeks gestation presents with a 3-day history of pleuritic chest pain. Upon admission a cesarean section is performed due to concern for fetal distress. On closure of the abdomen, she suffers complete cardiovascular collapse with PEA arrest. Spontaneous crculation returns after 20 minutes of cardiopulmonary resuscitation. Blood pressure is 80/40, PaO2 is 40 mm Hg on FiO2 of 1.0. You are called to discuss options for urgent mechanical circulatory support. Which of the following is the best strategy?:
Intra-aortic Balloon pump
Veno-venous ECMO
Veno-Arterial ECMO
Percutaneous Right Ventricular Assist Device
Percutaneous Left Ventricular Assist Device
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