MCQ Resuscitation 1

Which of the following best describes Noradrenaline?

Receptor HR VC CO Side FX

A α

o ++++ Decrease Reflex brady

B β1, some β2,

+/- α1 in large doses

++++ + Increase Increased O2 consumption

C α, β

++++ ++++ Increase HTN

D α1, +/- β1

++ ++++ Decrease Reflex brady

Answer

2

With regards to the use of HCO-

3 in shock, which is FALSE?

A HCO-3 shifts O2 dissociation curve to the right to allow increased O2 delivery

from Hb at lower tissue pO2

B HCO-3 improves the myocardial depression associated with shock

C HCO-

3 counteracts the insensitivity to endogenous catecholamines attributed to acidosis

D HCO-3 worsens intracellular acidosis

Answer

3

Which of the following is NOT a criterion for SIRS?

A Temperature < 36oC

B HR > 90

C RR < 6 or PaCO2 < 23 mmHg

D WCC with > 10% immature bands

Answer

4

In early shock, which of the following is FALSE?

A SBP may rise as a result of increased cardiac contractility

B DBP may rise secondary to arteriolar VC

C A high mortality rate secondary to impaired LVF is seen in a persistent shock index >1

D Polyuria excludes shock secondary to sepsis

Answer

5

The first compensatory response to shock is which of the following?

A An increased CO

B A fall in O2 content of blood

C A rise in respiratory rate

D A fall in the mixed venous O2 saturation

Answer

6

With regards to lactic acidosis, which is FALSE?

A An elevated lactate is a marker of impaired O2 delivery or utilization

B A raised lactate correlates with short term prognosis of critically ill patients in ED

C In septic shock and in post resuscitation from cardiac arrest, one would expect a raised lactate with a reduced mixed venous O2 saturation

D A raised lactate in the setting of a metabolic acidosis, with a raised anion gap and normal osmolar gap and no ketosis is a characteristic feature of toluene poisoning

Answer

7

Which of the following is NOT a metabolic feature of shock?

A Prerenal azotemia

B Hyponatraemia

C Hyperglycaemia

D Hypoglycaemia

Answer

8

Which of the following best describes the following definition? “Sepsis associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion and perfusion abnormalities may include, but are not limited to lactic acidosis, oliguria, or an acute alteration in mental status.”

A Septic shock

B Sepsis

C Severe sepsis

D SIRS

Answer

9

A man who has lost 1700mL of blood in a trauma situation will

A Require only crystalloid fluid replacement

B Have a pulse rate of 90

C Have lost 30-40% of blood volume

D Have a normal pulse pressure

Answer

10

The most common cause of sudden cardiac death is

A A Cardiomyopathy

B B WPW

C C Coronary artery disease

D D Drugs

Answer

11

The following is true of Defibrillation

A Most defibrillators now manufactured use a monophasic waveform

B The monophasic waveform requires less energy for successful defibrillation than the biphasic type

C Biphasic waveforms allow smaller more portable defibrillation devices.

D Monophasic defibrillators should no longer be used

Answer

12

Regarding resuscitation guidelines which of the following is FALSE?

A Majority of survivors of sudden cardiac arrest have VF as a primary rhythm

B Emphasis is focused also on pre-arrest period and post-resuscitation management

C Fist pacing is of no value in unstable bradyarrhythmias when a pacemaker is not immediately available

D Rescue breathing provides a FiO2 0.15-0.18

Answer

13

Suggested indications for resuscitative thoracotomy in patients with traumatic cardiac arrest include all of the following EXCEPT

A Penetrating cardiac trauma and arrival in ED after <5min of out of hospital CPR and positive pupillary response

B Penetrating cardiac trauma and arrest in ED

C Penetrating thoracic trauma and arrival in ED after <15min of out of hospital CPR and positive pupillary response

D Blunt chest trauma and arrival in ED after <10min of out of hospital CPR

Answer

14

Which Antiarrhythmic drug increases the fibrillation threshold?

A Amiodarone

B Lignocaine

C Procainamide

D Vasopressin

Answer

15

What is the apgar score if the baby exhibits the following clinical features? Acrocyanosis, some flexion, irregular respirations, pulse<100, and nil reflex irritability.

A 2

B 3

C 4

D 5

Answer

16

In regard to ALS

A Endotracheal route administration of drugs cannot be used via a LMA

B Higher doses of Adrenaline have been shown to improve long term outcome

C ROSC is higher for patients receiving vasopressin 40IU than adrenaline

D Fibrinolysis is no longer recommended in a cardiac arrest due to suspected PE due to the high incidence of bleeding during CPR

Answer

17

With regard to defibrillation

A First shock efficacy for biphasic defibrillators is greater than 90%

B As little as 4% of the current reaches the heart

C Defibrillator pads should be placed within 12-15cm of a pacemaker

D A period of CPR before defibrillation is not beneficial in a prehospital prolonged arrest

Answer

18

Children differ to adults in the following ways

A Less than six months old are obligate mouth breathers

B They have a higher stroke volume

C The larynx is high and posterior

D The chest wall is more compliant

Answer

19

Which of the following should NOT influence the accuracy of pulse oximetry readings

A Patient movement

B Nail polish

C Hypotension

D Carboxyhaemoglobin

Answer

20

2,3-DPG production is NOT increased by

A Acidosis

B Hypoxia

C Anaemia

D Thyroid hormone

Answer

21

During resuscitation in hypothermia, which statement is TRUE?

A The dose of Adrenaline should be doubled until core temp > 35ºC

B The time interval between drug doses should be halved until temp > 30ºC

C Fixed, dilated pupils is an indication to abandon resuscitation efforts

D If VF / VT persists after 3 shocks, further shocks should be delayed until core temperature > 30ºC

Answer

22

Early Goal-Directed Therapy of Sepsis in the ED does NOT include

A Maintaining CVP 8 – 12 mmHg

B Maintaining MAP 65 – 90 mmHg

C Maintaining central venous O2 saturation (ScvO2) >/= 70%

D Transfusion of RBC to haematocrit >/= 40%

Answer

23

With regards to paediatric resuscitation, which of the following is INCORRECT?

A ETT size = Age/4 +4

B Weight in Kg = (Age x 2) + 8

C ETT insertion distance at lips = (Age/2) + 12

D Adrenaline dose 0.1ml / kg of 1:1000 solution

Answer

24

With respect to intraosseous needles which is FALSE

A The distal femur is one appropriate site for insertion

B An IO needle should be attempted in a paediatric resuscitation if IV access has not been achieved within 90 seconds

C Compartment syndrome is a recognised complication

D Their use is contraindicated in neonates due to the high rate of growth plate injury

Answer

27

Features increasing the safety of Endotracheal tubes include all of the following EXCEPT:

A Bevelled atraumatic tip

B Translucency of the tube

C Murphy’s eye

D Small volume , high pressure distal cuff

Answer

28

Factors making paediatric intubation more difficult include all the following EXCEPT:

A Upper airways are more compliant

B Large tongue

C Larynx is more cephalad

D Epiglottis is larger and floppy

Answer

29

Which of the following is NOT a link in the chain of survival?

A Early Defibrillation

B Early CPR

C Early Drug Delivery

D Post resuscitation care

Answer

30

With regards to cardiac arrest in the third trimester of pregnancy, which of the following statements is TRUE

A if there is no return of spontaneous maternal circulation within 10 minutes of cardiac arrest and CPR commencement, a perimortem caesarean section should be performed.

B the patient should be tilted by placing a roll under the patient's left hip and flank.

C adrenaline is contraindicated as it causes uteroplacental vasoconstriction.

D avoid the femoral vein when obtaining IV access.

Answer

31

Which of the following about central venous access is INCORRECT?

A There is a greater infection rate with femoral vein CVCs

B The risk of carotid puncture is greater with the central approach to the internal jugular as opposed to the posterior or anterior approach

C Femoral vein approach is relatively contraindicated in pregnancy

D The rate of infusion is dependant on the radius of the line and the length

Answer

33

With regard to central venous lines

A Pneumothorax is not a complication of internal jugular insertion

B Subclavian lines have the highest incidence of arterial puncture

C Using a supraclavicular approach the needle is directed at the contralateral nipple

D Femoral lines have the lowest incidence of venous thrombosis

Answer

34

Which is the most reliable method of confirming endotracheal tube placement?

A Equal bilateral breath sounds

B End Tidal CO2 capnography

C Misting of the tube with expiration

D Chest X-ray

Answer

35

With regards to parenteral fluid compositions which is CORRECT

A Hartmann's contains Na 131 K 5 Cl 111

B 5% Dextrose contains 50g/LDextrose osmol 300

C 4% Dextrose 0.18% saline contains Dextrose 40g/L Cl 30 Na 40 mmol

D 0.9% saline contains Na 150 mmol/L Cl 150 pH 6

Answer

36

According to the ILCOR 2010 Resuscitation Guidelines, once ROSC is achieved and the oxygen saturation of arterial blood can be monitored reliably, inspired oxygen is titrated to achieve a SaO2 of:

A >95%

B 90-95%

C 94-98%

D >93%

Answer

37

In regards to resuscitation of a 10Kg child, which of the following is FALSE:

A ETT size 4 would be appropriate

B The dose of adrenaline is 0.1mLs/kg of 1:10 000 solution

C The rate of external cardiac compressions is 120/min

D 5mL/kg 10% dextrose is used to treat hypoglycaemia

Answer

38

Which of the following is a criterion for SIRS?

A Temp > 39 or < 36

B Pulse > 100bpm

C Resp rate > 28

D WCC > 12 000 or < 4000

Answer

40

A left shift of the Haemoglobin-oxygen dissociation curve

A Favours unloading of oxygen and subsequent delivery to tissues

B Occurs with increased temperature

C Occurs as CO2 levels rise

D Occurs in alkalosis

Answer

39

Which of the following is FALSE regarding adult cardiac arrest?

A 50% of out of hospital cardiac arrests have an initial rhythm of VF/VT

B Atropine is not recommended in treatment of asystole

C Continuous waveform CO2 monitoring is useful for detecting ROSC

D There is less evidence supporting the use of hypothermia post-arrest for comatose survivors with an initially non-shockable rhythm.

Answer

Answers

1. D, (A phenylephrine, B dobutamine, C Adrenaline), Tintinalli p223 2. A It moves it to the left. Exercise, heat, acid, low 2,3,DPG move the curve to the

right to facilitate O2 offloading in an acidic environment. 3. C RR>20 4. D Shock index = HR/SBP (0.5 > Normal <0.7) 5. A 6. D 7. B 8. C Tintinalli p232 9. C Textbook of Adult Emergency Medicine. P 26 10. C 11. C Dunn 3rd ed p98, Rosen 5th ed p78, 12. C 13. D (open thoracotomy does not improve outcome in out of hospital arrest 2nd to

blunt trauma) Cardiac arrest associated with trauma Circulation.2005;112:IV-146-IV-149)

14. B 15. C 16. A 17. B ALS Manual 5th Edition 18. D APLS 4th edition 19. B Dunn p.814 20. A Dunn p.817 21. D 22. D Rivers E et al. N Engl J Med 2001; 345: 1368-77 Dunn 4th Ed page 834 23. D 24. D APLS Manual & Cameron et al (Paeds) 25. 26. 27. D 28. A 29. C Should be Early recognition and call for help ALS 5th Edition

30. D Comments:(Tintinalli 6th edition p 94) a) - wrong - caesarean should be done

within 5 mins. b) - wrong - should be placed under right hip, not left hip. c) - wrong - adrenaline DOES cause uteroplacental vasoconstriction and may be detrimental in the setting of maternal hypotension, but should be used as needed during cardiac arrest. d) - correct - uterine compression of IVC results in poor venous flow in lower limbs. e) wrong - this is not necessary, and would only delay a potentially lifesaving procedure.

31. B Tintinalli – central venous access 32. 33. C Dunn 4th Ed pgs 835-838 34. B Dunn 4th Ed pg 59 35. A Resus notes 36. C Dunn 5th edition page 6; ILCOR Guidelines 2010 37. C Paediatric Emergency Medicine, Cameron et al 38. D Severe Sepsis & Septic Shock: Review of the Literature and Emergency

Department Management Guidelines. Nguyen et al. 2006 39. A Textbook of Adult Emergency Medicine, Cameron et al. and the new ARC

guidelines 40. D Dunn (4th ed) p817, Cameron (3rd ed) p 28