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What is the most common site of rupture of a cerebral aneurysm with
resulting subarachnoid hemorrhage (SAH)?
a. Anterior cerebral artery
b. Middle cerebral artery
c. Anterior communicating artery
d. Posterior communicating artery - Correct Answer - c. Anterior
communicating artery
Donna is a 43-year-old teacher who was admitted 6 days ago with a
ruptured middle cerebral artery (MCA) aneurysm with subarachnoid
hemorrhage (SAH). She underwent surgery for aneurysm clipping 12
hours after admission, and has had an excellent post-operative course.
However, this morning, she complained of a severe headache, became
acutely confused and quickly progressed to unresponsiveness. What is
the likely cause for Donna's change of status?
a. Expansion of her original SAH
b. Uncal herniation
c. Cerebral vasospasm
d. Medication reaction - Correct Answer - c. Cerebral vasospasm
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Matthew is a 26-year-old who has been admitted to the ICU following a
motor vehicle accident. Upon assessment, it is noted that he has a
positive Cullen sign. What does this indicate?
a. Basilar skull fracture
b. Retroperitoneal hemorrhage
c. Pelvic fracture
d. Aortic tear - Correct Answer - b. Retroperitoneal hemorrhage
If bowel sounds are audible when auscultating Matthew's lungs, what
injury may he have sustained?
a. Ruptured spleen
b. Ruptured liver
c. Diaphragmatic injury
d. Gastric tear - Correct Answer - c. Diaphragmatic injury
If a patient sustains acute renal failure (ARF) secondary to cardiogenic
shock, what type of renal failure is this considered?
a. Intrinsic
b. Prerenal
c. Postrenal
d. Iatrogenic - Correct Answer - b. Prerenal
The RIFLE classification system provides a definition and classification
system for acute renal failure (ARF). What does the "R" in the RIFLE
acronym refer to?
pg. 2
,3|Page
a. Risk of renal dysfunction
b. Rapid response to failure
c. Role of dialysis
d. Recurrence of intrinsic disease - Correct Answer - a. Risk of renal
dysfunction
Andrew is a 47-year-old with advanced amyotrophic lateralizing
sclerosis (ALS). He requires total assistance for positioning, bathing and
mobility. His swallowing is impaired, so he takes nothing by mouth and
receives nutrition through tube feedings via a gastrostomy tube. Based
on his current condition, what type of asphyxia may Andrew be most
susceptible to?
a. Cardiac asphyxia
b. Neurological asphyxia
c. Foreign body asphyxia
d. Positional asphyxia - Correct Answer - d. Positional asphyxia
Ramona is a 21-year-old who has been admitted to the ICU after
suffering an anaphylactic reaction during dinner due to peanut sauce in a
dish that the host didn't tell her about. She was stabilized in the
emergency room with IV epinephrine and IV diphenhydramine.
However, 4 hours after being admitted to the ICU she becomes anxious,
develops hives and begins to have difficulty breathing. What is the most
likely cause for Ramona's symptoms?
a. Persistent anaphylaxis
b. Biphasic anaphylaxis
c. Unresponsive anaphylaxis
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d. Rebound anaphylaxis - Correct Answer - b. Biphasic anaphylaxis
Madge is a 91-year-old nursing home resident with a history of dementia
and atrial fibrillation who has been admitted to the ICU for treatment of
pneumonia. As you are performing her bed bath, you note bruising
around her breasts and genital area. What potential issue should be of
major concern in Madge's situation?
a. Idiopathic thrombocytopenia purpura (ITP)
b. Embolic stroke
c. Sexual abuse
d. Nursing home acquired pneumonia (NHAP) - Correct Answer - c.
Sexual abuse
Jerry is a 55-year-old veteran who has been admitted after a motor
vehicle accident with multiple injuries. His friend reported that he had
been using synthetic marijuana prior to the accident, and that he also
sees a psychiatrist at the VA hospital for an unknown diagnosis. He
stated that Jerry sometimes gets "hyper" for no reason, starts "ranting"
and becomes violent. Of the following, which general psychiatric
disorder is characterized by a pattern of aggression or violence which
includes irritability, agitation, and violent behavior during manic or
psychotic episodes?
a. Schizophrenia
b. Post-traumatic stress disorder (PTSD)
c. Bipolar disorder
d. Delusional disorder - Correct Answer - c. Bipolar disorder
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