ABSITE - Critical Care questions and answers with solutions 2025

All are potential causes of cardiogenic shock except:
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- Myocardial infarction.
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- Pericardial tamponade.
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- Tension pneumothorax.
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- Cardiac arrhythmias.
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- Excessive preload. - ANSWER Excessive preload.
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(Excessive preload is typically not a cause of cardiogenic shock, but is a result of cardiogenic sho
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ck.)



A 60-year-
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old man has an arterial PO of 60 mm Hg when the calculated alveolar PO is 94 mm Hg. This diffe
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rence is most commonly due to - ANSWER a ventilation-perfusion mismatch
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oxygen delivery and consumption - ANSWER -
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Under normal circumstances, approximately 20% to 30% of the oxygen delivered to the capillar
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y bed is extracted by the tissues.
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-
OIn conditions of decreased delivery of oxygen, tissues are capable of extracting up to 50% to 60
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% of the oxygen content in the capillary blood.
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- When cellular oxygen supply does not meet demand, anaerobic respiration results.
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(The variables in the equation for the delivery of oxygen are cardiac output, hemoglobin level, o
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xygen saturation of hemoglobin, and the partial pressure of oxygen dissolved in blood. Increases
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Oin the first three variables all yield significant increases in the total amount of oxygen carried by
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blood. The partial pressure of oxygen is multiplied by a factor of 0.003, however, and therefore h
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as a miniscule contribution to the total oxygen content.)
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Dopamine at doses of 5 to 10 μg/kg/min - ANSWER has a largely inotropic action profile
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,(Dopamine has a dose- O O O



dependent action profile. At 3 to 5 μg/kg/min, its actions are largely to increase renal blood flow
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. At doses of 5 to 10 μg/kg/min, it largely acts to stimulate myocardial β receptors and has an in
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otropic effect. At doses greater than 10 μg/kg/min, it stimulates α receptors and has a chronotr
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opic effect.) O




As oxygen delivery increases on the flat horizontal portion of the oxygen consumption-
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delivery curve - ANSWER Oxygen consumption remains the same
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(On the flat horizontal portion of the oxygen consumption-
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delivery curve, oxygen delivery meets cellular demand of oxygen; as oxygen delivery increases, o
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xygen consumption remains the same.)
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Most disorganized ventricular arrhythmias (frequent PVCs, ventricular fibrillation) are caused by
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- ANSWER Metabolic derangements.
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(Most disorganized ventricular arrhythmias are caused by some sort of metabolic derangement
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such as ischemia or magnesium or potassium deficiencies. These abnormalities are not well trea
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ted by antiarrhythmic medications.)
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The best management for a patient with a posterior knee dislocation - ANSWER Arteriogram.
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(The patient may have fairly normal pulses and still have an intimal injury of the popliteal artery
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that is similar to the intimal disruption that can be seen in aortic isthmus injury.)
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the possible etiologies of multiorgan failure - ANSWER -
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OAnticytokine antibodies have shown therapeutic promise in animal studies.
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- Evidence has shown that intestinal mucosa is made permeable by sepsis.
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- The "two-
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hit" hypothesis postulates that after mounting an appropriate response to some physiologic insu
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lt, the patient is left with a primed immune system which manifests an exaggerated immune res
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ponse to a second challenge.
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-
OThe early stages after injury actually appear to consist of an immediate proinflammatory state a
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,s the organism tries to address the physiologic insult. When properly modulated, this is an appro
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priate function. When overexpressed, this proinflammatory state leads to the systemic inflamm
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atory response syndrome. Later, anti-
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inflammatory and immunosuppressive mechanisms are brought into play to bring the organism
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back to homeostasis. If overmanifested, they can lead to a relative generalized immunosuppress
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ion and late incidents of sepsis or multiorgan failure.
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compensatory mechanisms in shock - O O O O



OANSWER Antidiuretic hormone causes the reabsorption of free water by the kidney and has vas
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oconstrictive properties. O




(Antidiuretic hormone is released from the posterior pituitary where it stimulates free water ret
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ention by the kidney and acts as a powerful vasoconstrictor.)
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A 71-year-
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old man with colon cancer is in the intensive care unit following a left hemicolectomy. His blood
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pressure is 72/38 mm Hg, pulse rate is 114/min, respiratory rate is 23/min, and oxygen saturatio
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n is 94% on 2 L of oxygen by nasal cannulae. A pulmonary artery catheter shows a central venou
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s pressure of 8 cm H O, a pulmonary artery pressure of 22/8 mm Hg, a pulmonary artery wedge
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pressure of 6 mm Hg, and a cardiac output of 3.4 L/min. The next step in management should b
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e the intravenous administration of - ANSWER a fluid bolus
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pulmonary artery catheters - ANSWER Allow accurate approximation of left atrial pressure.
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The magnitude of a left-to-right shunt in the presence of an ASD is determined by -
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ANSWER Difference in compliance between left and right ventricles.
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(The blood will tend to fill the more compliant ventricle which will usually be the right, until chro
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nic pulmonary hypertension yields right ventricular hypertrophy.)
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Compared to conventional ventilation (endotracheal intubation), noninvasive ventilation (mask,
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continuous positive airway pressure) is - O O O O O



OANSWER contraindicated in hemodynamically unstable patients
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, According to the American College of Chest Physicians/Society of Critical Care Medicine Consens
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us Conference, which of the following are not part of the diagnostic criteria for sepsis? -
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ANSWER Hypotension defined as a systolic blood pressure less than 90 mm Hg.
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(Sepsis is defined as bacteriologic evidence of infection superimposed on a clinical picture of SIR
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S. According to the ACCP/SCCM, by definition these patients are hemodynamically stable. If they
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Oshould become hemodynamically unstable (defined as a systolic blood pressure <90 mm Hg), th
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e name for the condition changes to "severe sepsis.")
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SIRS - ANSWER - Temperature greater than 38°C or less than 36°C.
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- Heart rate greater than 90 bpm.
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- Respiratory rate greater than 22 bpm
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- White blood cell count greater than 12,000 or less than 4,000 and greater than 10% bands.
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abdominal compartment syndrome - O O O



ANSWER Once diagnosed, treatment consists of reopening the abdomen including doing so at t
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he bedside if necessary.
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(The presence of an abdominal compartment syndrome requires decompression of the abdome
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n. If the patient is too unstable to be transported to the operating room, the abdomen should b
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e promptly reopened at the bedside.)
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carotid bruit - ANSWER a marker for generalized atherosclerosis
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(In fact, studies have shown that a carotid bruit is a risk factor for coronary artery disease and fu
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ture myocardial infarction.)
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alveolar ventilation - O O



ANSWER The alveolar gas equation characterizes the potential for oxygen uptake and carbon di
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oxide removal. O




(Tachypnea at a given minute ventilation increases anatomic dead-
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space ventilation, not alveolar ventilation. Minute ventilation is the volume of gas that is inspire
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d and expired at the nasopharynx and is different than that occurring at the alveolus by the anat
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omic dead- O