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A 19yoF transferred from a critical access hospital after
presenting with fever, tachycardia, and hypotension.
Underwent laparoscopic appendectomy 8 days ago. CT
abdomen/pelvis reveals 5x6cm rim-enhancing fluid
collection in RLQ. WBC is 18, temp 38.9 (102F), HR 124,
lactic acid 4.8.
In addition to fluid resuscitation and broad-spectrum
antibiotics, which of the following interventions will be
most beneficial in treating her sepsis?
A) IV hydrocortisone
B) norepinephrine infusion
C) percutaneous abscess drainage
D) sodium bicarbonate infusion - correct answer-
C) percutaneous abscess drainage
A 22yoM is admitted to hospital after MCC. He was
wearing a helmet that sustained obvious damage. On
,initial exam, he will not open eyes to painful stimuli but
makes incomprehensible sounds; he withdraws from pain
but cannot localize it. Vitals: RR 14, HR 88, BP 110/60,
SpO2 93% on high flow oxygen face mask. During initial
management, patient is cleared for spinal cord injury,
intubated, and placed on assist control ventilation. Initial
CT brain shows small subdural hematoma and evidence of
increased ICP. Neurosurgical consult obtained, ICP device
placed. Which of the following is the most appropriate
initial management for this patient?
A) administration of corticosteroids to decrease ICP
B) maintain PaCO2 25-30 by mild hyperventilation
C) elevation of head of bed 30-45 while maintaining head
and neck in neutral position
D) maintenance of SBP < 90 - correct answer-
C) elevation of the head of bed 30-45° while maintaining
the head and neck in neutral position
A 24yoM admitted to ICU after falling from roof.
Admission CT reveals left frontal lobe contusion. No
intubation is required. Patient on 3L NC. Observed to have
a generalized seizure.
,Which of the following best characterizes the most
appropriate initial management?
A) phenytoin, 18-20 mg/kg IV, should be administered as
rapidly as possible
B) no drug therapy indicated unless ICP exceeds 25 mmHg
C) IV benzodiazepine, such as lorazepam, 0.1 mg/kg,
administered at the onset of seizure activity, may
terminate the seizure
D) IV neuromuscular relaxant such as vecuronium (10,g)
should be administered to decrease the cerebral oxygen
requirement - correct answer- C) an IV
benzodiazepine, such as lorazepam, 0.1 mg/kg,
administered at the onset of seizure activity, may
terminate the seizure.
A 25yoM with PMHx T1DM presents with 3 day history of
URI and a 1 day history of abdominal pain, n/v. Hedid not
take insulin for 24 hours because he was unable to eat
and was concerned about hypoglycemia. On exam,
breathing deeply and appears acutely ill. Na 132, K 6, Cl
85, bicarb 18, BUN 35, Cr 1.3, glucose 350, pH 7.1. UA
positive for ketones, serume acetone present. In addition
to IV insulin therapy, which of the following management
, strategies is most appropriate for this patient with
diabetic ketoacidosis?
A) sodium bicarbonate, 150 mEq/L infusion
B) sodium chloride 0.9% infusion
C) sodium chloride 3% infusion
D) furosemide infusion and sodium polystyrene sulfonate
- correct answer- B) sodium chloride 0.9%
infusion
A 27yoM admitted to ICU with SAH after MVC. Initial GCS
8 with labored respirations. He was intubated in the ED
and placed on a ventilator. Shortly after arrival to the unit,
SpO2 reads 57% with HR 46 and no pulse.
Which of the following is the safest and most immediate
method to verify correct ET tube placement?
A) palpation over the epigastrum for abdominal distention
B) manual bag-mask breathing
C) qualitative exhaled carbon dioxide monitor or detector
D) portable chest radiograph - correct answer-
C) qualitative exhaled carbon dioxide monitor or detector