1-This ECG shows :
A)
B)
C)
D)
E)
1st Degree AV Block
2nd Degree AV Block, Type I
2nd Degree AV Block, Type II
3rd Degree AV Block
PVC’s ( ventricular extrasystole )
2-Staff measures to prevent infection in ICU are the following except :
A) Wash hands and forearms before and after touching patient
B) Wear disposable gloves if in contact with patient
C) Use strict aseptic technique for invasive procedures
D) Stethoscopes should be cleaned between patients
E) Use strict aseptic technique for changing ventilator circuits and drug
infusions.
3-Concerning Catheter-related Blood Stream Infection,the true answer is :
A)Intravascular catheters are a minor source of infection in the ICU.
B) Type of catheter has no importance in infection
C)Catheter maintenance technique is not essential
D) Use of catheter for total parenteral nutrition increase infection
E) Long duration of catheter use decrease infection
4-Which statement about anaphylaxis is FALSE ?
A) Most anaphylactic episodes are mediated by IgE
B) All dog bites should be considered contaminated
C) Allergens causing IgE-mediated anaphylaxis are primarily proteins
D) 6%–8% of children have food allergy
E) Anaphylactoid Reaction are IgE-mediated
5- Which statement about anaphylaxis is true ?
A) Most common causes of fatal food poisoning are fishes
B) Diagnosing Anaphylaxis is based on clinical presentation
C) Incidence of food allergy is more common in adults than children
D) Risks of epinephrine administration far outweigh risks of anaphylaxis
E) The cause of anaphylaxis is always obvious
6-Which of the following causes of PEA is likely to respond to immediate treatment?
a. massive pulmonary embolism
b. hypovolemia
c. massive acute myocardial infarction
d. myocardial rupture and stroke
e. all of the above have the same response
7-Mortality in myocardial infarction is reduced by
A. Nifedipine
B. Beta-blockers
C. Nitroprusside
D. Intravenous magnesium
E. Intravenous nitrates
8- Which of the following is NOT associated with cardiac tamponade?
(A) Pulsusparadoxus.
(B) Narrow pulse pressure.
(C) Electrical alternans.
(D) Left ventricular hypertrophy.
(E) Hypotension
9-What is the best test for evaluating a hemodynamically stable patient in the ED with
a suspected abdominall aortic aneurysm ?
A- Ultrasound
B- CT-scan
C- Angiography
D- MRI
E- Echocardiography
10-High central venous pressure, low blood pressure and acute circulatory failure are
found in all of the following EXCEPT:
A. tension pneumothorax
B. pulmonary embolism
C. congestive cardiac failure
D. venous air embolism
E. haemorrhage.
11-A young man admitted to casualty following a road traffic accident is found to
have central dislocation of the hip and is shocked. Likely causes are:
a) ruptured bladder
b) ruptured urethra
c) blood loss
d) neurogenic shock
e) fat embolism
12-All of the following are parts of anaphylaxis management EXCEPT
a) Fluids
b) Beta blockers
c) Oxygen
d) Adrenaline
e) Hydrcortison
13- Which of the following anaphylaxis signs has the highest incidence ?
a) Diarrhea
b) Vomiting
c) Urticaria
d) Dyspnea
e) Hypotension
14-Which statement about drowning/ near drowning is true ?
A) Drainage of water from the lungs is recommended in every near drowning
B) Water in the stomach must be removed by resuscitation of near drowning
C) Adult drowning is most common cause of accidental death
D) There are no clinical differences in initial management between fresh and salt
water
E) Hypothermic patients have increasedmetabolism
15- Regarding inhalational injury burn , Choose the best answer
a. Increase fluid administration by 50%
b. Decrease fluid intake by 20%
c. CO and cyanide intoxication of no importance
d. Colloids can be given from the start
e. Try to avoid early intubation
16-In compartment syndrome, acute renal failure is due to
A) Pre renal causes
B) Renal causes
C) Post renal causes
D) All three types are present
E) None of the above
17-In thoracic trauma thoracotomy is indicated if
A)
Bleeding from chest tube is 250 ml per hour for more than four hours
B)
Always do thoracotomy irrespective of the amount of blood coming
from chest tube
C)
If there is > 500 cc blood at introducing the chest tube
D)
If blood coming from the chest tube is not coagulated
E)
Do thoracotomy at the place of trauma
18-In rhabdomyolysis
a. Diamox is used for alkalinisation of urine
b. Diamox is used to do metabolic alkalosis of blood
c. Diamox is used to prevent more muscle destruction
d. Diamox is not used at all
e. None of the above
19-In compartment syndrome
A)
Fasciotomy is indicated if intracompartmental pressure is more than 30
mm Hg
B)
Fasciotomy is done if there is no pulse in the periphery.
C)
Fasciotomy is not indicated at all
D) Fascitomy is cutting the skin and subcutanous fat
E)Fasciotomy is done when the limb is black.
20-Which statement about drowning is FALSE ?
A) Up to 78% infant drowning occur in the sea
B) Males are more likely to drown than females
C) Most of pathologic consequences of near drowning is due to hypoxia ,
hypothermia
D) Initiate PEEP at 3–5 cmH2O in mechanically ventilated patients. Increase as
required to maintain arterial O2 saturation (SaO2) ≥90%.
E) No one is dead until they are warm and dead
21-Treatment of raised intracrainial pressure includeall of the following EXCEPT
A) CSF drainage
B)
Permissible hypercarbia
C)
I.V mannitol 20%
D)
Sedation
E)Hypothermia
22- In thoracic trauma (choose the best answer)
A) Chest trauma is responsible for 25 % of trauma deaths
B) Most patients with chest injury ultimately require thoracotomy
C) Massive hemothorax is defined as > 750 mm blood in the chest cavity
D) Continuing blood loss > 50 ml / hour is an indication for thoracotomy
E) Chest tubes are hardly indicated
23-Characteristic injuries of blunt thoracic trauma include all except
a. Fractured sternum
b. Transected aorta
c. Pulmonary contusion
d. Ruptured spleen
e. Fractured pelvis
24-The following hematological parameters would raise the suspicion of DIC except
a. Decreased platelets
b. Increased fibrionogen
c. Increased FDP
d. Profuse bleeding
e. Prolonged thrombin time
25-What is the most common symptom of a ruptured abdominal aortic
aneurysm?
A-Hematuria.
B-Syncope
C-Change in level of consciousness.
D-Pain
E-Shortness of breath
26-What is the first of sign of an arterial occlusion?
A) Pallor.
B) Pulselessness.
C) Paresthesias.
D) Pain.
E) Hypertension
27-Which statement is true?
A) Myocardial Contusion is the most common blunt cardiac injury in trauma
B) Myocardial Contusion has angina-like pain which is responsive to
nitroglycerin
C) Cardiac Tamponade causes widening in pulse pressure
D) Hypotension in Cardiac Tamponade is responsive to treatment
E) All of the above
28-Which statement about Mechanisms causing third spacing & edema is TRUE?
A) massive inflammation
B) venous obstruction
C) increased blood volume
D) low serum albumin
E) All of the above
29-Which statement about angina/MI is FALSE
A) Angina pectoris usually lasts 3-8 minutes (rarely longer than 15 mins)
B) Unstable angina may occur during rest
C) Angina pectoris usually relieved with rest and/or nitroglycerin within 3-5
minutes
D) In acute MI Chest Pain lasts longer than angina pain (up to 12 hours)
E) Changes in pulse, BP, respiration are diagnostic of acute MI
30-All the following are Major Calcium functionsEXCEPT :
A) Cardiac muscle relaxations
B) Transmission of nerve impulses
C) Blood clotting factor
D) Formation of teeth & bone
E) Requires: Vitamin D.
31-All the following areHypomagnesemia ManifestationsEXCEPT :
A) Mental status changes
B) Muscle twitiching, tremors
C) Hyperreflexia
D) Tachycardia, labile B.P.
E) Affects renal K reabsorption ( leads to hyperkalemia)
32-Which statement about Phosphate (PO4 -) is NOT TRUE
A) Normal Phosphate blood level is 3.0 - 4.5mg/dL or 1.8 - 2.6 mEq/L
B) Main intracellular buffer
C) PTH regulates P excretion by proximal renal tubule
D) PO-4 &Ca+ are equilibrated ( >Ca+ = < PO-4 )
E) Manifestations of Hypophosphatemia (Signs & Symptoms) are mainly cardiac
33-All the following arecauses of Hypokalemia EXCEPT :
A) Hypermagnesemia
B) Ileostomy
C) Steroids
D) Epinephrine
E) Aminoglycosides
34-Which statement about postoperative Systemic hypotension is NOT TRUE
A) Is a common complication,
B) can cause hypoperfusion of vital organ systems.
C) symptoms of hypoperfusion (e.g., disorientation, nausea, angina, reduced urine
output) indicate a good compensatory mechanisms
D) Consequent tissue hypoxia promotes inefficient anaerobic metabolism and lactic
acidemia.
E) During hypotension, the SNS diverts blood flow to preserve the brain, heart, and
kidneys
35-Which of the following antihypertensives may cause bradycardia?
a- Captopril
b-Clonidine
c-Hydralazine
d-Nifedipine
e-Phenoxybenzamine
36-Which statement about postoperative sinus tachycardia is NOT TRUE
A) Postoperative sinus tachycardia is rarely associated with a physiologic increase in
SNS influence.
B) It is usually harmless, but it can precipitate acute myocardial ischemia in patients
with coronary artery disease.
C) Seldom interferes with ventricular filling but compromises cardiac output in
patients with stenoticvalvular lesions.
D) Exacerbates hypertension and might indicate acidemia, hypoxemia, or malignant
hyperthermia.
E) Is treated by giving analgesics for pain, intravenous fluids for hypovolemia, or
sedatives to calm anxiety
37-All the following areCauses of postoperative increased upper airway resistance
EXCEPT:
A) posterior tongue displacement,
B) soft tissue collapse or edema .
C) laryngospasm or edema,
D) extrinsic compression from hematoma(expanding neck hematom), or tumor
E) Severe laryngeal obstruction secondary to hypercalcemia after parathyroid
excision.
38-The lungs response to injury in ARDS:
A) An exudative phase :1st 24 hours
B) An early proliferetive phase:10-20days
C) A late proliferetive phase :25-35days
D) Fibrotic phase due to accumulation of neutrophil .
E) Non of the above.
39-Regarding Pulmonary Embolus ,Select the incorrectanswer :
A) A fragment of the thrombus that breaks off.
B) Travels in the blood.
C) It lodges at the pulmonary vasculature.
D) Begin in the upper extremity veins.
E) The morbidity and mortality associated remains high.
40-RegardingSigns and Symptoms of PE, Select the incorrect answer
A) Dyspnea 73%
B) Pleuritc Pain 66%
C) Leg Swelling 33%
D) Hematmesis 80%
E) Palpitations 12%
41-Regarding Primary risk factors of PE.Select the incorrect answer
A)Surgery.
B) Early mobilization.
C)Major Trauma
D)Congestive Heart Failure
E)Myocardial infarction.
42-RegardingECG of Acute pulmonary embolism ,Select the incorrect answer :
A)prominent S wave in lead I,
B) Q wave and inverted T wave in lead III
C ) Sinus tachycardia
D)Peak T wave in leads V1 - V3
E)Right Bundle Branch Block
43-Regarding D-dimer test , Select the incorrect answer :
A)A marker for thrombosis and fibrinolysis,
B) Can be useful in the exclusion of PE.
C )Positive in trauma, postoperative ,sepsis and malignancies.
D)90% with PE will have normal D-dimer.
E)A small protein fragment present in the blood .
44-Which drug used for intubation in acute severe asthma is inappropriate ?
A) Midazolam.
B)Pentothal .
C )Ketamine
D)Propofol .
E) Halothane
45-RegardingVentilatory Settings in Status Asthma ,Select the incorrect answer :
A)Mode : volume control.
B)Minute ventilation :<10 L/min
C )Respiratory rate :10–15 breaths/min
D)PEEP: 12-20 cm H2O .
E)Pplatue .:<30 cm H2O
46- Regarding Definition of COPD, Select the incorrect answer
A)(COPDs) are a group of disorders .
B) airflow limitation.
C ) Is fully reversible .
D) the most common of which are chronic bronchitis and emphysema.
E) Related to smoking.
47-Regarding Chest Radiographic Findings in COPD,Select the incorrectanswer :
A)Chest radiographic alterations usually occur early.
B) The radiograph is usually normal in mild disease.
C ) Changes reflecting airway disease and hyperinflation.
D) Bronchial walls reflected as an increase in bronchovascular markings.
E) Emphysema is manifested by an increased lucency of the lungs.
48-Regarding Treatment of the acute Exacerbationof COPD ,Select the incorrect
answer
A)Eliminate respiratory irritants.
B) Optimize bronchodilation
C ) NSAID.
D) Antibiotics
E) Respiratory Support.
49-Causes of Distributive shock include all of the following EXCEPT
A) SIRS – related.
B) Dehydration.
C )Anaphylactic.
D) Neurogenic.
E) Endocrine: Thyroid, Adrenal.
50-Resuscitation of patients with trauma may include all of the following EXCEPT
A)Adequate pulmonary oxygenation.
B) Control of bleeding.
C ) Replacement of hemorrhage lost volume.
D) B-Blocker.
E) Relief of pain.
51-Treatment of septic shock include all of the following EXCEPT :
A) Restore intravascular volume.
B) Stabilize hemodynamic parameters with vasodilator.
C ) Cultures are taken.
D)Antibiotic therapy (urgent).
E) Arrange for definitive care for the site of sepsis.
52-A 38-year-old farm worker presents to the ED with hypersalivation, urinary
incontinence, diarrhea, and muscle weakness after being in a recently "sprayed"
field. He has prominent wheezing and is producing copious amounts of clear
sputum.
Which of the following statements is TRUE of the treatment for this condition?
A) Atropine should be administered as 1 mg IV every 5 minutes until muscle
weakness has resolved.
B) Supportive care is the only appropriate treatment for this condition.
C) Pralidoxime will regenerate cholinesterase molecules if given any time after
exposure.
D) Atropine and pralidoxime are used to treat this condition
E) Give adrenaline
53-A patient with tachycardia, hypertension, diaphoresis, agitation, and
mydriasis is
MOST likely exhibiting which type of toxidrome?
A) Sympathomimetic toxidrome.
B) Cholinergic toxidrome.
C) Opioid toxidrome.
D) Benzodiazepines toxidrome
E) None of the above
54-In which of the following patients with a toxic ingestion is the use of gastric
lavage MOST appropriate?
A) A 30-year-old male who swallowed 50 pills of acetaminophen 3 hours ago.
B) A 25-year-old woman who took half a bottle of amitryptiline 30 minutes ago
C) A 16-year-old male who accidentally swallowed a glass full of turpentine 15 min.
ago.
D) A 20-year-old male who swallowed 50 pills of salicylates 4 hours ago
E) All of the above are appropriate
55-Which statement about poisoning is FALSE
a. Proper support of ABCs is first step in managing poisoning
b. Organophosphate are absorbed through the skin
c. Aspiration of hydrocarbons into the lungs causes pneumonitis
d. Regadingaspirine :Ingestion of 50mg/kg body weight usually produces
severe toxicity
e. Regarding tricyclic antidepressant poisoning : Death may result from
cardiorespiratory depression and acidosis
56-Signs of aspirin poisoning include all of the following EXCEPT
a. Hypothermia
b. Convlsions
c. Coma
d. Hypoglycemia
e. Sweating
57-All of the following can be used in managing organophosphorous poisoning
EXCEPT
a. gastric lavage
b. beta blocker
c. atropine
d. pralidoxime
e. charcoal
58-Which statement about Carbon monoxide is FALSE?
a. Carbon monoxide is a colorless, odorless
b. Affinity to HB is greater than 200 X that of oxygen
c. Carbon monoxide acts as an intracellular toxin
d. Carbon monoxide interferes with heart and skeletal muscle
e. Doesn’t cause mortality
59-Which of the following is a trigger of digoxine toxicity
a. Hypokalemia
b. Hypocalcemia
c. Atropine
d. hyperkalemia
e. All of the above
60- A 25-year-old man requires urgent assessment in the emergency department.
Recently admitted following a fall of 20mwhile climbing, he has suddenly become
hypotensive
(BP 55/30 mmHg), hypoxaemic (SpO2 88% on 15 L/min O2 via a non-rebreathe
mask) and tachycardic (HR 160 bpm) having been cardiovascularly stable with good
saturations
on admission 60 minutes earlier. He has sustained multiple bilateral rib fractures, a
sternal fracture, bilateral fractured scapulae and a mid-shaft femoral fracture but no
pelvic fracture. Auscultation of his lung fields reveals bilateral air entry, his trachea is
midline, his abdomen is soft and non-distended and there has been no response to
administration of 3000mL of crystalloid. Which of the following is the
MOST LIKELY diagnosis to explain the sudden deterioration?
a) Blood loss secondary to multiple fractures
b) Cardiac tamponade
c) Severe, bilateral pulmonary contusions
d) Tension pneumothorax
e) Liver laceration