Medicine
Critical Care & Sepsis
A patient with severe sepsis requires central venous access. Which practice best reduces catheter-related bloodstream infection?
A. Maximal sterile barrier precautions with chlorhexidine skin antisepsis
B. Routine prophylactic systemic antibiotics for every line
C. Daily line replacement
D. Avoid hand hygiene
Correct Answer: A
Evidence-based central-line bundles emphasize hand hygiene, maximal sterile barriers, chlorhexidine skin preparation and daily review of line necessity.
Medicine
Critical Care & Sepsis
A patient with organophosphate poisoning has salivation, lacrimation, bronchorrhea and bradycardia. Which antidotal regimen is appropriate?
A. Atropine plus pralidoxime
B. Naloxone plus bicarbonate
C. Vitamin K only
D. Methylene blue only
Correct Answer: A
Atropine treats muscarinic toxicity while pralidoxime reactivates acetylcholinesterase if given appropriately.
Medicine
Critical Care & Sepsis
A patient with opioid overdose is comatose with respiratory depression and pinpoint pupils. Which antidote is indicated?
A. Naloxone
B. Flumazenil
C. Atropine
D. Pralidoxime
Correct Answer: A
Naloxone competitively reverses opioid-induced respiratory and CNS depression.
Medicine
Critical Care & Sepsis
A patient develops pulseless electrical activity. Which reversible cause should be actively sought during CPR?
A. Tension pneumothorax
B. Stable hypertension
C. Chronic eczema
D. Cataract
Correct Answer: A
Resuscitation requires identification of reversible causes of PEA such as hypoxia, hypovolemia, tension pneumothorax, tamponade, toxins and thrombosis.
Medicine
Critical Care & Sepsis
A critically ill patient has low blood pressure, rising creatinine and altered mentation. Which bedside parameter is useful for tracking organ perfusion during resuscitation?
A. Urine output
B. Hair color
C. Pupil color only
D. Body mass index alone
Correct Answer: A
Urine output is a practical marker of renal perfusion and overall response to resuscitation, interpreted alongside other hemodynamic data.
Medicine
Critical Care & Sepsis
A patient after massive transfusion develops diffuse bleeding, prolonged coagulation tests and low fibrinogen. What complication should be considered?
A. Dilutional/consumptive coagulopathy
B. Hyperthyroidism
C. Acute asthma
D. Nephrotic syndrome
Correct Answer: A
Massive hemorrhage and transfusion can produce dilution and consumption of coagulation factors and fibrinogen, requiring protocolized hemostatic management.
Medicine
Critical Care & Sepsis
Which finding is most characteristic of neurogenic shock after high spinal cord injury?
A. Hypotension with relative bradycardia and warm skin
B. Hypotension with severe tachycardia and cold skin in all cases
C. Hypertension with bradycardia
D. Pulmonary edema only
Correct Answer: A
Loss of sympathetic tone can cause vasodilation and bradycardia, distinguishing neurogenic shock from most hypovolemic states.
Medicine
Critical Care & Sepsis
A trauma patient is hypotensive, tachycardic, has flat neck veins and cool skin. What type of shock is most likely?
A. Hypovolemic shock
B. Cardiogenic shock
C. Obstructive shock from tamponade
D. Neurogenic shock
Correct Answer: A
Blood or volume loss produces reduced preload, tachycardia, cool skin and low venous pressure.
Medicine
Critical Care & Sepsis
A patient with shock has cold extremities, elevated JVP and pulmonary edema after a large MI. What type of shock is most likely?
A. Cardiogenic shock
B. Distributive shock
C. Hypovolemic shock
D. Neurogenic shock
Correct Answer: A
Pump failure after major MI causes cardiogenic shock with low output, venous congestion and pulmonary edema.
Medicine
Critical Care & Sepsis
A patient with severe ARDS remains profoundly hypoxemic despite lung-protective ventilation. Which adjunct may improve oxygenation and outcomes in appropriate patients?
A. Prone positioning
B. Flat supine positioning only
C. Routine bicarbonate infusion
D. No PEEP
Correct Answer: A
Prolonged prone positioning is beneficial in selected patients with severe ARDS when applied with lung-protective ventilation.
Medicine
Critical Care & Sepsis
A ventilated patient with ARDS should generally receive which ventilation strategy?
A. Low tidal volume ventilation based on predicted body weight
B. Very high tidal volumes to normalize CO2
C. Zero PEEP
D. Routine hyperoxia
Correct Answer: A
Lung-protective ventilation with low tidal volume reduces ventilator-induced lung injury and mortality in ARDS.
Medicine
Critical Care & Sepsis
Which crystalloid is generally preferred for initial resuscitation in sepsis?
A. Balanced crystalloid or isotonic crystalloid solution
B. Hypertonic glucose only
C. Albumin as mandatory first fluid in all patients
D. Sterile water
Correct Answer: A
Initial sepsis resuscitation uses isotonic crystalloids, with balanced solutions commonly favored when available.
Medicine
Critical Care & Sepsis
A patient with sepsis has a lactate of 5.2 mmol/L. What does this finding most importantly indicate?
A. High illness severity and possible tissue hypoperfusion
B. Normal perfusion
C. Isolated liver disease only
D. Guaranteed bacterial source
Correct Answer: A
Marked lactate elevation in sepsis is associated with tissue hypoperfusion and worse prognosis, although causes can be multifactorial.
Medicine
Critical Care & Sepsis
In suspected sepsis with shock, what is the key antibiotic principle?
A. Administer appropriate broad-spectrum antimicrobials promptly
B. Wait 24 hours for all cultures
C. Use antivirals only
D. Avoid source control
Correct Answer: A
Septic shock requires urgent antimicrobial treatment after cultures are obtained when this does not create harmful delay.
Medicine
Critical Care & Sepsis
A septic patient remains hypotensive after adequate initial crystalloid resuscitation. Which vasopressor is first-line?
A. Norepinephrine
B. Dopamine in all patients
C. Phenylephrine in all patients
D. Nitroglycerin
Correct Answer: A
Norepinephrine is the preferred first-line vasopressor for septic shock because it effectively raises vascular tone with a favorable arrhythmia profile.
Medicine
Critical Care & Sepsis
Which laboratory finding most strongly supports consumptive coagulopathy in DIC?
A. Isolated elevated hemoglobin
B. Normal platelet count with normal coagulation studies
C. Isolated eosinophilia
D. Low fibrinogen with elevated D-dimer
Correct Answer: D
Consumption of fibrinogen and increased fibrin breakdown are characteristic of DIC.
Medicine
Critical Care & Sepsis
Which complication or major adverse outcome is particularly associated with Disseminated intravascular coagulation (DIC)?
A. Acute kidney injury from prolonged renal hypoperfusion
B. Progressive multiorgan hypoperfusion
C. Simultaneous microvascular thrombosis and major bleeding
D. Upper-airway obstruction
Correct Answer: C
DIC can produce organ ischemia from microthrombi while factor consumption causes severe bleeding.
Medicine
Critical Care & Sepsis
A patient is diagnosed with Disseminated intravascular coagulation (DIC). Which is the most appropriate management principle?
A. Give prompt broad-spectrum antimicrobials, balanced crystalloid resuscitation and norepinephrine if hypotension persists
B. Treat the underlying cause and provide blood-component support when clinically indicated
C. Control the source and restore intravascular volume, using blood products early when major hemorrhage is present
D. Urgently treat the cardiac cause, support perfusion and arrange reperfusion when acute coronary occlusion is responsible
Correct Answer: B
Control of the trigger is essential; component therapy is individualized to bleeding, procedures and laboratory abnormalities.
Medicine
Critical Care & Sepsis
In a patient with suspected Disseminated intravascular coagulation (DIC), which investigation or diagnostic approach is most appropriate at this stage?
A. Platelet count, PT/INR, aPTT, fibrinogen and D-dimer
B. Immediate potassium assessment with continuous ECG monitoring
C. Measure serum lactate and obtain appropriate cultures without delaying treatment
D. Rapid bedside assessment for the source of volume loss with serial perfusion markers
Correct Answer: A
The pattern of thrombocytopenia, prolonged clotting times, low or declining fibrinogen and elevated fibrin-degradation markers supports DIC.
Medicine
Critical Care & Sepsis
A patient has sepsis with diffuse bleeding, thrombocytopenia, prolonged coagulation studies and increased fibrin breakdown. What is the most likely diagnosis?
A. Impending upper-airway failure
B. Life-threatening hyperkalemia
C. Septic shock
D. Disseminated intravascular coagulation (DIC)
Correct Answer: D
DIC causes systemic coagulation activation with consumption of platelets and clotting factors, producing both thrombosis and bleeding.