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
Oncology
A patient with metastatic cancer has severe persistent pain despite regular non-opioid therapy. What principle is appropriate?
A. Escalate analgesia according to pain severity, including opioids when indicated
B. Avoid opioids categorically
C. Use antibiotics for pain
D. Stop all palliative treatment
Correct Answer: A
Cancer pain should be treated proportionately using multimodal analgesia, including opioids when clinically indicated.
Medicine
Oncology
A patient receiving cisplatin requires monitoring for which major toxicity?
A. Nephrotoxicity and ototoxicity
B. Severe hypoglycemia only
C. Hyperthyroidism only
D. Aplastic crisis in every patient
Correct Answer: A
Cisplatin can cause dose-limiting kidney injury and ototoxicity, among other adverse effects.
Medicine
Oncology
Which symptom in a cancer patient most strongly suggests superior vena cava syndrome?
A. Facial swelling with distended neck veins and dyspnea
B. Isolated ankle sprain
C. Watery diarrhea only
D. Unilateral calf pain without chest symptoms
Correct Answer: A
Obstruction of the SVC causes venous congestion of the head, neck and upper limbs with dyspnea and visible collateral veins.
Medicine
Oncology
A patient with colorectal cancer has a KRAS mutation. Why is this clinically relevant?
A. It can predict lack of benefit from anti-EGFR therapy in metastatic disease
B. It confirms small-cell lung cancer
C. It proves hereditary breast cancer
D. It indicates sensitivity to trastuzumab
Correct Answer: A
Activating RAS mutations predict resistance to anti-EGFR monoclonal antibodies in metastatic colorectal cancer.
Medicine
Oncology
A patient with prostate cancer develops new severe back pain. Which metastatic pattern is classically associated with prostate cancer?
A. Osteoblastic bone metastases
B. Purely lytic lesions only
C. No bone metastases
D. Brain metastases only
Correct Answer: A
Prostate cancer commonly spreads to bone and often produces osteoblastic/sclerotic lesions.
Medicine
Oncology
A smoker presents with hematuria and a renal mass. Which paraneoplastic finding can renal cell carcinoma produce?
A. Polycythemia from ectopic erythropoietin
B. Severe neutropenia from EPO
C. Hypocalcemia from calcitonin
D. Central diabetes insipidus
Correct Answer: A
Renal cell carcinoma can produce erythropoietin and cause secondary erythrocytosis, among several paraneoplastic syndromes.
Medicine
Oncology
A patient with HER2-positive breast cancer may benefit from which targeted monoclonal antibody?
A. Trastuzumab
B. Bevacizumab for every case
C. Rituximab
D. Cetuximab only
Correct Answer: A
Trastuzumab targets HER2 and is a key component of therapy for appropriate HER2-positive breast cancers.
Medicine
Oncology
A woman with estrogen receptor-positive breast cancer receives adjuvant endocrine therapy. Which drug is a selective estrogen receptor modulator?
A. Tamoxifen
B. Trastuzumab
C. Imatinib
D. Rituximab
Correct Answer: A
Tamoxifen is a selective estrogen receptor modulator used in hormone receptor-positive breast cancer.
Medicine
Oncology
A patient receiving immune checkpoint inhibitor therapy develops severe diarrhea and colitis. What is the likely mechanism?
A. Immune-related adverse event
B. Bacterial food poisoning is certain
C. Lactose intolerance only
D. Tumor lysis syndrome
Correct Answer: A
Checkpoint inhibitors can trigger autoimmune-like inflammatory toxicities, including colitis, hepatitis, pneumonitis and endocrinopathies.
Medicine
Oncology
Which medication is used to rapidly lower uric acid in high-risk tumor lysis syndrome?
A. Rasburicase
B. Warfarin
C. Tamoxifen
D. Mesna
Correct Answer: A
Rasburicase converts uric acid to a more soluble metabolite and is used for rapid uric acid reduction in high-risk TLS.