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.
Medicine
Critical Care & Sepsis
What is the main purpose of intravenous calcium in severe hyperkalemia?
A. Permanently remove potassium from the body
B. Increase potassium absorption from the gut
C. Stabilize the cardiac membrane
D. Cause osmotic diuresis
Correct Answer: C
Calcium antagonizes the cardiac effects of hyperkalemia; it does not substantially reduce serum potassium.
Medicine
Critical Care & Sepsis
Which complication or major adverse outcome is particularly associated with Life-threatening hyperkalemia?
A. Upper-airway obstruction
B. Ventricular arrhythmia or asystole
C. Ventilator-associated lung injury
D. Hypoxic cardiac arrest
Correct Answer: B
Severe hyperkalemia can cause progressive conduction block and fatal arrhythmia.
Medicine
Critical Care & Sepsis
A patient is diagnosed with Life-threatening hyperkalemia. Which is the most appropriate management principle?
A. Give intravenous calcium to stabilize the myocardium, then use measures that shift potassium intracellularly and remove potassium
B. Urgently treat the cardiac cause, support perfusion and arrange reperfusion when acute coronary occlusion is responsible
C. Give intramuscular epinephrine promptly and repeat as clinically required while supporting airway and circulation
D. Use lung-protective mechanical ventilation with low tidal volumes when invasive ventilation is required
Correct Answer: A
IV calcium protects the heart but does not lower potassium; additional therapies are required to shift and eliminate potassium.
Medicine
Critical Care & Sepsis
In a patient with suspected Life-threatening hyperkalemia, which investigation or diagnostic approach is most appropriate at this stage?
A. Rapid bedside assessment for the source of volume loss with serial perfusion markers
B. Urgent ECG and bedside echocardiography
C. Clinical diagnosis; do not delay emergency treatment for laboratory confirmation
D. Immediate potassium assessment with continuous ECG monitoring
Correct Answer: D
ECG monitoring is essential; treatment should not be delayed when hyperkalemia and compatible ECG changes are convincing.
Medicine
Critical Care & Sepsis
A patient has severe weakness and ECG conduction abnormalities in the setting of a markedly elevated serum potassium. What is the most likely diagnosis?
A. Septic shock
B. Hypovolemic shock
C. Life-threatening hyperkalemia
D. Cardiogenic shock
Correct Answer: C
Marked hyperkalemia with ECG changes is a medical emergency because malignant arrhythmias may occur.
Medicine
Critical Care & Sepsis
Which clinical change is particularly concerning in a patient who initially had loud stridor?
A. The patient speaks more comfortably
B. Stridor becomes quieter while the patient becomes drowsy
C. Oxygen saturation improves
D. Respiratory effort normalizes
Correct Answer: B
A suddenly quiet airway in a tiring patient may reflect critically reduced airflow rather than improvement.
Medicine
Critical Care & Sepsis
Which complication or major adverse outcome is particularly associated with Impending upper-airway failure?
A. Hypoxic cardiac arrest
B. Ventricular arrhythmia or asystole
C. Simultaneous microvascular thrombosis and major bleeding
D. Multiple-organ dysfunction syndrome
Correct Answer: A
Complete airway obstruction rapidly causes profound hypoxemia and cardiac arrest.
Medicine
Critical Care & Sepsis
A patient is diagnosed with Impending upper-airway failure. Which is the most appropriate management principle?
A. Use lung-protective mechanical ventilation with low tidal volumes when invasive ventilation is required
B. Give intravenous calcium to stabilize the myocardium, then use measures that shift potassium intracellularly and remove potassium
C. Treat the underlying cause and provide blood-component support when clinically indicated
D. Call for expert airway support and secure a definitive airway before complete obstruction occurs
Correct Answer: D
A deteriorating airway should be secured early by the most experienced available team using an appropriate difficult-airway plan.
Medicine
Critical Care & Sepsis
In a patient with suspected Impending upper-airway failure, which investigation or diagnostic approach is most appropriate at this stage?
A. Clinical diagnosis; do not delay emergency treatment for laboratory confirmation
B. Arterial blood gas plus chest imaging and evaluation for a noncardiogenic cause
C. Rapid airway assessment while preparing definitive airway management
D. Immediate potassium assessment with continuous ECG monitoring
Correct Answer: C
In a threatened airway, assessment and intervention occur simultaneously; extensive testing must not delay securing the airway.
Medicine
Critical Care & Sepsis
A patient has progressive stridor, exhaustion, altered consciousness and worsening oxygenation. What is the most likely diagnosis?
A. Cardiogenic shock
B. Impending upper-airway failure
C. Anaphylactic shock
D. Acute respiratory distress syndrome (ARDS)
Correct Answer: B
Stridor plus fatigue and altered mental status suggests critical upper-airway compromise with impending respiratory arrest.
Medicine
Critical Care & Sepsis
Which ventilation strategy is a core principle in ARDS?
A. Low tidal-volume lung-protective ventilation
B. Routine very high tidal volumes
C. Zero PEEP in all cases
D. Hyperventilation to normalize every blood gas value
Correct Answer: A
Low tidal volumes and limitation of injurious airway pressures are foundational ARDS ventilation principles.
Medicine
Critical Care & Sepsis
Which complication or major adverse outcome is particularly associated with Acute respiratory distress syndrome (ARDS)?
A. Multiple-organ dysfunction syndrome
B. Acute kidney injury from prolonged renal hypoperfusion
C. Progressive multiorgan hypoperfusion
D. Ventilator-associated lung injury
Correct Answer: D
High tidal volumes and excessive pressures can worsen alveolar damage and barotrauma.
Medicine
Critical Care & Sepsis
A patient is diagnosed with Acute respiratory distress syndrome (ARDS). Which is the most appropriate management principle?
A. Treat the underlying cause and provide blood-component support when clinically indicated
B. Give prompt broad-spectrum antimicrobials, balanced crystalloid resuscitation and norepinephrine if hypotension persists
C. Use lung-protective mechanical ventilation with low tidal volumes when invasive ventilation is required
D. Control the source and restore intravascular volume, using blood products early when major hemorrhage is present
Correct Answer: C
Lung-protective ventilation reduces ventilator-induced lung injury; prone positioning is important in selected severe cases.
Medicine
Critical Care & Sepsis
In a patient with suspected Acute respiratory distress syndrome (ARDS), which investigation or diagnostic approach is most appropriate at this stage?
A. Immediate potassium assessment with continuous ECG monitoring
B. Arterial blood gas plus chest imaging and evaluation for a noncardiogenic cause
C. Platelet count, PT/INR, aPTT, fibrinogen and D-dimer
D. Measure serum lactate and obtain appropriate cultures without delaying treatment
Correct Answer: B
Oxygenation assessment and bilateral imaging abnormalities are central to recognizing ARDS while excluding predominant hydrostatic edema.
Medicine
Critical Care & Sepsis
A patient develops acute severe hypoxemia with bilateral pulmonary opacities after sepsis, without evidence that heart failure fully explains the edema. What is the most likely diagnosis?
A. Acute respiratory distress syndrome (ARDS)
B. Impending upper-airway failure
C. Life-threatening hyperkalemia
D. Disseminated intravascular coagulation (DIC)
Correct Answer: A
Acute hypoxemic respiratory failure with bilateral noncardiogenic opacities after a known insult is characteristic of ARDS.
Medicine
Critical Care & Sepsis
What is the preferred initial route for epinephrine in most adults with anaphylaxis?
A. Subcutaneous injection into the arm
B. Oral administration
C. Intravenous bolus in every patient
D. Intramuscular injection into the anterolateral thigh
Correct Answer: D
IM epinephrine in the lateral thigh provides rapid, reliable absorption and is the standard first-line route.