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Question 1. Which ECG change is most indicative of an acute ST-elevation myocardial infarction (STEMI)? A) Peaked T waves B) ST segment elevation C) Prolonged PR interval D) Inverted U wave Answer: B Explanation: ST segment elevation is the hallmark ECG finding in acute STEMI, indicating myocardial injury due to complete coronary artery occlusion. Question 2. A patient develops sudden severe chest pain radiating to the back and a widened mediastinum on chest X-ray. What is the most likely diagnosis? A) Acute pericarditis B) Aortic dissection C) Pulmonary embolism D) Tension pneumothorax Answer: B Explanation: Aortic dissection often presents with tearing chest pain and a widened mediastinum on X- ray due to blood dissecting the aortic wall. Question 3. What is the initial medication of choice for a patient in pulseless ventricular tachycardia? A) Amiodarone B) Atropine C) Epinephrine D) Adenosine Answer: C
Explanation: Epinephrine is given first during pulseless VT as part of advanced cardiac life support, followed by defibrillation and antiarrhythmics. Question 4. Which hemodynamic parameter is most useful for assessing left ventricular preload? A) Central venous pressure (CVP) B) Pulmonary artery wedge pressure (PAWP) C) Mean arterial pressure (MAP) D) Cardiac output Answer: B Explanation: PAWP reflects left atrial pressure and is the best indicator of left ventricular preload. Question 5. Which medication is a positive inotrope used in acute decompensated heart failure? A) Labetalol B) Dobutamine C) Furosemide D) Nitroglycerin Answer: B Explanation: Dobutamine increases myocardial contractility, improving cardiac output in heart failure. Question 6. A patient with hypertensive crisis is started on sodium nitroprusside. What is a critical risk to monitor? A) Hyperkalemia B) Cyanide toxicity C) Renal failure D) Thrombocytopenia Answer: B
Answer: B Explanation: Urine output (>0.5 mL/kg/hr) is a direct indicator of organ perfusion and kidney function. Question 10. Which arrhythmia requires synchronized cardioversion? A) Asystole B) Ventricular fibrillation C) Unstable supraventricular tachycardia D) Sinus bradycardia Answer: C Explanation: Unstable SVT is treated with synchronized cardioversion to avoid inducing ventricular fibrillation. Question 11. What is the gold standard for diagnosing pulmonary embolism in a critically ill patient? A) Chest X-ray B) CT pulmonary angiography C) Ventilation/perfusion scan D) Echocardiogram Answer: B Explanation: CT pulmonary angiography provides definitive imaging for pulmonary embolism. Question 12. Which mechanical ventilation mode delivers a set tidal volume at a set rate, allowing spontaneous breaths in between? A) Assist-control (AC) B) Synchronized intermittent mandatory ventilation (SIMV) C) Pressure support ventilation D) High-frequency oscillatory ventilation
Answer: B Explanation: SIMV delivers mandatory breaths but allows spontaneous breathing between. Question 13. What is the classic finding in acute respiratory distress syndrome (ARDS) on chest imaging? A) Hyperinflation B) "White-out" bilateral infiltrates C) Pleural effusion D) Lung nodule Answer: B Explanation: Diffuse bilateral infiltrates ("white-out") are characteristic of ARDS. Question 14. Which intervention is most effective in preventing ventilator-associated pneumonia (VAP)? A) Frequent chest X-rays B) Daily sedation vacations C) Elevating the head of the bed to 30-45 degrees D) Routine oral suctioning Answer: C Explanation: Keeping the head of the bed elevated reduces aspiration risk and VAP incidence. Question 15. What blood gas pattern indicates uncompensated metabolic acidosis? A) Low pH, low PaCO2, low HCO3- B) High pH, high PaCO2, high HCO3- C) Low pH, normal PaCO2, low HCO3- D) Normal pH, low PaCO2, low HCO3- Answer: C
Answer: C Explanation: End-tidal CO2 detection is the most reliable confirmation of tracheal tube placement. Question 19. Which electrolyte abnormality increases the risk for torsades de pointes? A) Hyperkalemia B) Hypomagnesemia C) Hypercalcemia D) Hyponatremia Answer: B Explanation: Hypomagnesemia can prolong the QT interval, predisposing to torsades de pointes. Question 20. What is the priority intervention for suspected tension pneumothorax? A) Obtain a chest X-ray B) Place the patient in Trendelenburg position C) Immediate needle decompression D) Start antibiotics Answer: C Explanation: Tension pneumothorax is a life-threatening emergency requiring immediate needle decompression. Question 21. Which sign is most specific for pericardial tamponade? A) Pulsus paradoxus B) Tachycardia C) Crackles D) Hypertension
Answer: A Explanation: Pulsus paradoxus (exaggerated fall in systolic BP during inspiration) is classic for tamponade. Question 22. Which finding is associated with right-sided heart failure? A) Pulmonary edema B) Jugular venous distension C) S3 gallop D) Crackles at lung bases Answer: B Explanation: Right heart failure causes systemic congestion, including jugular venous distension. Question 23. Which is the best indicator of effective chest compressions during CPR? A) Palpable pulses B) Chest wall recoil C) End-tidal CO2 of 20 mmHg or higher D) Visual chest movement Answer: C Explanation: End-tidal CO2 levels >20 mmHg indicate effective compressions and cardiac output. Question 24. What is the primary goal in the management of acute decompensated heart failure? A) Increase preload B) Decrease afterload C) Increase heart rate D) Reduce urine output
Answer: B Explanation: Vasopressors are titrated to maintain a MAP ≥65 mmHg for adequate organ perfusion. Question 28. Which is a sign of hypovolemic shock? A) Bounding pulses B) Warm, flushed skin C) Tachycardia and hypotension D) Bradycardia and hypertension Answer: C Explanation: Hypovolemic shock presents with tachycardia and hypotension due to reduced circulating volume. Question 29. What is the preferred medication for rate control in atrial fibrillation with rapid ventricular response? A) Digoxin B) Amiodarone C) Beta-blocker D) Atropine Answer: C Explanation: Beta-blockers are first-line for controlling ventricular rate in atrial fibrillation. Question 30. A patient is receiving heparin and develops a sudden drop in platelets. What is the likely diagnosis? A) DIC B) HIT (heparin-induced thrombocytopenia) C) TTP
D) ITP
Answer: B Explanation: HIT is a complication of heparin with a drop in platelets and risk of thrombosis. Question 31. Which is the best strategy to prevent pressure injuries in the ICU? A) Frequent position changes B) Applying topical antibiotics C) Keeping skin dry D) Using high-flow oxygen Answer: A Explanation: Regular repositioning relieves pressure, preventing tissue breakdown. Question 32. What is an early sign of sepsis in a critically ill patient? A) Hypotension B) Altered mental status C) Hyperglycemia D) Tachypnea Answer: D Explanation: Increased respiratory rate is often the earliest sign of sepsis. Question 33. Which medication should be used to reverse benzodiazepine overdose? A) Naloxone B) Flumazenil C) Protamine sulfate D) Vitamin K
Explanation: CAM-ICU is the validated tool for assessing delirium in critically ill patients. Question 37. Which is a potential complication of enteral tube feeding? A) Hypercalcemia B) Aspiration pneumonia C) Renal failure D) DVT Answer: B Explanation: Enteral feeding increases risk for aspiration, especially if the head is not elevated. Question 38. What is the most common cause of upper GI bleeding in critically ill patients? A) Esophageal varices B) Gastric ulcer C) Mallory-Weiss tear D) Duodenal ulcer Answer: D Explanation: Duodenal ulcers are a frequent source of upper GI bleeding in the ICU. Question 39. Which laboratory value is most indicative of disseminated intravascular coagulation (DIC)? A) Elevated platelets B) Prolonged PT and aPTT C) Increased fibrinogen D) Decreased D-dimer Answer: B Explanation: DIC presents with prolonged coagulation times due to factor consumption.
Question 40. What is the primary treatment for diabetic ketoacidosis (DKA)? A) IV insulin and fluids B) Oral hypoglycemics C) Sodium bicarbonate D) Vasopressors Answer: A Explanation: DKA requires insulin to lower glucose and fluids to correct dehydration. Question 41. What is a sign of successful thrombolytic therapy for an acute myocardial infarction? A) Persistent chest pain B) Resolution of ST segment elevation C) Bradycardia D) Ongoing arrhythmia Answer: B Explanation: ST segment normalization indicates reperfusion after thrombolytic therapy. Question 42. Which is the best indicator of successful fluid resuscitation in hypovolemic shock? A) Decreased heart rate B) Increased urine output C) Increased CVP D) Decreased respiratory rate Answer: B Explanation: Improved urine output demonstrates restored perfusion to kidneys.
A) High tidal volume B) Low tidal volume C) Low PEEP D) High respiratory rate Answer: B Explanation: Low tidal volume ventilation reduces volutrauma and improves outcomes in ARDS. Question 47. Which is a contraindication to thrombolytic therapy in stroke? A) Onset within 3 hours B) Platelet count >150, C) Recent major surgery D) Age > Answer: C Explanation: Recent surgery increases bleeding risk, making thrombolytics unsafe. Question 48. What is the recommended target glucose range for critically ill patients? A) 60-80 mg/dL B) 80-110 mg/dL C) 140-180 mg/dL D) 200-250 mg/dL Answer: C Explanation: Maintaining glucose between 140-180 mg/dL reduces complications. Question 49. A rapid drop in serum sodium can cause which life-threatening complication? A) Central pontine myelinolysis
B) Cerebral edema C) Acute renal failure D) Seizures Answer: B Explanation: Rapid sodium correction causes water to shift into brain cells, leading to cerebral edema. Question 50. What is the antidote for warfarin overdose? A) Protamine sulfate B) Vitamin K C) Fresh frozen plasma D) Desmopressin Answer: B Explanation: Vitamin K reverses warfarin’s anticoagulant effects. Question 51. What is the most common cause of death in patients with acute pancreatitis? A) Hypovolemic shock B) Hemorrhage C) Infection/sepsis D) Hyperkalemia Answer: C Explanation: Pancreatic necrosis can lead to infection and sepsis, the leading cause of death. Question 52. Which finding is most concerning in a burn patient? A) Edema at burn site B) Hoarseness and stridor
C) Fasting glucose D) Cosyntropin stimulation test Answer: B Explanation: The water deprivation test differentiates DI from other causes of polyuria. Question 56. What is the first-line antihypertensive in aortic dissection? A) Nitroglycerin B) Labetalol C) Hydralazine D) Furosemide Answer: B Explanation: Labetalol controls BP and HR, reducing aortic wall stress. Question 57. Which is the most common cause of upper airway obstruction in unconscious patients? A) Foreign body B) Edema C) Tongue falling back D) Blood clot Answer: C Explanation: The tongue occludes the airway when muscle tone is lost. Question 58. What is a late sign of compartment syndrome? A) Pain out of proportion B) Pallor C) Pulselessness
D) Paresthesia Answer: C Explanation: Pulselessness is a late, ominous sign indicating severe ischemia. Question 59. What is the initial management for suspected acute ischemic stroke? A) Aspirin administration B) Immediate brain CT C) IV heparin D) Thrombolysis Answer: B Explanation: Non-contrast CT rules out hemorrhage before initiating stroke therapy. Question 60. Which is an early sign of hepatic encephalopathy? A) Seizure B) Asterixis C) Coma D) Hyperreflexia Answer: B Explanation: Asterixis (flapping tremor) is an early, sensitive finding. Question 61. What initial step should be taken for a patient with suspected meningococcal sepsis? A) Dexamethasone B) Immediate antibiotics C) MRI of the brain D) IVIG
