MCQ Resuscitation 1 Which of the following best describes Noradrenaline?

Receptor A B 1, some 2, +/- 1 in large doses C , D 1, +/- 1 Answer

HR

VC

CO

Side FX

++++

Decrease

Reflex brady

++++

Increase

Increased O2 consumption

++++

++++

Increase

HTN

++

++++

Decrease

Reflex brady

2 A B C D Answer

With regards to the use of HCO 3 in shock, which is FALSE? HCO 3 shifts O2 dissociation curve to the right to allow increased O2 delivery from Hb at lower tissue pO2 HCO 3 improves the myocardial depression associated with shock HCO 3 counteracts the insensitivity to endogenous catecholamines attributed to acidosis HCO 3 worsens intracellular acidosis
-

3 A B C D Answer

Which of the following is NOT a criterion for SIRS? Temperature < 36 C HR > 90 RR < 6 or PaCO2 < 23 mmHg WCC with > 10% immature bands
o

4 A B C D Answer

In early shock, which of the following is FALSE? SBP may rise as a result of increased cardiac contractility DBP may rise secondary to arteriolar VC A high mortality rate secondary to impaired LVF is seen in a persistent shock index >1 Polyuria excludes shock secondary to sepsis

5 A B C D Answer

The first compensatory response to shock is which of the following? An increased CO A fall in O2 content of blood A rise in respiratory rate A fall in the mixed venous O2 saturation

6 A B C D

With regards to lactic acidosis, which is FALSE? An elevated lactate is a marker of impaired O2 delivery or utilization A raised lactate correlates with short term prognosis of critically ill patients in ED In septic shock and in post resuscitation from cardiac arrest, one would expect a raised lactate with a reduced mixed venous O2 saturation A raised lactate in the setting of a metabolic acidosis, with a raised anion gap and normal osmolar gap and no ketosis is a characteristic feature of toluene poisoning

Answer

7 A B C D Answer

Which of the following is NOT a metabolic feature of shock? Prerenal azotemia Hyponatraemia Hyperglycaemia Hypoglycaemia

Which of the following best describes the following definition? Sepsis associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion and perfusion abnormalities may include, but are not limited to lactic acidosis, oliguria, or an acute alteration in mental status. Septic shock Sepsis Severe sepsis SIRS

A B C D Answer

9 A B C D Answer

A man who has lost 1700mL of blood in a trauma situation will Require only crystalloid fluid replacement Have a pulse rate of 90 Have lost 30-40% of blood volume Have a normal pulse pressure

10 A B C D Answer

The most common cause of sudden cardiac death is A Cardiomyopathy B WPW C Coronary artery disease D Drugs

11 A B C D Answer

The following is true of Defibrillation Most defibrillators now manufactured use a monophasic waveform The monophasic waveform requires less energy for successful defibrillation than the biphasic type Biphasic waveforms allow smaller more portable defibrillation devices. Monophasic defibrillators should no longer be used

12 A B C D Answer

Regarding resuscitation guidelines which of the following is FALSE? Majority of survivors of sudden cardiac arrest have VF as a primary rhythm Emphasis is focused also on pre-arrest period and post-resuscitation management Fist pacing is of no value in unstable bradyarrhythmias when a pacemaker is not immediately available Rescue breathing provides a FiO2 0.15-0.18

13 A B C D Answer

Suggested indications for resuscitative thoracotomy in patients with traumatic cardiac arrest include all of the following EXCEPT Penetrating cardiac trauma and arrival in ED after <5min of out of hospital CPR and positive pupillary response Penetrating cardiac trauma and arrest in ED Penetrating thoracic trauma and arrival in ED after <15min of out of hospital CPR and positive pupillary response Blunt chest trauma and arrival in ED after <10min of out of hospital CPR

14 A B C D Answer

Which Antiarrhythmic drug increases the fibrillation threshold? Amiodarone Lignocaine Procainamide Vasopressin

15

What is the apgar score if the baby exhibits the following clinical features? Acrocyanosis, some flexion, irregular respirations, pulse<100, and nil reflex irritability. 2 3 4 5

A B C D Answer

16 A B C D Answer

In regard to ALS Endotracheal route administration of drugs cannot be used via a LMA Higher doses of Adrenaline have been shown to improve long term outcome ROSC is higher for patients receiving vasopressin 40IU than adrenaline Fibrinolysis is no longer recommended in a cardiac arrest due to suspected PE due to the high incidence of bleeding during CPR

17 A B C D Answer

With regard to defibrillation First shock efficacy for biphasic defibrillators is greater than 90% As little as 4% of the current reaches the heart Defibrillator pads should be placed within 12-15cm of a pacemaker A period of CPR before defibrillation is not beneficial in a prehospital prolonged arrest

18 A B C D Answer

Children differ to adults in the following ways Less than six months old are obligate mouth breathers They have a higher stroke volume The larynx is high and posterior The chest wall is more compliant

19 A B C D Answer

Which of the following should NOT influence the accuracy of pulse oximetry readings Patient movement Nail polish Hypotension Carboxyhaemoglobin

20 A B C D Answer

2,3-DPG production is NOT increased by Acidosis Hypoxia Anaemia Thyroid hormone

21 A B C D Answer

During resuscitation in hypothermia, which statement is TRUE? The dose of Adrenaline should be doubled until core temp > 35C The time interval between drug doses should be halved until temp > 30C Fixed, dilated pupils is an indication to abandon resuscitation efforts If VF / VT persists after 3 shocks, further shocks should be delayed until core temperature > 30C

22 A B C D Answer

Early Goal-Directed Therapy of Sepsis in the ED does NOT include Maintaining CVP 8 12 mmHg Maintaining MAP 65 90 mmHg Maintaining central venous O2 saturation (ScvO2) >/= 70% Transfusion of RBC to haematocrit >/= 40%

23 A B C D Answer

With regards to paediatric resuscitation, which of the following is INCORRECT? ETT size = Age/4 +4 Weight in Kg = (Age x 2) + 8 ETT insertion distance at lips = (Age/2) + 12 Adrenaline dose 0.1ml / kg of 1:1000 solution

24 A B C D Answer

With respect to intraosseous needles which is FALSE The distal femur is one appropriate site for insertion An IO needle should be attempted in a paediatric resuscitation if IV access has not been achieved within 90 seconds Compartment syndrome is a recognised complication Their use is contraindicated in neonates due to the high rate of growth plate injury

27 A B C D Answer

Features increasing the safety of Endotracheal tubes include all of the following EXCEPT: Bevelled atraumatic tip Translucency of the tube Murphys eye Small volume , high pressure distal cuff

28 A B C D Answer

Factors making paediatric intubation more difficult include all the following EXCEPT: Upper airways are more compliant Large tongue Larynx is more cephalad Epiglottis is larger and floppy

29 A B C D Answer

Which of the following is NOT a link in the chain of survival? Early Defibrillation Early CPR Early Drug Delivery Post resuscitation care

30 A

With regards to cardiac arrest in the third trimester of pregnancy, which of the following statements is TRUE if there is no return of spontaneous maternal circulation within 10 minutes of cardiac arrest and CPR commencement, a perimortem caesarean section should be performed. the patient should be tilted by placing a roll under the patient's left hip and flank. adrenaline is contraindicated as it causes uteroplacental vasoconstriction. avoid the femoral vein when obtaining IV access.

B C D Answer

31 A B C D Answer

Which of the following about central venous access is INCORRECT? There is a greater infection rate with femoral vein CVCs The risk of carotid puncture is greater with the central approach to the internal jugular as opposed to the posterior or anterior approach Femoral vein approach is relatively contraindicated in pregnancy The rate of infusion is dependant on the radius of the line and the length

33 A B C D Answer

With regard to central venous lines Pneumothorax is not a complication of internal jugular insertion Subclavian lines have the highest incidence of arterial puncture Using a supraclavicular approach the needle is directed at the contralateral nipple Femoral lines have the lowest incidence of venous thrombosis

34 A B C D Answer

Which is the most reliable method of confirming endotracheal tube placement? Equal bilateral breath sounds End Tidal CO2 capnography Misting of the tube with expiration Chest X-ray

35 A B C D Answer

With regards to parenteral fluid compositions which is CORRECT Hartmann's contains Na 131 K 5 Cl 111 5% Dextrose contains 50g/LDextrose osmol 300 4% Dextrose 0.18% saline contains Dextrose 40g/L Cl 30 Na 40 mmol 0.9% saline contains Na 150 mmol/L Cl 150 pH 6

36

According to the ILCOR 2010 Resuscitation Guidelines, once ROSC is achieved and the oxygen saturation of arterial blood can be monitored reliably, inspired oxygen is titrated to achieve a SaO2 of: >95% 90-95% 94-98% >93%

A B C D Answer

37 A B C D Answer

In regards to resuscitation of a 10Kg child, which of the following is FALSE: ETT size 4 would be appropriate The dose of adrenaline is 0.1mLs/kg of 1:10 000 solution The rate of external cardiac compressions is 120/min 5mL/kg 10% dextrose is used to treat hypoglycaemia

38 A B C D Answer

Which of the following is a criterion for SIRS? Temp > 39 or < 36 Pulse > 100bpm Resp rate > 28 WCC > 12 000 or < 4000

39 A B C D Answer

Which of the following is FALSE regarding adult cardiac arrest? 50% of out of hospital cardiac arrests have an initial rhythm of VF/VT Atropine is not recommended in treatment of asystole Continuous waveform CO2 monitoring is useful for detecting ROSC There is less evidence supporting the use of hypothermia post-arrest for comatose survivors with an initially non-shockable rhythm.

40 A B C D Answer

A left shift of the Haemoglobin-oxygen dissociation curve Favours unloading of oxygen and subsequent delivery to tissues Occurs with increased temperature Occurs as CO2 levels rise Occurs in alkalosis

Answers 1. D, 2. A 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. C D A D B C C C C C D B C A B D B A D D D D D A C (A phenylephrine, B dobutamine, C Adrenaline), Tintinalli p223 It moves it to the left. Exercise, heat, acid, low 2,3,DPG move the curve to the right to facilitate O2 offloading in an acidic environment. RR>20 Shock index = HR/SBP (0.5 > Normal <0.7)

Tintinalli p232 Textbook of Adult Emergency Medicine. P 26 Dunn 3 ed p98, Rosen 5 ed p78, (open thoracotomy does not improve outcome in out of hospital arrest 2 blunt trauma) Cardiac arrest associated with trauma Circulation.2005;112:IV-146-IV-149)
nd rd th

to

ALS Manual 5 Edition th APLS 4 edition Dunn p.814 Dunn p.817 Rivers E et al. N Engl J Med 2001; 345: 1368-77 Dunn 4 Ed page 834 APLS Manual & Cameron et al (Paeds)
th

th

Should be Early recognition and call for help ALS 5 Edition Comments:(Tintinalli 6th edition p 94) a) - wrong - caesarean should be done within 5 mins. b) - wrong - should be placed under right hip, not left hip. c) wrong - adrenaline DOES cause uteroplacental vasoconstriction and may be detrimental in the setting of maternal hypotension, but should be used as needed during cardiac arrest. d) - correct - uterine compression of IVC results in poor venous flow in lower limbs. e) wrong - this is not necessary, and would only delay a potentially lifesaving procedure. Tintinalli central venous access Dunn 4 Ed pgs 835-838 th Dunn 4 Ed pg 59 Resus notes th Dunn 5 edition page 6; ILCOR Guidelines 2010 Paediatric Emergency Medicine, Cameron et al Severe Sepsis & Septic Shock: Review of the Literature and Emergency Department Management Guidelines. Nguyen et al. 2006 Textbook of Adult Emergency Medicine, Cameron et al. and the new ARC guidelines th rd Dunn (4 ed) p817, Cameron (3 ed) p 28
th

th

30. D

31. 32. 33. 34. 35. 36. 37. 38.

B C B A C C D

39. A 40. D