Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Neurologic Disorders--->Encephalopathy and Delirium
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Question 1# Print Question

A 34-year-old previously healthy female was admitted to the hospital in labor. She was hypertensive on admission and complained of right upper quadrant pain. Fifteen minutes after delivery she developed a generalized onset motor seizure and was intubated and admitted to the ICU.

Her seizure is MOST likely:

A. A late initial manifestation of a preexisting epilepsy
B. A complication of delivery before normalization of blood pressure
C. Associated with subcortical vasogenic cerebral edema on imaging
D. A complication of high dermatomal level of epidural analgesia/anesthesia
E. Associated with thrombocytosis and cerebral vascular occlusion

Question 2# Print Question

A 63-year-old man with a history of hypertension controlled with three agents and type 2 diabetes treated with metformin presents with new-onset confusion, nausea, and vomiting. His daughter states that he had self-discontinued his antihypertensive medications. He is normoglycemic but hypertensive with systolic blood pressure consistently above 200 mm Hg.

Brain imaging did not show evidence of acute hemorrhage or ischemic changes; chest imaging was unremarkable. Assuming that the patient’s symptoms are due to hypertension, the recommended goal for blood pressure reduction during the first hour is:

A. <140 mm Hg
B. <160 mm Hg
C. ≤15%
D. ≤25%
E. ≤40%

Question 3# Print Question

A 67-year-old man with chronic liver disease was admitted to the ICU with confusion and agitation. Laboratory studies are remarkable for hyperammonemia, serum K of 2.9 mEq/L, elevated urine leukocyte esterase, and large quantities of bacteria in urine.

Which of the following interventions is LEAST likely to result in improvement of this patient’s status?

A. Diuresis with furosemide
B. Antibiotics for urinary tract infection
C. Late-night carbohydrate-rich meal when able to tolerate
D. Lactulose
E. Polyethylene glycol

Question 4# Print Question

A 69-year-old woman with type 2 diabetes has been diagnosed with diabetic nephropathy. If her disease continues to progress to endstage kidney disease, which of the following neurologic findings is most likely to lead to initiation of renal replacement therapy in this patient.

A. Acute-onset right hemiplegia
B. Glove-pattern paresthesia of upper extremities
C. Overt uremic encephalopathy presenting with seizures
D. Memory impairment and diminished ability to concentrate
E. Stupor progressing to coma

Question 5# Print Question

A 72-year-old man has survived a witnessed cardiac arrest with return of spontaneous circulation after 32 minutes of cardiopulmonary resuscitation. There was a delay with securing advanced airway—an emergency tracheostomy was performed 15 minutes after onset of chest compressions. He is now in the ICU 72 hours after the arrest, intubated, showing no signs of discomfort off of sedative or analgesic medications.

Which of the following is MOST likely to predict an adverse clinical outcome in this patient?

A. Plasma lactate 7 mmol/L
B. K 6.0 mEq/L
C. Segmental pulmonary embolus on computed tomography
D. Urine output 0.1 mL/kg/hr
E. Extensor response to pain

Category: Critical Care Medicine-Neurologic Disorders--->Encephalopathy and Delirium
Page: 1 of 2