Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Environmental Injury
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Question 1# Print Question

A 65-year-old male is admitted to the hospital after he was found down in his kitchen during a house fire. On admission to the hospital, he was somnolent, had singed nasal hairs, and carbonaceous material in his mouth. He was hypoxic to the 80s and hoarse and was intubated for airway protection. His carboxyhemoglobin in the ED was 10%. He had no cutaneous burns identified. He was admitted to the ICU. On the ventilator, his settings are:

  • volume control
  • tidal volume 6 mL/kg
  • PEEP 10
  • RR 18
  • FiO2 70% with plateau pressure 25
  • O2 sat 99%

with last ABG:

  • pH 7.4
  • pCO2 45
  • pO2 80

On bronchoscopy, he had moderate erythema and carbonaceous deposits.

What is the BEST management of this patient’s inhalation injury?


A. Start broad-spectrum antibiotics
B. Continue lung protective ventilation and wean FiO2 as tolerated
C. Extubate patient and transition to BiPAP
D. Increase tidal volume to 10 mL/kg

Question 2# Print Question

A 19-year-old male is brought in by ambulance to the ED after a near-drowning episode in which he was caught in a rip tide. Rescuers extracted him from the water within 20 minutes. On the scene, he was coughing and mildly confused. On arrival to the ED he is found to be awake and alert, with initial oxygen saturation 85% on room air. Supplemental oxygen is administered via aerosol face mask at 10 L/min, and after 30 minutes, his oxygen saturation rises to 90%. He remains awake and is in no distress.

What is the BEST next step in management?

A. An oxygen saturation of 90% is sufficient. Trial him off face mask in preparation for discharge from the ED
B. Use the Heimlich maneuver to extract additional fluid from his lungs
C. Intubate the patient and perform bronchoscopy to clear the aspirated fluid
D. Initiate noninvasive positive pressure ventilation such as BiPAP

Question 3# Print Question

A 34-year-old woman female fell off a dam into a lake while intoxicated. She was extracted approximately 10 minutes after the incident. She is unresponsive at the scene, and rescue breathing was initiated by onlookers. On EMS arrival, she has a pulse and is her respiratory rate is 10. Supplemental oxygen is administered and she is brought to the ED. On arrival, her GCS is 8, and her oxygen saturation is 85% on 15L non-rebreather. She is intubated.

Which of the following is TRUE regarding freshwater versus saltwater drowning? 

A. Patients who suffer near-drowning in salt- versus freshwater should be managed similarly
B. Saltwater ingestion results in a hyperosmolar load, and patients benefit from desmopressin administration
C. Freshwater ingestion results in a hypo-osmolar load, and these patients benefit from diuresis with furosemide
D. Patients with saltwater ingestion are more prone to developing pneumonia

Question 4# Print Question

A 45-year-old male ascends to 16 000 feet on an ice climbing expedition. He initially develops some headaches, and then becomes increasingly confused. Two days into the trip, he becomes unable to walk straight and trips over his feet. His climbing partners become increasingly concerned and administer supplemental oxygen and dexamethasone they have with them. They assist him with descent to a safe location where he is transported by helicopter to the local emergency department, where he is found to be interactive with improved mental status and only mild ataxia.

Which of the following is the MOST appropriate management for this patient?

A. Lumbar puncture and administration of empiric antibiotics
B. Treat with acetazolamide exclusively
C. Supplemental oxygen administration and continuation of dexamethasone therapy
D. Discharge patient with outpatient follow-up

Question 5# Print Question

A 28-year-old painter is working on an aluminum ladder when the ladder he is working on comes in contact with high-voltage power lines (∼14 000 V). He has immediate pain to his bilateral hands, forearms, and feet but is able to lower himself to the ground. He presents to the ED, where he has a normal ECG, but continues to complain of arm and foot pain. He has superficial partial-thickness burns to his bilateral hands, but full sensation and range of motion. Volume resuscitation with 150 mL/h of LR (lactated Ringer’s) is initiated. Three hours later, the patient is complaining of bilateral forearm swelling, hand numbness, and limited ability to move his fingers.

Which of the following is the BEST next step in management of this patient? 

A. Elevate bilateral arms above the level of the heart
B. Wrap bilateral arms to provide compression
C. Take patient to OR for forearm fasciotomies and carpal tunnel release
D. Perform CTA to examine upper extremity flow

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Environmental Injury
Page: 1 of 2