Multiple Choice Questions (MCQ)

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

A 57-year-old government employee who works to counter bioterrorism without any pertinent medical history is exposed to a small amount of an unknown white powder on his skin. Over 4 days, he develops a flulike illness with symptoms including malaise, fever, and fatigue. On presentation to the emergency department, he has a :

  • temperature of 38.5°C (101.3°F)
  • HR of 102/min
  • BP of 148/86 mm Hg
  • O2 of saturation of 98% on room air

Physical examination is notable for the skin lesion figure below:

Laboratory studies are notable for a WBC of 10,800. Gram staining of the substance reveals large, spore-forming, gram-positive bacilli. 

The patient is placed in isolation and admitted to the general medical service. Twelve hours after admission, the patient becomes increasingly altered. He endorses nuchal rigidity and photophobia, is unable to formulate complete sentences, and is transferred to the ICU. Lumbar Puncture demonstrates:

  • amber colored fluid
  • an opening pressure of 35 cm H2O
  • 4800 WBCs/mm3 with 85% PMNs
  • 30 RBCs/mm
  • protein of 400 mg/dL
  • glucose of 24 mg/dL

 In addition to antitoxin, which of the following antibiotic(s) should be empirically started on this patient in the ICU?

A. Moxifloxacin and clindamycin
B. Ciprofloxacin, meropenem, and linezolid
C. Cefepime and vancomycin
D. Levofloxacin and acyclovir

Question 2# Print Question

Twelve employees of a clothing factory are transported to the emergency department after a fire at their factory. The factory utilizes wool, silk, and multiple other clothing products. The group was in the building for 2 hours while the fire was ablaze. A 55-yearold male who was found located close to the fire presents with headache, vomiting, and altered mental status. He also reports a “bitter almond” smell. Initial examination is notable for:

T37.0°C (98.6°F)

HR 121/min

BP 160/96 mm Hg

O2 saturation of 92% on room air

The patient appears flushed. His clothing is removed, and his skin is rinsed with soap and water. 

As laboratory test results are pending, the patient has multiple episodes of convulsions and is intubated for airway protection. Laboratory test results are shown in the table below:

 Which of the following treatments for cyanide toxicity should be AVOIDED in this patient?

A. Sodium nitrite
B. Sodium thiosulfate
C. Hydroxocobalamin
D. 100% Oxygen

Question 3# Print Question

Multiple villagers in a war-torn Middle Eastern country are exposed to an unknown toxic agent. They present to a medical facility complaining of abdominal pain, diarrhea, frequent urination, and excessive tearing in their eyes. Physical examination is notable for bradycardia, miosis, and salivary secretions.

Which of the following is the most likely agent and what is the appropriate antidote?

A. Sarin Nerve Gas; Atropine and pralidoxime
B. Atropa belladonna; Physostigmine
C. Benzodiazepines; Flumazenil
D. Arsenic; Dimercaprol

Question 4# Print Question

A 56-year-old male who was working at a nuclear power plant presents to the emergency department complaining of significant nausea and vomiting. Initial vitals are:

  • temperature of 36.8°C (98.2°F)
  • HR of 108/min
  • BP of 118/76 mm Hg
  • O2 saturation of 96% on room air

Physical examination is otherwise unremarkable. He is decontaminated, placed in isolation, and admitted to the ICU for further management. It is estimated that he was exposed to 4 -6 Gy of radiation.

On day 8 of admission, his laboratory studies are notable for:

  • WBC of 1500/µl with ANC of 300/µl
  • Hgb of 5.8 g/dL
  • Hct of 23%
  • Plt of 23000/ µL

In patients with hematopoietic radiation injury, which of the following is NOT a recommended component of treatment?

A. Granulocyte colony-stimulating factor for patients exposed to >2 Gy
B. Empiric antibiotics for patients with ANC <500
C. Hematopoietic cell transplantation for individuals exposed to >10 Gy
D. Administration of blood products that have undergone leukoreduction and irradiation

Question 5# Print Question

A 55-year-old male presents to an emergency department in China with a 5-day history of cough, fever, and myalgias. On presentation, his:

  • temperature of 39.8°C (103.6°F)
  • HR of 112/min
  • BP of 98/66 mm Hg
  • O2 saturation of 88% on room air, which improves to 94% on 2 L of nasal cannula

Chest X-ray demonstrates a left lower lobe pneumonia. He receives 2 L of lactated ringers, is started on empiric broad spectrum antibiotics with cefepime and vancomycin, and is admitted to an isolated bed on the general medicine floor for further management. Two days after admission, he develops a worsening oxygen requirement, is transferred to the ICU, where he is ultimately intubated for hypoxic respiratory failure. His CXR just before intubation is shown below.

A nasopharyngeal aspirate and endotracheal aspirate are ultimately positive for Avian Influenza A H7N9.

Which of the following is true regarding the management of H7N9?

A. Inhaled zanamivir should be reserved for patients with underlying airway disease
B. Treatment with an antiviral agent such as oseltamivir or zanamivir is recommended, even if more than 48 hours have elapsed since illness onset
C. Treatment with IV zanamivir is preferred over PO oseltamivir
D. Antiviral administration should be held until laboratory testing has confirmed the viral pathogen

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Disaster Management
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