Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Infections and Immunologic Disease--->Immunological Diseases
Page: 2

Question 6# Print Question

A 56-year-old woman with systemic lupus erythematosus (SLE), who is maintained on prednisone 20 mg daily, presents for open right hemicolectomy for colon cancer. She is admitted to the surgical ICU postoperatively for refractory hypotension.

Which of the following is true regarding perioperative stress dose steroid supplementation?

A. Before an elective surgical case, preoperative adrenocorticotropic hormone (ACTH) stimulation testing is warranted in this patient to determine need for stress dose steroid administration
B. The dose and duration of perioperative steroid administration are the same regardless of the type of surgery
C. Stress dose steroids should be administered similarly regardless of the duration of this patient’s prednisone use
D. Dexamethasone may alternatively be used for stress dose steroid administration, as it has higher relative glucocorticoid activity compared with hydrocortisone
E. Stress dose steroids should be administered only in the event of intraoperative hypotension refractory to intravenous fluids and vasopressors

Question 7# Print Question

Which of the diffuse connective tissue disorders (DCTDs) has the highest rate of pulmonary involvement?

A. Systemic lupus erythematosus (SLE)
B. Systemic sclerosis (SS)
C. Polymyositis (PM)
D. Dermatomyositis (DM)
E. Rheumatoid arthritis (RA)

Question 8# Print Question

A 54-year-old woman with SLE, maintained on chronic prednisone, and complicated by stage III chronic kidney disease presents with acute anuric kidney injury.

Which of the following statements is most correct regarding this patient’s renal failure?

A. Following treatment, renal biopsy is unlikely to show pathologic changes despite clinical improvement
B. In the longer term, cyclophosphamide, mycophenolate mofetil, or calcineurin inhibitors may be used alone or in combination to improve disease remission
C. Azathioprine reduces rate of progression to end-stage renal disease
D. High-dose corticosteroids are contraindicated
E. When renal replacement therapy is initiated in the acute setting, patients will invariably require long-term hemodialysis

Question 9# Print Question

Which of the following is most consistent with a diagnosis of Takayasu arteritis (TAK)?

A. Immediate revascularization should be pursued during active flares to prevent ischemic complications
B. Blood pressure discrepancy ≥10 mm Hg between the contralateral upper extremities is a diagnostic criterion
C. Corticosteroids alone achieve remission in >90% cases
D. Angiography demonstrates stenosis of the aorta, its branches, and/or large arteries of the upper or lower extremities
E. Pulmonary arteries are spared

Question 10# Print Question

A 64-year-old gentleman with hypertension, hyperlipidemia, and mild asthma presents to the emergency department from home with massive hemoptysis. He is intubated for airway protection, and chest CT scan shows diffuse bilateral alveolar ground-glass opacities with inter- and intralobular thickening. He is admitted to the ICU where bronchoscopy and BAL is performed and consistent with diffuse alveolar hemorrhage (DAH). During his ICU course, he develops worsening acute renal failure with hematuria. Anti– glomerular basement membrane (anti-GBM) antibody is positive.

Which of the following statements is most likely correct regarding his disease?

A. The cause of this patient’s pulmonary-renal syndrome is a type of vasculitis
B. Patients must have both pulmonary and renal manifestations in order to be diagnosed with anti-GBM disease
C. A positive ANCA precludes diagnosis of anti-GBM disease
D. Anti-GBM antibodies are directed at smooth muscle cells of medium-sized arteries
E. Urinalysis will likely show dysmorphic red cells, red cell casts, and proteinuria

Category: Critical Care Medicine-Infections and Immunologic Disease--->Immunological Diseases
Page: 2 of 2