Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Abdominal and Gastrointestinal Surgery
Page: 2

Question 6# Print Question

A 47-year-old female undergoes bilateral mastectomy with immediate reconstruction with free TRAM flap. She is admitted to the ICU for flap monitoring. When you evaluate her, she is complaining of shortness of breath and is intermittently unresponsive.

How do you proceed?

A. Immediately start CPR and request STAT echo
B. Immediately start CPR and decompress bilateral chests by needle thoracostomy
C. Call surgery bedside for resuscitative thoracotomy
D. Immediately start CPR, and call cardiac to consider ECPR (extracorporeal cardiopulmonary resuscitation)

Question 7# Print Question

A 77-year-old female presents with acute worsening of abdominal pain. She describes nausea and vomiting along with some diarrhea after a recent trip to Florida, but states that these symptoms were improving when she suddenly developed severe acute abdominal pain. She denies similar abdominal complaints in the past and reports no prior abdominal surgeries. Past medical history is significant for atrial fibrillation of which she takes rivaroxaban, although she does report she may missed a few doses earlier in the week.

What would be the test of choice to confirm the diagnosis?

A. Echocardiogram
B. Abdominal ultrasonography
C. CT angiography
D. CT with contrast

Question 8# Print Question

Which of the following is NOT considered a risk factor for nonocclusive mesenteric ischemia (NOMI)? 

A. Infrarenal aortic bifemoral bypass surgery (ABF)
B. Hemodialysis
C. Acute myocardial infarction
D. Burn injury

Question 9# Print Question

A 79-year-old female with a past medical history of COPD is admitted to the ICU for community-acquired pneumonia. She develops fever, and blood-tinged diarrhea. She remains KUB reveals air-fluid levels within the small bowel. A CT demonstrates fatstranding involving the colon and colonic wall thickening.

The BEST method to confirm the diagnosis and begin treatment is:

A. Obtain stool cultures and start IV antibiotics
B. Request an emergent surgical consultation for exploratory laparotomy
C. Barium enema and IV antibiotics
D. Nasogastric decompression, IV antibiotics, and request urgent colonoscopy

Question 10# Print Question

Which scenario is MOST consistent with abdominal compartment syndrome (ACS)? 

A. A 34-year-old obese male (120 kg), mechanically ventilated with abdominal distension and bladder pressures of 22 cm H2O. Fraction of inspired oxygen is 35%; positive end-expiratory pressure is 12 mm Hg. Peak inspiratory pressures are 28 cm H2O
B. A 55-year-old female (75 kg) is admitted preoperatively for surgical resection of a pelvic mass. She is breathing spontaneously on 4 L. Bladder pressure is 22 cm H2O
C. An 18-year-old (70 kg) gunshot-wound victim with multiple of injuries involving the chest, abdomen, and extremities. He received 22 units of packed red blood cells, 18 units of fresh frozen plasma, and 2 packs of platelets intraoperatively. He has an open abdomen with a vacuum-assisted dressing in place. He is mechanically ventilated with fraction of inspired oxygen at 60% and positive end-expiratory pressure of 18 mm Hg. Peak inspiratory pressures are 40 cm H2O. Urine output has been minimal. Bladder pressure is 22 cm H2O
D. A 38-year-old (85 kg) burn victim with 20% total body surface area of partial-thickness wounds involving the flank and left lower extremity. He has received 8 L of resuscitation over the first 24 hours. The bladder pressure is 22 mm Hg. He is breathing comfortably on 2 L nasal cannula. Urine output is 60 mL/h

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Abdominal and Gastrointestinal Surgery
Page: 2 of 3