Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pharmacology and Toxicology--->Toxins and Poisoning
Page: 2

Question 6# Print Question

A 48-year-old male is well known to your hospital for his severe alcohol use disorder. In the emergency department a breathalyzer showed an ethanol level of 250 mg/dL, and he was noted to be more somnolent than usual. He then had an episode of emesis streaked with bright red blood. He was intubated for airway protection and admitted to the ICU. In the ICU, an elevated osmolal gap is noted and he is started empirically on fomepizole. The next day, an arterial blood gas is drawn with a pH of 7.38, but the patient does not awaken to participate in a spontaneous awakening trial/spontaneous breathing trial (SAT/SBT).

What is the likely substance responsible for his continued altered mental status?

A. Isopropyl alcohol
B. Methanol
C. Propylene glycol
D. Ethylene glycol
E. Ethanol

Question 7# Print Question

A 53-year-old female is well known to your hospital for her neardaily visits for acute alcohol intoxication. After a curious 3-day absence from the emergency department, she is brought in by local paramedics after being found, confused, in a local park. Her heart rate on arrival is 163 bpm and her blood pressure is 210/105. She is noted to be tremulous and diaphoretic and tells the ED that she quit alcohol “cold turkey” 3 days prior. Despite repeated doses of parenteral lorazepam, she continues to be in moderate-to-severe alcohol withdrawal and a continuous infusion of lorazepam is initiated. Assuming that the infusion is titrated to avoid oversedation, what acid-base disturbance would you expect to see with a prolonged infusion of lorazepam?

A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
E. Primary respiratory alkalosis with secondary metabolic acidosis

Question 8# Print Question

A 19-year-old male was brought to the emergency department of your hospital by his fraternity brothers after he “chugged” two full bottles of whiskey as part of a pledging ritual. EMS transported the patient to the emergency department where he was intubated for unresponsiveness. Point-of-care glucose was normal, as were serum electrolytes. An ethanol level is measured at 450 mg/dL. He is admitted to the ICU for further management.

What is the appropriate next step in management?

A. Immediate gastric lavage via placement of large-bore stomach (Ewald) tube
B. Administration of activated charcoal
C. Administer large volume crystalloid volume resuscitation for hemodilution
D. Continue supportive care
E. Consult nephrology for emergent dialysis

Question 9# Print Question

A 23-year-old female is admitted to the ICU after ingesting a bottle of medication in a suicide attempt. In the emergency department, the patient complained of abdominal pain and ringing in her ears, and would tell the physicians only that she bought the bottle of “pain medication” from a neighborhood convenience store earlier in the day. On arrival to the ICU, she is tachypneic and lethargic.

What acid-base disturbance would you expect on blood gas analysis?

A. Primary metabolic acidosis
B. Primary respiratory alkalosis
C. Mixed metabolic acidosis and respiratory alkalosis
D. Primary metabolic acidosis with compensatory respiratory alkalosis
E. Primary respiratory acidosis with compensatory metabolic acidosis

Question 10# Print Question

An 18-year-old male is admitted to your ICU after ingesting two “handfuls” of generic pain medications. In the emergency department, acetaminophen was not detected and a salicylate level was 20 mg/dL (therapeutic reference range 10-30 mg/dL). Upon arrival to the ICU, the patient complains of mild nausea and is mildly tachypneic. Lab testing in the ICU is notable for a pH of 7.50 and a repeat salicylate level of 35 mg/dL.

What should be your next step in clinical management? 

A. Draw a repeat salicylate level in 2 hours
B. Administer intravenous sodium bicarbonate
C. Administer N-acetyl-cysteine (Acetadote)
D. Endotracheally intubate the patient for anticipated respiratory failure
E. Discharge the patient

Category: Critical Care Medicine-Pharmacology and Toxicology--->Toxins and Poisoning
Page: 2 of 2