ABA Critical Care & Pain Medicine 3

Question 1

Which vasopressor is recommended as the FIRST-LINE agent in septic shock according to current guidelines?

Accepted Answer

Norepinephrine

Answer

Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-adrenergic effects with less tachycardia compared to dopamine.

Question 2

A chronic pain patient on 90 MME/day of oral oxycodone requires conversion to IV morphine infusion. Using standard equianalgesic ratios, what is the appropriate starting IV morphine dose per day?

Accepted Answer

30 mg/day IV morphine

Answer

Oral oxycodone 90 MME converts to 30 mg/day IV morphine using the equianalgesic ratio (oxycodone oral:morphine IV = 3:1), with clinical titration as needed.

Question 3

A patient develops ventilator-associated pneumonia (VAP). Which bundle element has the STRONGEST evidence for prevention?

Accepted Answer

Subglottic secretion drainage with specialized ETT

Answer

Subglottic secretion drainage using specialized endotracheal tubes significantly reduces VAP incidence by preventing aspiration of oropharyngeal secretions.

Question 4

In neuraxial pain management, which complication is MOST specific to intrathecal opioid administration (versus epidural)?

Accepted Answer

Delayed respiratory depression up to 24 hours later

Answer

Intrathecal hydrophilic opioids (e.g., morphine) can cause delayed respiratory depression up to 24 hours post-administration due to cephalad CSF spread to respiratory centers.

Question 5

Which parameter BEST guides the decision to discontinue vasopressors in a recovering septic shock patient?

Accepted Answer

Lactate clearance >10% and MAP >65 mmHg on decreasing doses

Answer

Serial lactate measurements demonstrating clearance combined with hemodynamic stability on tapering vasopressor doses indicate adequate perfusion restoration.

(ABA) ASA (American Society of Anesthesiologists) Board Certification Practice Test

(ABA) ASA (American Society of Anesthesiologists) Board Certification Practice Test

ABA Critical Care & Pain Medicine 3