BCA Critical Care & Intensive Care 2 — Questions and Answers
Question 1: A mechanically ventilated patient develops sudden hypotension, tachycardia, and decreased breath sounds on the left. Which diagnosis should be addressed first?
- Left pleural effusion
- Tension pneumothorax (Correct answer)
- Left main stem intubation
- Pericardial tamponade
Correct answer: Tension pneumothorax
Tension pneumothorax causes obstructive shock and requires immediate needle decompression before confirmation by imaging.
Question 2: What is the target MAP recommended by the Surviving Sepsis Campaign for septic shock resuscitation?
- ≥55 mmHg
- ≥65 mmHg (Correct answer)
- ≥75 mmHg
- ≥85 mmHg
Correct answer: ≥65 mmHg
The Surviving Sepsis Campaign recommends a MAP ≥65 mmHg as the initial resuscitation target in septic shock.
Question 3: Which ventilator parameter is most directly associated with ventilator-induced lung injury (VILI)?
- FiO2
- PEEP level
- Tidal volume (driving pressure) (Correct answer)
- Respiratory rate
Correct answer: Tidal volume (driving pressure)
Excessive tidal volumes and driving pressures cause volutrauma and barotrauma, the primary mechanisms of VILI.
Question 4: A patient in the ICU develops oliguria, rising creatinine, and FENa <1%. Which condition is most consistent?
- Acute tubular necrosis
- Prerenal azotemia (Correct answer)
- Obstructive uropathy
- Contrast nephropathy
Correct answer: Prerenal azotemia
FENa <1% indicates avid sodium retention by intact tubules, consistent with prerenal azotemia from reduced renal perfusion.
Question 5: Which neuromuscular blocking agent is preferred for rapid sequence intubation in a patient with hyperkalemia?
- Succinylcholine
- Pancuronium
- Rocuronium (Correct answer)
- Vecuronium
Correct answer: Rocuronium
Succinylcholine is contraindicated in hyperkalemia due to risk of fatal hyperkalemic cardiac arrest; rocuronium (with sugammadex reversal available) is preferred.
Question 6: In the management of ARDS, the ARDSNet trial demonstrated mortality benefit with which ventilation strategy?
- High-frequency oscillatory ventilation
- Tidal volumes of 6 mL/kg IBW (Correct answer)
- Inverse ratio ventilation
- Pressure-controlled ventilation
Correct answer: Tidal volumes of 6 mL/kg IBW
The landmark ARDSNet trial showed reduced mortality with low tidal volume ventilation (6 mL/kg IBW) compared to 12 mL/kg.
Question 7: Which vasopressor is recommended as first-line therapy for septic shock according to current guidelines?
- Epinephrine
- Dopamine
- Norepinephrine (Correct answer)
- Vasopressin
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor in septic shock due to its predominant alpha-1 effect and favorable safety profile.
BCA Critical Care & Intensive Care 2
A mechanically ventilated patient develops sudden hypotension, tachycardia, and decreased breath sounds on the left.
Which diagnosis should be addressed first?