EDAIC Intensive Care Medicine 2 โ Questions and Answers
Question 1: A patient with ARDS has a PaO2/FiO2 ratio of 110 mmHg. According to the Berlin Definition, this classifies as:
- Mild ARDS
- Moderate ARDS
- Severe ARDS (Correct answer)
- Not ARDS โ ratio too low
Correct answer: Severe ARDS
Severe ARDS is defined by PaO2/FiO2 โค100 mmHg; moderate is 101โ200; 110 mmHg falls in the severe category.
Question 2: Which vasopressor is recommended as first-line therapy for septic shock in current surviving sepsis guidelines?
- Epinephrine
- Vasopressin
- Norepinephrine (Correct answer)
- Phenylephrine
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock due to its strong ฮฑ-adrenergic effect and favorable cardiac output profile.
Question 3: A ventilated ICU patient has a plateau pressure of 34 cmH2O and a PEEP of 8 cmH2O. The driving pressure is:
- 42 cmH2O
- 26 cmH2O (Correct answer)
- 34 cmH2O
- 8 cmH2O
Correct answer: 26 cmH2O
Driving pressure = Plateau pressure โ PEEP = 34 โ 8 = 26 cmH2O.
Question 4: In acute liver failure, which finding indicates the poorest prognosis according to King's College Criteria?
- Bilirubin >300 ยตmol/L alone
- INR >6.5 in acetaminophen-induced ALF (Correct answer)
- ALT >5000 U/L
- Serum albumin <20 g/L
Correct answer: INR >6.5 in acetaminophen-induced ALF
An INR >6.5 (PT >100 s) in acetaminophen-induced ALF is an independent criterion for transplant listing under King's College Criteria.
Question 5: Prone positioning in severe ARDS improves survival primarily by:
- Reducing ventilator-induced lung injury through more homogeneous ventilation (Correct answer)
- Increasing FRC and reducing functional dead space
- Enhancing cardiac output via reduced afterload
- Decreasing sedation requirements
Correct answer: Reducing ventilator-induced lung injury through more homogeneous ventilation
Prone positioning redistributes ventilation, reducing dorsal atelectasis and making lung stress/strain more homogeneous, thereby limiting VILI.
Question 6: Which scoring system is most validated for predicting ICU mortality and is widely used across European ICUs?
- APACHE IV
- SAPS II (Correct answer)
- SOFA
- MODS
Correct answer: SAPS II
SAPS II (Simplified Acute Physiology Score II) is widely validated and used in European ICUs for mortality prediction.
Question 7: A patient on continuous renal replacement therapy (CRRT) becomes hypotensive. The most likely cause related to the CRRT circuit is:
- Excessive ultrafiltration rate (Correct answer)
- Heparin overdose causing vasodilation
- Air embolism from venous return
- High blood flow rate causing cardiac arrhythmia
Correct answer: Excessive ultrafiltration rate
Excessive net ultrafiltration removes intravascular volume faster than it can be replaced, causing hypovolemia and hypotension.
EDAIC Intensive Care Medicine 2
A patient with ARDS has a PaO2/FiO2 ratio of 110 mmHg.
According to the Berlin Definition, this classifies as: