EDAIC Intensive Care Medicine 5 — Questions and Answers
Question 1: Enteral nutrition in mechanically ventilated ICU patients should ideally be started:
- Within 24–48 hours of ICU admission if hemodynamically stable (Correct answer)
- Only after bowel sounds are confirmed
- After 72 hours to avoid feeding intolerance
- Only when oral feeding is contraindicated for >7 days
Correct answer: Within 24–48 hours of ICU admission if hemodynamically stable
Early enteral nutrition within 24–48 hours reduces infectious complications and mortality in hemodynamically stable ventilated patients.
Question 2: The SOFA score assesses organ dysfunction across how many organ systems?
- 4
- 5
- 6 (Correct answer)
- 8
Correct answer: 6
SOFA evaluates 6 organ systems: respiratory, coagulation, hepatic, cardiovascular, neurological (GCS), and renal.
Question 3: Which finding on bedside echocardiography most reliably indicates fluid responsiveness?
- Inferior vena cava diameter >2.5 cm
- Respiratory variation in IVC diameter >18% in ventilated patients (Correct answer)
- Left ventricular ejection fraction <40%
- E/e' ratio >14
Correct answer: Respiratory variation in IVC diameter >18% in ventilated patients
IVC collapsibility (spontaneous breathing) or distensibility (positive pressure ventilation) >18% predicts fluid responsiveness with reasonable sensitivity and specificity.
Question 4: A patient with acute pancreatitis and organ failure is admitted to the ICU. Antibiotic prophylaxis should be given:
- Routinely to all severe pancreatitis patients
- Only when infected pancreatic necrosis is confirmed or strongly suspected (Correct answer)
- After 48 hours if fever persists
- Whenever CRP exceeds 200 mg/L
Correct answer: Only when infected pancreatic necrosis is confirmed or strongly suspected
Prophylactic antibiotics do not improve outcomes in sterile pancreatitis; they are indicated only when infected necrosis is confirmed or strongly suspected.
Question 5: In the management of massive pulmonary embolism with cardiovascular collapse, the treatment of choice is:
- Anticoagulation with IV heparin alone
- Systemic thrombolysis (e.g., alteplase 100 mg over 2 hours) (Correct answer)
- Catheter-directed thrombolysis only
- Emergency surgical embolectomy as first line
Correct answer: Systemic thrombolysis (e.g., alteplase 100 mg over 2 hours)
Systemic thrombolysis with alteplase is the first-line treatment for massive PE with hemodynamic instability unless contraindicated.
Question 6: A patient on the ICU has a lactate of 6 mmol/L and MAP of 58 mmHg despite 30 mL/kg fluid resuscitation. The next step is:
- Give another 20 mL/kg fluid bolus
- Start vasopressors (norepinephrine) and reassess (Correct answer)
- Initiate CRRT immediately
- Perform urgent echocardiography before any further treatment
Correct answer: Start vasopressors (norepinephrine) and reassess
After adequate fluid resuscitation, persistent hypotension in septic shock requires vasopressors; norepinephrine is first-line per Surviving Sepsis Campaign.
Question 7: Delirium in ICU patients is best assessed using which validated tool?
- Glasgow Coma Scale (GCS)
- Confusion Assessment Method for the ICU (CAM-ICU) (Correct answer)
- Mini-Mental State Examination (MMSE)
- Richmond Agitation-Sedation Scale (RASS)
Correct answer: Confusion Assessment Method for the ICU (CAM-ICU)
CAM-ICU is the most validated and widely used delirium screening tool for ICU patients, applicable even in non-verbal ventilated patients.
EDAIC Intensive Care Medicine 5
Enteral nutrition in mechanically ventilated ICU patients should ideally be started: