FFICM FFICM Organ System Failure and Support 1 — Questions and Answers
Question 1: Which KDIGO (Kidney Disease: Improving Global Outcomes) criteria define acute kidney injury Stage 1?
- Serum creatinine rise ≥0.3 mg/dL within 48h or ≥1.5× baseline within 7 days (Correct answer)
- Serum creatinine rise ≥2× baseline
- Urine output <0.3 mL/kg/h for 24h
- GFR decrease >50% from baseline
Correct answer: Serum creatinine rise ≥0.3 mg/dL within 48h or ≥1.5× baseline within 7 days
KDIGO Stage 1 AKI is defined as a creatinine rise ≥0.3 mg/dL within 48 hours or 1.5–1.9× baseline within 7 days, or urine output <0.5 mL/kg/h for 6–12 hours.
Question 2: In continuous renal replacement therapy (CRRT), which modality uses both convection and diffusion for solute removal?
- Continuous veno-venous hemodiafiltration (CVVHDF) (Correct answer)
- Continuous veno-venous hemofiltration (CVVH)
- Continuous veno-venous hemodialysis (CVVHD)
- Sustained low-efficiency dialysis (SLED)
Correct answer: Continuous veno-venous hemodiafiltration (CVVHDF)
CVVHDF combines convection (ultrafiltration) and diffusion (dialysate) mechanisms, providing superior clearance of both small and middle molecular weight solutes.
Question 3: Which electrolyte abnormality most commonly complicates continuous renal replacement therapy requiring supplementation?
- Hypophosphatemia (Correct answer)
- Hyperkalemia
- Hypernatremia
- Hypercalcemia
Correct answer: Hypophosphatemia
Phosphate is efficiently removed by CRRT and is not present in standard replacement fluids, making hypophosphatemia the most common electrolyte complication requiring supplementation.
Question 4: Which scoring system is most commonly used to assess severity and prognosis in acute liver failure?
- King's College Criteria (Correct answer)
- SOFA score
- APACHE II
- Child-Pugh score
Correct answer: King's College Criteria
The King's College Criteria identify patients with acetaminophen or non-acetaminophen acute liver failure who are unlikely to survive without liver transplantation.
Question 5: What is the primary mechanism of hepatic encephalopathy in critically ill patients with liver failure?
- Accumulation of ammonia and false neurotransmitters impairing cerebral function (Correct answer)
- Cerebral infarction from portal hypertension
- Direct viral invasion of neural tissue
- Hypoglycemia-induced neuronal death
Correct answer: Accumulation of ammonia and false neurotransmitters impairing cerebral function
Hepatic encephalopathy arises primarily from ammonia accumulation (impaired urea cycle), along with inflammatory mediators and false neurotransmitters that disrupt cerebral astrocyte function.
Question 6: In acute respiratory distress syndrome (ARDS), what is the Berlin Definition criterion for severe ARDS?
- PaO2/FiO2 ratio <100 mmHg with PEEP ≥5 cmH2O (Correct answer)
- PaO2/FiO2 ratio <200 mmHg with PEEP ≥5 cmH2O
- PaO2/FiO2 ratio <300 mmHg with PEEP ≥5 cmH2O
- SpO2 <88% on FiO2 1.0
Correct answer: PaO2/FiO2 ratio <100 mmHg with PEEP ≥5 cmH2O
The Berlin Definition classifies severe ARDS as PaO2/FiO2 <100 mmHg on PEEP ≥5 cmH2O, with mild (<300) and moderate (<200) completing the three-tier classification.
FFICM FFICM Organ System Failure and Support 1
Which KDIGO (Kidney Disease: Improving Global Outcomes) criteria define acute kidney injury Stage 1?