Module 2 Quiz

A patient has a respiratory rate of 32 breaths/min, SpO2 88% on 15L O2, GCS of 12, and a systolic BP of 80 mmHg. According to standard ICU referral criteria, how many organ systems are potentially failing? *

One (respiratory only)

Two (respiratory and neurological)

Three (respiratory, neurological, and circulatory)

None — wait for blood results first

Which of the following is the MOST appropriate first step when a ward doctor is concerned that a patient may need ICU admission? *

Write a detailed referral letter and send via internal mail

Contact the ICU team immediately by telephone to discuss the patient

Wait until the morning ward round before escalating

Transfer the patient to a high-dependency bed without discussion

Which scoring system is most commonly used to identify ward patients at risk of deterioration and prompt ICU referral in UK hospitals? *

APACHE II

NEWS2 (National Early Warning Score 2)

SOFA score

Glasgow Coma Scale alone

Which of the following is NOT part of the information that should be communicated when making an ICU referral using the SBAR framework? *

Situation: current clinical problem and observation values

Background: relevant past medical history and reason for admission

Assessment: your working diagnosis and concerns

Review: the number of previous ICU admissions in the past 5 years

A 58-year-old is admitted to ICU following a generalised tonic-clonic seizure. She is now GCS 10 (E3V3M4). What is your immediate priority? *

Arrange urgent CT head

Secure the airway and assess breathing

Commence levetiracetam infusion

Insert a urinary catheter and measure hourly urine output

When positioning a sedated, intubated ICU patient, which of the following is the standard default position? *

Flat (0°) to maximise cerebral perfusion pressure

Head-up at 30–45° to reduce ventilator-associated pneumonia risk

Left lateral decubitus to protect the right lung

Reverse Trendelenburg at 20° to reduce aspiration

Which IV fluid is most appropriate for initial resuscitation in a critically ill patient with suspected hypovolaemic shock? *

5% Dextrose (D5W)

0.9% Normal Saline (large volumes)

Balanced crystalloid (e.g. Hartmann's solution or Plasmalyte)

5% Human Albumin Solution as first-line

What is the target MAP (mean arterial pressure) in most critically ill patients without specific neurological indications? *

50–55 mmHg

65–70 mmHg

80–85 mmHg

90–100 mmHg

Before transferring a critically ill patient from one hospital to another, which of the following is MOST important? *

Ensuring the patient has had a full bath and hair wash

Stabilising the patient as much as possible before departure

Waiting for all outstanding blood results before leaving

Transferring as rapidly as possible without pre-transfer preparation

During transfer of a ventilated patient, which of the following monitoring parameters is ESSENTIAL at a minimum? *

SpO2 only

SpO2 and ETCO2 only

SpO2, ECG, non-invasive blood pressure, and ETCO2

SpO2, ECG, invasive arterial BP, CVP, and ETCO2

Which of the following is a recognised complication that is significantly more likely to occur during inter-hospital transfer compared to the stable ICU environment? *

Development of a pulmonary embolism

Equipment failure and physiological deterioration

Hospital-acquired MRSA

Accidental extubation is less common in transit than on the ICU

Cerebral perfusion pressure (CPP) is calculated as: *

MAP minus CVP

MAP minus ICP

Systolic BP minus ICP

MAP plus ICP

The Monroe-Kellie doctrine states that the total volume within the rigid skull is fixed. Which three components make up intracranial volume? *

Brain tissue, arterial blood, and CSF

Brain tissue (including neurones and glia), blood (arterial and venous), and CSF

Brain parenchyma, extracellular fluid, and lymph

Neurons, white matter, and ventricular CSF only

Cerebral autoregulation maintains constant cerebral blood flow across a MAP range of approximately: *

40–60 mmHg

50–150 mmHg

70–100 mmHg

100–200 mmHg

Which of the following is the primary metabolic substrate for the brain, accounting for approximately 98% of CNS energy production? *

Lactate

Ketone bodies

Glucose

Glutamine

A patient with severe traumatic brain injury (TBI) has an ICP of 28 mmHg. In addition to head-up positioning at 30°, which is the most appropriate immediate pharmacological intervention? *

IV furosemide 40 mg

IV mannitol 20% (0.5–1 g/kg) or hypertonic saline

IV dexamethasone 8 mg

IV phenytoin loading dose

Which of the following Glasgow Coma Scale scores indicates the patient is unable to protect their own airway and warrants urgent consideration of intubation? *

GCS 15

GCS 12 – 14

GCS 9-11

GCS <8

In subarachnoid haemorrhage (SAH), which of the following is the most feared secondary neurological complication occurring 4–14 days after the initial bleed? *

Re-bleeding from the aneurysm

Cerebral vasospasm causing delayed ischaemic neurological deficit (DIND)

Acute obstructive hydrocephalus

Central diabetes insipidus

Which of the following is the recommended blood glucose target range in critically ill neurological patients? *

3–6 mmol/L (tight control)

6–10 mmol/L

10–14 mmol/L

14–18 mmol/L — hyperglycaemia is protective for the brain

A patient presents with a generalised tonic-clonic seizure lasting 8 minutes. The seizure has now stopped. What is the correct FIRST-LINE treatment for status epilepticus in the UK if the seizure recurs or continues beyond 5 minutes? *

IV phenytoin 15–18 mg/kg

IV lorazepam 4 mg (or IM/buccal midazolam if no IV access)

IV sodium valproate 30 mg/kg

Which of the following is NOT a recognised cause of raised intracranial pressure (ICP)? *

Subdural haematoma

Hyponatraemia

Severe hypercalcaemia

Malignant cerebral oedema post-large MCA infarct

Which of the following ventilation strategies is used to ACUTELY lower ICP in a patient with impending cerebral herniation? *

Permissive hypercapnia (PaCO2 7–8 kPa)

Hyperventilation to PaCO2 3.5–4.0 kPa

PEEP increase to 15 cmH2O

Increasing FiO2 to 1.0

The Cushing reflex (Cushing's triad) — seen with severe raised ICP — classically comprises: *

Hypotension, tachycardia, and irregular breathing

Hypertension, bradycardia, and irregular respirations

Hypertension, tachycardia, and Cheyne-Stokes breathing

Bradycardia, hypotension, and apnoea

Which of the following is the legally accepted term in the UK for the irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe? *

Persistent vegetative state

Brain stem death

Minimally conscious state

Locked-in syndrome

Before performing formal brain stem death tests, which of the following preconditions MUST be satisfied? *

A CT head showing no intracranial pathology

The patient must be >18 years old

Irreversible structural brain damage must be established, and reversible causes must be excluded

The next-of-kin must consent to brain stem testing

Brain stem death testing includes assessment of which of the following reflexes? Select the MOST complete correct list. *

Pupillary light reflex, corneal reflex, and plantar response

Pupillary light reflex, corneal reflex, oculovestibular reflex, gag/cough reflex, and apnoea test

Pupillary light reflex, deep tendon reflexes, and apnoea test

Glasgow Coma Scale, corneal reflex, and EEG

How many doctors must perform brain stem death tests in the UK, and what are the requirements for those doctors? *

One consultant in any specialty

Two doctors, both of whom must be consultants registered for >5 years and competent in the field

Two doctors, at least one of whom must be a consultant; neither can be part of the transplant team

Three doctors including an independent neurologist

In Scotland, as of 2021, the legal framework for organ donation operates under which system? *

Opt-in system: donation requires the deceased to have registered as a donor

Opt-out (deemed consent) system: all adults are considered potential donors unless they have registered an objection

Family consent system: family decision overrides all other considerations

Mandated donation: all organs must be used unless medically contraindicated

What is the difference between DBD (donation after brain death) and DCD (donation after circulatory death)? *

DBD occurs in patients who have suffered brain stem death while being ventilated; DCD occurs after planned withdrawal of life-sustaining treatment or unexpected cardiac arrest

DBD requires family consent; DCD does not

DCD produces better organ quality than DBD in all circumstances

DBD is only possible in patients under 50 years of age

Which of the following best describes the NHSBT guidance on approaching families regarding organ donation? *

The clinical team managing the patient should approach the family without involving the specialist nurse for organ donation (SNOD)

The SNOD (specialist nurse for organ donation) should be involved early and ideally participate in or lead the family conversation

The family should be approached only after all brain stem tests are completed and confirmed

Organ donation should only be raised after the family has independently asked about it

Which of the following organs is LEAST tolerant of warm ischaemia and must be retrieved and preserved most rapidly for transplant? *

Kidney

Liver

Heart

Pancreas