Module 3 Quiz

A 24-year-old is brought in drowsy with pinpoint pupils and RR 8. Which toxidrome does this represent and what is the immediate treatment? *

Sympathomimetic toxidrome — give benzodiazepines

Opioid toxidrome — give naloxone IV

Anticholinergic toxidrome — give physostigmine

Cholinergic toxidrome — give atropine

A patient presents 10 hours after taking 40 paracetamol tablets. ALT is 2400 U/L and INR is 3.2. Serum paracetamol level is 40 mg/L. Should N-acetylcysteine (NAC) be given? *

No — the paracetamol level is below the treatment line at 10 hours

No — it is too late to give NAC after 8 hours

Yes — there is clear evidence of hepatotoxicity regardless of the paracetamol level

Yes — but only if the paracetamol level is above the treatment nomogram line

Which of the following poisonings is MOST effectively treated by urinary alkalinisation with IV sodium bicarbonate? *

Paracetamol overdose

Tricyclic antidepressant overdose

Salicylate (aspirin) overdose

Opioid overdose

Which feature is MOST characteristic of serotonin syndrome (as opposed to neuroleptic malignant syndrome)? *

Onset over days following antipsychotic dose change

Bradycardia and hypotension

Clonus (particularly lower limb) and hyperreflexia

Normal reflexes with profound rigidity

Which of the following is the MOST common cause of acute liver failure in the UK? *

Hepatitis B

Paracetamol overdose

Autoimmune hepatitis

Wilson's disease

Why should fresh frozen plasma (FFP) NOT be given routinely to correct the coagulopathy of acute liver failure? *

FFP causes fluid overload and is never appropriate in liver failure

FFP masks the INR as a prognostic marker and does not improve outcomes in the absence of active bleeding

FFP contains too many clotting factors and causes thrombosis in ALF

The liver metabolises FFP differently and it worsens coagulopathy

Hypoglycaemia in acute liver failure occurs because of: *

Excessive insulin secretion from a damaged pancreas

Failure of hepatic glycogenolysis and gluconeogenesis

Peripheral glucose uptake is increased by inflammatory mediators

The liver produces excess glucagon which paradoxically lowers blood glucose

According to KDIGO criteria, which of the following defines Stage 2 AKI? *

Creatinine rise ≥26.5 μmol/L within 48 hours

Creatinine 1.5–1.9× baseline

Creatinine 2.0–2.9× baseline OR urine output <0.5 mL/kg/h for ≥12 hours

Creatinine ≥3× baseline or requirement for RRT

A patient develops AKI with urine sodium 48 mmol/L, urine osmolality 285 mOsm/kg, and granular casts on urinalysis. What does this indicate? *

Prerenal AKI — give a fluid bolus

Intrinsic AKI (acute tubular necrosis) — focus on the underlying cause

Postrenal AKI — request urgent renal ultrasound

Which of the following is an ABSOLUTE indication to initiate RRT immediately regardless of urine output or creatinine trend? *

Creatinine >500 μmol/L

Urine output <20 mL/hour for 4 hours

Hyperkalaemia with ECG changes unresponsive to medical treatment

Metabolic acidosis with pH <7.25

What is the primary mechanism by which CVVH (continuous veno-venous haemofiltration) removes solutes? *

Diffusion down a concentration gradient across a semipermeable membrane

Convection — solutes are dragged across the membrane with water by hydrostatic pressure

Ion exchange with a resin in the haemofiltre

Active transport by the filter membrane

What is the recommended timing for initiating enteral nutrition in a haemodynamically stable ICU patient? *

Within 6 hours of ICU admission

Within 24–48 hours of ICU admission

Only after bowel sounds are confirmed present

After 72 hours once metabolic stability is established

Which electrolyte abnormality is the hallmark of refeeding syndrome? *

Hypokalaemia

Hypomagnesaemia

Hypophosphatemia

Hyponatraemia

A patient is receiving propofol at 3 mg/kg/hour. Why is this important when calculating their nutritional requirements? *

Propofol inhibits enteral absorption and nutrition should be withheld

Propofol is formulated in a 10% lipid emulsion providing approximately 1.1 kcal/mL

Propofol causes hypoglycaemia requiring additional glucose supplementation

Propofol interacts with enteral feed and the two should not be given simultaneously

Which vitamin must be given BEFORE glucose or nutritional supplementation in a patient at risk of refeeding syndrome? *

Vitamin D

Vitamin K

Thiamine (Vitamin B1)

Folate