My daughter ms.saimansi who i loved more deare to my heart turns 11 years today. She was born on a monday .she was a beautiful baby who i recieved following a caesarean section for my ex wife.i staúed with my exwifecin hospital for 2 days and got the mother and baby discharged. Due to misunderstandings my ex wife forced me to divorce me on mutual grounds.after all i wanted baby to grow normally. Hope she is fine. I keep praying for her welfare every day.....
Sunday, 5 April 2020
Friday, 15 March 2019
mrcp mcq 1-5
For the prevention of stress-related mucosal disease in critically ill patients, the best end point for clinically important gastrointestinal bleeding is:
A. Endoscopically proven mucosal ulceration
B. Grossly positive nasogastric tube output with a drop in hemoglobin level of 1 g/dL
C. Coffee-ground emesis and melanotic stools
D. Guaiac-positive nasogastric tube output of 1 L
E. Hematemesis and transfusion of packed red blood cells, 2 units
2. Which of the following clinical features in a patient with severe necrotizing pancreatitis indicates the greatest risk of death?
A. Admission C-reactive protein level of 50 mg/dL and a Ranson Score of 3
B. C-reactive protein level of 150 mg/dL and a Ranson Score of 3 after admission for 48 hours
C. Acute Physiology and Chronic Health Evaluation (APACHE II) score >8 on admission
D. CT 72 hours after admission showing 30% necrosis
E. CT 14 days after admission showing 50% necrosis and a walled-off fluid collection
3. A 37-year-old man experiences a grand mal seizure and has a massive witnessed aspiration. He is intubated in the emergency department for severe hypoxemia and sent to the ICU. His chest radiograph shows diffuse bilateral infiltrates. He is on 100% oxygen, a volume-control mode with a rate of 20/min, tidal volume of 420 mL (ideal body weight of 70 kg [154 lb]), and a positive end-expiratory pressure (PEEP) of 5 cm H2O. Initial blood gas measurement shows a PaO2 of 48 mm Hg, PaCO2 of 57 mm Hg, and pH of 7.20. His inspiratory plateau pressure is 29 cm H2O, and his flow graphic indicates an adequate expiratory time (ie, no evidence for air trapping). Which of the following ventilator changes is/are most appropriate?
a. Increase PEEP to 10 cm H2O and maintain other settings.
b. Maintain PEEP at 5 cm H2O, reduce tidal volume to 350 mL, and increase rate to 24/min.
c. Increase PEEP to 10 cm H2O, reduce tidal volume to 350 mL, and increase rate to 24/min.
d. Increase PEEP to 10 cm H2O, reduce tidal volume to 350 mL, and maintain rate.
e. Maintain PEEP at 5 cm H2O and increase tidal volume to 700 mL.
4. A 68-year-old man with chronic obstructive pulmonary disease, hypertension, and hyperlipidemia is being weaned from mechanical ventilation. As part of a standardized weaning protocol, he is started on a spontaneous breathing trial. He initially tolerates the trial well, but later shows evidence of desaturation and agitation. He is given heavier doses of lorazepam for sedation, and assist-control ventilation is resumed. The patient’s current medications are metered-dose ipratropium/albuterol inhalers through the ventilator circuit; prednisone, 40 mg/day; lisinopril, 5 mg/day; and atorvastatin, 10 mg/day. The next day he is calm but confused.
4.Which of the following instruments is most likely to be of value in evaluating the patient?
a. Beck Depression Inventory
b. Activities of daily living
c. Confusion Assessment Method for the ICU (CAM-ICU)
d. Folstein Mini-Mental State Examination (MMSE)
e. Instrumental activities of daily living
5. A 69-year-old patient with diabetes is placed on mechanical ventilation for severe sepsis and acute respiratory distress syndrome due to community-acquired pneumonia. On day 1, he receives assist-control ventilation with FIO2 of 70% and positive endexpiratory pressure (PEEP) of 12 cm H2O, but by day 3 he is on FIO2 of 45% and PEEP of 7 cm H2O. He is on a propofol drip and has received intermittent fentanyl but now appears to be in no pain. His Richmond Agitation-Sedation Scale (RASS) score is -4, which means that he responds only to physical, and not to verbal, stimulation. Which of the following is the best course of action regarding weaning him from sedation and ventilation?
a. Change his propofol drip to intermittent bolus sedation, and then change his ventilator to pressure support ventilation.
b. Completely stop sedation and if he wakes to verbal stimulation, put the ventilator on continuous positive airway pressure as a trial of spontaneous oxygenation and ventilation.
c. Switch his drip from propofol to fentanyl as an analgesia-based sedation strategy to cover both anxiety and pain with one medication and reduce PEEP to 5 cm H2O.
d. After more recovery, gradually reduce both the sedation dosage and the ventilatory support to avoid abrupt changes and risk of anxiety.
A. Endoscopically proven mucosal ulceration
B. Grossly positive nasogastric tube output with a drop in hemoglobin level of 1 g/dL
C. Coffee-ground emesis and melanotic stools
D. Guaiac-positive nasogastric tube output of 1 L
E. Hematemesis and transfusion of packed red blood cells, 2 units
2. Which of the following clinical features in a patient with severe necrotizing pancreatitis indicates the greatest risk of death?
A. Admission C-reactive protein level of 50 mg/dL and a Ranson Score of 3
B. C-reactive protein level of 150 mg/dL and a Ranson Score of 3 after admission for 48 hours
C. Acute Physiology and Chronic Health Evaluation (APACHE II) score >8 on admission
D. CT 72 hours after admission showing 30% necrosis
E. CT 14 days after admission showing 50% necrosis and a walled-off fluid collection
3. A 37-year-old man experiences a grand mal seizure and has a massive witnessed aspiration. He is intubated in the emergency department for severe hypoxemia and sent to the ICU. His chest radiograph shows diffuse bilateral infiltrates. He is on 100% oxygen, a volume-control mode with a rate of 20/min, tidal volume of 420 mL (ideal body weight of 70 kg [154 lb]), and a positive end-expiratory pressure (PEEP) of 5 cm H2O. Initial blood gas measurement shows a PaO2 of 48 mm Hg, PaCO2 of 57 mm Hg, and pH of 7.20. His inspiratory plateau pressure is 29 cm H2O, and his flow graphic indicates an adequate expiratory time (ie, no evidence for air trapping). Which of the following ventilator changes is/are most appropriate?
a. Increase PEEP to 10 cm H2O and maintain other settings.
b. Maintain PEEP at 5 cm H2O, reduce tidal volume to 350 mL, and increase rate to 24/min.
c. Increase PEEP to 10 cm H2O, reduce tidal volume to 350 mL, and increase rate to 24/min.
d. Increase PEEP to 10 cm H2O, reduce tidal volume to 350 mL, and maintain rate.
e. Maintain PEEP at 5 cm H2O and increase tidal volume to 700 mL.
4. A 68-year-old man with chronic obstructive pulmonary disease, hypertension, and hyperlipidemia is being weaned from mechanical ventilation. As part of a standardized weaning protocol, he is started on a spontaneous breathing trial. He initially tolerates the trial well, but later shows evidence of desaturation and agitation. He is given heavier doses of lorazepam for sedation, and assist-control ventilation is resumed. The patient’s current medications are metered-dose ipratropium/albuterol inhalers through the ventilator circuit; prednisone, 40 mg/day; lisinopril, 5 mg/day; and atorvastatin, 10 mg/day. The next day he is calm but confused.
4.Which of the following instruments is most likely to be of value in evaluating the patient?
a. Beck Depression Inventory
b. Activities of daily living
c. Confusion Assessment Method for the ICU (CAM-ICU)
d. Folstein Mini-Mental State Examination (MMSE)
e. Instrumental activities of daily living
5. A 69-year-old patient with diabetes is placed on mechanical ventilation for severe sepsis and acute respiratory distress syndrome due to community-acquired pneumonia. On day 1, he receives assist-control ventilation with FIO2 of 70% and positive endexpiratory pressure (PEEP) of 12 cm H2O, but by day 3 he is on FIO2 of 45% and PEEP of 7 cm H2O. He is on a propofol drip and has received intermittent fentanyl but now appears to be in no pain. His Richmond Agitation-Sedation Scale (RASS) score is -4, which means that he responds only to physical, and not to verbal, stimulation. Which of the following is the best course of action regarding weaning him from sedation and ventilation?
a. Change his propofol drip to intermittent bolus sedation, and then change his ventilator to pressure support ventilation.
b. Completely stop sedation and if he wakes to verbal stimulation, put the ventilator on continuous positive airway pressure as a trial of spontaneous oxygenation and ventilation.
c. Switch his drip from propofol to fentanyl as an analgesia-based sedation strategy to cover both anxiety and pain with one medication and reduce PEEP to 5 cm H2O.
d. After more recovery, gradually reduce both the sedation dosage and the ventilatory support to avoid abrupt changes and risk of anxiety.
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