\ ,'''

/)l

D
tH
\* _\r ' ScreeningexdminationforPostGraduateDiplomainCriticalcaremedicin"-L"Io-

-// l.,,Chestxraymanifestationsofheartfailure,
t v/^. Pleural effusion
b. KerlY b lines c v-r

c. Tram lines in basalreas

d. Prominent azYgous vein
e. UPPer lobe venous diversion
2. PulmonarY embolism
purmonary angiogram
is dieitdr substraction
l. ::iltJ:ffi:#:"#l.,"sis 6'.vs
purmonarv embofism
xrav is suspicious or
:. Iiff:,:::'il:il::['est shows thrombus in sesmental
areas
e. ct pulmoina;;;;t;;t"
fh Peak exPiratory flow rate
-f Calculated in ml/sec
a.
f b. Average of 3 values is
taken
\
u ' v
T' c. Seated Position is best "'

F d. Highest in
the morning
e. Reliably diagnoses asthma and COPD
4. Totalblood volume
in red cerr mass and brood
vorume is due to both increase
l. ffi::::1""1 ,T:,11::;1,,*,
t*
(
volume
body compensates in 24 hours
c. ln moderate hemmorage
5. Surfactant
a. Proiduced bY tYPe t Pneumocytes than surfactant
b. Elastic tissue affect more for the lung compliance
bond
c. Surfactant is a phospholipid wit ha protein bronchioles
d, Terminar bronchioles are distal to the respiratory
a
\-r
"'l

6. Structures in posterior mediastinum

a. Trachea
b. OesoPhagus (r-J
c. Thorasic aorta
d. sterno Pericardial ligament
e. thYmus
7./ coronary blood flow

l/ "/ a. occur onlY in systole

Q,{s
b. 250mUmin
c. 50% of cardiac output
nerves
d. Mainly depend on autonomic
7

reft ventricres are

8. i;rif,,i-*;::j|r}[or more affected in reduced
row
a. Digoxin
b. Spiranolactone
c. Amilioroid
d. Heparin
e. ACEI
changes in hyperkataemia,
ECG
2_ a. prominent
8t"- p wave
b. St segment depression
c. Broad eRS
d. prominent U wave
e. Tall T wave
10. Non shockabte rhythems,
a. PEA
b. VF V\
c. Puselesss VT
d. Sinus bradycardia
e. Asystole
During resuscitation

CTr.(
a' sternar compression shourd be
tess than 1 cm to avoid sternat
v r-
b. fracture
Should be continued for 60 minuites
c. lnitial energy in biphsic defibrillators
is 200 J
d. Adrenaline is indicated in asystole
at
\- r "'
,n\
,,12)
tYZ
ttt oree phi neph rine
a. Stimulate p1 receptors
b. Stimulate $2 receptors
c. Vasoconstriction
e. lnotrophic
L3. Vasopresin
a. Causes water ietension
b. Decreased.coron ary ftow
c. Limb ischemia
d. vasoconstrition
e. dilate uterine vessels
L4. Hyponatremia,
a. SIADH
b. Diabetes insipidus
- )n, c. Cerebral salt wasting
d. Dehydration
 J

'g
I

e. Adrenal insufficiencY
15. .......
a. Supine - increaped pulmonary flow 400 ml
b. Pulmonary capillaries dialated
c. lnbtween breaths equal to atmospheric pressure
16. Pulmonary capillary wedge pressure
a. lndicate preload of left ventricle
b. Calculated in Pulsatile end
c. Lv work load cnt
d. lncreased in Mitralstenosis
e. lncreased in RVI
17. Hemostasis
a. Platelet aggregation precede vasoconstriction
b. Antithrombin is inhibitorY
c. contractile elements of platelets contract and aggregate platelets hoa
d. Thrombus is not extending beyond normal epithelium
6

L8. MonocYte can transform in to

a. lsaTlYmPhocYte
b. Tissue macroPhages
c. Endothelial Progenitor cells h-*
d. EosinoPhil
e. Multinucleated giant cell
19. Morphine
a. Sinus bradYcardia
b. Second degree Av block
c. HYPotension
d. BronchosPasm
e. TachyPnoea
20. Propofol
a. ls used in sedation of infan
b. Causes hYPotension
c. Cerebral oxygen demand is increased
21. Vegetation seen in mitral valve. what are the possible causes
a. SLE
b. Bacterialendocarditis Cr, S
c. CA
d. Myocarditis
22. Fixed dialated PuPil
a. Heroin abuse
b. Severe hYPothermia
c. Brain conning

\
 f

'>o

23. Capnograph
? a" Measure arterial CO2
-{
b. lnspiratory CO2
c. Asses response to CpR
d. Uses spectrometry
{ 24. Pulse oxymetry
^
a. Measure heart rate and saturation
25. Features of critically ill child
Pro a. Absent radial pulse
b. Exha ustion
c. ra dyca rd ia
B

d. Silent chest
Decreased heart contractility
,u ,b.0.
r. a. Hypoxia
b. N icotin \/
c. Acidosis
d. Se psis
27, MR!
a. No ionizing radiation
T
-
b. Magnetic field rotates perpendicularly
c. Cardiac pacing is safe
d. contraindicated after cardiac bypass surgery
28. Digoxin
a. Nrrow therapeutic index
b. Hyperkalaemia
c.
Used for supraventriculkar tachycardia
29. Factors causing right shift of oxy-hemoglobin dissociation curve

<J a. lncreased 2,3 DPG

b. lncreasedtemperature
c. lncreased CO2
d. Hyperventilation
e. Decreased H+ concentration
30. Procalcitonin

9,/c
a. Decreased in viral infection
b. lncreased in autoimmune disease
c. Pro hormone of calcitonin
d. Produced by thyroid
e. lncreased in sepsis
31. Diagnosis of UTI
7
€
a. Uncentrifuged gram stain
b. Urinary nitrite
 .a

c. Urinary Ph
d. Granular cast
e. Semiquantitative culture
32. Effects of parathyroidectomy
a. lncreased osteoclast stimulation
b. Chovesteks sign
c. lncreased neuromuscularexcitability
d. lncreased phospaturia 4/.
e. Hyper calcemia
33. Statistics
a. lncrease in sample size can decrease confidence interval
b. Confidence interval decreases with increases of standard deviation
c. ./.,1
34. tT
35. Phase ii trials
a. Used in marketing
b. Asses the safety of a drug
36. Albumin
a. Produced only by liver
b. Catabolism at tissues
c. Daily production is24el24 hours
/ d. Affect oncotic pressure of the vascular compartment
e. Life time about 7 days
37. GFR reduced in
a. Hypoprotenemia.
b. Urethral obstruction Kqn (,
c. Efferent arteriolar contraction
d. Hypertension
e. ....
38. High anion gap
a. Lactic acidosis
b. Ketoacidosis
43,
c. Ureterosygmoid anastomosis
d. Renal tubularacidosis
e. Chronic kidney disease
39. Gl Tract
1-,
a. Act as an immune system
40. Sinus bradycardia e

a. Viral fever
b. O bstructive ja u ndice
c. Status asthmaticus
d. Guillan Bare syndrome

\
 t
/
--A

..l -J

e. Large cerebral hemmorage

4L. EEG

F
t€ a. Alpha waves disappear on eye opening
T b. Gamma waves a re usually pathologic
c. ls useful in diagnosing brain death

t,,---
d. Useful in continuous cerebral monitoring
d

Following antibiotics have anti anaerobic activity

a. Amikacin
b. lmipenam
c. Piperacillin tazobactum
d. Ceftazidime
a
lyr a.aa

@, 43. Extended spectrum beta lactamase producing bacteria

o4 44. During 3'd trimester of pregnancy
{. a. Cardiac output increases -
b. Water retension
c. Decrease co2
d. Hyperventilation
45. CSF

a. Daily producton is about 450m1

,\ b. Produced by arachnoid villi
c. lncreased lCP is excluded reliably when papiloedema is a bse nt
d. tn recombant position a pressure of 200 mmwater is norma I
46. Cerebral blood flow
a. 50mllL00e/min
b. Auto regulated in between 60 - 160 mmHg
c. Depend on cerebra! perfusion pressure
AcetylCholine
a. Is a neuro transrnitter
\,
b. Action depend on .....
c. Absent in stellate ganglion

\ 48. Skeletal muscle

49. Arterial blood pressure measurernent
a. Best site is posterior tibial artery
b. Tube should be easilY dilated
c. Arterial thrombosis is a complication
d. Parellel tube should be used???l
50. Toxic effects of high concentration oxygen
r?J a. PulmonarY fibrosis
b. lntra PulmonarY shunt
51. Following are inoconstricters,
a. Dobutamine
 \
)
\
>
I

b. Dopamine
c. Dopexamine
d. Norepineph rine
6
\- r ...

52.

Positive !notrophes

Cardiac output

Normal

Negative lnotrophes

(vr

End diastolic volume

a. Shows the frank starling law

Refer to chapter 6 Aitkenhead, text book of anaesthesia

53. Flow volume loops of Bronchial asthffi?, COPD, restrictive Iung disease, upper airway
obstruction and normal person es
-

-{'
 /

DIPLOMA IN CRITICAL CARE MEDICINE SCREENING EXAMINATION 2OTT

1)Regarding arterial blood gas report

a) PaCO2 is a measured value

b) PaO2 is a calculated value
c) Spo2 is a measured value 43-
d) pH is a directly measured value \
e) BE is a measured value.
TFFTF

2)r/

a) Megabite is 106 of a bite

b) Picogram is greater than naogram.
c) There are 1000 milimoles in one mole
d) Mililiter is 103 of a liter
e) Pico is L0-6 of mega F--,F,T,F,F
3)r /F

a) One Pint =500 ml (473)

b) One inch=3cm (2.5)
c) 1ml of wat er=25 drops(2O)
d) One pound=4OOg (a53)
a) lKPa =7.5cmH2o FFFFF
lu, r('
4.Regrading Compute l' ^, Lr-r_
,/\ a) CPU is the controlling unit
b) Memory measured by bites
c) Random access memory is lost when computer shut down
d) Virus is a software
e) LAN and VAN are 2 different networks (TTTff) f,r
5.Pulseoxymetry is incorrect in the presence of ,

a) Ca rboxyhaemoglobin
b) Haemorrhagic shock
c) Methylhaemoglobin
d) Sunlight pJ
e) Nail polish (TTTTT)

\
 a

)U

6) Neu rotra nsmitters a re,

a) GABA
b) c-AM P

c) 5-Hyd roxytrypta mine

d) Acetyl choline (TFTTF )
e) K*

L--4) lncreased interstitial fluids occurs with

a) lncreased Venous Pressure

Pt b) lncreased in Total ECF volume
5Y'. c) Hemorrhage
d) Good lymphatic drainage -
lncreased oncotic pressure (TTFFF)
__:)
8)Renal blood flow

e:r a) Higher than cerebral blood flow per unit of mass (K-420 B-54)
b) Regulated totally by autonomic nervous system
(Norepi ne ph ri ne, Dopa mine,Angiotensi n2,Prostagla ndin,Acetylcholi ne)
c) Renin secretion has a main role
d) Cortex is more vascular than the medulla
e) Decreased by reduction of blood volume of 10 percentage Class2 (Is%-30%) (TFTTF)

g)Thiazide diuretics
V
a) Rapidly increase GFR
b) Given as a treatment for Na excess
c) Has a myocardial suppressant effect
d) Acts on Distal convoluted tubules
e) lncreased blood sugar is a known complication fffi
1O)WOFT indicated acute severe asthma Life threatening(cyanosis O2 less than 8 and CO2 more than 6)

a) PEFR of 400Umin
.-r
Rt
b) PaCO2 of3KPa
c) SYS. Blood Pressure of 200
d) RR of 25
e) Silent chest (FTFFF)

tf* 1

a
 ,-(Causes of putmonary edema
\

f Tr T r t-
\
e) Arteriota'r dilatation (...TTTT) \
t L2.Mountain sickness is( latent period of 6 hours 3500m)

a) A collection of symptoms including fatigue and headache

b) Causes Cerebral oedema (dexamethazone can be given)( low Po2.arteria! dilation
,transudation)lactic acidosis due to )
c) Causes pulmonary oedema (nifidipine can be given)
d) Occurs after 6 hours reaching high altitude
e) Can be prevented by acetazolamide (TTT[) \r

13)Drugs that crosses blood brain barrier (glucose,anesthetic,atropine,penicillin

a) Suxamethonium
b) Morphine
q) Penicillin
d) Dopamine
e) Profopol (F,T,T,F,T) @_

/ 14)Suxa methoniu m

a) Molecular weight is higher than vecuronium

b) Causes malignant hyperthermia
r- c) Resistance to plasma acetylcholineesterase
d) Repeated doses can leads to phase ii block
e) ls a Non depolarizing muscle relaxant (...TFTF)

@on depot arizing muscle relaxant causes

a) Acidosis
b) Hyperkalaemia
c) Hype rca lcae m ia
d) Hypothermia
e) Apnea (F.... T)
 a

L6)following can be measured as a marker of Endocrine HTN

a) Urinary VMA
g ) High doze overnight dexa suppression test
( c) Spot urinary k and plasma K
d) !7-Hydroxy progesterone
e) Serum TSH (TT...T.TT)

t7)Regarding lg

a) lgM does not crosses the placenta

s,, b) lgD is not found in serum (1% plasma major component in the b cellmembrane)
4 c) lgE inhibit mast cell degranulation
d) lgG bacterialopsnization
e) lgM is larger than lgG T,FF,IT
18) lmmediate post operative patient -what features indicates that he has severe hypovoleamic shock

a) CRF less than 2 seconds

b) Pcv 30
-' ,r.- c) UOP 50 ml for the last 3 hours
r- q BP solso
e) Heart rate 95/min FFTTF

19)WOTF denotes need of urgent decompression of a tension pneumothorax

a) Visible pulmonary outline

e_s b) Deviation of the mediastinum to the normal side
c) Flattening of the diaphragm \t

d) Significant reduction of affected side lung volume

e) Deviation of the trachea to the opposite side (...TTTT)
2}lHigh anion gap acidosis

a) DKA
b) Lactic acidosis
tle
s- c) Rena ! tu bula r acidosis
d) End stage renal failure
e) U retero enterostomy TTFTF
i

zllPortal vein

a) Formed by superior mesenteric artery and splenic vein

b) Drains to liver sinusoids
c) Lies posterior to the neck of the pancreas
d) Has multiple competent valves <,^
)
e) Divided in to branches at porta hepatis (FTTF...T.)
t l}lcsF

a) Formed in arachnoid villi

b) Produces 450m|/day
c) Absence of papiloedema excludes increased ICP
d) Sugar estimation in isolation is usefull
e) 200mmH2O normalin recumbent position FTFFF(130mmH2o 10mmHg...65-195 Norma.lrange
70-L80mmCSF))

23lrlF

a) lnternaljugular vein between two heads of scalenous anterior muscle

b) L/Brachicephalic vein -posterior to the L Sternoclavicular joint
c) Beginning of SVC-Posterior to the L't costal cartilage
d) lnsertion of SVC to the RA-Pos.to the 2 costal cartilage(3'd)
e). Beginning of aortic arch-Pos. to the manubrio-sternal joint (FTTFT) \",

24)Poly unsaturated fatty acids

t<4 a) Myristic acid

b) Palmitic acid
c) Linoleic acid \+
d) Linolenic acid
e) Arachnoid acid (FFTTT)

I ami no acids
t/25)essentia
a) Argenine
b) Le ucine
c) lso-leucin
d) Histidine
e) Methonine (FTT.T.F)
 26.Enzymes produced in small intestine

a) Ma ltase
b) Trypsine
g/
t c) Chymotrypsinogen
d) Ribon uclease
e) Amylase (TFFFF)
27)following isolation of MRSA in wound of a surgical patient

a) Patient should isolate

b) !nform infection control unit
c) Daily cleaning of the wound with hypertonic saline
d) After examination of the patient using alcoholic hand rub
e) Cover with gauze (...TTF..TF...)
28)a patient who was on regular warfarin therapy found to have INR of 6 in the last clinic visit

5o- : causes may be

nq /-

a) Roxythromycin
b) Carbamazepine
c) Amoxicillin
d) Gresiofulvin
e) Omqprazole TFFF...
29)L/s pn u mothorax

a) Rapid thread pulse

as
b) Hyper resonant L hemithorax
c) Air under L diaphragm -
d) Surgical emphysema over L side
e) Elevated JVP TTFTT
-r@t the time of the birth'

a) Pulrnonary vascular resistance is high

444.,
b) Systemic vascular resistance is low
o' c) L to R shunt converted in to opposite direction at the PDA
d) RV afterload is decreased
e) There is no connection between ventricles TTFTT
 t
r
/^'

3LlrlF

a) Sympathetic vasodailator transmitter is Ach

b) When sympathetic trunk is cut off vasoconstriction occurs
c) Baroreceptors are located in arterial wall (carotid sinus and aortic arch)
d) ln NMJ neuro transmitter is adrenaline
e) Bladdear and bowel controlled mainly by parasympathetic system (TFTFT)

32)Phrenic nerve

a) Originated from 4 and 5 cervical nerves

b) lnnervated the pericardium
c) Has a dermatomal supply
d) Purely sensory nerve
e) lnnervates the diaphragm (TTFFT)

33)C!ose relationships of the LA,

a) Esophagus
b) L recurrent laryngeal nerve
c) RV

d) Thymus
e) Carina TFFFT
34)structures in the anterior mediastinum

a) Thymus
^. b) Main bronchi
c) Heart
d) Oesphagus Cv>

e) Phernic nerve TFFFF

35)regarding the R Iung

a) R main bronchus is more in line with the trachea

b) R posterior apical segment is the most dependent part
c) Lower lobe apical segment is auscultated just below the angle of the R scapulae a
d) Blood vessels lie in the interlobar space
e) R hillum lies higher than the I Hillum (level of 3'd to 4th costal artilage and T5 T6 vertebra)
(rF...FF)
 J

36)factors causing Hb-Oz curve to shift to R

a) lncreased CO,
<, b) Hypoventilation
c) tncreased H*
d) Hypothermia
e) lncreased 2,3 DPG ( TTTFT)

rdia occurs i n
,_P7)bradyca
a) Obstructive ja undice
cL b) GBS
r
vira I feve r
c) Acute severe asthma
d) Large cerebra! haemorrhage (T.F.FFT)

38)ECG changes

4. a) Short PR interval in hypokalemia

'5 b) PR interval denotes AV nodal delay
c) T wave indicates ventricular depolarization
d) U wave in hyperkalemia
e) Tent T waves seen in acute ischaemia (FTFFF)
39)CPR

a) Chest compression should be less than one inch to prevent rib fractures
'-u' b) No point of cardiac massage after intubation
c) Cardiac compressions 50 cycles per minute -
d) lnitial shock -200j biphasic
e) Adrenalin is indicated in asystole (TFFTT)

40)ca pnogra ph
 G
\F

a) C indicates endtidal CO2

b) A occurs in inspiration
c) B occurs in early expiration
d) Normal endtidal CO2 level is 30 -40 mmhg TFFT
41)measurement of expiratory pCO2 by capnogrphy

a) Plateau phase reflect end tidal CO2

t
b) with a given minute volume changes in pco2 refelects cradiac out put
c) Can be used as a guide to CpR
d) Rebreathing causes elevation of baseline
e) ls useful to confirm tracheal intubation FTTTT :

42)lncretins

a) Action is similar to Glucogan

b) Acts on GLUT receptors (FF)
43)ln a normal distribution

a) Mean=median
b) 95% of variables lies in +or - one SD ULJ
c) lncludes distribution of data in normal individuals
d) Skewed to L side (TFTF)
I 44lcase control study

a) Cannot be used to asses to diseases with multiple risk factors

b) Recall error applies 44
45)CT scan is re\{einvestigation in
\
a) Acute padcreatitits
b) Staging of cblor.ectal CA
c) Urinarycalculi 1
d) Diagnosing bladdear CA
e) Acute stroke (TTTFT)
46)TAG elevated in
 \a

a) Hypothyrosdism
*v b) Alcoholism
c) Regular exercise
d) Nephrotic sYndrome
e) Acute infection TTFTF

47)nutritional supplementation of critically ill

a) Have uniform energy requirement of 25 kcal/kg/day

b) Overfeeding is not a problem since they have loose lot of energy during the disease process
c) lf not given properly can lead to infection
d) Protein loose suggest starvation
e) Can be via peripheral vein (FFTFT)
48)surfactant I
a) Produced bYtYPe ii PneumocYtes
-*b) A phospholipid bound to a protein
c) Terminal bronchioles are distal to the respiratory bronchioles
d) Elastic tissues in alveoli affects lung compliance than surfactant
e) Respiratory bronchioles doesn't have cartilages (TTFTTT)
49)coronary blood flow

a) Occurs onlY in sYstole

b) 250 ml/ min
c) Represents more than half of the cardiac output
d) Mainly depends on autonomic supply
Subendocardial potion of LV is more vulnerable to ischaemia
(FfiFFT)
e)
50)propofol

a) ls contain as a colorless solution -

b) Highly liPid soluble
c) Use as inductive agent
d) Can decrease the blood Pressure
e) Fat overload syndrome is a complication FTTTT

sr)r lF
T
,.,
J'

b
D

a) Non depolarizing muscle relaxant binds competively to nicotinic Ach Receptors

b) Atracurium is long acting(medium)
c) Atracurium acts with in 50 seconds
d) Vecuronium does not have cardiac side effects
e) Atracurium causes bronchospasm (TFFTT)

52)ECG changes in hyperkaleamia

a) Sine wave
b) Inverted t waves f
c) U waves t
,^\ d) Short PR interval
e) qT prolongation (TFFFT)
53)increased trophonin levels occurs in

a) ARF
tA
b) Se psis ' )
c) MI
d) Pulmonary embolism
e) Liver failure (TTTT...)

54)GLP -glucogan like peptides

a) Secreted in small intestine

b) Potent'stimulator of insulin secretion
c) Carbohydrate meal will increase blood G LP levels
d) Also formed by the brain ...TTTT
,*
\-* 55)T. Dopa mine

a) Acts only on dopamine receptors

b) Low dose dopamine is indicated in ARF
c) Higher doses causes vasoconstriction
d) lt is the first line agent of inotropic agent in sepsis FFTF

56. Morphine
 o'
a
o

a) It is mu receptor agonist
b) Causes respiratory depression
c) Duration of action is 7 hours
d) Causes hitamine release
e) Action is reversed by naloxone (TT...T[)

57)Th i azol id i ned iones

a) Acts by interacting with PPAR segments

b) Redistributes fatty acids
c) Glitazone is a example
) d) Deose not cause heart failure
e) Lower p-lasma glucose levels to norma! Ievels TTT I

Compiled by 3'o batch DCCM

Big thanx to Dr.Dinithi

.tJ

'4,
 Selection Exam for Diploma 6. Lung complience

in Critical Care Nov 20L2 a. Equals to elastic forces of the lung

.a b. lncreased in acute asthma
-1. ECG
v c. lncreased in exercise

a. Uses microelectrodes-
a
b. Lcm is equal to 1 mV- V7. Following drugs are partial agonists
8. c. lndicator of stroke volume-
( d. Can diagnose complete heart
a. Flumenazil

block-
b. Digoxin
c. Na loxone
;*
flF)
2. Pulse oxymetry
U g. Following drugs have antiemetic action
a. Need to be pulesetile for accurate
reading-
a. Metacloprom ide

b, Over reads in hypothermia-

b. Domperidone
S c. Omeprazole
c. Over reads in smokers
d. Uses infrared and red light
d. Clopromazine

tG e. Onda nsetrone

Hr
3.CSF
9. Hormones responsible to metabotic
a. Contains 2-3 monocytes response to trauma
b. Same conc of sugar as in ptasma
c. CSF in ventricles connected with a. Thyroxin

subarachnoid space
1c
5 b. Cortisol

Blood stained in SAH

c. lnsu lin
d. Adrenalin
Absorbed by coroid plexus
ffi)t tr)
t
10. ACE inhibitors
^ o.ilroke Volume

, a. lncreased in with venous return

a. lncrease Bradykinine

b. Depends on Ieft ventricular end

b. Causes cardiac hypertrophy

diastolic pressure
c. Renal protective
t" d. Cardio protective
c. Reduced in increased peripheral
resista nce
e. Ca uses hyperka laem ia

,H
I
.f,Dl
Gastric emptying J1,. Mannitol
U/s.
a. lncreased by erythromycin q) a. Acts on distal tubute

b. Under influence of CCK

b. Secreted by renal tubule
a' c. ls a polypeptide
.F,^
c. Reduced in pregnancy
d. Scavengers free radicalsfil*)
5
b\
a*'ll
 t

L2. Measurements of disPersion 18. DC Shock can be given to

a. Mean a. Rapid atrial fibrillation

b. Standard error b. Pulse less electrical activitY

\r<,
1< c. SD c. Asystole

d. Range d. Ve ntricu Iafi bri I lation

({#, 0flr)
13. Tests of significance 19. Following units are correctly linked

a. Studnts T test a. M Rl -Tesla

\f/
s/ b. Chi Square test ,7
\
b. DC Shock -Watts

c. Meta analYsis c. USS -kilo Hz

fH d.
g.
X Ray
Absolute temPerature
14. Metabolic acidosis {;ffir}
?,
a. Diabetic ketoacidosis 20.ACE inhibitors -
'e^ b. ln high P COz
:"
c. Hyporkalaemia a. lncrease breakdown of
Bradykinine
.ftilt) b. Causes cardiac hYPertroPhY
c. Renal protective
15. Anti platelet drugs
d. Ca rdio protective
g. Causes hyperkalaemia
a. Aspirin irreversiblY inhibit COX
b. Clopidogrel should be converted 0
to its metabolites for the activity
2!.S/EofAmiodarone
c. Action of cloPidogrel lasts less
a. HypothYroidism
d. :::: .1 :::]. is ress potent than b. PhotosensitivitY
Aspirin c. Peripharal neuroPathY
J#t? d. Pu mgna ryoedema \,
e. Corneal dePosits
I of Suxamethonium
v15. C t
ffi
a. DYstoPia MYotonica
gative N balance
b. HYPerkalaemia
c. Neonates a. Acute renal failure
d. Liver failure b. Post surgical
c. Sta rvatio n
,l L7 . Digoxin
a. Has narrow theraPeutic index
b. Can be given in SVT
c. Not suitable for elderlY
d. Prolong AV conduction G\= a. ls measured bY SPirometrY

(# \r b. Reduced in acute asthma

Ot r( s)r
 ?r

c. Has diurna! variation in normal 29. I ncreased Triglycerides

individ ua ls
(* a. Liver disease

'(-
24. Cerebral Blood flow c. Pa ncreatic d isease

a. Depends on ICP , t#t

b. Depends in perfusion pressure
c. ls 50 mL/100g/min
30. lncreased BU

d. ls regulated between mean

a. Dehyd ration
arterial pressure of 60- L60 mmHg
b. Acute renalfailure
(-) .4.
\ c. Liver failure

25. Hyponatraemia occurs in {Dt

a. Cerebral salt Iosing syndrome 3L. Massive transfusion causes
/1
,J
2 b. SIADH
a. Hypoka Iaem ia
c. Dia betes insipid us )
\ b. Hypothermia
d. Conn's Syndrome
c. Platelet deficiency
t# (*)
26. Following drugs causes extrapyramidal
32.2,3 DPG
side effects
a. ls a by -product of glycolysis
a. Clopropamide g b. lncreased in stored blood
b. Halopiridol
c. Make more 02 dv?ilable in tissues
c. Metaclopromide
d. Carbimazole
ffi)
(;n 33. Intracellular Buffers

27. ABG a. H PO42-

A' a. Bubbles in the syringe reduces p

b. HCO3-
c. P rotie ns
Coz
d. Haemoglobin
ee b. Storage in room temp Causes
1 reduced P Oz
ffi)
c. Excessive heparin increase pH 34.T1 F

d. Storage in room temp increases

pH a. Anterior facial vein communicates
(If) with cavernous sinus
b. Femoral vein lies lateral to the
28. Wound healing is impaired by a rte ry
c. Va lves of sa phenous veins
a. Severe psychological stress
arranged to drain blood from
$'J b. Presence of gra n ulation tissue
deep to superficial
c. NSAIDS
d. Zn deficiency i

ili
 ?a \

35. Anatomy of the neck b. ln local anaesthetics the conc is 1:

20000
a. Internaljugular vein lies latera! to c. Has prolong actiono,
interna I ca rotid a rtery
frt)
b. Vagus nerve lies between trachea
and oesophagus
C
c. Oesophagus Iies immediately 40. Following drugs adsorbed by derma! route
anterior to prevertibral fascia
d. Sympathetic chain lies
a. Atro pine

immediately posterior to carotid

b. Diazepam

sheath
c. Morphine

e. Externaljugular vein has

d. GTN

competent valves
(fl) U

FNFI) ar/+l. !n Putmonary hypertension

36. Vagus nerve supplies a.

t'
A" wave appear in JVP

a. Tympanic membrane
(a b' LBBB -
L
Pul. Mean arterial pressure more
(.- b. Ca rdiac plexus ic'
tha n 25 mmHg
c. Oesophagea I plexus

\ d. Diaphragm -tt
e. Upper eye lid
(Gl
42" Features of heart failure
37 . Dobutamine
a. Kerlies B lines
a. Used in low output failure
cL
b. FIat Ieft heart border
b. I ncrease peripheral vascular
Y
c. Enlarged Ll atrium
resista nce d. Upper lobe diversion
c. I ncrease mesenteric circulation (G)
43. Features of normal ECG
\-
a. QRS is quadriPhasic in V1
38. Morphine 1s} b. T wave is inverted in L1
c. PR interval is less than 0.2 sec
a. Acts on p recaPtors 1

d. than 120 ms
QRS complex is less
b. Causes bradycardia
c. Depress myocardium directlY
ffi)
d. Repeated administration causes 44. Effects of anticholinester,ase
tolera nce
e. !ncreased dose causes euPhoria a. M iosis

J#l b. lncreased sa livation

c. Dia rrhoea
39. Adrenaline d. Tachyca rd ia
e. Hypertensive crisis
a. Simulates both alfa and beta
(*{)
rece pto rs
2o_

45.Causes of pupillary dilatation

a. Hypotherm ia ,

b. Pontine haemorrhage
c. Stimulation of Symp. System
d. During seizures
#.
46, Pulmona ry surfacta nt

Deficiency responsible for hyaline

membrane disease of new born
Reduce surface tension
fF)
47 . Ca pnogra phy '

a. ldentifies oesophageal intubation

1 b. Useful to detect discontinuation

from ventilator
0)
48. Anatomy of main Bronchi

a. There are L0 total broncho

pulmonary segments in each lung
b. R/ bronchus measures 2.5 cm
t c. R/ bronchus is related to azygos
t
vein
d. ln children angles of divisions of
bronchi are exaggerated

D)
.-\ a\
5a
i.

v
 I

41)Regarding Trachea

. Tracheal bifurcation at the level of T4- T5 " ,s: -T.

RS Left lobar bronchus is more in line with rachea f-
The angle between the 2 main bronchi is 60 -70 degrees T,
Thyroid is the most common external cause of tracheal compression r
02)Aldesterone
Secretion is increased by rennin
e- ),
Vasoconstrictor
Antogonised by spironolactone

Oz;Bactericida I

%,orhexidine
Va ncomicin
Neomycin t
D^^
Erythromycin
Fusidic acid

03)Jugular veonous bulb oxygen saturation

Measurement is decrased in status epilepticus
Can be increased following use of thiopental
Hyperca rbia

Oa)Oxygen flux
&)- lndepndent of oxygen flow at the tissue tevel

r^
,/ or)chlorothiazide
Decreases Na and Cl reabsorption of glomerular filtrate
Can ca,use hyperkalemia
Results hyperglycemia
Can cause metabolic acidosis

06)Following drugs can be used as transdermally active patch

Fenta nyl
G
GTN
Diazepa m
Morphine
Peth id ine

@
irur("It,nz _
t
''
,/
 -\

07) Regarding lntracranial pressure

lncreases when lie down from supine
t-t4"4- More than central venous pressure
Frusemide affects more than mannitol
Steroids is effective in increased ICP when associated with tumors

08)During the immediate post surgical period

,r,, lncreased K+ excreation
7.
I ncreased Na+ absorption
Hyperglycemia
Decreased N a+excretion

Ft
09) regarding the compliance of the lung
Depends on the air flow
decreased with surfacta nt
t'
10)Damage to left cEiiVical sympathetic trunk
Results in loss of taste sensation in anterior Ll3 of the tongue
lvg
Decreased salivation
Decreased sweating from the left side of he face
Partial ptosis of the Ieft side
Miosis of the the Ieft eye

'-1-1+ABG
Trapped air bubble causes decrease in PCO2
L5 Excess heparin can cause increase PH
Kept in room temperature can cause dcrease in PH

Neeeds to apply correction for oxygen when kept in ,o,[.mperature

l2lPulse oxymetry
€-5 Use ambient light to do the measurement
FIow must pulsatileto do the measurement
Measures are increased with carboxy hemoglobin

Use isobastic point in the measurement

13)Regarding the larynx

4t Extends from the C4-C6

Inlet is closed by the posterior cricoareytenoid muscle
lnnervated by recurrent laryngeal nerve up to vestibular fold
Thyroid ishmus is anterior relatioh

@o b*e ^aEt-n- f)os I

- ,
3
ca,t^r-
aL
I

!4)recurrent larfnseal nerve can be damaged in severe Mitral stenosis

wedge pressu re
mona ry ca pi lla ilr
-,,r(S)Pul
V,.'...,.,
Equals to the left atrid! p.'es$ure N3
the right atrial p,'essure i
Equals to
Measures Mean pulmonary artery presl[1fg:*="*.-2 . . r
Measure Aortic pressu:'e after valve closure

L6)following are true regarding 70kg man

Daily energy requirement with moderate activity is 3500kcal
GFR is 1-200m|/min
Minimal Daily requirement is 450m1 to prevent negative balance

17)ln pregnancy
GFR increases
lncreases clotting factors ob I
lncreases the cardiac output
lncreases the total lung volume

18)U nfracti nated HePari n

Crosses placenta
Facilitate formation of inactive thrombin antithrombin complex
ilo'-'
In high concentrations ca n in hibit aggregation of platelets
!n high concentrations inbit factor Xii, Xi

19)Wa rfa rin

,_ Highly protein bound t1,n

Decrease production of prothrombin

Oral bioavailability is high

,/zol Fullterm neonate

Cardiac output is increased by increased HR
Ductus arteriosus is anatomically closed
days Pon
Foramen ovale is functionally closed in 2-3
Pulmonary vascular resistance is decreased with the first breath
ln some congenital heart diseases patent ductus arteriosus is needed

zL)Na+ counter transport in kidney is coupled with

,-<4
CI.

,Dil F b)r Dr dtr

b) T r)r
 -
J

Ca+
G lucose -{
Amino acid
H+

y'rr)tn ECG
No P wave is seen in nodal rhythem
ct- QRS complex is 0.8sec
,f Qr,
PR interval is 0.L sec _

PR interval is prolonged in hypocalcemia

,-,t+l Ca rdiac m uscte action potentia !

'L-.J- Due to Na+influx

tut
Depends on the Ca+
Absolute refractory period is similar to the action potential duration

zs)Brachia I plexus
Roots are posterior to the Serratus Anterior
Formed by the ventral rami or C5-TL
Cords related to the axillary artery
Posterior cord is formed by the all roots

26) I nternal J ugular vein

ls a continuation of transverse sinus
Cervical sympathetic trunk is anterior to it

27)increased muscle growth

Growth hormone
\4 lnsulin
v
Steroids
G !ucagon

28) I ncrease gastric acid secretion

Acetylcholine
QZ H ista mine
Vaga I stim ulation
Somatostatin
lncreased sym pathetic activity

,/rrlrmmediate management of anaphylactic shock

@
 Epinephrine
Piriton
Hydrocortizoe

t.\
io)Adrenosympathetic response to shock
lnireased cardiac contractility
resistance ( ns
Decreased peripheral

techola mines

uzz)Atropine
T Decreases bronchial secretions
T Causes mydriasis
G)
I1 Decreases muscle strength
Causes ganglion blockade

33)Acute Phase Proteins

Alpha 1 antitrYpsin
Cholesterol
.+
CRP

34)Acute pancreatitis
Persistant Diabetes mellitus is a complication
.r'4, Causes hyPercalcaemia
Hypocalcemia is a known cause 4r,
Hypertryglyceredimia

35) Rega rding a nti biotics

lmipenum causes seizures
Beta lactum antibiotics causes needs no dose adjustment in renal failure
Aminoglycosides once daily regimen can decrease the renal impairment
A)

*'{.
<-
fl'a Jat' t
*4o,( l^ % r,,n,
t\lobou 11

-\( .lh,r^
'$ L,
"-ot.1

l,:
Yr\-
 /

\--rr)o bstructive ja u n d i ce
Causes increased urobilinogen

io-) lncreases fat content offaeces

Causes increased ALp
May leads to coagulopathy

\q €8)functions of the liver

Detoxification of d rugs
Stores vit B12
Synthesizes albumin
Secrete digestive enzymes
efihropoietin
Produces
\i
-Jp)rega rding platelet tra nsfusion
Cv- Need filtration
n-- , Needs crossmatcthing
a<'
effective after 2/S2ofstorage

40)tncompatible blood transfusion

t'u. Cause agglutination of donor red cells
Tissue hypoxia
' Renalimpairment

41)following are increased in the extracellular fluid when compared with the intracellular
fluid
"Lr- K+
Po4-
H+
\-
42)Accidental contact of health care worker with blood/blood stained fluid
4\ Hep B immunoglobulin irrespective of patients immune status
Patients blood for Hb s antibodies
After Hep B vaccines is given regular booster doses are given
lf HIV antibodies positive patient antiretroviral lg should be given to the worker

43lr/F
CT uses xrays
USS uses sound waves
?
) Oigital x ray no radiation hazard
MRI uses magnetic field
Contrast solutions used are water soluble
\ 1,, ,2-
)

44)At the temperature of 30*c

Oxygen consumption is decreased
G FR is decreased
\r"
lncreased solu bility of the CO2

Un etderly
Pulse pressure is increased
llncreased Functional residua! capacity
Decreased level of lntracranial pressure
tncreased heart rate to the exersice

46lRegarding the osmolality of the body fluids

a;n
T
47l. in hypocalcaemia
Chosvteks sign is Positive
Troissures sign is positive
4L
/ or)Regarding the osmolality of the body fluid
Ca+ is the most abundant ll l^
,t-
Total osmolality of lntracellular fluid and Extracellular fluid is equal

-
L-
49)Following are approximately correct
Plasma osmolality is 300mosm/l

sOlnegarding the blood pressure measurement

,/
Standard cuff in an obese patient causes decreased BP measurement
11 Should cover2/3ofthe uPPerarm
Standard width of the cuff is 15cm 'r
Small cuff give falsely high reading -1
Large cuff gives falsely low reading

51) regarding the successful resuscitation following basic life support

Pco2 value should be 2%
cvs
Po2 value should be t6%
Mixed venous oxygen saturation should be75%

52)increased Risk of DW
Pregnancy
ocP h-

Malignancy
 t

Lupus anticoagulant
I 17
53) polycythemia causes
lncreased blood viscosity

54) increased lntraabdominal pressure

s, lncreased ICP
Ventilation perfusion mismatch
Decrease liver blood flow
Decrease G FR

5s)ln JVP
C wave is not clinically significant
A wave is due to atrial systole
V wave due to ventricular filling

-y.-descent is steep in dehydration

Constrictive perica rd itis

56)following are Nephrotoxic

ACE inhibitors
Ra d iocontrast
NSAIDS
PCM

57)Oxytocin during the pregnancy

Tra nsient hypotension
t1
J !ntestinal colic
Nausea vomiting
Pe ri phe ra I vasoconstriction
\,

By Dr NH
 | '/-

Dip in CriticalCare 2014 November

1. Regarding structures embedded within or close proximity to parotid gland

a. Facialnerve
b. lnternal jugularvein
c. Externa! carotid artery
d. Otic ganglion
e. Superficialtempora! nerve

2. Regarding Dura
a. Venous sinuses are lnvested between endocranium and the meningeal layers
b. Rupture of middle meningeal artery causes EDH
c. Cranial nerves get covered by the dura on exiting the cranium
d. Falx cerebri is a fold of Dura
e. Does not have a sensory innervation
3. Regarding median nerve
a. Supply muscles of arm
b. tnjury causes loss of sensation of lateral 3 % fingers
c. Pass superficialto flexor retinaculum
d. Arise from medial and lateral chords of brachial plexus
e. Comprise the neurovascular bundle of the arm

4. Atropine
a. Causes bradycardia when given in small doses
b. ls more potent than glycopyrrolate
c. lncreases physiological dead space
d. Acts on both muscarinic and nicotinic receptors
e. Causes mydriasis

s' *'u::o':u.r1:intervar
n
b. Represent ventricular depolarization and repolarization
c. lncreased in hypermangesemia
d. Not dependent on heart rate
e. ?Prolonged in arrhythmeas

6. Regarding CPR
a. Chest compressions should be interrupted to assess pulse
b. Amiodarone indicated after 3'd shock
c. Adrenaline given after 1't shock
d. After intubation the respiratory rate should be maintained at 20/min
e. Pulse should be assessed immediately after defibrillation
 I

7. lntradermal administration of drugs

a. Creates a reservoir ofdrug in stratum corneum
b. Water soluble drugs reach systemic concentration more effectively
c. Drug can be given directly to central compartment
d. Lipid soluble drugs reach plasma concentration rapidly
e. lonized drugs can be given

8. Regarding anion gap

a. !s the true difference btw anions and cations
b. ls about 10m mom/l in plasma
c. lncreased in Lithium administration
d. Reduced in hypoalbuminemia
e. lncreased in respiratory alkalosis
p) Physiologicat changes in pregnancy
a. Placenta starts producing progesterone at 4 weeks POA
b. Causes respiratory alkalosis
v
c. Cardiac output falls in 3'd trimester
d. Thyroid hormone production increases
e. The Hb concentration decreases
L0. The following reduce afterload
a. Noradrenaline
b. Phenylephrine
c. Clonidine
d. Amiodarone
e. Ephedrine
LL, Oxygen hemoglobin dissociation curve
a. Sigmoid in shape due to permissive binding
b. SPo2 80% shows PaOZ of 60mmHg
c. Rt shift in increased 2,3 DPG
d. L.39ml of 02 bind to l gram of Hb
e. Oxygen content is plotted against PaO2
L2. COzdissociation curve
a. More linear and steeper than ODC
b. Is PaCO2 plotted against Conc of COz
c. Shifted to the right in acidosis
d. CO2 bind to HB using Bhor effect
L3. Clopidogrel
a. Bind reversibly to ADP receptors on platelets
b. Affect arachidonic acid metabolism

,) {,
^) d)r e)
 c. Is a pro drug
d. Cause throm bocytopenia
e. ls a recognized cause of aplastic anemia

L4. Following drugs inhibit bacterial protein systhesis

a. Cefuroxime
b. ryth romycin
E

c. Ciprofloxacin
d. Vancomycin
e. Chloramphenicol
15. Regarding use of LMWH compared to heparin
a. Shows predictable effects in body
b. Monitoring by activated thromboplastin time
c. Dose need to be reduced in renal failure
n d. Effectively reversed with protamine
e. Incidence of thrombocytopenia is less

L6. Bronchospasrn can happen in following situations

a. Cold air
b. Ciga rette smoke
c. Noradrenaline
d. High PaCO2
e. Beta 2 agonists

L7. C'l is a preferred investigation in following situations

a. DVT
b. Aortic dissection
c. Cerebral infarction
d. Viscerallnjury
n, e. Pulm Embolism

18. Effects of H2 receptor stimulation

a. Vasoconstriction
b. Bronchoconstriction
c. Hypotension
d. Reduced gastric acid secretion
e. Tachycardia
19. Sphygmomanometer
a. Measures absolute pressure
b. Wider cuff needed for Iarger people
c. Point where the mercury meniscus touches the glass is taken as the reading
d. The same principle used in DINAMAP
ta rl T c) -r r)A .) 1
^'r
20. Regarding blood pressure monitoring using auscultatory rnethod
a. Sound are heard due to closure of cardiac valves
b. SBP is the point where sounds appear
c. DBP is the point where the maximum sound intensity is heard
d. MAP can be measured
e. SBP measured via palpatory method is larger than auscultatory method

21. Regarding Doppler effect

a. The change of amplitude is proportional to the flow
b. Observed frequency is more when the source mover away from observer
c. Used to measure cardiac output
d. Used to measure flow
e. Principle is used in pulse oxymetry

22. Regarding x ray V

a. Horizontalfissure not seen in majority
b. Trachea bifurcate at T4
c. Lt hilum is up than rt hilum
d. Right bronchus is longer
e. Hilar shadow mainly consist of bronchial shadow

23. Syntocinon
a. ls an alkaloid
b. Secreted from posterior pituitary
c. Relaxes smooth muscles
d. lncreases blood pressure
e. Used in active management if 3'd stage of tabour
24. Regarding following drugs
a. Clonidine is a central alpha2 agonist
b. Dexmedetomidine is a peripheral alpha2 agonist
v
c. Phenylephrine is a selective alphal agonist
d. Phenoxybenzamine is a selective alpha antagonist
25. Respiratory center
a. Located in hypothalamus
b. Not affected by vomiting
c. Affected by swallowing
d. Fires in active inspiration
e. Fires in passive expiration

25. Neurotransmitters at autonomic ganglia

a. NA
 b. 5HT
c. ista rn ine
H

d. Ach
e. Dopamine

Saturated venous pressure

@
a. ls 47mmHg for water at 37C
b. lncreases Iinearly with temperature
c. Does not increase with temperature
d. Cannot exceed atmospheric pressure
e. Affected by ambient pressure
28. Rega rding calibration
a. Errors can occur after 2 point calibration
b. Calibrated using 2variables
' c. More calibration points increases accuracy
d. lncreased gradient increases sensitivity
29. Peg?rding K

a. Freely filtered at glomerulus

b. !ncreased secretion by aldosterone antagonists
c. Secretion increased in first 3-4 days post operatively

30. Regarding Calcium

a. Majority absorbed in proximal intestine
b. Renal reabsorption is under influence of PTH

c. Ionized fraction not increased in hypoalbuminernia

d. Active absorption from diet increased in hypocalcemia

a. Causes wide pulse pressure

b. Common cause of angina
c. Leads to left ventricular enlargement
d. Caused by anklylosing spondylitis
e. Reduced end diastolic volume

32. Pain perception

a. Carried via dorsal column
b. Affected by severing spinothalamic tracts
c. Enhanced by endorphins
d. lnfluenced by descending tracts terminating at spinal cord
e. lnfluenced by 1 alpha fiber stimulation
 33. Regarding Desmopressin
a. Causes hyponatremia
b. Elevate blood pressure
34. Regarding cardiac action potential
a. Upper limit is 40mV
b. Depolarization is caused by opening of Na channels
c. Repolarization is by reduced K+ conductance
d. Calcium is responsible for the plateau
e. ln pacemaker cells resting potential is maintained by K+ channels
35. Hematocrit
a. Measured using centrifugation
b. lncreased in megaloblastic anemia
c. lncreased by burns
Frv
\$ Reearding metabolism of RBC
a. Lifespan 90 days
b. Broken down in reticuloendothelialsystem
c. lron is released and excreted in urine
d. Bilirubin is transported to liver bound to albumin
e. Needed in bile salt synthesis
37. RBC
a. Have increased surface area to diameter
b. Survive for 6-8 weeks
c. Mostly released as reticulocytes
38. Regarding gastric acid secretion
a. PH is gastric acid is 4
b. Pepsinogen converted to pepsin \--
c. lnhibited by H1 receptor blockers
d. Ferrous compounds converted to ferric compounds prior to absorption
e. Stimulated by somatostatin

39. Glucagon
a. Stimulate glycogenolysis in skeletal muscle
b. Protein catabolism
c. Used as an ionotrope
d. Stimulate fatty acid synthesis from fat
40. Anaphylactoid reaction
a. Similar to anaphylaxis
b. Occur in absence of prior sensitization
 c. Caused hypotension
d. Result in complement activation via classical and alternate pathway
e. Occur in response to drugs

41. Tests for non parametric data

a. Student t test
b. Rank sum test
c. U test
42. Regarding.d.ispersion of data

43. Regarding serotonin

a. A neurotransmitter at spinal cord
b. 5HT4 receptors present in heart/heart failure
c. Metabolized by COMT
44. Following are causes for error
a. Drift
b. Zero stability?

45. Regarding pulmonary blood flow

a. Affected by gravity
b. Affected by ainray pressure
c. ls 10 times less pulmonary vascular resistance than systemic

46. Surfactant
a. Deficient in hyaline membrane disease of newborn
b. Arranged in a lipophilic and hydrophilic layer
c. lncreases compliance in absence of air-fluid.interface
n d. Stabilizes larger alveoli
47. Following are removed from circulation by the lung
a. Serotonin
b. Angiotensin 2
c. NA
d. ADH
e. Bradykinin
48. Regarding veins
a. Have sympathetic innervation
b. Contain less smooth muscle in media than arteries
c. Contain majority of blood in body
d. ln places with AV fistulas the vein smooth muscle gets thickened
49. Regarding renal blood flow
a. Receive 25% of cardiac output
b. Reduced byAT2
c. Majority of blood supplies the medulla
d. ?Autoregulated
e. ?Tubuloglomerularfeedback influences

50. Regarding platelet

a. Activation result in increased local Ca2+ conc
b. TXA2 release causes vasodilatation
c. ?Undergo conformational change upon contact with collagen
d. Activation inhibits plasminogen

51. NormalSaline
a. Osmolality is similar to plasma
b. PH similarto plasma !/
c. Contain higher chloride conc than plasma
d. Should not be used for neonates
e. lf administered in excess causes a metabolic acidosis
52. Regarding UTI in ICU
a. Prophylactic antibiotics prescribed for all catheterized patients
b. Diagnosis based on clinicalfeatures than laboratory evidence
c. Cultures should be sent frequently
d. Meatus should be cleaned daily via ?cholhexidine solution
53. lnfection controlmeasure in ICU
a. 70% alcohol with Cholhexidine is suitable for disinfecting skin prior to can nulation
b. Hand washing not necessary after using gloves
c. Hand washing not necessary after contact with a'patient with a non infectious
disease 'v
d. ?Floor & windows should be disinfected after each admission
e. Hand washing necessary before and after each contact

54. Regarding transmission of disease

a. Hepatitis vaccine is not necessary if health care worker has received 3 prior
immunisations
b. After needle stick injury patients blood is sent for HIV and hepatitis screening
c. Anti retro viral prophylaxis and Hepatitis vaccination needed for needlestick injuries

55. Troponin
a. !s involved in binding of actin on myosin
b. Troponin I levels elevated in liver disease
 c. Binds to calmodulin

55. Following are risk factors for contrast nephropathy

a. Multiple myeloma
b. Diabetes Mellitus
c. Dehydration
d. Allergic reactions

Compiled by CYA & RG

SICU Ampara
A

n
\i

L:g
 \,a
X
Selection ex amination for post-graduate diplorna in Criti ca! Care Medicine-
2015

CSF differ from plasma as CSF contain;

a ) Hig h PaCO2 co ntent

b) High Mg2+ content

c) High HCO3- content
d) High sugar content
e) Hig h Pr- content

2- COZ electrode;
/^ a) Use glass electrodes sensitive to PH
b) Directly measure HCO3-
c) Na HC 03 s o lutio n

3- Pace maker action potential;

a) Repolarize due to long lasting Ca2+ channels opening
b) ln parasympathetic stimuhtion hyperpolarization is due to K+ channels
c) RMP -70mV
d) Depolarizationis dueto Na+ channels

4- ACE
a) lncrease bradykinin
b) Blocked by Enalapril
c) React with renin to produce A2
d) Present in endothelium

5- Hyperkalemia
a) PR prolongation
b) Narrow QRS
c) QT prolongation
d) Causes digoxin toxbity
e) Heart stops at systole

6- D'rgoxin
a) Wide therapeutic index
b) Toxicityis commonamong elderly
c) Teratogenic
d) Toxicity is produced by impaired renal functions

1lD.
lIl t,t,\" oo
 e) Toxicity causes bradycardia
7- ROTEM can be used to detect
a) Hb concentration
b) Fibrinolys's
c) Fibrinogen content
d) ?PLr
e) il/WF

8- PT can be used to asses;

a) Heparin
b) LMWH
c) Warfarin
d) VWdisease
e) PLT function v

9- Aspirin
a) Reversibly inhibit COX-2
b) Action last for lOdays
c) Sublingualroute has faster onsetthan oralroute

1O-Which of the following drugs have significant anti-P LT activity

a) H'rgh dose aspirin
b) Clopidogrel
c) Lowdose ibuprofen

lL- Endogenous substances acting on opioid receptors;

a) Morphine
b) Endo-morphine
c) Leu-encephalin v
12- Pro-drugs;
a) Midazolam
b) ?nalophrene/naloxone
c) Promethazine

13- Antibiotics
a) Cephalosporins should be avoided in patients with history of allergy to penicillin
b) Penicillin need no dose adjustment in renalfailure
c) Nitrofurontoin can be given to treat acute pyelonephritis
d) Metronidazole can be used to treat Clostredium difficile
e) MRSA needed broadspectrum antibiotics

2lPage
 L4- Neurog enic thoracic outlet syndrome;
a) Caused by pressure on lower trunk of brachial p lexus
b) Causes pain in shoulder and arm
c) May need to excise ?f'l cervicalrib

15- lncrease Na excr

3lPage
 e) End stag e rena I disease

2I- Direct determ ina nts of mixed venous o2content'

a) COz production
b) Cytochrome enzyme system
c) B lood flow

22- l-fypothermia
a ) Hyperco ag ulability
b) Reduced ICP
c) Reduced im munity
d) lncrease blood pressure
e) Reduced ETCO2
\-
23- Following symptoms can be seen in patients with loss of >2Lof bbod;
a) Gcs 10/1s
b) HR> 100
c) BP 80/60
d) ?PP decline <10%

24- Regarding CXR

a) L hilum is h'rgherthan R
b) Trachea bifurcation angle 100o in adult
c) Dome of right diaphrag m is 5cm h'rg her than left
d) Pulmonary arteries are visible more clearly than veins

25- lmaging in lung diseases;

a) MRI- gives excellentinformation on lungs
b) HRCT gives good information on interstitiial lung disease v
c) Bronchogram is the best option to visualize bronchlal tree
d) PE- CT

26- LO Sphincter
a) Tone increase by atropine
b) Metoclopramide cause increase tone
c) Consist of striated muscles
d) Supplied by vagus
e) Sympathet'rc causes increase tone

27- Pulmonary plethora in CXR;

a) PE

alP a g e
 b) Pulmonary HT

c) HF
d) L-R shunt
e) Pulmonary venous congestion

28- Diastolic dysf unction of heart;

a) ncreased LVED P
I

b) NormalSV
c) Causes pul.HT
d) Reduced diasto lic filling
e) Reduced co mplia nce
29- Aortic balloon catheter is significant, because itcauses
,,.
a) Increase SBP
b) lncrease DB P
c) Reduction in 02 consumption
30- Nitrates
a) Reduce preload
b) Arteriolar vasodilatation
c) Reduce HR
d) May cause PP H

31- Foeta ! Hb;

a) Co nsist of 2 alpha & zbeta chains
b) Convertto aduft HbA @ 6 months
c) Affinity more for 2,3DPG than aduh Hb
d) Causes reduce sickling of HbS
A
32- Haza rdous effects of imag ing ;
a) USS causes foetal anomalies
b) lonizing radiation caused by CXR
c) B a riurn ca uses a na

5lPage

-
 c)Tissue atrophy
d)R educe nuclear cytop lasmic ratio
e)Tissue atypia?

34- Microa ng iopathic haemo lytic a naemia caused by;

a) March haemog lo binaernia
b) Drc
c) TTP

35- Delirium caused by;

a) AIcoho Iwithdrawal
b) Schizo phrenia
c) Anti-convulsa nt intoxicatio n
d) Flypog lycemia v
e) Thia mine deficiency

36- Radiology
a) MR I cannot be used to diagnose prostate CA

37-COZ;
a) educed tem perature- increased solubility
R

b) 200 times soluble than 02

c) Carries in blood mainlyvia dissolutionform
d) PaCO2 affected by dissolved COz??

38- Regarding temperature of a liquid;

a) Boiling point is when temp>room tem.
b) Depends on satur.vapour pressure

39- Pulse oxirnetry is incorrect in the presence of;

v
a) Hyperoxia
b) AV fistula
c) Severe T R
d) Ca

6lPage
 e) FEVLcan be assessed?

41, Dead s pace;

a) Can be calculated by single breath N2 wash out method
b) Increased by IPPV
c) Hypovolaemia causes increase DS

42- Alpha adre nerg ic recepto rs;

a ) P res e nt in lung a lveo Ii
b) Activatio n ca uses increase Ca m p
c) CaZ+??
d) Ligand gated??

^\ 43- Renalfailure caused by;

a) Protamine

44- Heparin;
a) Main action is by activating protease inhibitor anti-thrombin lLL
b) LMWH

45- Warfarin
a) Causes inactivation of fac.x

46- Opioid receptors;

a) Are Gs pr- coupled recepto rs
b) Activation will causes increase c-AMP

47- Dexmedetomidate ;
a a) ls alpha 2 analog ue
b) Antanalgesic
c) Causes resp iratory fa ilure

48- Regarding influenza epidemic;

a) OPD doctors should wear masks
b) Hand washing with ahohol based hand rub
c)Good out-come in patients started anti-viraltherapy after 48 hours of hospitalization

49- Disease trans mission;

50- Post-operative infections can be avoided by;

a) Using prophylact'rc antibiotics before contaminated Sx
"7
l;' .:: Yt, ,:
 b) Using AB for clean Sx
c) Prolong use of AB in post-op period
d) Regular standardization of sterilizing equipment
e) Ma inta ining directio na I ventilatio n in theater
51- p value;
a) p>0.5 mea

8lE) a g e
f-rt

>o t{

1) Following found more in CSF compaired to plasma?

a) Pco2
b)sugar
c)HCO3-
d)Mg2+
e)H+

2) prodrugs are?
a)acycloviur
b)carbamezepine
c)promethasine
d)midazolam
e)nalbuphine

3)Hyponatraemia seen in?

a)sHDl{
b)Dl
c)liVei failure
il._ampbgleric-in_E Rx
eleideisive sweating

4)PT prolonged in?

a)Von willebrand disease
b)heparin therapy
c)LMWH therapy
d)warferin therapy
e)TTP

s)physiologycal death space?

a)Can be measured with single breath N2 analysis
b)depend on tidal volume
c)decreased in IPPV
d)increased in hypovolaemia
e)increased in atelectasis

6)Dexrnedetomedine
a)central alpha 2 antagonist
b)obtund stress response to surgery
c)cause respiratory depression
d)
e)

7)Digoxin
a)has wide theraputic index
b)teratogenic
c)toxicity is common among elderly
d)toxicity is produce by impaired renal function
e)toxicity cause bradycardia
f)increased toxicity in hyperkalaemia
 8)Adrenergic receptors?
a)G protein couple
b)found in alveoli
c)ligand gated channels
d)when stimulate increase cAMP
e)

9)which of the following drugs have significant antiplatelet activity?

a)high dose asprin
b)clopidogrel
cllow dose indomethasine
d)low dose ibuprofen
e)epoprostenol

10)Drugs which increase lower oesophageal spincter tone? \,

a)Atropine
b)metaclopramide
c)symphathatic sti mulation
d)acetylcholine
e)neostigmine

11)Nitrates?
a)increase incidence of PPH
b)dialate arterioles
c)cause methamogobinaemia
d)reduce preload
e)ISMN largely metabolized in liver

12)hypothermia
a)reduce MAP
b)reduce ETCO2
c)theraputic hypothermia inirease post resuscitation survival rate
d) \r
e)

13)ACE
a)react with renin to produce angiotensin 2
b)found in endothelium
c)increase bradykinin
d)is losartan
e)blocked by enalapril

14)MU receptors
Fa)Gs protein coupled
ca2+ conductance
K+ conductance

,l qJ r t}r I c D p- s"t'tx e)r

7uv'-t\ ulrrlr-ua
=r \urrr
w^ &,u tr o,tt \\L\ q,r^L \,, , Cf. [ ,-
: $' -? t 4 Sga \
^ru"n^
 d)naloxone etfective in all opioid receptors
e) i ncrased adenalylcyclase

:1 S)Mixed venous saturation directly relaled to?

a) alveolar ventil ation
b)co2 level
c)blood flow
d)cytochrome oxydase system
e)amount of haemoglobin

1 6)pacemaker action potential?

a)depolarizAtion due to na+ influx
b)repolarizalion due to ca2+
c)RMP -70
d)Cholinergic stimulation cause hyperpolarization
A e)pre potential by k+

17)Area under the curves of the following gives cardiac output?

a)arterial pressure wave
b)capnography
o)ECG QRS complex wave form
d)wave of the pulse oxymeter
e)CVP trace
f)thermodilution cu rve

18)pulmonary hypertension can devolop in?

a)pulmonary embolism
b)L-R shunt
C)eiceSSive resection of lung
d)ARDS
e)protamine

1 g)thromboelastogram can diagnose?

a)hypocalcaOmia
b)hyperfibioganaemia
c)excessive fi briolysis
d)
e)

20)Anticoagulants?
a)warfarin antagonise factor x
b)heparin augment protease inhibitor antithrombin iii
c)LMWH inhibit factor xii
d)vit k irreversibly inhibit by warfarin
e)

z1)Endogenous opioids are?

f' a)endomorphine
r b)leuenkephalin
' c)beta endophin *A
T' d)dynorphin k,-
T. e)norciceptin

22)Pain?
a)ketamin act on GABA receptors
b)electiibal stimulation done on A delta fibers in pain relief
c)opioid receptors are only precent in CNS
d)
e)

23)Anion gap acidosis in?

z4)right of heart composed ot?

a)R ventricle
b)R atrium
c)SCV
d)base of left ventricle
e)L atrium

2s)neurogenic thoracic outlet syndrome?

a)may need 1st rib excision
b)may cause pain and parasthesia in arm and shoulder
c)cause Raunalds phenomen
d)Adson's test is done for diagnosis
e)caused by pressure on lower trunk of brachial plexus
IJ
26)CO2 electrode
a)PH sensitive glass electrode
b)electrolyte solution NaHCOS
c)calibrated by 5% co?
d)measure COz content
e)standard HCOS- is rneasured

27)H2HCO3 / HCOS- buffer system is?

ntracell ular buffer system
i

al PH
due to abundance
titrated by lung abd kidney
active in acidic PH
 29)Fetal Hb?
a)contain 2 alpha and 2 beta chain
b)bind with 2,3 DPG with high affinity
c)replase by adult Hb in 6 months
d)contain Fe3+
e)shift ODC curue to Ieft

29)A person has lose 2L of blood

a)GCS 10/1 5
b)SPO?<9O/"
c)BP 80/60
d)pulse pressure variation <10/"
e)RR < 10

30)Regarding imaging?
a)ionising radiation is used in MR!
b)pre op MRI is not helpful in prostatic CA
c)MRl is used in fetal anomalis detection
d)may need sadation in agitated patient
e)use radio frequency wave

31)Hyperaemic lung fields seen in

a)pulmonary embolism
b)heart failure
c)hilar lympadenopathy
d)mitral stenosis
e)

can be seen in?

a)ascites in cirrhosis
b)etfusion i pneumonia
c)effusion in septic arthritis
d)pericardial etfusion in M!
,^ e)ankle odema in HF

33)CO2
a) 200 times more soluble than o2
b)production in resting person 250m1/min
d)most carry in blood as disolve form
d)30% of COZ in in arterial blood is in carbamino forrn
e)shift ODC curve to left

34)Asprin
a)reversibly inhibit cox 1
b)inhibit thromboxine A2 production
c)action last for 10 days
d)vasodilate

;r) ta)r c)r O. 4r a) F

n,lwstoe*J^
)
(*;Tf;*- |n u;_ilne rr*r ,^4t,
 e)sublingual route has faster onset than oral route

35)Null hypothesis

36)probability

37) Micro angiopathic haemolytic anaemia occur in?

a)eclampsia
b)Drc
malignant hypertension
c)
d)haemalytic uremic syndrome
e)SLE

38)hyperkelimia
a)indieaSed PR intreval
-d
b)inCreaSed OT interval
c)narroW ORS complex
d)cardiac arrqst in -systole
elcause digoxin toxicity

39)wii$ht's Respi rometer

a)measure tida! volume and minute volume
b)accurate at high flow rate
c)is a flow meter
d)unid irectional
e)have high inertia

40)T Lymphocytes
a)transformed in to B lymphocytes
b)matured in thymus
c)deficient in AIDS
d)consist of cytotoxic cells
e)secretes immunoglobulins
\-
41)Temperature in a liquid?
a)at boiling point temperature higher than room tempareture
b)temperature depend on SVP
c)indicate avarage kinetic energy
d)if SVP is high, it has Iow boiling temperature
e)desfluorine is vapour at 25C and l ATM pressure

z)Pulse oxymetry is innacurate in?

a)tricuspid incompetence
b)A-V fistula
c)hyperoxia
d)anaemia
e)CO poisoning
 43)02 delivery devices
a)nasalprone 02 flow 6l/min
b)face mask-to prevent apperator death space flow should be adequate
c)face mask with bag more effective
d)venturi mask depend on pattern of breathing
/ e)Anaesthetic circuits can deliver 100% 02

44)circulatory assistance in aortic bulb?

a)incease myocardial oxygen perfusion
b)actively deflate in systole
c)can be use in cardiac failure
d)can be use in severe aortic valve insuficiency
e)reduce aorti root mean pressure

45)Diastolic dysfunction
.^ is increased
creased
is norma!
with concentric hypertrophy
be misdiagnosed as volume overload

46)MRland imaging
. a)better in visualising posterior cranial fossa than CT
b)CT-PA can diagnose pulmonary embolism
c)visible area of myocardium can be detected by MRI
d)focul lesions better identified by MRlthan CT
e)

47)Antibiotics
a)beta lactams dose should be reduce in RF
b)metranidazole can be use in clostridium difficilae diarrhea
o)MRSA need broad spectrum antibiotics
d)cephalosporin should avoided in patient with history anaphylaxis to penicillin
e)nitrofurantoin can be given to treat acute pyelonephritis

^ 48)post operative infections reduce by?

a)prior administration of broad spectrum antibiotics
b)evaluation of sterilization methods
c)continuation of post of antibiotics
d)unidirectional ventilation in area
e)

49)Heat can be lost in critialcare setting by?

a)radiation
b)evaporation
c)convection
d)conduction
e)respiration
 -l

sO)lnfection contro! in icu?

a)sharp equipment- discarded to sharp bin
b)central line insertion- barrier method
c)spillage of body fluid- discard
d)cleaning surrounding- with disinfectant
e)

51 )features of dysplasia
a)increase mitotic bodies
b)increase cytoplasm : nuclear ratio
c)epithelial polarizing
d)atropy
e)hyperplasia

s2)Clinical information in icu

a)can identity drug response
b)can give standard care va>/

c)epidemiolog ical factors

d)
e)

S3)chest radiograph
alcarry ionizing rad iation
b)pulmonary vein can be visualised than pulmonary artery
c)right hilum is upper compaired with Ieft
d)right hemi diaphragm Scm above than left
e)

S4lTramadol
a)inhibit pain by inhibiting neurotransmiter uptake
b)can have dependance
c)can antagonised by naloxone
d)is a recemic mixture
e)vomiting is common side etfect
\,
ss)risk of irnaging
a)contrast neph ropathy
-T- b)anaphylactoid reaction to bariurn
c)
d)
e)

can be used to detect

a)Hb concentratin
b)fribrinolysis
c)platelet function
d)VWF deficiency
e)clotti ng factor def iciency

I
tf

57) lncreased Na+ excretion

alin$ieaSe atrial pressure
blcus_hin$ xd
c)thi*ide treatment
dlaldosterone
e)ettd'iid vasod i a! atatio n

^\
 il
-)

_)

\.

((
 I

SELECTION EXAMINATION FOR POSTGRADUATE DIPLOMA !N CRITICAL CARE

MEDICINE - NOVEMBER 2016

1. Regarding spinal cord

A. Tabes dorsalis affects posterior columns
B. ln Brown sequard syndrome there is loss of ipsilateral pain and ternperature
C. Exaggerated reflexes in spinal shock
D. Syringomyelia causes early Ioss of pain and temperature

2. Compliance of the lung

A. Reduced in pregnancy
B. Reduced in neonates
C. lncreased in elderly
D. Reduced in emphysema

3. CXR findings in ARDS

A. Air trapping? Appearance
B. Basal patches more than apices
C. Frequent occurrence of pleural effusion
D. Persistence of CXR appearance even after clinica! improvement
E. lmprovement with diuretic bolus

4. Antibiotics used in MRSA

A. Vancomycin
B. Teicoplanin
C. Aztreonam
D. Cefotaxime
E. Meropenem

5. Organisms causing community acquired pneumonia

A. Cytomegalovirus
B. lnfluenza A
C. Acinetobacter
^
6. Causes of hyponatraemia
A. SIADH
B. Cirrhosis
C. Diabetes insipidus
D. Cerebral salt wasting syndrome

7. Polyuria caused by
A. 3/" NaCI infusion
B. Posterior pituitary damage
C. Acute alcoho! intake
D. Hyperaldosteronism
E. Acetazolamine

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8. Response to massive hemorrhage include
A. lncreased production of acute phase proteins
B. Renin system activated
C. Reduction in Hb concentration
D. lncreased diastolic blood pressure
E. lncreased ANP production

9. Cytochrome p450 inducers

A. Cimetidine
B. Steroid hormones
C. Erythromycin
D. Carbamazepine
E. Metronid azole

10. Warfarin
A. ln early pregnancy can cause fetal bone malforrnations
B. Will produce more anticoagulation in the fetus than the rnother
C. Metabolized in the liver \/
D. Effects readily reversed by vitamin K

11. Diazepam
A. Effects produced by hyperpolarization of the membrane
B. Water soluble
C. Produces active metabolites
D. lncreases the muscular tone

12. Wide QRS in ECG more than 0.12 sec seen in

A. Left BBB
B. Right BBB
C. Ventricular ectopic
D. Junctiona! escapes
E.VT

13. Standard precautions include

A. Using gloves to touch the intact skin
B. Sterile gloves when performing LP
C. Hand washing after touching patients immediate environment
D. lsolating a patient with chicken pox
E. Using N95 mask for H1N1 infection

14. Treatment of UTI

A. Blood culture should be taken in suspected acute pyelonephritis before starting
antibiotics
B. lV antibiotics are given in hospitalized patients with pyelonephritis
C. Broad spectrum lV antibiotics should be started in patients with mixed heavy growth
D. IV antifungals should be started for yeast positive catheterised patients

N
u-2"
15. Post surgical infection prevention
A. lV antibiotics for 48h in clean surgeries
B. Prophylactic antibiotics for patients on ventilators
C. Review the need of invasive lines
D. Prophylactic broad spectrum antibiotics before clean surgery
E. Surveillance for surgical site infection

16. Acute severe asthma

A. lncreased mucous secretion
B. Mucosal oedema contributes to airway narrowing
C. Respiratory bronchioles are damaged
D. Salbutamol nebulization willworsen V/Q mismatch
E. PaCO2 of 45 implies impending respiratory arrest

17. Following relaxes bronchial smooth muscles

A. Hydrocortisone
B. Fexofenedine
C. Adrenaline
D. Triotropium bromide
E. Salbutamol

18. Which of the following has relatively more action on Beta 1 receptors
A. Adrenaline
B. Dopamine
C. Dobutamine
D. Noradrenaline
E. Milrinone

19. Regarding oxytocin

A. Receptors are also found in eNS
B. Effective in first trimester
C. Causes behavioralchanges in the mother
D. Contraindicated in pre eclampsia
E. Causes hypotension

20. Physiological changes in pregnancy

A. lncrease in plasma volume by 50h
B. lncrease in RBC by 30%
C. lncrease in PaCO2
D. lncreased HCO3

21 . Features ofacute inflammation

A. lncreased gap between endothelial cells
B. Margination of neutrophils along the vessels
C. Formation of histiocytes
D. Granuloma formation
E. Angiogenesis

Prepared by DCCM 2017 Batch

 \

22. Structures in the superior mediastinum

A. Arch of aorta
B. Thoracic duct
C. Thymus
D. Enlarged retrosternal thyroid
E. Pericardium

23. Widening of mediastinum in chest x ray seen in

A. Rotation of the patient
B. Thymus in the children
C. lnspiratory film
D. Upper lobe collapse
E. Unfolding of aorta

24.lntracellular concentration is more than the extracellular concentration for which of the
following ions
A. Mg
B.PO4 :,
v
C.Ca
D. HCO3
E. Ct

25. Mineral corticoid activity high in

A. Prednisolone
B. Hydrocortisone
C. Dexamethasone
D. Fludrocortisone
E. Testosterone

26. Regarding Networking in hospitalsettings

A. Can send messages instantly
B. One scanner can be used by several users
C. LAN has a high speed of communication
D. WAN is used to connect several computers within a geographic area
L
27. Health information system
A. Prevents medical errors
B. Wil! not improve the productivity
C. Patients personal information is at risk
D. Will not prevent duplication
E. Cost effective in long term

28. Hyperventilation causes

A. Carpopedal spasm
B. Respiratory acidosis
C. Peripheral vasodilation
D. Increased work of breathing
E. lncreased cerebra! blood flow

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 29. Regarding larynx
A. Recurrent laryngeal nerve supplies cricothyroid muscle
B. Bilateral partialdamage of Recurrent laryngeal nerve will need tracheostorny
C. In Unilateral damage to Recurrent Iaryngeal nerve, phonation is greatly affected
D. Left recurrent laryngeal nerve can be compressed by mediastinal rnass

30. Regarding autonomic nervous system

A. There is a sympathetic ganglion for corresponding each spinal cord segments
B. Parasympathetics ganglion supplies nerve to lacrimaland salivary glands
C. Pre ganglionic fibers are myelinated
D. Cell bodies of sympathetic nerves lie in the lateral horns

31. Regarding Horners syndrome

A. Dry forehead
B. Ptosis
C. Conjunctival injection
D. Exophthalmus
E. Miosis

32. Higher CVP seen in

A. Pericardial effusion
B. lntra abdominal hypertension
C. Right ventricular myocardial infarction
D. Right pneumothorax
E. Portal vein thrombosis

33. High difference between alveolar and arterial Oxygen seen in

A. Higher inspired oxygen concentration
B. Pneumonia
C. CPAP

34. ln diabetic ketoacidosis

A..Subcutaneous insulin is used
B. Dextrose infusion is contraindicated
'A, 1 C. Is a hypocoagulable state
D. Correcting the acidosis is more important than correcting the plasma volume
E. Total body potassium is depleted at the time of diagnosis

35. Anion gap acidosis occurs

A. When cations are more than the Anion
B. ln ketoacidosis
C. In lactic acidosis
D. Diarrhoea
E. Uraemia

36. Regarding MRI

A. Uses magnetic and radio waves
B. Safe in pregnancy
C. Gadolinium is used as contrast media
D. High soft tissue visualization
Prepared by DCCM 2017 Batch
 \

37. Pulse oxymetry

A. Uses red-light
B. Over reads at cooltemperature
C. Over reads in smokers
D. lnaccurate in neonates due to the presence of fetal hemoglobin

38. ArterialPO2 value in an ABG denotes

A. The content of oxygen
B. Tissue delivery of oxygen
C. The tissue demand of oxygen
D. The amount of oxygen dissolved in blood
E. Alveolar capillary diffusion of oxygen

39. Regarding acid bace balance by the kidney

A. Excreted mainly as H+ ions
B. Minimum urinary pH is 4.5
C. H+ Secreted mainly in the dista! convoluted tubules
D. Glutamine is metabolized to NH4+ and HCO3- in the tubular cells U
40. Regarding inspiratory capacity
A. It is the tidalvolume plus inspiratory reserve volume
B. The amount of maximum air exchange that can occur with inspiration
C. The maximum air inhaled after a normal expiration
D. The totalvolume of air that can be filled by the Iungs
E. Amount of air in the Iungs after a normal expiration

41. Regarding CSF

A. Monocytes of 2-3
B. Protein content is elevated in Guillen Barre syndrorne
C. Same glucose content as plasma
D. Absorbed by the choroid plexus

- 42. GFR can be accurately calculated using

A. lnulin
B.PAH \/
C. Creatinine
D. Urea
E. Sorbitol

43. HCOS important because

A. of its abundance
B. H+ binds Hb in deoxygenated state with more atfinity
C. HCO3 contributes to 50% of the intracellular buffer

44. During quite breathing following muscles are used in inspiration

A. Diaphragm
B. lnternal intercostal
C. External intercostal
D. Scalene muscles
E. Abdominal muscles

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 45. lnsulin dependent glucose uptake occurs in
A. Pancreas
B. Liver
. C. Brain
D. Skeletal muscle
E. Fat

46. Regarding antiplatelet drugs

A. Aspirin reversibly inhibits COX 1
B. Clopidogre! inhibits Glycoprotein llb/llla Receptors
C. Abciximab inhibits ADP Receptors
D. Aspirin is used in the primary management of STEMI
E. Dypiridamole inhibits phosphodiesterases non specifically

47. Regarding knee jerk

A. Conditional reflex
B. Polysynaptic reflex
- C. Carried by muscle spindle
D. Diminished in L4 root lesion
E. Exaggerated in spinal shock

48. Regarding USS

A. Doppler uss sound is audible
B. Transducer act as both transmitter and receiver
C. Gel decreases reflection
D. FIuid in the bladder increases the depth of visualization
E. Fasting increases reflection of the waves

49. ROTEM
A. Whole blood is used
B. Temperature correction is done
C. pH correction is.done
D. Fibrinogen deficiency can be identified
E. Excess fibrinolysis can be identified

50. Regarding anaphylaxis

A. lt's a type I hypersensitivity reaction
B. Occurs on the first exposure of the allergen
C. Hydrocortisone is the first Iine treatment
D. Cutaneous manifestations are pathognomonic

51. Effects of hypothermia include

A. Metabolic acidosis

52. Which of the following are true

A. Correlation coefficiency ranges from -1 to +
B. Correlation Tested to check the association between two variables
C. 3 SD covers 99.9% of population
D. Sample size will not affect the confidence interval
Prepared by DCCM 2077 Batch

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E. increasing the sample size will reduce the standard error of mean

53. Which of the following are true

A. Pie chart can be used for nominal and ordinal data
B. Simple bar chart can be used to describe two variables
C. Histogram has no gaps between bars
D. Two variables can be compared using scattered diagram
E. Bimodaldistribution has two humps

54. Which of the following are true

A. Skewed distribution will affect the range of the data
B. ln Skewed distribution, mode median and mean line in the same position
C. Standard deviation is a measure of dispersion
D. Regression coefficient?
E. Type 1 error is due to false positive results

55. Lesions and the findings

A. Pituitary adenoma- bitemporal hemianopia
-
----.-___5O Nociceptors are modulated by which of the following
A. Histamine
B. Bradykinin
C. Substance P
D. Potassium

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 \

Selection Examination for Postgraduate Diploma in Critical Care Medicine

November 2017

t. Regarding QT interval
a) Measured from beginning of Q wave upto the begining of T wave
b) Prolonged by Digoxin
c) Prolonged in Hyperkalemia
d) Corrected QT interval will be shorter in bradycardia

2. Diastolic filling of heart

a) Mainly occurs in late diastole
b) Aided by sympathetic stimulation in a nonnal heart
c) Decompensated in hypertensive heart disease
rn'
d) Increased by lusitropic drugs

3. Urinary sodium concenfiation of25mmoUl is seen in

a) Cushings disease
b) Severe hypovolemia
c) Renal tubular necrosis

4. Factors increasing pulmonary arteial vascular resistance

a) Low alveolar partial pressure of oxygen
b) Hyrpercapnia
c) Hypocapnia
d) Alpha adrenoceptor agonists

s. Features ofhyperemesis gravidarum

a) Hyperkalemia
b) Metabolic alkalosis
c) Loss ofweight
d) Hyponatremia
e)

G. furtibiotic resistance is expected in

a) Staph Aureus
b) Group A Streptococcus
 c) Micobacterium Tuberculosis
d) Acitinobacter
e) Treponema pallidum

7. Drugs that can be given for atypical pneumonia

a) Clindamycin
b) Doxycyclin
c) Cefoperozone Sulbactum
d) Erythromycin
e) Amikacin

r 8. In a patient with shock BP and JVP are low.tachycardic .peripheries are v

warm.The type of shock
a) Hypovolemic shock
b) Cardiogenic shock
c) Distributive shoc
d) Obstructive shock
e) Neurogenic shock

s. WOTF are true

a) Mean is higher in a positively skewed distribution
b) Mean median and mode is at the same level in a normal distribution
c) Mean is a measure of central tendancy
d) SD is a measure of dispersion

ro. Regarding PCM

a) Metabolizedby glucuronisation , sulphation and methylation
b) Toxicity is increased by NAC?
c) Toxicity causes centrilobular necrosis of liver
d) Glutathione is used in detoxification

n. Regarding Ramifentanil
a) Should be given as an infusion
b) Causes respiratory muscle rigidity
c) Metabolized by plasma choline esterases
 d) Potency equal to fentanyl
e)

rz. Regarding chest xray PA(l)

a) Within lcm of the periphery lung parenchymal margin is not
visualized properly
b) Left hilum is higher than right
c) Right border of the cardiac shadow represents right arium
d) 10-12 ribs can be seen in fully inflated lung fields
e) Right hemidiaphragm is above the left
-\
ra. Regarding chest xray PA(2)
a) There should be a distance of 180cm between the xray sonrce and the
plate
b) Resolution is high in digital xxays
c) Better visualization of lung parenchyma can be achieved
d) Pulmonary arteries and veins cannot be differentiated
e) Oesophagus pierces diaphragm at Tl0
r+.TlF
a) Hydrocortisone is given for bronchodialation in asthma
b) Frusemide increases chloride reabsorption from t OH

rs. Biguanides
a) Prevents peripheral utilization of glucose
b) Reduce gut absorption of glucose
c) Causes weight gain
d) Inhibits conversion of fat to glucose within liver
re. Regarding oesophagus
a) 25cm long
b) Supplied by bronchial artery
c) Diaphragmatic opening is at T8 level
d) Progesterone relaxes LOS
rz. Regarding trachea
a) Supplied by superior thyroid artery
b) Bifurcates at T4
c) Extends from
rs. Tissue oxygen delivery depends on
a) Myocardial confractility
b) Cardiac preload
c) Cardiac afterload
d) Cardiac output
e) Mixed venous saturation
rs. Regarding parietal pleura
a) Has the same vascular and nervous supply of the thoracic wall

zo. Regarding Oxygen

a) Stable molecule with indefiniteT %
b) To'xicity caused by free radicals
c) Repelled by magnetic field'
d) Partial pressure is altered by vapour pressure

2L. Regarding cardi ac cycle

a) Both ventricles contract at the same time
b) Left ventricular systole is followed by right
c) Pulmonary valve closes after aortic valve

22. Amiodorone Side effects

a) Pneumonitis
b) Tachycardia
c) Photosensitivity
d) Cirrhosis

23. Regarding Clopidogral

a) Is a prodrug
b) Acts on llla 1lb receptors

e1
et
 c) ROTEM reduces clotting time

z+. Regarding SVC

a) Lower % is nthe middle mediastinum
b) Spans from I't to 3'd costal cartilages
c) Overlapped by aortic arch
d) Azygous vein is a tributary

zs. Regarding an ideal gas

a) In a constant temperature Pcl V

zs. Regarding Prothrombin Time

a) Whole blood is used
b) Measwed at body temperature
c) Gives a measure of clot stabilization

27. WOF are true regarding receptors in emesis

a) Vestibular apparatus has 5HT2 receptors
b) Chemoreceptor trigger zone has opioid receptors
c) GI tract has Ml receptors
d) Chemoreceptor trigger zone has D2 receptors

za. Regarding electricity

a) Isolation circuits has an earttr wire
b) DC current leakage doesn't cause any physical stimulation
c) 50Hz AC current is more halmful than lkHzAC current
d) All frequencies can cause tissue burning

zg. Arteial pressure wave form

a) Diastolic notch is reduced in reduction of afterload
b) Broad base is seen in reduced contractility
c) Plethysmography gives the cardiac output
d) >15% volume variation is indicated in hypervolemia
so. Which of the following reduce thePaO2?
a) IncreasedCO2 in inspired air
b) Shunts
c) Hypoventilation
d) Exercise

sr. T/F
a) Type 2 enor increases with increase of population varience
b) Type 2 error gives power
c) Student t test is used to test SD of two samples

32. GI motility is increased in

a) Ondensetron
, b) Metochlopramide
c) Neostygmine

33. Regarding ADH

" '

a) Acts on Y2 receptors
b) Acts at loop of Henle. n

c) Causes cerebral vasocorstriction

gq.Data can be transferred from one computer to another using

a) USB drive
b) Cloud storage
c) External hard disk
d) Email
e) VGA cable

ss. T/F ,l
il pdf file is better than HTML for printing
b)
ae. Opioids
a) Fentanyl only has mu receptor activity
b)
az. Regarding log dose response curve
 a) X axis represents dose andY axis represents respoffie
b) It is a semi logarhythmic curve
c) Potency is represented by the height of the curve
d) If the height of the curve is high efficacy is higher
e) Curve is sigmoid shaped

ss. Regarding oxytocin

a) Receptors are also found in CNS
b) Effective in I't trimester
c) Causes behavioural changes in mother
d) Contra indicated in pre eclampsia
e) Causes hlpotension

sg. Anticoagulation
a) Heparin inactivate antithrombin lll and thrombin
b)

+0. Pulse oximeter

a) Based on oxygen haemoglobin dissociation curye

+r. Autonomic nervous system

+2. Complement cascade

+E. T/F
n
a) hypoalbuminemia may cause acidosis
b)

c+.In old age

a) Ventilatory response to Carbon dioxide is diminished

+s. Doppler effect to.t

+s. Suxamethonium
+2. Humidifier lbd
\ ,
a

;
 ,
p

Selection Examination for Dlploma in Gritical care Medicine

November 201 8

1. K+ influx across a cell membrane

a. Catecholamine

b. Acidosis

c. Insulin
d. Temperature
e. Aldosterone
^
2. Drug side effects correctly matched

a. Vancomycin - histamine release

b. Cephalosporin - interstitial nephritis

c. Gabapentin - Steven johnson's

d. Ototoxicity - aminoglycoside

3. Antipseudomonal drugs

a. Amikacin
,- b. Cefotaxime

c. Cefepime
d. Meropenem
e. Colistin

4. Latent infections

a. Salmonella typhi
b. Vibrio cholerae

c. Herpes simplex
/ I

frl

d. Hepatitis b

5. Errors of statistics

a. Type 1 error is false positive

b. Type 2 error is a true negative

c. Type2 error is important in measuring power

d. Type 1 error rejects true nul! hypothesis

6. Power of statistics

a. ls a measure of rejecting the null hypothesis v

b. Value is between 0 to 1

c. Can be used to determine the size of the sample

d. The value can be increased with the interest of the magnitude of the population

7 . l-argl vessels of the neck

a. Left ICA starts from the brachiocephalic trunk

b. Right side brachiocephalic vein is more vertical
c. Left brachiocephalic vein is longer than right
d. SVC joins the RA below the level of carina
v
8. Myasthenia gravis
a. Potentiate the action of non depol arizing muscle relaxants
b. Ascending type muscle weakness

c. Sensory involvement is a suggestive feature of MG

9., Hepatic enzyme inducers

a. Phenytoin

, ,,-
 b. Clopidogrel

c. Nicotine

d. Rifampicin

e. Ciprofloxacin

10. Regarding internet

a. Google chrome is a search engine

b. lnternet explorer is a web browser

c. File type:pdf "pseudomonas" is the best way to find all the pdf files regarding
pseudomonas

d. When similar keywords are used different search engines shows similar results

e. Pubmed may allow you to download some research articles from well reputed
journals

11. Regarding lT

a. Virus is a system software

b. 'Backdoor' of a computer system can bypass the authentication

c. 'Access denied'term used to stop access of the intended user

d. Trojans are a threat to computer systems

n
12. Factors increase the afterload

a. Heart rate
b. Vasodilatation

c. Blood viscosity
d. lncrease intrathoracic pressure

e. Aortic impedance

13. Action potentials of pacernaker cells and myocytes

 (

a. Resting membrane potential is more negative in myocytes

b. Pacemaker action potential transmission is facilitated by slow leaking of ca and

Na

c. Plateau of myocyte potentials are maintained by fast ca channels

14. Regarding cardiac cycle

a. Aortic and pulmonary valves close at the end of isometric ventricular contraction

b. Splitting of the second herd sound by delayed closure of the aortic valve

c. 'a'wave is due to passive filling of right atria

d. 'C'WAVE is prominent in tricuspid regurgitation v

'l 5. Mixed venous saturation reduce in

a. Low cardiac output

i b. Low HB
c. AV fistula
d. Hypothyroidism
e. More dissolved oxygen

16. Elevated JVP in

a. RV infarction v
b. Cardiac tamponade
c. Tension pneumothorax
d. Large pulmonary embolism
e. Distributive shock

17. Pulmon ary capillary wedge pressure is more than 1Smmhg

A. ARDS
 b. Negative pressure pulmonary oedema

c. Reloading of pulmonary oedema

d. Cardiogenic pulmonary oedema

e. Pulmonary embolism

1 8. Regarding antibiotic resistance

a. Third generation cephalosporin is resistant to beta lactamase

b. Repeated use causes selection of resistant organisms

c. Spontaneous mutation can cause resistance

19. Regarding ICU setting

a. Decision of Resuscitation Iies with the consultant

b. Euthanasia is a decision of dying

c. Patient has a right to refuse treatment

20. Suxamethonium

a. ls non competitive partial agonist of nicotinic receptors

b. Action is increased in myasthenia gravis

' c. Cause prolonged respiratory depression in GBS

21 . Regarding anticoagulants

a. Coumarin drugs act by inhibiting the action of vit k

b. Heparin potentiate the action of antithrornbin 3
c. APTT should be monitored in LMWH therapy
d. Action of warfarin is reversed by prothrombin precipitate
e. Apixaban is an intravenous vit K antagonist
22. Regarding alveolar ventilation

a. Alveolar PaO2 is only affected by fraction of inspired o2

b. Alveolar PCO2 is only affected by alveolar

c. ventilation

d. CO2 is used to measure alveolar diffusion

e. lncreasing the thickness of the membrane will affect more on oxygen than
carbon dioxide

23. Regarding ABG

a. Should measure within 30 minutes in room ternperatur" a,

b. Base deficit indicate metabolic acidosis

24.|n neonates cardiac output is mainly by t(*t L.\-r \4 A

a. Narrowest paft is at glottis
b. Transverse ribs prevent the increase of tidal volurne

c. Foramen ovale closes within 48hrs

d. Pulmonary vascular resistance is high at birth

25. ABG report of a normal ventilated patient

PCO2-25 \r
PO2- 80
pH- 7.35
HCO3_-10
BE - -10
Lactate 3.2
NormalNa K

Results shows,

a. Metabolic acidosis

b. Respiratory alkalosis as a compensation

 c. Suggestive inadequate oxygen at tissue

d. Suggestive of high anion gap

26. Erect abdominal x ray can be used to diagnose

a. Bowel perforation
b. Chronic pancreatitis
c. Mechanical obstruction of small bowel

d. Pyelonephritis
n e. Psoas abscess

27. Free gas in the abdomen can be detected by

a. Supine chest x ray

b. Supine abdominal x ray

c. Cxr PA
d. Lateral decubitus abdominal x ray
e. Erect abdominal x ray

28. CT scan of a trauma patient

a. Can Assess the retroperitoneum

n b. High specificity
c. Can be used to diagnose hollow organ injury
d. Can be used in an unstable patient
e. Contrast contraindicated in renal failure

29. Endothelial glycocalyx

a. Situated just outside the basement membrane

b. Made only by proteins

 c. Damage by increase volume of blood
d. lnfluenced by N-acetylcysteine
e. Damaged by steroids

30. Regarding respiration

a. Throughout respiration the transpulmonary pressure is negative

b. Throughout inspiration the intrapleural pressure is negative

c. Apex is more ventilated than base in erect position

31. Warfarin
v
. a. 997o protein bound

b. Action reversed by prothrombin concentrate

32. Regarding bronchialtree 'o'

a. Bronchio pulmonary."gr"ni separated by interstitium

b. Left main bronchus lies beneath aorta

c. Carina is at t5 level

d. Diameter of Right main bronchus is more than the left

33. Student T test

\,

34. Spinal cord injury at C6 causes

a. Causes paradoxical chest movements

b. Reduce cough reflex

c. Causes tachyarrhythmias
d. Reduce FRC

B) o)r b)r
 35. Blood supply of spinal cord

a. Anterior 1/3 supply by anterior spinal artery

b. Posteriorly there are 2 posterior spinal arteries

c. Allthe spinal arteries are formed by vertebral arteries

d. Artery of Adamkiewicz is a important connection of Anterior spinal artery

e. Anterior spinal artery occlusion can be compensated by collateral supply

36. Regarding sympathetic trunk

a. Supply to pancreas via celiac ganglion

b. From C3 to TT12
c. Preganglionic fibers are myelinated
d. Preganglionic fibers are shorter than parasyrnpathetic

37.!n pregnancy

a. Metabolic alkalosis may occur

b. Causes reduced FRC

c. lncrease intragastric pressure

38. Regarding lung volumes

^\ a. FRC can be measured by spirometer

39. Regarding ABG

a. PaCOZ is directly measured

b. HCO3 is indirectly measured
c. Saturation is directly measured

40. Correct combination of reflexes and cranial nerves

a ( rr\ef<
,'4 ( C.t 3
Q3 q- 7 F
b-r T Or 6L
O,F DT SPo>-
A) f , c)r
+)T
 a. Gag- 9,1 0

b. Corneal reflex-5,7

c. Vestibulo ocular reflex- 6, 3, I

d. Cough reflex- 9,1 0

e. Pupillary reflex- 2,3

41 . Prerenal and interstitial renal failure can be differentiated by

42.,Hyponatream ia causes
v
a. lndapamide

43. Hypokalemic metabolic acidosis

a. Type 1 renal tubular acidosis

b. Conn's syndrome

c. Acetazolamide

44. ECG with Wide QRS complex

a. WFW syndrome with atrial fibrillation

b. Junctiona! escapes

c. Nodal rhythm

d. Ventriculartachycardia

45. Over resuscitation with normal saline

a. Metabolic acidosis
b. Reduced renal blood supply
c. Hyponatremia
d. Renal failure

)
 r
a

46. Cardiac biomarkers

a. Myoglobin peaks at t hr

b. CKMB peaks at 48 hrs

c. Trop I last for 4 days

1

d. BNP rise with pulmonary oedema

e. Trop C is cardiac specific

47 . Desired effects of PEEP

a. lncrease lung volume

b. lncrease Pao2
c. lncrease dead space

48. Regarding the pathophysiology of diseases

a. GORD causes dysplasia

b. Lower esophageal sphincter is physiological

. LOS is at the level of 60cm from upper incisor teeth

49. Therapeutic use of Mg

a. Causes vasodilation
b. Bronchodilation
c. Excreted mainly via kidney

d. Reduce nerve excitability

50. Regarding management of sepsis

a. Antibiotic loading dose should be used

b. Dose should be doubled in renal replacement therapy
51 . Dose adjustment in renal failure should be done in

d. Metronidazole

b. Clarithromycin

c. Cefotaxime

d. Meropenum

52. Regarding renal blood flow

a. 20Yo of cardiac output

b. lncreased by distal tubular low sodium concentration
c. PG caused increased renal blood flow

T
L. Mixed venous pressure
2. Valsava manoeuvre
3. Ways of measuring cardiac out put
4. Fetal circulation

2 umbilical veins

Ll3 of blood in R atrium go to the R ventricle

Ductus arteriosus closed at birth

5. Subclavian vein

Lies posterior to the medial Ll3 of the L't rib

Easily compressible

Lies anterior to the scalenous anterior

5. La rynx

At the level of C3 - C6

Superior laryngeal nerve is a branch of the vagus nerve

Paralysis of the external laryngeal nerve makes vocal cords in cadaveric position

7 . Platelets

in a agitator

for 35 days
'1

8. Massive blood transfusion cause

hypocalcaemia, reduce factor 8,

10. Deoxygenated Hb has more affinity for coz

11, Drugs act on q, receptors
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t

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'1

f.
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