Intensive Care Medicine MCQs Multiple

Choice Questions with Explanatory

Answers 1st Edition Steve Benington
Visit to download the full and correct content document:
https://textbookfull.com/product/intensive-care-medicine-mcqs-multiple-choice-questio
ns-with-explanatory-answers-1st-edition-steve-benington/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Siegel s Property Essay and Multiple Choice Questions

and Answers 5th Edition Brian N. Siegel

https://textbookfull.com/product/siegel-s-property-essay-and-
multiple-choice-questions-and-answers-5th-edition-brian-n-siegel/

Microsoft Office Top 1850 Multiple Choice Questions

Answers MCQs for all Examination and Interview MS
Office MS Excel MS Word MS PowerPoint and MS Access
Question Bank Kanaujia Er Avnindra
https://textbookfull.com/product/microsoft-office-
top-1850-multiple-choice-questions-answers-mcqs-for-all-
examination-and-interview-ms-office-ms-excel-ms-word-ms-
powerpoint-and-ms-access-question-bank-kanaujia-er-avnindra/

The EHRA Book of Interventional Electrophysiology:

Case-based learning with multiple choice questions 1st
Edition Hein Heidbuchel

https://textbookfull.com/product/the-ehra-book-of-interventional-
electrophysiology-case-based-learning-with-multiple-choice-
questions-1st-edition-hein-heidbuchel/

OSCEs for Intensive Care Medicine Peter Hersey

https://textbookfull.com/product/osces-for-intensive-care-
medicine-peter-hersey/
Revision notes in intensive care medicine 1st Edition
Camporota

https://textbookfull.com/product/revision-notes-in-intensive-
care-medicine-1st-edition-camporota/

Surgical Intensive Care Medicine 3rd Edition John M.

O'Donnell

https://textbookfull.com/product/surgical-intensive-care-
medicine-3rd-edition-john-m-odonnell/

Pediatric Neurosurgery - In Multiple-Choice Questions

(Mar 25, 2024)_(3031495721)_(Springer) 1st Edition
Samer S. Hoz

https://textbookfull.com/product/pediatric-neurosurgery-in-
multiple-choice-questions-mar-25-2024_3031495721_springer-1st-
edition-samer-s-hoz/

Critical Care Medicine Review 1000 Questions and

Answers 1st Edition Abraham Sonny & Edward A Bittner &
Ryan J. Horvath & Sheri Berg.

https://textbookfull.com/product/critical-care-medicine-
review-1000-questions-and-answers-1st-edition-abraham-sonny-
edward-a-bittner-ryan-j-horvath-sheri-berg/

Neurocritical Care Board Review Questions and Answers

1st Edition Asma Zakaria Md

https://textbookfull.com/product/neurocritical-care-board-review-
questions-and-answers-1st-edition-asma-zakaria-md/
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page i

Intensive Care Medicine

MCQs
Multiple Choice Questions with Explanatory Answers

Editor:
Steve Benington MBChB MRCP FRCA EDIC FFICM
Authors:
Shoneen Abbas MBChB MRCP FFICM
Ruth Herod MBChB FRCA FFICM
Daniel Horner BA MBBS MD MRCP(UK) FCEM FFICM
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page ii

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

tfm Publishing Limited, Castle Hill Barns, Harley, Shrewsbury, SY5 6LX, UK
Tel: +44 (0)1952 510061; Fax: +44 (0)1952 510192
E-mail: info@tfmpublishing.com
Web site: www.tfmpublishing.com

Editing, design & typesetting: Nikki Bramhill BSc Hons Dip Law
First edition: © 2015
Front cover image: © 2015 Sudok1/Dreamstime.com LLC
Paperback ISBN: 978-1-910079-07-2
E-book editions: 2015
ePub ISBN: 978-1-910079-08-9
Mobi ISBN: 978-1-910079-09-6
Web pdf ISBN: 978-1-910079-10-2

The entire contents of Intensive Care Medicine MCQs — Multiple Choice

Questions with Explanatory Answers is copyright tfm Publishing Ltd. Apart
from any fair dealing for the purposes of research or private study, or
criticism or review, as permitted under the Copyright, Designs and Patents
Act 1988, this publication may not be reproduced, stored in a retrieval
system or transmitted in any form or by any means, electronic, digital,
mechanical, photocopying, recording or otherwise, without the prior written
permission of the publisher.

Neither the authors nor the publisher can accept responsibility for any injury
or damage to persons or property occasioned through the implementation
of any ideas or use of any product described herein. Neither can they accept
any responsibility for errors, omissions or misrepresentations, howsoever
caused.

Whilst every care is taken by the authors and the publisher to ensure that all
information and data in this book are as accurate as possible at the time of
going to press, it is recommended that readers seek independent
verification of advice on drug or other product usage, surgical techniques
and clinical processes prior to their use.

The authors and publisher gratefully acknowledge the permission granted

to reproduce the copyright material where applicable in this book. Every
effort has been made to trace copyright holders and to obtain their
permission for the use of copyright material. The publisher apologizes for
any errors or omissions and would be grateful if notified of any corrections
that should be incorporated in future reprints or editions of this book.
ii
Printed by Gutenberg Press Ltd., Gudja Road, Tarxien, PLA 19, Malta
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page iii

Contents

Page

Preface iv

Acknowledgements vi

Abbreviations vii

Converting units of measurement xii

Topic index xiii

Paper 1: Questions 1

Paper 1: Answers 39

Paper 2: Questions 105

Paper 2: Answers 143

Paper 3: Questions 219

Paper 3: Answers 259

iii
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page iv

Preface

This book contains three 90-question multiple choice papers designed to

test the candidate’s knowledge of intensive care medicine (ICM) and their
ability to apply it. Each paper begins with 60 multiple true false (MTF)
questions consisting of a stem and five statements, each requiring a true
or false answer. These are followed by 30 single best answer (SBA)
questions where a clinical vignette is presented with five possible
solutions. The candidate should select the one that best addresses the
problem, mirroring clinical practice where a case usually has several
possible approaches.

Topics have been chosen to cover the breadth of knowledge required

of the modern intensivist, including resuscitation, diagnosis, disease
management, organ support, applied anatomy, end-of-life care and applied
basic sciences. There is a strong focus on the evidence base
underpinning the specialty, making this book particularly useful for
physicians and others approaching professional examinations in ICM and
related acute medical and surgical specialties. There is no ‘pass mark’,
although a score of less than four out of five in an MTF question or an
incorrect response to an SBA question should help the candidate identify
areas where they would benefit from further reading. Each question is
accompanied by a detailed and fully referenced answer; the majority of
references are freely accessible online or through institutional
subscriptions.

The authors are all senior trainees or consultants practising intensive

care medicine in the UK with firsthand experience of passing professional
examinations. In addition, they have extensive training and experience in

iv
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page v

Preface

acute medicine, anaesthesia and emergency medicine, respectively, and

have drawn on their experience to devise questions that reflect these
specialties and their interface with intensive care medicine. The authors
hope that this book will be a useful resource not only for those
approaching examinations but for anyone wishing to keep up-to-date in
this fast-changing specialty.

Steve Benington MBChB MRCP FRCA EDIC FFICM

Shoneen Abbas MBChB MRCP FFICM
Ruth Herod MBChB FRCA FFICM
Daniel Horner BA MBBS MD MRCP(UK) FCEM FFICM

v
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page vi

Acknowledgements

The Editor would like to thank Dr Ola Abbas and Dr Fiona Wallace for their
invaluable help proofreading the manuscript. Also, thanks to Dr John
Macdonald, Dr Hakeem Yousuff, Dr Richard Ramsaran and Dr Andrew
Martin for their comments while testing the questions.

vi
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page vii

Abbreviations

The following are the most commonly used abbreviations throughout the book:

AAGBI Association of Anaesthetists of Great Britain and Ireland

ABG Arterial blood gas
ACS Abdominal compartment syndrome
ACTH Adrenocorticotropic hormone
AF Atrial fibrillation
AFE Amniotic fluid embolism
AFLP Acute fatty liver of pregnancy
AIS Abbreviated Injury Scale
AKI Acute kidney injury
ALF Acute liver failure
ALI Acute lung injury
ALS Advanced Life Support
AP Acute pancreatitis
APACHE Acute Physiology and Chronic Health Evaluation
APLS Advanced Paediatric Life Support
APRV Airway pressure release ventilation
aPTT Activated partial thromboplastin time
ARDS Acute respiratory distress syndrome
ARR Absolute risk reduction
ASIA American Spinal Injury Association
AT Anaerobic threshold
ATLS Advanced Trauma Life Support
ATN Acute tubular necrosis
BE Base excess
BMI Body mass index
BNP B-natriuretic peptide
BP Blood pressure
BTS British Thoracic Society
CAM-ICU Confusion Assessment Method for the Intensive Care Unit
cAMP Cyclic adenosine monophosphate vii
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page viii

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

CAP Community-acquired pneumonia

CDI Clostridium difficile infection
cGMP Cyclic guanosine monophosphate
CIN Contrast-induced nephropathy
CK Creatine kinase
CKD Chronic kidney disease
Cl- Chloride
CMAP Compound muscle action potential
CMV Cytomegalovirus
COPD Chronic obstructive pulmonary disease
CPAP Continuous positive airway pressure
CPET Cardiopulmonary exercise testing
CPIS Clinical Pulmonary Infection Score
CPK Creatinine phosphokinase
CPP Cerebral perfusion pressure
CPR Cardiopulmonary resuscitation
CRP C-reactive protein
CRRT Continuous renal replacement therapy
CSF Cerebrospinal fluid
CT Computed tomography
CTPA Computed tomography pulmonary angiogram
CVC Central venous catheter
CVP Central venous pressure
CXR Chest X-ray
DBD Donation after brainstem death
DCD Donation after cardiac death
DDAVP Desmopressin
DI Diabetes insipidus
DIC Disseminated intravascular coagulation
DKA Diabetic ketoacidosis
DVT Deep vein thrombosis
ECG Electrocardiogram
ECMO Extracorporeal membrane oxygenation
EEG Electroencephalography
EMG Electromyography
ESR Erythrocyte sedimentation rate
ETCO2 End-tidal carbon dioxide
EVD External ventricular drain
FFP Fresh frozen plasma
FRC Functional residual capacity
viii HR Heart rate
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page ix

Abbreviations

GBS Guillain-Barré syndrome

GCS Glasgow Coma Scale
GFR Glomerular filtration rate
GMC General Medical Council
GTN Glyceryl trinitrate
HAS Human albumin solution
HCM Hypertrophic cardiomyopathy
HFOV High-frequency oscillatory ventilation
HME Heat and moisture exchangers
HRS Hepatorenal syndrome
IABP Intra-aortic balloon pump
IAH Intra-abdominal hypertension
IAP Intra-abdominal pressure
ICP Intracranial pressure
ICU Intensive care unit
ICUAW Intensive care unit-acquired weakness
ILCOR International Liaison Committee on Resuscitation
INR International Normalised Ratio
ISS Injury Severity Score
K+ Potassium
KDIGO The Kidney Disease: Improving Global Outcomes
LDH Lactate dehydrogenase
LMA Laryngeal mask airway
LMWH Low-molecular-weight heparin
LP Lumbar puncture
LQTS Long QT syndrome
LVOT Left ventricular outflow tract
MAP Mean arterial pressure
MDR Multidrug resistance
MELD Modified End-stage Liver Disease
MEN Multiple endocrine neoplasia
MEOWS Modified Early Obstetric Warning Score
MET Metabolic equivalent
MG Myasthenia gravis
Mg2+ Magnesium
MH Malignant hyperthermia
MHRA Medicines and Healthcare Products Regulatory Agency
MI Myocardial infarction
MODS Multiple Organ Dysfunction Score
MPAP Mean pulmonary artery pressure
MPM Mortality Prediction Model ix
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page x

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

MRC Medical Research Council

MRI Magnetic resonance imaging
MRSA Methicillin-resistant Staphylococcus aureus
NICE The National Institute for Health and Care Excellence
NIV Non-invasive ventilation
Na+ Sodium
NAC N-acetyl cysteine
NF Necrotizing fasciitis
NHSBT National Health Service Blood and Transplant
NICE National Institute for Health and Care Excellence
NMS Neuroleptic malignant syndrome
NNT Number needed to treat
NPV Negative predictive value
NSAID Non-steroidal anti-inflammatory drug
PAC Pulmonary artery catheter
PAOP Pulmonary artery occlusion pressure
PCI Primary coronary intervention
PCR Polymerase chain reaction
PCV Pressure-controlled ventilation
PCWP Pulmonary capillary wedge pressure
PE Pulmonary embolism
PEEP Positive end-expiratory pressure
PEFR Peak expiratory flow rate
P:F ratio
Ratio of partial pressure of arterial oxygen to fraction of
inspired oxygen
PLR Passive leg raising
PN Parenteral nutrition
POSSUM Physiological and Operative Severity Score for the
enUmeration of Mortality and Morbidity
PPI Proton pump inhibitor
Pplat Plateau pressure
PPV Positive predictive value
PRIS Propofol infusion syndrome
PT Prothrombin time
PTHrP Parathyroid hormone-related protein
QALY Quality-adjusted life-year
RASS Richmond Agitation Severity Scale
RCT Randomised controlled trial
rFVIIa Recombinant Factor VIIa
RIFLE Risk, Injury, Failure, Loss, End-stage renal disease
x ROC Receiver operator characteristic
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page xi

Abbreviations

ROSC Return of spontaneous circulation

ROSIER Recognition of Stroke in the Emergency Room
RR Respiratory rate
RSBI Rapid Shallow Breathing Index
RTS Revised Trauma Score
SAH Subarachnoid haemorrhage
SAPS Simplified Acute Physiology Score
ScvO2 Central venous oxygen saturation
SDD Selective digestive tract decontamination
SIADH Syndrome of inappropriate antidiuretic hormone secretion
SID Strong ion difference
SLE Systemic lupus erythematosus
SNAP Sensory (or mixed) nerve action potential
SOFA Sequential Organ Failure Assessment
STEMI ST elevation myocardial infarction
SVC Superior vena cava
SVRI Systemic vascular resistance index
TBI Traumatic brain injury
TBSA Total body surface area
TEG Thromboelastography
TIA Transient ischaemic attack
TIPSS Transjugular intrahepatic portosystemic shunting
TISS Therapeutic Intervention Scoring System
TLS Tumour lysis syndrome
TRISS Trauma Injury Severity Score
TSS Toxic shock syndrome
TTP Thrombotic thrombocytopaenia purpura
VAD Ventricular assist device
VAP Ventilator-associated pneumonia
VATS Video-assisted thoracoscopic surgery
VCV Volume-controlled ventilation
VF Ventricular fibrillation
VT Ventricular tachycardia
Vt Tidal volume
VTE Venous thromboembolism
vWF von Willebrand Factor
WCC White cell count
WFNS World Federation of Neurosurgeons
WPW Wolff-Parkinson-White
WSACS World Society of the Abdominal Compartment Syndrome
xi
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page xii

Converting units of
measurement
Laboratory results presented in the questions are given in standard UK
units. The following conversion factors may be useful to readers from
other areas:

1μmol/L = 0.0113mg/dL (e.g. serum bilirubin, creatinine)

1kPa = 7.5mmHg (e.g. PaO2)

xii
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page xiii

Topic index

Anaesthesia 2.84, 3.61, 3.90

Applied anatomy 1.27, 2.6, 2.9, 3.3, 3.52

Burns & trauma 1.14, 1.23, 1.71, 1.83, 2.29, 2.49,

2.58, 2.85, 3.9, 3.17, 3.20, 3.55, 3.65,
3.74

Cardiovascular 1.15, 1.25, 1.31, 1.33, 1.41, 1.47,

1.75, 1.85, 1.90, 2.10, 2.28, 2.43,
2.46, 2.55, 2.60, 2.67, 2.73, 2.74,
2.76, 2.77, 2.83, 3.19, 3.21, 3.36,
3.40, 3.45, 3.50, 3.53, 3.64, 3.76,
3.81

Diagnostic tests 2.12, 3.30

Ethics & legal 1.57, 1.60, 2.36

Evidence and biostatistics 1.20, 2.3, 2.68, 3.11, 3.18

Gastroenterology & hepatology 1.7, 1.52, 1.65, 1.88, 2.24, 2.35, 2.75,
3.25, 3.49, 3.51, 3.86

Haematology & clotting 1.2, 1.5, 1.26, 1.44, 1.84, 3.10, 3.38,
3.39, 3.48

xiii
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page xiv

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

Metabolic & nutritional 1.9, 1.24, 1.37, 1.40, 1.62, 1.64, 1.82,
2.7, 2.8, 2.21, 2.41, 2.44, 2.52, 2.59,
2.63, 2.80, 2.86, 2.87, 3.4, 3.5, 3.29,
3.31, 3.42, 3.58, 3.68, 3.69, 3.70

Microbiology & infection control 1.28, 1.36, 1.74, 2.34, 2.40, 2.45,
2.47, 2.48, 2.81, 3.2, 3.15, 3.16, 3.24,
3.34, 3.66, 3.83, 3.88

Miscellaneous 1.49, 1.56, 1.89, 2.42, 2.79, 3.41,

3.71, 3.82

Neurology & neurosurgery 1.1, 1.8, 1.10, 1.16, 1.17, 1.29, 1.42,
1.53, 1.55, 1.58, 1.61, 1.66, 1.73,
1.79, 1.80, 2.19, 2.22 2.27, 2.30,
2.38, 2.64, 2.89, 3.22, 3.35, 3.46,
3.72, 3.77

Obstetrics 2.70, 2.72, 3.67, 3.75

Organ donation 1.45, 2.39, 3.32, 3.62

Organ support & sedation 1.12, 1.72, 1.78, 1.81, 1.86, 2.1, 2.5,
2.16, 2.20, 2.62, 3.43, 3.47, 3.59,
3.85, 3.87, 3.89

Paediatrics 1.46, 3.14, 3.55

Pharmacology 1.3, 1.6, 2.15, 2.18, 2.54

Physics & clinical measurement 1.30, 1.43, 2.13, 2.14, 2.17, 2.21,
2.51, 2.57, 2.78, 3.27, 3.33, 3.54,
3.56

xiv
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page xv

Topic index

Renal 1.13, 1.21, 1.22, 2.25, 2.50, 2.82,

2.90

Respiratory & ventilation 1.4, 1.11, 1.18, 1.50, 1.51, 1.59, 1.69,
1.70, 1.76, 1.77, 1.87, 2.23, 2.26,
2.65, 2.88, 3.1, 3.7, 3.8, 3.13, 3.44,
3.60, 3.78

Resuscitation & sepsis 1.34, 1.35, 2.4, 2.11, 2.37, 2.61, 2.66,
2.71, 3.6, 3.23, 3.26, 3.63, 3.73, 3.80

Scoring systems 1.19, 1.38, 1.54, 1.68, 2.2, 2.33, 2.56,

3.12, 3.28

Surgery 2.53, 3.83, 3.84

Toxicology & poisoning 1.32, 1.39, 1.48, 1.63, 1.67, 2.31,

2.32, 2.69, 3.37, 3.57, 3.79, 3.89

xv
prelims Intensive Care Medicine MCQs_prelims Intensive Care Medicine MCQs.qxd 12/04/15 12:54 PM Page xvi

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

xvi
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 1

Paper 1
Questions

Paper 1
Multiple True False (MTF) questions — select true or false for each of
the five stems.

Questions
1 Guillain-Barré syndrome (GBS):

a. Affects more females than males.

b. Is a disease of the middle-aged.
c. When secondary to a respiratory illness, the majority of cases
present within a month.
d. The presence of cranial nerve signs effectively rules out the
diagnosis.
e. The most common associated pathogen is Clostridium perfringens.

2 In the trauma patient with massive haemorrhage, the

following statements are correct:

a. An initial target systolic blood pressure of 80-90mmHg is

recommended for the patient without brain injury.
b. Desmopressin at a dose of 0.3μg/kg is recommended in the
bleeding patient taking platelet-inhibiting drugs.
c. Recombinant factor VIIa (rFVIIa) can be considered as a rescue
measure provided the platelet count is greater than 30 x 109/L.
d. Pre-injury warfarin use doubles the odds of death for trauma
patients with blunt head injury.
e. Antifibrinolytic drugs recommended for use in the bleeding major
trauma patient include tranexamic acid, aprotinin and aminocaproic
acid.

1
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 2

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

3 The following drugs undergo non-organ metabolism:

a. Esmolol.
b. Atracurium.
c. Inhaled nitric oxide.
d. Propofol.
e. Adrenaline.

4 Which of the following features of an asthma attack

are classified as ‘life-threatening’ in the 2011 BTS
asthma guideline?

a. Inability to complete sentences in one breath.

b. PaO2 of >8kPa.
c. Silent chest.
d. PaCO2 >6kPa.
e. Peak expiratory flow rate (PEFR) <50% of predicted.

5 With regard to bleeding and coagulopathy in the

critically ill patient:

a. If a platelet transfusion is indicated, 1 unit will raise the count by

approximately 20 x 109/L.
b. The principal constituents of cryoprecipitate include Factors VIII,
XIII, vWF, fibronectin and fibrinogen.
c. A suggested dose of fresh frozen plasma in the bleeding trauma
patient with coagulopathy is 30ml/kg.
d. Desmopressin at a dose of 0.3μg/kg is a useful treatment in
patients with coagulopathy related to uraemia, cirrhosis and aspirin
use.
e. At temperatures of 33-35°C, altered enzyme kinetics equate to a
33% reduction in normal clotting factors.

2
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 3

Paper 1

6 Regarding drug-receptor interactions:

a. An antagonist has receptor affinity and intrinsic activity.

Paper 1
b. Increasing the dose of a partial agonist can elicit a maximal effect.
c. β-receptor blockers are reversible antagonists.
d. Flumazenil is an inverse agonist.
e. Phenoxybenzamine is an irreversible antagonist at α-adrenoceptors.

7 Regarding the hepatorenal syndrome (HRS):

Questions
a. It is commonly over-diagnosed in patients with cirrhotic liver
disease.
b. HRS Type 1 has the poorest outcome.
c. Kidneys from patients with HRS are suitable for transplantation.
d. The condition is associated with splanchnic vasodilatation.
e. Terlipressin must be given by infusion.

8 With regard to a patient with a neuromuscular

disorder on the critical care unit:

a. Potassium-sparing diuretics should be avoided in patients with

hypokalaemic periodic paralysis.
b. Suxamethonium use should be avoided in patients with myasthenia
gravis.
c. Patients with motor neurone disease typically require double the
standard dose of suxamethonium to provide optimum intubating
conditions.
d. Local anaesthesia can exacerbate symptoms of multiple sclerosis.
e. In Guillain-Barré syndrome, non-depolarising neuromuscular
blocking drugs may be used, but should be significantly dose-
reduced.

3
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 4

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

9 Regarding parenteral nutrition in the critically ill

patient:

a. A patient with enteral feeds running at 40ml/hr with 4-hourly

aspirates of >200ml is deemed to be failing enteral nutrition.
b. Daily caloric intake should be 100-130% of the patient’s calculated
daily energy expenditure.
c. Parenteral nutrition can be administered peripherally.
d. Approximately 1g/kg/day of nitrogen is required.
e. Copper, zinc and selenium (trace elements) are present in
commercially produced parenteral nutrition solutions.

10 A 67-year-old male has a diagnosis of myasthenia

gravis (MG). Which of the following medications
should be avoided to reduce the risk of exacerbation?

a. Gentamicin.
b. Paracetamol.
c. Trimethoprim.
d. Ciprofloxacin.
e. Aspirin.

11 The following statements are true regarding the

management of acute severe asthma:

a. PEFR <33% is a criterion diagnosis.

b. Aminophylline should be given as a first-line intravenous
bronchodilator.
c. The use of IV magnesium sulphate to reduce mortality is supported
by level I evidence.
d. Ketamine 5mg/kg is the preferred induction agent if rapid sequence
intubation is required.
e. A restrictive fluid regime should be used in patients at risk of
intubation.
4
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 5

Paper 1

12 Regarding the role of selective digestive tract

decontamination (SDD) on the ICU:

Paper 1
a. Eight potentially pathogenic micro-organisms are responsible for
the majority of infections in critical care.
b. SDD is ‘selective’ because it is anaerobe-sparing.
c. Primary endogenous pathogens are targeted by intravenous
antibiotics for the first 4 days.
d. After 10 days potentially pathogenic micro-organisms have been

Questions
eradicated and all antibiotics are stopped.
e. There is level I evidence that SDD increases the prevalence of
antibiotic resistance.

13 A 59-year-old male is admitted with a gradual onset of

peripheral oedema and frothy urine. He is
subsequently diagnosed with nephrotic syndrome.
The condition is associated with:

a. Hypercalcaemia.
b. Venous thrombosis.
c. Hyperlipidaemia.
d. Risk of myocardial infarction.
e. Hypervolaemia.

14 The following have been demonstrated to be useful

prognostic variables in moderate to severe traumatic
brain injury:

a. Age.
b. Pupillary reaction.
c. Sensory neurological deficit.
d. The presence of non-evacuated haematoma on CT brain scan.
e. Serum glucose.

5
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 6

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

15 Regarding the use of ventricular assist devices (VADs)

for the management of acute and chronic heart
failure:

a. Ventricular assist devices can be used for a maximum of 3-4 weeks.

b. A short-term left ventricular assist device takes blood from the right
atrium and injects it into the main pulmonary artery.
c. Most modern ventricular assist devices produce a pulsatile flow.
d. The insertion of an LVAD worsens aortic regurgitation.
e. All patients with VADs must be anticoagulated.

16 Regarding diagnostic lumbar puncture (LP):

a. Meningitis is a relatively rare complication of LP.

b. Suspected bacteraemia is a contraindication to LP.
c. Aspirin should be stopped for at least 24 hours prior to LP.
d. LP is contraindicated in patients with a suspected spinal epidural
abscess.
e. It is recommended that LP is not performed in patients with platelet
counts of <100 x 109.

17 With regard to intracranial pressure (ICP) monitoring:

a. Ocular nerve sheath diameter >6mm measured with ultrasound

reliably predicts raised intracranial pressure of >20mmHg.
b. ICP monitoring through an external ventricular drain allows
therapeutic intervention.
c. On a standard intracranial pressure waveform, P3 represents
cerebral compliance.
d. Cerebral hypoxia results in hypoxic vasoconstriction and reduced
cerebral blood flow, thus causing a temporary reduction in ICP.
e. Lundberg Type A waves are always pathological.

6
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 7

Paper 1

18 Regarding the mechanics of positive pressure

ventilation:

Paper 1
a. Setting an extrinsic positive end-expiratory pressure (PEEP) less
than intrinsic PEEP will reduce elastic work of the respiratory
system.
b. One risk of applying PEEP is a reduction in oxygen delivery (DO2).
c. A decelerating flow pattern is seen in volume-controlled ventilation.
d. The difference between peak and plateau pressures is greater

Questions
with volume-controlled ventilation than pressure-controlled
ventilation.
e. Dynamic compliance equals the tidal volume divided by (peak
pressure minus total positive end-expiratory pressure).

19 The following are examples of severity scoring systems

in the intensive care unit:

a. Acute Physiology and Chronic Health Evaluation III (APACHE III).

b. CT Calcium Score.
c. Sequential Organ Failure Assessment (SOFA).
d. Mortality Prediction Model (MPM).
e. Glasgow-Blatchford Score.

20 The following are examples of superiority randomised

controlled trials (RCTs) relevant to critical care, whose
results support the proposed null hypothesis:

a. ProCESS.
b. PROSEVA.
c. TTM.
d. VASST.
e. OSCAR.

7
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 8

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

21 Regarding plasma exchange:

a. It is a highly effective treatment for thrombotic thrombocytopaenic

purpura.
b. The most commonly used replacement fluid is 4.5% albumin in
physiological saline.
c. Therapeutic plasma exchange requires central venous access.
d. Paraesthesia is a common complication.
e. Thrombosis is a common complication.

22 In patients with, or at risk of, acute kidney injury (AKI),

international consensus guidelines suggest the
following:

a. In critically ill patients, insulin therapy should target a plasma

glucose of about 6-8mmol/L.
b. Administration of colloid boluses to expand intravascular volume.
c. Parenteral nutrition should be used in preference to the enteral
route in patients with AKI.
d. N-acetyl cysteine (NAC) should not be used for the prevention of
post-surgical AKI.
e. Low-dose dopamine has a role in the treatment of established AKI.

23 With regard to the Medical Research Council-funded

CRASH trials:

a. The CRASH 1 trial examined the role of steroids in traumatic brain

injury (TBI).
b. The CRASH 2 trial assessed the role of tranexamic acid in
traumatic brain injury (TBI) within a pilot sample.
c. The CRASH 3 trial is designed to assess the effectiveness of
tranexamic acid in TBI within a multicentre cohort.

8
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 9

Paper 1

d. The number needed to treat (NNT) in Crash 2 to save one life was
>50.
e. There is now level I evidence to support the role of steroids in

Paper 1
TBI.

24 Regarding diabetic ketoacidosis (DKA):

a. DKA can be diagnosed if a known diabetic patient presents with

hyperglycaemia (plasma glucose >10mmol/L) and a serum

Questions
bicarbonate of <15mmol/L.
b. A high serum ketone level indicates more severe disease.
c. DKA should be treated with a fixed rate insulin infusion.
d. When managing a patient with DKA, their usual insulin regime
should be stopped but oral antidiabetic medication should be
continued.
e. DKA is deemed to have resolved when urinary ketones are no
longer detectable.

25 The following apply to levosimendan:

a. It impairs diastolic relaxation.

b. It is a sodium channel sensitiser.
c. It increases myocardial oxygen consumption.
d. It can be used with β-blockers.
e. No loading dose is required due to the very short half-life.

26 With regard to thrombotic thrombocytopaenia

purpura (TTP):

a. Platelet transfusion is recommended to maintain a platelet count of

>10 x 109/L.

9
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 10

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

b. The principal abnormality occurs due to the production of an

abnormal vWF cleaving protein.
c. The diagnostic pentad includes microangiopathic haemolytic
anaemia.
d. The diagnostic pentad includes proven or suspected arterial or
venous thrombosis.
e. Administration of solvent/detergent-treated fresh frozen plasma is a
useful treatment option.

27 Anatomical landmarks and anatomy in relation to

therapeutic practical procedures are as follows:

a. Needle decompression of a tension pneumothorax is best

performed by inserting a needle immediately below the second rib
in the mid-axillary line.
b. A chest drain should be inserted in the 5th intercostal space, just
anterior to the mid-axillary line.
c. Abdominal paracentesis can safely be performed 1cm below the
umbilicus.
d. A central venous catheter inserted into the femoral vein will lie
medial to the femoral nerve and lateral to the femoral artery.
e. Needle insertion for landmark-guided pericardiocentesis is
immediately below and to the right of the xiphisternum, between the
xiphisternum and the right costal margin.

28 A 67-year-old male has been mechanically ventilated

for 2 weeks on the ICU. He has had multiple courses of
antibiotics for chest sepsis. He develops profuse
diarrhoea over 2 days. A diagnosis of Clostridium
difficile infection is considered. Regarding this
organism:

a. Around 20% of all cases of antibiotic-associated diarrhoea are due

to Clostridium difficile.

10
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 11

Paper 1

b. β-lactam antibiotics are least commonly associated with Clostridium

difficile infection.
c. The onset of diarrhoea may not occur until several weeks after the

Paper 1
termination of antibiotic therapy.
d. Stool culture has a high specificity but low sensitivity for diagnosis.
e. Asymptomatic carriage of C. difficile among hospitalised patients is
low.

29 Regarding the acute management of a subarachnoid

Questions
haemorrhage:

a. The peak incidence of vasospasm occurs at day 4.

b. Use of intravenous magnesium to reduce the incidence of
vasospasm is supported by the MASH (Magnesium for Aneurysmal
Subarachnoid Haemorrhage) trials.
c. Hypervolaemia, hypertension and haemodilution therapy reduces
the incidence of vasospasm.
d. Mean arterial pressure (MAP) targets should be set to >90mmHg
following protection of the aneurysm.
e. Clipping and coiling are equally effective treatment options in terms
of neurological outcome.

30 Regarding the pre-operative assessment of exercise

capacity:

a. 1 metabolic equivalent (MET) is roughly equivalent to climbing one

flight of stairs.
b. The anaerobic threshold (AT) is the point at which oxygen supply
exceeds demand.
c. Patients with an AT of >15ml/min O2 have a high relative risk of
cardiopulmonary morbidity following major non-cardiac surgery.
d. Cardiopulmonary exercise testing is relatively contraindicated in the
presence of severe aortic stenosis.
e. Oxygen consumption = cardiac output x (arterial-mixed venous
oxygen content).
11
Paper 1 questions_Paper 1 questions.qxd 12/04/15 10:35 AM Page 12

Intensive Care Medicine MCQs — Multiple Choice Questions with Explanatory Answers

31 A patient on the cardiothoracic intensive care unit has

an intra-aortic balloon pump (IABP) in situ. Which of
the following apply with regard to the IABP?

a. An IABP is contraindicated in aortic stenosis.

b. The IABP can be inserted via the femoral route.
c. The balloon inflates during systole.
d. Heliox is used to inflate the balloon.
e. An IABP improves cerebral and coronary perfusion.

32 In a patient with acute severe tricyclic antidepressant

poisoning:

a. A dominant R-wave >3mm is often seen in lead aVR.

b. QRS prolongation is a useful prognostic feature and should be
routinely measured.
c. First-line treatment for acute dysrhythmia should include a 2-4g
bolus of magnesium sulphate.
d. Intralipid® can be used as a rescue measure.
e. The pH should be normalised by intubation and hyperventilation.

33 Regarding the physiology of the donor heart following

cardiac transplantation:

a. β-adrenergic blockers will have no effect on the heart rate.

b. The Valsalva manoeurvre will have no effect on heart rate.
c. Glyceryl trinitrate (GTN) will cause coronary vasodilatation.
d. The post-cardiac transplant patient can suffer anginal pain.
e. The heart rate will not increase during exercise unless a
pacemaker is fitted.

12
Another random document with
no related content on Scribd:
 *** END OF THE PROJECT GUTENBERG EBOOK JUHANNUS-
ILTANA ***

Updated editions will replace the previous one—the old editions will
be renamed.

Creating the works from print editions not protected by U.S.

copyright law means that no one owns a United States copyright in
these works, so the Foundation (and you!) can copy and distribute it
in the United States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part of
this license, apply to copying and distributing Project Gutenberg™
electronic works to protect the PROJECT GUTENBERG™ concept
and trademark. Project Gutenberg is a registered trademark, and
may not be used if you charge for an eBook, except by following the
terms of the trademark license, including paying royalties for use of
the Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is very
easy. You may use this eBook for nearly any purpose such as
creation of derivative works, reports, performances and research.
Project Gutenberg eBooks may be modified and printed and given
away—you may do practically ANYTHING in the United States with
eBooks not protected by U.S. copyright law. Redistribution is subject
to the trademark license, especially commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE
 PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free

distribution of electronic works, by using or distributing this work (or
any other work associated in any way with the phrase “Project
Gutenberg”), you agree to comply with all the terms of the Full
Project Gutenberg™ License available with this file or online at
www.gutenberg.org/license.

Section 1. General Terms of Use and

Redistributing Project Gutenberg™
electronic works
1.A. By reading or using any part of this Project Gutenberg™
electronic work, you indicate that you have read, understand, agree
to and accept all the terms of this license and intellectual property
(trademark/copyright) agreement. If you do not agree to abide by all
the terms of this agreement, you must cease using and return or
destroy all copies of Project Gutenberg™ electronic works in your
possession. If you paid a fee for obtaining a copy of or access to a
Project Gutenberg™ electronic work and you do not agree to be
bound by the terms of this agreement, you may obtain a refund from
the person or entity to whom you paid the fee as set forth in
paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be

used on or associated in any way with an electronic work by people
who agree to be bound by the terms of this agreement. There are a
few things that you can do with most Project Gutenberg™ electronic
works even without complying with the full terms of this agreement.
See paragraph 1.C below. There are a lot of things you can do with
Project Gutenberg™ electronic works if you follow the terms of this
agreement and help preserve free future access to Project
Gutenberg™ electronic works. See paragraph 1.E below.
1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the
collection of Project Gutenberg™ electronic works. Nearly all the
individual works in the collection are in the public domain in the
United States. If an individual work is unprotected by copyright law in
the United States and you are located in the United States, we do
not claim a right to prevent you from copying, distributing,
performing, displaying or creating derivative works based on the
work as long as all references to Project Gutenberg are removed. Of
course, we hope that you will support the Project Gutenberg™
mission of promoting free access to electronic works by freely
sharing Project Gutenberg™ works in compliance with the terms of
this agreement for keeping the Project Gutenberg™ name
associated with the work. You can easily comply with the terms of
this agreement by keeping this work in the same format with its
attached full Project Gutenberg™ License when you share it without
charge with others.

1.D. The copyright laws of the place where you are located also
govern what you can do with this work. Copyright laws in most
countries are in a constant state of change. If you are outside the
United States, check the laws of your country in addition to the terms
of this agreement before downloading, copying, displaying,
performing, distributing or creating derivative works based on this
work or any other Project Gutenberg™ work. The Foundation makes
no representations concerning the copyright status of any work in
any country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other

immediate access to, the full Project Gutenberg™ License must
appear prominently whenever any copy of a Project Gutenberg™
work (any work on which the phrase “Project Gutenberg” appears, or
with which the phrase “Project Gutenberg” is associated) is
accessed, displayed, performed, viewed, copied or distributed:
 This eBook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it away
or re-use it under the terms of the Project Gutenberg License
included with this eBook or online at www.gutenberg.org. If you
are not located in the United States, you will have to check the
laws of the country where you are located before using this
eBook.

1.E.2. If an individual Project Gutenberg™ electronic work is derived

from texts not protected by U.S. copyright law (does not contain a
notice indicating that it is posted with permission of the copyright
holder), the work can be copied and distributed to anyone in the
United States without paying any fees or charges. If you are
redistributing or providing access to a work with the phrase “Project
Gutenberg” associated with or appearing on the work, you must
comply either with the requirements of paragraphs 1.E.1 through
1.E.7 or obtain permission for the use of the work and the Project
Gutenberg™ trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is posted

with the permission of the copyright holder, your use and distribution
must comply with both paragraphs 1.E.1 through 1.E.7 and any
additional terms imposed by the copyright holder. Additional terms
will be linked to the Project Gutenberg™ License for all works posted
with the permission of the copyright holder found at the beginning of
this work.

1.E.4. Do not unlink or detach or remove the full Project

Gutenberg™ License terms from this work, or any files containing a
part of this work or any other work associated with Project
Gutenberg™.

1.E.5. Do not copy, display, perform, distribute or redistribute this

electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1 with
active links or immediate access to the full terms of the Project
Gutenberg™ License.
1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form,
including any word processing or hypertext form. However, if you
provide access to or distribute copies of a Project Gutenberg™ work
in a format other than “Plain Vanilla ASCII” or other format used in
the official version posted on the official Project Gutenberg™ website
(www.gutenberg.org), you must, at no additional cost, fee or expense
to the user, provide a copy, a means of exporting a copy, or a means
of obtaining a copy upon request, of the work in its original “Plain
Vanilla ASCII” or other form. Any alternate format must include the
full Project Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,

performing, copying or distributing any Project Gutenberg™ works
unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing

access to or distributing Project Gutenberg™ electronic works
provided that:

• You pay a royalty fee of 20% of the gross profits you derive from
the use of Project Gutenberg™ works calculated using the
method you already use to calculate your applicable taxes. The
fee is owed to the owner of the Project Gutenberg™ trademark,
but he has agreed to donate royalties under this paragraph to
the Project Gutenberg Literary Archive Foundation. Royalty
payments must be paid within 60 days following each date on
which you prepare (or are legally required to prepare) your
periodic tax returns. Royalty payments should be clearly marked
as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information
about donations to the Project Gutenberg Literary Archive
Foundation.”

• You provide a full refund of any money paid by a user who

notifies you in writing (or by e-mail) within 30 days of receipt that
s/he does not agree to the terms of the full Project Gutenberg™
 License. You must require such a user to return or destroy all
copies of the works possessed in a physical medium and
discontinue all use of and all access to other copies of Project
Gutenberg™ works.

• You provide, in accordance with paragraph 1.F.3, a full refund of

any money paid for a work or a replacement copy, if a defect in
the electronic work is discovered and reported to you within 90
days of receipt of the work.

• You comply with all other terms of this agreement for free
distribution of Project Gutenberg™ works.

1.E.9. If you wish to charge a fee or distribute a Project Gutenberg™

electronic work or group of works on different terms than are set
forth in this agreement, you must obtain permission in writing from
the Project Gutenberg Literary Archive Foundation, the manager of
the Project Gutenberg™ trademark. Contact the Foundation as set
forth in Section 3 below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend

considerable effort to identify, do copyright research on, transcribe
and proofread works not protected by U.S. copyright law in creating
the Project Gutenberg™ collection. Despite these efforts, Project
Gutenberg™ electronic works, and the medium on which they may
be stored, may contain “Defects,” such as, but not limited to,
incomplete, inaccurate or corrupt data, transcription errors, a
copyright or other intellectual property infringement, a defective or
damaged disk or other medium, a computer virus, or computer
codes that damage or cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except

for the “Right of Replacement or Refund” described in paragraph
1.F.3, the Project Gutenberg Literary Archive Foundation, the owner
of the Project Gutenberg™ trademark, and any other party
distributing a Project Gutenberg™ electronic work under this
agreement, disclaim all liability to you for damages, costs and
expenses, including legal fees. YOU AGREE THAT YOU HAVE NO
REMEDIES FOR NEGLIGENCE, STRICT LIABILITY, BREACH OF
WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE
PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE
FOUNDATION, THE TRADEMARK OWNER, AND ANY
DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE
TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL,
PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE
NOTICE OF THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you

discover a defect in this electronic work within 90 days of receiving it,
you can receive a refund of the money (if any) you paid for it by
sending a written explanation to the person you received the work
from. If you received the work on a physical medium, you must
return the medium with your written explanation. The person or entity
that provided you with the defective work may elect to provide a
replacement copy in lieu of a refund. If you received the work
electronically, the person or entity providing it to you may choose to
give you a second opportunity to receive the work electronically in
lieu of a refund. If the second copy is also defective, you may
demand a refund in writing without further opportunities to fix the
problem.

1.F.4. Except for the limited right of replacement or refund set forth in
paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED,
INCLUDING BUT NOT LIMITED TO WARRANTIES OF
MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied

warranties or the exclusion or limitation of certain types of damages.
If any disclaimer or limitation set forth in this agreement violates the
law of the state applicable to this agreement, the agreement shall be
interpreted to make the maximum disclaimer or limitation permitted
by the applicable state law. The invalidity or unenforceability of any
provision of this agreement shall not void the remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the

Foundation, the trademark owner, any agent or employee of the
Foundation, anyone providing copies of Project Gutenberg™
electronic works in accordance with this agreement, and any
volunteers associated with the production, promotion and distribution
of Project Gutenberg™ electronic works, harmless from all liability,
costs and expenses, including legal fees, that arise directly or
indirectly from any of the following which you do or cause to occur:
(a) distribution of this or any Project Gutenberg™ work, (b)
alteration, modification, or additions or deletions to any Project
Gutenberg™ work, and (c) any Defect you cause.

Section 2. Information about the Mission of

Project Gutenberg™
Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new computers.
It exists because of the efforts of hundreds of volunteers and
donations from people in all walks of life.

Volunteers and financial support to provide volunteers with the

assistance they need are critical to reaching Project Gutenberg™’s
goals and ensuring that the Project Gutenberg™ collection will
remain freely available for generations to come. In 2001, the Project
Gutenberg Literary Archive Foundation was created to provide a
secure and permanent future for Project Gutenberg™ and future
generations. To learn more about the Project Gutenberg Literary
Archive Foundation and how your efforts and donations can help,
see Sections 3 and 4 and the Foundation information page at
www.gutenberg.org.
 Section 3. Information about the Project
Gutenberg Literary Archive Foundation
The Project Gutenberg Literary Archive Foundation is a non-profit
501(c)(3) educational corporation organized under the laws of the
state of Mississippi and granted tax exempt status by the Internal
Revenue Service. The Foundation’s EIN or federal tax identification
number is 64-6221541. Contributions to the Project Gutenberg
Literary Archive Foundation are tax deductible to the full extent
permitted by U.S. federal laws and your state’s laws.

The Foundation’s business office is located at 809 North 1500 West,

Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up
to date contact information can be found at the Foundation’s website
and official page at www.gutenberg.org/contact

Section 4. Information about Donations to

the Project Gutenberg Literary Archive
Foundation
Project Gutenberg™ depends upon and cannot survive without
widespread public support and donations to carry out its mission of
increasing the number of public domain and licensed works that can
be freely distributed in machine-readable form accessible by the
widest array of equipment including outdated equipment. Many small
donations ($1 to $5,000) are particularly important to maintaining tax
exempt status with the IRS.

The Foundation is committed to complying with the laws regulating

charities and charitable donations in all 50 states of the United
States. Compliance requirements are not uniform and it takes a
considerable effort, much paperwork and many fees to meet and
keep up with these requirements. We do not solicit donations in
locations where we have not received written confirmation of
compliance. To SEND DONATIONS or determine the status of
compliance for any particular state visit www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states where

we have not met the solicitation requirements, we know of no
prohibition against accepting unsolicited donations from donors in
such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot make

any statements concerning tax treatment of donations received from
outside the United States. U.S. laws alone swamp our small staff.

Please check the Project Gutenberg web pages for current donation
methods and addresses. Donations are accepted in a number of
other ways including checks, online payments and credit card
donations. To donate, please visit: www.gutenberg.org/donate.

Section 5. General Information About Project

Gutenberg™ electronic works
Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could be
freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose network of
volunteer support.

Project Gutenberg™ eBooks are often created from several printed

editions, all of which are confirmed as not protected by copyright in
the U.S. unless a copyright notice is included. Thus, we do not
necessarily keep eBooks in compliance with any particular paper
edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,

including how to make donations to the Project Gutenberg Literary
Archive Foundation, how to help produce our new eBooks, and how
to subscribe to our email newsletter to hear about new eBooks.