Q.1 Which of the following is the most important initial step in managing a patient with septic shock in the ICU?
Start antibiotics immediately
Begin vasopressors
Administer IV fluids
Intubate the patient
Explanation - The cornerstone of initial septic shock management is fluid resuscitation to restore intravascular volume and improve perfusion, followed closely by antibiotics and vasopressors if needed.
Correct answer is: Administer IV fluids
Q.2 Which vasopressor is considered first-line in septic shock?
Epinephrine
Dopamine
Phenylephrine
Norepinephrine
Explanation - Norepinephrine is the first-line vasopressor in septic shock because of its effectiveness in increasing mean arterial pressure without causing significant arrhythmias.
Correct answer is: Norepinephrine
Q.3 In the ICU, which electrolyte disturbance is most commonly associated with prolonged mechanical ventilation?
Hypernatremia
Hypokalemia
Hyperkalemia
Hypocalcemia
Explanation - Hypokalemia can cause muscle weakness and impaired respiratory muscle function, often complicating weaning from mechanical ventilation.
Correct answer is: Hypokalemia
Q.4 What is the recommended tidal volume for lung-protective ventilation in ARDS?
4–6 mL/kg of predicted body weight
8–10 mL/kg of actual body weight
10–12 mL/kg of predicted body weight
6–8 mL/kg of actual body weight
Explanation - Lung-protective ventilation with low tidal volumes (4–6 mL/kg predicted body weight) reduces mortality in ARDS patients.
Correct answer is: 4–6 mL/kg of predicted body weight
Q.5 Which scoring system is commonly used to predict mortality in ICU patients?
APACHE II
Glasgow Coma Scale
NYHA classification
CHA₂DS₂-VASc
Explanation - The APACHE II (Acute Physiology and Chronic Health Evaluation II) score is widely used to predict ICU mortality risk.
Correct answer is: APACHE II
Q.6 Which of the following is a contraindication for non-invasive ventilation (NIV)?
COPD exacerbation
Cardiogenic pulmonary edema
Severe metabolic acidosis with shock
Obesity hypoventilation syndrome
Explanation - NIV is contraindicated in hemodynamic instability or severe metabolic acidosis requiring immediate intubation.
Correct answer is: Severe metabolic acidosis with shock
Q.7 Which monitoring device provides continuous cardiac output measurement in the ICU?
Arterial line
Central venous catheter
Swan-Ganz catheter
Pulse oximeter
Explanation - The pulmonary artery catheter (Swan-Ganz) can measure cardiac output, pulmonary pressures, and mixed venous oxygen saturation.
Correct answer is: Swan-Ganz catheter
Q.8 What is the most common cause of ICU-acquired infections?
Central line-associated bloodstream infection
Ventilator-associated pneumonia
Catheter-associated urinary tract infection
Surgical site infection
Explanation - Ventilator-associated pneumonia is the most frequent ICU-acquired infection due to prolonged intubation and mechanical ventilation.
Correct answer is: Ventilator-associated pneumonia
Q.9 Which sedative agent is preferred for patients requiring sedation in the ICU with risk of delirium?
Midazolam
Propofol
Ketamine
Dexmedetomidine
Explanation - Dexmedetomidine has sedative properties with less respiratory depression and may reduce delirium risk compared to benzodiazepines.
Correct answer is: Dexmedetomidine
Q.10 What is the recommended target blood glucose range in critically ill ICU patients?
70–110 mg/dL
80–180 mg/dL
140–220 mg/dL
100–200 mg/dL
Explanation - Current guidelines recommend maintaining blood glucose in the range of 80–180 mg/dL to avoid hypoglycemia while controlling hyperglycemia.
Correct answer is: 80–180 mg/dL
Q.11 Which electrolyte abnormality is most commonly associated with tumor lysis syndrome in ICU?
Hypophosphatemia
Hyperphosphatemia
Hypomagnesemia
Hypernatremia
Explanation - Tumor lysis syndrome causes release of intracellular phosphate, potassium, and uric acid, leading to hyperphosphatemia.
Correct answer is: Hyperphosphatemia
Q.12 What is the main mechanism of action of prone positioning in ARDS management?
Reduces airway resistance
Improves cardiac output
Enhances alveolar recruitment
Increases secretion clearance
Explanation - Prone positioning redistributes ventilation and perfusion, improving alveolar recruitment and oxygenation in ARDS.
Correct answer is: Enhances alveolar recruitment
Q.13 Which of the following is a complication of prolonged propofol infusion in ICU?
Renal failure
Propofol infusion syndrome
Neuroleptic malignant syndrome
Malignant hyperthermia
Explanation - Propofol infusion syndrome is a rare but life-threatening complication characterized by metabolic acidosis, cardiac failure, and rhabdomyolysis.
Correct answer is: Propofol infusion syndrome
Q.14 Which ICU scoring system is used to assess the severity of organ dysfunction?
APACHE II
SOFA score
Glasgow Coma Scale
CURB-65
Explanation - The SOFA (Sequential Organ Failure Assessment) score evaluates the extent of organ dysfunction in ICU patients.
Correct answer is: SOFA score
Q.15 In a patient with raised intracranial pressure (ICP), which of the following is contraindicated?
Head elevation
Mannitol infusion
Hyperventilation
Hypotonic saline infusion
Explanation - Hypotonic solutions worsen cerebral edema by increasing brain water content, hence are contraindicated in raised ICP.
Correct answer is: Hypotonic saline infusion
Q.16 Which of the following is a late sign of hypoxemia in ICU patients?
Tachycardia
Restlessness
Cyanosis
Hypertension
Explanation - Cyanosis is a late sign of hypoxemia when oxygen saturation is significantly low; early signs include tachycardia and agitation.
Correct answer is: Cyanosis
Q.17 What is the best diagnostic test for confirming ventilator-associated pneumonia?
Sputum culture
Endotracheal aspirate culture
Bronchoalveolar lavage
Chest X-ray
Explanation - Bronchoalveolar lavage with quantitative cultures provides the most accurate diagnosis of ventilator-associated pneumonia.
Correct answer is: Bronchoalveolar lavage
Q.18 Which of the following is a major risk factor for ICU delirium?
Younger age
Hypoxemia
Physical activity
Short ICU stay
Explanation - Hypoxemia and metabolic derangements are major contributors to ICU delirium.
Correct answer is: Hypoxemia
Q.19 Which of the following is the gold standard for confirming central venous catheter placement?
Ultrasound
ECG guidance
Chest X-ray
Blood aspiration
Explanation - Post-procedure chest X-ray is the gold standard for confirming central venous catheter position and ruling out pneumothorax.
Correct answer is: Chest X-ray
Q.20 In shock management, the target mean arterial pressure (MAP) is generally:
50 mmHg
60 mmHg
65 mmHg
75 mmHg
Explanation - Guidelines recommend maintaining MAP ≥65 mmHg to ensure adequate tissue perfusion in shock patients.
Correct answer is: 65 mmHg
Q.21 What is the preferred anticoagulant for preventing DVT in ICU patients?
Unfractionated heparin
Warfarin
Aspirin
Clopidogrel
Explanation - Low-dose unfractionated heparin or low-molecular-weight heparin is used for DVT prophylaxis in ICU patients.
Correct answer is: Unfractionated heparin
Q.22 Which electrolyte should be closely monitored in patients on amphotericin B in the ICU?
Calcium
Potassium
Sodium
Chloride
Explanation - Amphotericin B causes renal potassium wasting, leading to hypokalemia that must be monitored in ICU patients.
Correct answer is: Potassium
Q.23 Which ventilator parameter is most important to prevent barotrauma in ICU patients?
PEEP
Plateau pressure
FiO₂
Respiratory rate
Explanation - Keeping plateau pressure <30 cmH₂O is essential to reduce the risk of barotrauma in ventilated patients.
Correct answer is: Plateau pressure
Q.24 What is the most appropriate fluid for initial resuscitation in septic shock?
Normal saline
5% dextrose
Albumin
Ringer’s lactate
Explanation - Balanced crystalloids like Ringer’s lactate are preferred over saline due to lower risk of hyperchloremic acidosis.
Correct answer is: Ringer’s lactate
Q.25 Which parameter is used to assess readiness for extubation in ICU?
SpO₂ >85%
Rapid shallow breathing index
PEEP <10 cmH₂O
PaCO₂ >60 mmHg
Explanation - Rapid shallow breathing index (RSBI) is used to assess readiness for extubation; RSBI <105 predicts successful weaning.
Correct answer is: Rapid shallow breathing index