Free DHA Critical Care Medicine mock test

Critical Care Medicine sample questions with answers

4 more original exam-style Critical Care Medicine questions, worked in full. They are not real or recalled exam questions, and none of them is in the diagnostic above, so sit that first if you have not.

1. Question 1 · Cardiovascular critical care

   A patient with inferior STEMI is hypotensive with clear lungs, raised jugular venous pressure and ST elevation in V4R. Which treatment should be avoided?

   1. ACautious intravenous fluid loading
   2. BUrgent primary percutaneous intervention
   3. CSublingual glyceryl trinitrate
   4. DInotropic support if fluid fails
   Show answer and explanation

   Correct answer: C. Sublingual glyceryl trinitrate

   Right ventricular infarction is preload-dependent, so nitrates and diuretics can cause profound hypotension. Cautious fluid loading and early reperfusion are appropriate.

   Reference: ESC Guidelines for the Management of Acute Coronary Syndromes 2023

2. Question 2 · Neurocritical care

   A patient with aneurysmal subarachnoid haemorrhage had the aneurysm secured by coiling. Which drug regimen improves neurological outcome?

   1. AOral nimodipine 60 mg every 4 hours for 21 days
   2. BIntravenous nicardipine to keep systolic below 100 mmHg
   3. CProphylactic hypervolaemia and haemodilution
   4. DTranexamic acid 1 g every 8 hours for 21 days
   Show answer and explanation

   Correct answer: A. Oral nimodipine 60 mg every 4 hours for 21 days

   Oral nimodipine 60 mg every 4 hours for 21 days improves outcome after aneurysmal SAH. Prophylactic triple-H therapy is no longer recommended, and prolonged antifibrinolytics increase ischaemic complications.

   Reference: AHA/ASA Guideline for Aneurysmal Subarachnoid Haemorrhage 2023

3. Question 3 · Renal, metabolic, fluids and electrolytes

   A woman with sodium 114 mmol/L has a generalised seizure. What is the initial treatment and the safe correction limit?

   1. A1 litre of 0.9% saline over 1 hour; limit rise to 20 mmol/L in 24 h
   2. BFluid restriction to 800 mL/day; limit rise to 12 mmol/L in 24 h
   3. C150 mL of 3% saline over 20 minutes; limit rise to 10 mmol/L in 24 h
   4. DTolvaptan 15 mg orally; limit rise to 15 mmol/L in 24 h
   Show answer and explanation

   Correct answer: C. 150 mL of 3% saline over 20 minutes; limit rise to 10 mmol/L in 24 h

   Severely symptomatic hyponatraemia is treated with 150 mL boluses of 3% saline over 20 minutes, aiming for a 5 mmol/L rise, with total correction kept within 10 mmol/L in the first 24 hours to avoid osmotic demyelination. Fluid restriction is too slow for seizures.

   Reference: European Clinical Practice Guideline on Hyponatraemia 2014

4. Question 4 · Neurocritical care

   Before clinical brain death testing in an adult, which prerequisite must be met?

   1. ANormal EEG performed within 24 hours
   2. BSerum sodium between 140 and 145 mmol/L exactly
   3. CAbsence of any vasopressor support
   4. DCore body temperature of at least 36 degrees C
   Show answer and explanation

   Correct answer: D. Core body temperature of at least 36 degrees C

   Confounders must be excluded before testing, including hypothermia (core temperature at least 36 degrees C), sedative drugs and severe metabolic disturbance. Vasopressors are allowed if target blood pressure is achieved, and EEG is an ancillary test, not a prerequisite.

   Reference: AAN/AAP/CNS/SCCM Brain Death Guideline 2023