MCQ Paper No.4

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Please select True or False for the following questions.

1. Chest X-ray can usually differentiate between the following in a patient with normal anatomy:

a. CVC in the SVC or ascending aorta
b. CVC in the SVC or azygous vein
c. CVC in the SVC or hemi-azygous vein
d. CVC above or below the pericardial reflection
e. CVC in the SVC or internal mammary vein
2. The following are specific treatments for the associated condition:
a. Bretylium and local anaesthetic toxicity
b. Intralipid and local anaesthetic toxicity
c. Dantrolene and malignant hyperpyrexia
d. Cyproheptadine and serotonin syndrome
e. Aspirin and n-acetyl cysteine
3. Ethylene glycol poisoning:

a. Typically causes a metabolic alkalosis
b. Co-poisoning with ethanol may be protective
c. It typically causes renal failure and liver failure
d. Is associated with a normal osmolar gap
e. Folinic acid may be used in its treatment
4. Absolute contraindications to DCD organ donation include:

a. Age > 75
b. Recent sepsis
c. Creutzfeldt-Jakob disease
d. Active haematological malignancy
e. HIV infection
5. Risk factors for ventilator associated pneumonia include:

a. NG tube
b. Increased gastric residual volume
c. Gastric acid suppression
d. Previous antibiotic exposure
e. Muscle relaxants

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3 thoughts on “MCQ Paper No.4”

  • Matt Smith

    For question 3: Folinic acid may be used in its [ethylene glycol poisoning] treatment – True
    According to LITFL – “In methanol toxicity, folic acid (50mg IV Q4-6H) or folinic acid (1-2mg/kg IV Q4-6H) increases the breakdown of formic acid to carbon dioxide and water.” Not mentioned under ethylene glycol. I’m sure I read this in another review article somewhere too.

  • Richard Benson

    Sorry chaps I disagree:
    – Methanol is metabolised by alcohol dehydrogenase (ADH) to formaldehyde, which is further metabolised by aldehyde dehydrogenase (ALDH) to formic acid
    – Ethylene glycol is metabolised by ADH to glycoaldehyde, then by ALDH to glycolic acid, which is further metabolised to glycoxylic acid and finally oxalic acid

    Therefore:
    In ethylene glycol toxicity, pyridoxine (100mg IV Q6H) and thiamine (100mg IV Q6H) increase the metabolism of glycolic and glycoxlic acid to the less toxic metabolites glycine and alpha-hydroxy-beta-ketoadipate.
    In methanol toxicity, folic acid (50mg IV Q4-6H) or folinic acid (1-2mg/kg IV Q4-6H) increases the breakdown of formic acid to carbon dioxide and water.

    Not that any of this really matters clinically as serum levels aren’t exactly rapid 😉

    https://lifeinthefastlane.com/toxic-alcohol-ingestion/