Critical Care — MCQs
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Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)? 1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria. 2. It is same as bacteraemia. 3. It results in Multiple Organ Dysfunction Syndrome (MODS). 4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.
Consider the following statements : Systemic Inflammatory Response Syndrome is characterised by 1. Temperature either above 38°C or below 36°C. 2. Heart rate less than 80/minute. 3. Tachypnoea > 20/min. 4. Leucocyte count > 4 x 109/L. Which of the statements given above are correct ?
Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except
Which of the following is NOT a feature of Systemic Inflammatory Response Syndrome?
A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:
Glasgow coma scale (GCS) score ranges between:
Systemic Inflammatory Response Syndrome (SIRS) is characterized by all of the following EXCEPT:
Which one of the following is NOT a complication of massive blood transfusion?
All the following are criteria for SIRS, except
A patient admitted after a road traffic accident is put on mechanical ventilation. He opens his eyes on verbal command and moves all four limbs spontaneously. Calculate his GCS.
Critical Care Indian Medical PG Practice Questions and MCQs
Question 81: Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)? 1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria. 2. It is same as bacteraemia. 3. It results in Multiple Organ Dysfunction Syndrome (MODS). 4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.
- A. 2, 3 and 4
- B. 1, 2 and 3
- C. 1, 3 and 4 (Correct Answer)
- D. 1, 2 and 4
Explanation: ***1, 3 and 4*** - **SIRS** can be caused by the release of **lipopolysaccharide endotoxin** from the cell wall of dying **Gram-negative bacteria** like *E. coli*, triggering a systemic inflammatory response [1]. - One of the major complications of **SIRS** is the progression to **Multiple Organ Dysfunction Syndrome (MODS)**, where organs begin to fail due to uncontrolled inflammation [1]. - A component of the **SIRS criteria** is a white blood cell count greater than 12 x 10^9/L or less than 4 x 10^9/L, or the presence of more than 10% immature band forms [1]. *2, 3 and 4* - **Bacteremia** refers specifically to the presence of **viable bacteria** in the bloodstream, while **SIRS** is a broader inflammatory response that can be triggered by various causes (infectious or non-infectious). - While bacteremia can lead to SIRS, SIRS can also occur without bacteremia (e.g., pancreatitis, trauma). *1, 2 and 3* - **Bacteremia** is not the same as SIRS; bacteremia is a potential cause of SIRS, but SIRS can arise from non-infectious conditions as well. - The presence of bacteria in the blood (bacteremia) is a specific finding, whereas SIRS describes a *syndrome* of systemic inflammation. *1, 2 and 4* - This option incorrectly states that **SIRS is the same as bacteremia**, which it is not. - Also, while bacteremia can lead to SIRS, **MODS** is a crucial and often fatal consequence of advanced SIRS, which is omitted in this option.
Question 82: Consider the following statements : Systemic Inflammatory Response Syndrome is characterised by 1. Temperature either above 38°C or below 36°C. 2. Heart rate less than 80/minute. 3. Tachypnoea > 20/min. 4. Leucocyte count > 4 x 109/L. Which of the statements given above are correct ?
- A. 1 and 3
- B. 3, 4 and 1 (Correct Answer)
- C. 1, 4, 3 and 2
- D. 2, 4 and 3
Explanation: ***3, 4 and 1*** - **SIRS criteria** include a temperature above 38°C or below 36°C [1], and tachypnea with a respiratory rate greater than 20 breaths/minute. - Additionally, a white blood cell count greater than 12,000 cells/mm³ (12 x 10⁹/L) or less than 4,000 cells/mm³ (4 x 10⁹/L), or the presence of more than 10% immature band forms, are part of the criteria. *1 and 3* - This option correctly identifies **temperature** [1] and **tachypnea** as SIRS criteria but omits the leukocyte count, which is also a key component. - It is an incomplete set of correct criteria, missing one crucial element. *1, 4, 3 and 2* - This option incorrectly states a heart rate **less than 80/minute** as a SIRS criterion; the correct criterion for SIRS is a heart rate **greater than 90/minute**. - While it includes other correct criteria, the inclusion of an incorrect heart rate makes this option wrong. *2, 4 and 3* - This option incorrectly states a heart rate **less than 80/minute** as a SIRS criterion. The correct criterion for SIRS is a heart rate **greater than 90/minute**. - It also misses the **temperature** criterion, which is a fundamental component of SIRS [1].
Question 83: Systemic Inflammatory Response Syndrome (SIRS) diagnostic criteria include the following except
- A. Temperature > 38°C or < 36°C
- B. Tachycardia with a heart rate of more than 90/min.
- C. White cell count < 4000/mm³ (Correct Answer)
- D. Tachypnoea with a respiratory rate of > 20/min.
Explanation: ***White cell count < 4000/mm³*** - The correct SIRS criterion regarding white blood cell count is either > 12,000/mm³ or < 4,000/mm³ or the presence of > 10% **immature (band) forms**. [2] - This option correctly states a **WBC count below 4000/mm³**, which is indeed a criterion for SIRS. *Temperature > 38°C or < 36°C* - This is a correct criterion for SIRS, indicating a significant deviation from normal body temperature. [1] - Both **fever (hyperthermia)** and **hypothermia** are signs of systemic inflammation. *Tachycardia with a heart rate of more than 90/min.* - This is a correct criterion for SIRS, reflecting the increased metabolic demand and sympathetic activation during systemic inflammation. [2] - A persistent **heart rate above 90 bpm** is considered indicative of such stress. *Tachypnoea with a respiratory rate of > 20/min.* - This is a correct criterion for SIRS, showing the body's attempt to compensate for metabolic disturbances or increased oxygen demand. [2] - A **respiratory rate greater than 20 breaths per minute** or a PaCO2 less than 32 mmHg are both SIRS criteria.
Question 84: Which of the following is NOT a feature of Systemic Inflammatory Response Syndrome?
- A. Hypothermia (less than 36°C)
- B. Hyperthermia (more than 38°C)
- C. Bradycardia (Correct Answer)
- D. Leucocytosis
Explanation: ***Bradycardia*** - **Bradycardia** (a slow heart rate) is **not** a typical diagnostic criterion for **Systemic Inflammatory Response Syndrome (SIRS)**. - SIRS is usually associated with **tachycardia** (heart rate >90 beats/min) due to the body's increased metabolic demand and stress response [2]. *Hypothermia (less than 36°C)* - **Hypothermia** (<36°C) is a recognized diagnostic criterion for **SIRS**, indicating a dysregulated thermoregulatory response. - It often suggests a more severe or decompensated inflammatory state. *Hyperthermia (more than 38°C)* - **Hyperthermia** (>38°C) is a common and primary diagnostic criterion for **SIRS**, reflecting the body's inflammatory response to infection or injury [2], [3]. - This elevated core temperature is part of the systemic response to pathogens or tissue damage. *Leucocytosis* - **Leucocytosis** (white blood cell count >12,000 cells/mm³) is a key diagnostic criterion for **SIRS**, indicating a robust innate immune response [1], [2]. - A WBC count <4,000 cells/mm³ (leucopenia) or >10% immature neutrophils ("bands") also fulfills this criterion.
Question 85: A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cumm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having:
- A. Sepsis syndrome
- B. Systemic inflammatory response syndrome (Correct Answer)
- C. Multisystem organ failure (MSOF)
- D. Wound infection
Explanation: ***Systemic inflammatory response syndrome*** - The patient's presentation with **tachycardia** (pulse 106/min), **tachypnea** (respiratory rate 26/min), and **leukocytosis** (TLC 14000/µL) meets at least two criteria for **Systemic Inflammatory Response Syndrome (SIRS)** following a significant surgical stressor. - SIRS is a generalized inflammatory response to various insults, including major surgery, trauma, and infection, occurring in the absence of a confirmed infection. *Sepsis syndrome* - **Sepsis syndrome** is defined as SIRS with a **confirmed or suspected infectious source**. While the patient had a bowel injury, there is no definitive evidence of active infection provided (e.g., positive cultures, purulent discharge). - Although the bowel injury could lead to infection, the current information only confirms a systemic inflammatory response, not necessarily a microbial cause. *Multisystem organ failure (MSOF)* - **Multisystem organ failure (MSOF)** involves the failure of two or more organ systems. While the patient has elevated **BUN** and **creatinine**, indicating **acute kidney injury**, there's no evidence of failure in other systems required to diagnose MSOF. - MSOF is a more severe progression of SIRS or sepsis, characterized by severe organ dysfunction, which is not fully met by the current presentation. *Wound infection* - **Wound infection** is a localized infection and would typically present with signs like **erythema**, **purulent discharge**, **tenderness**, or **warmth** at the surgical site. None of these specific local signs are mentioned. - While a wound infection could be a potential source of SIRS or sepsis, the clinical picture provided describes a systemic response rather than a localized one.
Question 86: Glasgow coma scale (GCS) score ranges between:
- A. 1 and 15
- B. 2 and 15
- C. 3 and 15 (Correct Answer)
- D. 0 and 15
Explanation: **3 and 15** * The **Glasgow Coma Scale (GCS)** is a neurological scale that aims to give a reliable and objective way of recording the conscious state of a person [2]. * A score of **3 represents the lowest possible level of consciousness**, indicating a severe injury [1], while **15 represents full consciousness** [1]. * *1 and 15* * The GCS assesses three components: **eye opening, verbal response, and motor response** [2]. Each component has a minimum score of 1. * Therefore, a total score of 1 is not possible as the minimum score for any individual component is 1, and there are three components. * *2 and 15* * The lowest possible score for any single component in the GCS is 1 (e.g., no eye opening, no verbal response, no motor response). * With three components, the sum of the minimum scores (1+1+1) is 3, making a total score of 2 impossible. * *0 and 15* * The GCS is designed with a minimum score of 1 for each of its three categories. * A score of 0 is not used in the GCS scoring system; the lowest possible score for any component is 1, even in an unresponsive state.
Question 87: Systemic Inflammatory Response Syndrome (SIRS) is characterized by all of the following EXCEPT:
- A. Hyperthermia (>38˚C)
- B. Platelet count (<1,00,000/mm3) (Correct Answer)
- C. Tachypnoea (>20/min)
- D. Hypothermia (<36˚C)
Explanation: ***Platelet count (<1,00,000/mm3)*** - While **thrombocytopenia** can be a feature of severe infection or systemic illness, it is not one of the defining diagnostic criteria for **SIRS**. [1] - The definition of SIRS primarily focuses on inflammatory markers like temperature, heart rate, respiratory rate, and white blood cell count. *Hyperthermia (>38˚C)* - **Fever** is a classic sign of inflammation and infection, and a temperature greater than 38°C is one of the key diagnostic criteria for SIRS. [2] - This indicates the body's systemic inflammatory response to a perceived insult. [3] *Tachypnoea (>20/min)* - An increased **respiratory rate**, or **tachypnea**, is another important criterion for SIRS, reflecting increased metabolic demand or respiratory compensation. - This criterion helps identify patients with a significant physiological response to inflammation. *Hypothermia (<36˚C)* - While less common than fever, **hypothermia** (temperature less than 36°C) can also be a sign of a severe systemic inflammatory response, particularly in immunocompromised or severely ill patients. - It signifies a dysregulated thermoregulatory response in SIRS.
Question 88: Which one of the following is NOT a complication of massive blood transfusion?
- A. Hyperthermia (Correct Answer)
- B. Hyperkalemia
- C. Hypocalcaemia
- D. Coagulopathy
Explanation: ***Hyperthermia*** - **Hypothermia** is a more common complication of massive blood transfusion due to the administration of large volumes of cold blood products. - While theoretical, hyperthermia in this context would be rare and not a direct complication of the blood components themselves, unless equipment malfunction or infection occurs. [1] *Hyperkalemia* - Stored red blood cells **leak potassium** as they age, leading to higher potassium levels in the transfusion product. - Rapid infusion of large volumes can overwhelm the body's compensatory mechanisms, resulting in **elevated serum potassium**. *Hypocalcaemia* - **Citrate**, an anticoagulant used in blood storage, binds to ionized calcium in the recipient's blood. - Massive transfusions can lead to significant citrate accumulation, causing a drop in **ionized calcium levels**. *Coagulopathy* - Massive transfusions dilute clotting factors and platelets, which are not proportionally replaced in standard transfusion protocols. - This dilution can lead to impaired **hemostasis** and increased bleeding tendencies. [1]
Question 89: All the following are criteria for SIRS, except
- A. Heart rate >90/min
- B. Systolic blood pressure <90 mmHg (Correct Answer)
- C. Respiratory rate >20 bpm
- D. Temperature >38 degree Celsius or <36 degree Celsius
Explanation: ***Systolic blood pressure <90 mmHg*** - This criterion is associated with **septic shock** or **hypotension**, indicating organ dysfunction, which is a more severe stage beyond **SIRS**. - While low blood pressure can be seen in severe infections, it is not a direct diagnostic criterion for **SIRS** itself. *Heart rate >90/min* - An elevated **heart rate** (tachycardia) is a common physiological response to systemic stress and inflammation. - This criterion fulfills one of the four clinical parameters to diagnose **SIRS**. *Respiratory rate >20 bpm* - An increased **respiratory rate** (tachypnea) reflects the body's attempt to compensate for metabolic acidosis or increased oxygen demand during a systemic inflammatory response. - This criterion is one of the four clinical parameters used to diagnose **SIRS**. *Temperature >38 degree Celsius or <36 degree Celsius* - Both **fever** (>38°C) and **hypothermia** (<36°C) are indicators of a systemic inflammatory response, as the body's thermoregulation is affected [1]. - This criterion is one of the four principal parameters used to diagnose **SIRS** [1].
Question 90: A patient admitted after a road traffic accident is put on mechanical ventilation. He opens his eyes on verbal command and moves all four limbs spontaneously. Calculate his GCS.
- A. Eyes-3, Verbal -NT, Motor-6 (Correct Answer)
- B. Eyes -3, Verbal-1, Motor -6
- C. Eyes-2, Verbal -1, Motor -5
- D. Eyes-2, Verbal -NT, Motor -5
Explanation: ***Eyes-3, Verbal -NT, Motor-6*** - **Eyes opening to verbal command** scores 3 points on the GCS [1]. - The patient is on **mechanical ventilation**, meaning their verbal response cannot be assessed, leading to a "Non-Testable" (NT) score for verbal [1]. **Spontaneous movement of all four limbs** indicates full motor function, scoring 6 points [2]. *Eyes -3, Verbal-1, Motor -6* - While **eyes opening to verbal command** (3 points) and **spontaneous motor movement** (6 points) are correct, a verbal score of 1 implies **no verbal response** if the patient were able to speak, which is not applicable here due to mechanical ventilation. *Eyes-2, Verbal -1, Motor -5* - **Eyes opening to pain** scores 2, but the patient responded to verbal command. A verbal score of 1 is for no response, and a motor score of 5 indicates localizing to pain, not spontaneous movement. *Eyes-2, Verbal -NT, Motor -5* - **Eyes opening to pain** scores 2, but the patient responded to verbal command (3 points). While **Verbal-NT** is correct due to mechanical ventilation, a motor score of 5 (localizes to pain) is incorrect, as the patient moved limbs spontaneously (6 points).
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