A 17-year-old girl from a village in Andhra Pradesh is brought to casualty after chewing seeds of a yellow-flowered roadside shrub. She is vomiting, pulse is 38/min, and the ECG shows second-degree AV block. Serum potassium is 6.1 mmol/L. Atropine has given only a brief response. Which specific treatment is most effective?

Digoxin-specific antibody fragments

A 61-year-old man is in the coronary care unit after an extensive anterior wall MI. He is cold and clammy with BP 80/50 mmHg, bilateral crackles and urine output of 10 mL/h. A pulmonary artery catheter is placed. Which haemodynamic profile is expected?

Low cardiac output, high wedge pressure, high SVR

Low cardiac output, high wedge pressure, low SVR

High cardiac output, low wedge pressure, low SVR

Low cardiac output, low wedge pressure, high SVR

Critical care: sepsis, shock, ABG and poisoning

22 NEET-PG practice questions on Critical care: sepsis, shock, ABG and poisoning, part of General Medicine. The first 22 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 17-year-old girl from a village in Andhra Pradesh is brought to casualty after chewing seeds of a yellow-flowered roadside shrub. She is vomiting, pulse is 38/min, and the ECG shows second-degree AV block. Serum potassium is 6.1 mmol/L. Atropine has given only a brief response. Which specific treatment is most effective?
1. AIV physostigmine
2. BIV glucagon
3. CDigoxin-specific antibody fragments
4. DIV calcium gluconate
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Answer: C · Digoxin-specific antibody fragments
Yellow oleander (Cascabela thevetia) seeds contain cardiac glycosides that act like digoxin: they inhibit the Na+/K+-ATPase, causing vomiting, bradycardia, AV block, arrhythmias and hyperkalaemia, which marks severe poisoning. Digoxin-specific Fab fragments bind the glycosides and reverse the cardiotoxicity, as shown in trials in South Asia. Atropine and temporary pacing are used while waiting. Calcium is traditionally avoided in glycoside toxicity.
- A: Physostigmine treats anticholinergic poisoning and would worsen bradycardia.
- B: Glucagon is used for beta-blocker poisoning, not cardiac glycosides.
- D: Calcium is traditionally avoided in glycoside toxicity and does not reverse the block.
Question 2 · Medium
A 61-year-old man is in the coronary care unit after an extensive anterior wall MI. He is cold and clammy with BP 80/50 mmHg, bilateral crackles and urine output of 10 mL/h. A pulmonary artery catheter is placed. Which haemodynamic profile is expected?
1. ALow cardiac output, high wedge pressure, low SVR
2. BLow cardiac output, high wedge pressure, high SVR
3. CHigh cardiac output, low wedge pressure, low SVR
4. DLow cardiac output, low wedge pressure, high SVR
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Answer: B · Low cardiac output, high wedge pressure, high SVR
Cardiogenic shock after a large MI is pump failure: cardiac output and cardiac index fall, the left ventricle cannot empty, so the pulmonary capillary wedge pressure rises (with pulmonary oedema), and the systemic vascular resistance rises reflexly. That is why the skin is cold and clammy. Hypovolaemic shock has a low wedge pressure with a high SVR, and distributive (septic) shock has a low SVR with a normal or high output. Management includes urgent revascularisation, inotropes and vasopressors as needed.
- A: A low SVR does not fit the reflex vasoconstriction of pump failure.
- C: A high output with low SVR is distributive (septic) shock.
- D: A low wedge pressure with high SVR is hypovolaemic shock.
Question 3 · Medium
Several men from one village in Gujarat reach the district hospital a day after drinking illicit liquor. A 40-year-old has blurred vision and abdominal pain, and his pupils are dilated and sluggish. Na 138, Cl 100, HCO3 8 mmol/L; measured serum osmolality is 30 mOsm/kg more than calculated. Which treatment blocks formation of the toxic metabolite?
1. ADisulfiram
2. BFomepizole
3. CN-acetylcysteine
4. DMethylene blue
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Answer: B · Fomepizole
A cluster of patients after illicit liquor with visual symptoms, a high anion gap (138 - 100 - 8 = 30) and a high osmolal gap is methanol poisoning. Alcohol dehydrogenase converts methanol to formaldehyde and then formic acid, which causes the acidosis and damages the optic nerve. Fomepizole, or ethanol where it is unavailable, competitively blocks alcohol dehydrogenase; bicarbonate, folinic acid and haemodialysis are added. Early dialysis is key in severe cases.
- A: Disulfiram blocks aldehyde dehydrogenase and would not prevent formation of formaldehyde.
- C: NAC is the antidote for paracetamol.
- D: Methylene blue treats methaemoglobinaemia, not methanol.
Question 4 · Medium
A 26-year-old woman being treated for depression is brought to casualty after taking 40 tablets of amitriptyline. She is drowsy, with dilated pupils, dry skin and pulse 132/min. The ECG shows a QRS of 150 ms and a tall terminal R wave in aVR. She then has a run of broad-complex tachycardia. What is the drug of first choice?
1. AIV physostigmine
2. BIV flumazenil
3. CIV procainamide
4. DIV sodium bicarbonate
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Answer: D · IV sodium bicarbonate
Tricyclic overdose blocks fast sodium channels in the heart, widening the QRS and causing ventricular arrhythmias, with anticholinergic features and seizures. Hypertonic sodium bicarbonate is the first treatment for QRS widening or arrhythmia: the sodium load overcomes the channel block and alkalinisation reduces drug binding. Class Ia and Ic antiarrhythmics, which also block sodium channels, worsen toxicity. Flumazenil and physostigmine can provoke seizures or asystole in tricyclic poisoning.
- A: Physostigmine has caused asystole in tricyclic poisoning.
- B: Flumazenil can precipitate seizures in a mixed or tricyclic overdose.
- C: Procainamide also blocks sodium channels and worsens the cardiotoxicity.
Question 5 · Easy
A 58-year-old man with pneumonia remains hypotensive (MAP 56 mmHg) after 2 litres of balanced crystalloid in the medical ICU. His extremities are warm and his lactate is 4.2 mmol/L. Which vasopressor should be started first?
1. ADopamine
2. BDobutamine
3. CNoradrenaline
4. DPhenylephrine
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Answer: C · Noradrenaline
Noradrenaline is the first-line vasopressor in septic shock: its alpha-1 action restores vascular tone and its modest beta-1 action supports cardiac output. The target is a MAP of 65 mmHg. Compared with dopamine it causes fewer arrhythmias and is linked to lower mortality. If the MAP stays low despite rising doses, vasopressin is added, and adrenaline is a further option.
- A: Dopamine causes more arrhythmias and is no longer preferred in septic shock.
- B: Dobutamine is an inotrope used for low cardiac output; it may lower BP further.
- D: Phenylephrine is a pure alpha agonist kept for special situations.
Question 6 · Medium
A 28-year-old farmer from Tamil Nadu drank a mouthful of a herbicide 2 days ago. He has painful ulcers of the tongue and throat, oliguria and a rising creatinine, and his SpO2 is 95% on room air. Urine dithionite test is positive. Which treatment should be avoided?
1. AHaemodialysis for renal failure
2. BActivated charcoal by mouth
3. CIntravenous crystalloids
4. DSupplemental high-flow oxygen
Answer and explanation in LearnFree account
Question 7 · Easy
A 64-year-old woman is brought to casualty with fever and burning micturition for 3 days and is now drowsy. BP 82/48 mmHg, pulse 122/min, RR 26/min, and lactate 4.8 mmol/L. Blood cultures are drawn and IV antibiotics started. By the Surviving Sepsis Campaign guidance, how much IV crystalloid should be given within the first 3 hours?
1. AAt least 10 mL/kg
2. BAt least 60 mL/kg
3. C500 mL in total
4. DAt least 30 mL/kg
Answer and explanation in LearnFree account
Question 8 · Medium
A 66-year-old woman in the ICU with septic shock from a perforated diverticulum has had source control and adequate fluids. Over 6 hours her noradrenaline has risen to 0.4 µg/kg/min to hold a MAP of 65 mmHg. Besides adding vasopressin, what does current guidance suggest?
1. AWait for a short Synacthen test
2. BOral fludrocortisone alone
3. CIV methylprednisolone pulses
4. DIV hydrocortisone
Answer and explanation in LearnFree account
Question 9 · Medium
A 34-year-old woman on the surgical ward is given IV ceftriaxone. Within 5 minutes she has generalised urticaria, lip swelling, wheeze and BP 78/40 mmHg. The infusion is stopped and she is laid flat. Which drug and route should be given first?
1. AAdrenaline 0.5 mg intramuscularly
2. BChlorphenamine 10 mg intravenously
3. CAdrenaline 1 mg as an IV bolus
4. DHydrocortisone 200 mg intravenously
Answer and explanation in LearnFree account
Question 10 · Medium
A 25-year-old man fell from a coconut tree and has complete loss of power and sensation below the nipple line. BP 76/40 mmHg, pulse 50/min, his feet are warm and pink, and FAST scan shows no free fluid. There is no external bleeding. What type of shock does he have?
1. ANeurogenic shock
2. BCardiogenic shock
3. CSpinal shock
4. DHaemorrhagic shock
Answer and explanation in LearnFree account
Question 11 · Medium
A 30-year-old man with peptic ulcer disease has had persistent vomiting for 6 days. He looks dehydrated. ABG: pH 7.52, PaCO2 48 mmHg, HCO3 38 mmol/L. Na 134, K 2.8, Cl 82 mmol/L; urine chloride 8 mmol/L. What is the correct interpretation and treatment?
1. APrimary respiratory alkalosis: give a rebreathing bag
2. BSaline-responsive metabolic alkalosis: give 0.9% saline with potassium
3. CSaline-resistant metabolic alkalosis: give spironolactone
4. DMetabolic alkalosis with respiratory acidosis: intubate
Answer and explanation in LearnFree account
Question 12 · Medium
A 48-year-old man with severe falciparum malaria is ventilated in the ICU on day 2. Chest X-ray shows bilateral opacities not explained by effusion or collapse, and echocardiography shows normal left ventricular function. On FiO2 0.6 and PEEP 10 cmH2O, PaO2 is 66 mmHg. By the Berlin definition, how severe is his ARDS?
1. AMild
2. BIt does not qualify as ARDS
3. CModerate
4. DSevere
Answer and explanation in LearnFree account
Question 13 · Medium
A 22-year-old farmer from Haryana is brought to casualty 2 hours after swallowing tablets kept for storing wheat. He smells of garlic, BP is 70/40 mmHg despite fluids, and the ECG shows frequent ventricular ectopics. A silver nitrate-soaked paper exposed to his gastric aspirate turns black. What is the mechanism of toxicity?
1. APhosphine inhibits cytochrome c oxidase
2. BPhosphine uncouples oxidative phosphorylation
3. CPhosphine inhibits acetylcholinesterase
4. DPhosphine converts haemoglobin to methaemoglobin
Answer and explanation in LearnFree account
Question 14 · Hard
A 23-year-old student is brought to casualty with nausea and right upper abdominal pain. Over the past 36 hours she took about 20 paracetamol 500 mg tablets at intervals of a few hours for toothache. Her paracetamol level is 40 mg/L, ALT is 260 U/L and INR 1.4. What is the next best step?
1. AGive activated charcoal and repeat the level in 4 hours
2. BObserve, as the level is below the treatment line
3. CPlot the level on the nomogram before deciding
4. DStart IV N-acetylcysteine now
Answer and explanation in LearnFree account
Question 15 · Easy
A family of four in Shimla is brought to casualty one winter morning with headache, dizziness and vomiting after sleeping in a closed room with a coal brazier. The father is confused; his SpO2 on pulse oximetry is 98% on room air. What is the first step in management?
1. AIV sodium nitrite
2. B100% oxygen through a non-rebreathing mask
3. CIV methylene blue
4. DOxygen by nasal cannula to keep SpO2 above 94%
Answer and explanation in LearnFree account
Question 16 · Medium
A 52-year-old woman with known breast cancer comes to casualty with breathlessness. BP 86/64 mmHg, pulse 124/min, JVP raised. Consider these possible findings: 1. Systolic BP falling by more than 10 mmHg during inspiration. 2. A prominent y descent in the JVP. 3. QRS amplitude alternating from beat to beat. 4. Muffled heart sounds. Which findings are expected if she has cardiac tamponade?
1. A1, 2, 3 and 4
2. B1, 3 and 4 only
3. C2, 3 and 4 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 17 · Hard
A 40-year-old man is brought to casualty with vomiting, ringing in the ears and rapid breathing after swallowing many tablets from his father's aspirin strip. ABG: pH 7.43, PaCO2 22 mmHg, HCO3 14 mmol/L. Na 140, Cl 104 mmol/L. What is his acid-base status?
1. ACompensated high anion gap metabolic acidosis
2. BPrimary respiratory alkalosis with renal compensation
3. CHigh anion gap metabolic acidosis with respiratory alkalosis
4. DNormal anion gap metabolic acidosis
Answer and explanation in LearnFree account
Question 18 · Hard
A 32-year-old man on multidrug therapy with dapsone for leprosy is admitted with breathlessness and headache. SpO2 is 84% and does not improve on 10 L/min oxygen; his lips look slate-grey. ABG on oxygen shows PaO2 210 mmHg, and his blood is chocolate-brown. He has no known G6PD deficiency. What is the most appropriate treatment?
1. AIV methylene blue
2. BIV hydroxocobalamin
3. CHyperbaric oxygen
4. DIV ascorbic acid alone
Answer and explanation in LearnFree account
Question 19 · Easy
A 19-year-old college student is brought to casualty 4 hours after swallowing 30 tablets of paracetamol 500 mg after a quarrel. She has nausea but is otherwise well. Her 4-hour paracetamol level is above the treatment line. How does the antidote she needs protect the liver?
1. AIt speeds up renal excretion of paracetamol
2. BIt binds paracetamol in the gut
3. CIt inhibits the CYP2E1 enzyme
4. DIt replenishes hepatic glutathione
Answer and explanation in LearnFree account
Question 20 · Medium
A 55-year-old man with COPD is brought in drowsy after a week of increasing breathlessness. On 4 L/min oxygen by face mask his ABG shows pH 7.24, PaCO2 78 mmHg, HCO3 33 mmol/L and PaO2 88 mmHg. He can protect his airway. What is the next best step?
1. ANon-invasive ventilation with titrated oxygen
2. BIV sodium bicarbonate to correct the pH
3. CIV doxapram as the main treatment
4. DIncrease oxygen to keep SpO2 above 98%
Answer and explanation in LearnFree account
Question 21 · Hard
A 67-year-old diabetic man is brought to casualty with fever and a swollen, foul-smelling left foot. BP 84/50 mmHg, pulse 118/min. The resident lists four actions for the first hour: 1. Measure serum lactate. 2. Take blood cultures before starting antibiotics. 3. Give broad-spectrum IV antibiotics. 4. Start a vasopressor only after the full 30 mL/kg of fluid has been infused, whatever the BP. Which of these are part of the Hour-1 sepsis bundle?
1. A1 and 3 only
2. B1, 2 and 3 only
3. C2, 3 and 4 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 22 · Medium
A 70-year-old man with cholangitis has received 30 mL/kg of crystalloid in the ICU. He now needs noradrenaline to keep his MAP at 65 mmHg, and his lactate is 3.6 mmol/L. His SOFA score has risen by 4 from baseline. By the Sepsis-3 definitions, how is his condition classified?
1. ASystemic inflammatory response syndrome
2. BHypovolaemic shock
3. CSeptic shock
4. DSepsis without shock
Answer and explanation in LearnFree account

Critical care: sepsis, shock, ABG and poisoning

A 61-year-old man is in the coronary care unit after an extensive anterior wall MI. He is cold and clammy with BP 80/50 mmHg, bilateral crackles and urine output of 10 mL/h. A pulmonary artery catheter is placed. Which haemodynamic profile is expected?

A 58-year-old man with pneumonia remains hypotensive (MAP 56 mmHg) after 2 litres of balanced crystalloid in the medical ICU. His extremities are warm and his lactate is 4.2 mmol/L. Which vasopressor should be started first?

A 28-year-old farmer from Tamil Nadu drank a mouthful of a herbicide 2 days ago. He has painful ulcers of the tongue and throat, oliguria and a rising creatinine, and his SpO2 is 95% on room air. Urine dithionite test is positive. Which treatment should be avoided?

A 66-year-old woman in the ICU with septic shock from a perforated diverticulum has had source control and adequate fluids. Over 6 hours her noradrenaline has risen to 0.4 µg/kg/min to hold a MAP of 65 mmHg. Besides adding vasopressin, what does current guidance suggest?

A 34-year-old woman on the surgical ward is given IV ceftriaxone. Within 5 minutes she has generalised urticaria, lip swelling, wheeze and BP 78/40 mmHg. The infusion is stopped and she is laid flat. Which drug and route should be given first?

A 25-year-old man fell from a coconut tree and has complete loss of power and sensation below the nipple line. BP 76/40 mmHg, pulse 50/min, his feet are warm and pink, and FAST scan shows no free fluid. There is no external bleeding. What type of shock does he have?

A 30-year-old man with peptic ulcer disease has had persistent vomiting for 6 days. He looks dehydrated. ABG: pH 7.52, PaCO2 48 mmHg, HCO3 38 mmol/L. Na 134, K 2.8, Cl 82 mmol/L; urine chloride 8 mmol/L. What is the correct interpretation and treatment?

A 23-year-old student is brought to casualty with nausea and right upper abdominal pain. Over the past 36 hours she took about 20 paracetamol 500 mg tablets at intervals of a few hours for toothache. Her paracetamol level is 40 mg/L, ALT is 260 U/L and INR 1.4. What is the next best step?

A family of four in Shimla is brought to casualty one winter morning with headache, dizziness and vomiting after sleeping in a closed room with a coal brazier. The father is confused; his SpO2 on pulse oximetry is 98% on room air. What is the first step in management?

A 40-year-old man is brought to casualty with vomiting, ringing in the ears and rapid breathing after swallowing many tablets from his father's aspirin strip. ABG: pH 7.43, PaCO2 22 mmHg, HCO3 14 mmol/L. Na 140, Cl 104 mmol/L. What is his acid-base status?

A 19-year-old college student is brought to casualty 4 hours after swallowing 30 tablets of paracetamol 500 mg after a quarrel. She has nausea but is otherwise well. Her 4-hour paracetamol level is above the treatment line. How does the antidote she needs protect the liver?

A 55-year-old man with COPD is brought in drowsy after a week of increasing breathlessness. On 4 L/min oxygen by face mask his ABG shows pH 7.24, PaCO2 78 mmHg, HCO3 33 mmol/L and PaO2 88 mmHg. He can protect his airway. What is the next best step?

A 70-year-old man with cholangitis has received 30 mL/kg of crystalloid in the ICU. He now needs noradrenaline to keep his MAP at 65 mmHg, and his lactate is 3.6 mmol/L. His SOFA score has risen by 4 from baseline. By the Sepsis-3 definitions, how is his condition classified?