Intensive/Critical Care

Intensive/Critical Care CDI.

You have 45 minutes to complete 45 questions. The test will automatically stop, and the result will be submitted.

Please choose 1 correct option out of 4 for each question.

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TVH Intensive/Critical Care

1 / 45

For acute on chronic liver failure in cirrhosis, ICU documentation must include:

Cirrhosis with acute decompensation from infection or bleed

Acute on chronic liver failure in patient with cirrhosis

Decompensated cirrhosis with multi organ dysfunction

Acute hepatic decompensation superimposed on chronic disease

2 / 45

For vasoplegic shock after cardiac surgery, ICU documentation should phrase it as:

Refractory hypotension following cardiac surgery requiring pressors

Low systemic vascular resistance due to inflammatory response

Postoperative vasoplegic shock after cardiac surgery

Circulatory collapse after cardiopulmonary bypass procedure

3 / 45

When documenting transfusion‑related acute lung injury (TRALI), best ICU wording is:

Acute lung injury with hypoxemia following blood transfusion

Transfusion related acute lung injury after blood product administration

Acute respiratory distress temporally related to transfusion event

Non cardiogenic pulmonary edema associated with donor antibodies

4 / 45

To capture critical illness myopathy, ICU documentation should say:

Generalized weakness and difficulty weaning from the ventilator

Post ICU neuromuscular weakness affecting mobility and function

Critical illness myopathy in mechanically ventilated patient

Myopathic changes suspected from prolonged immobilization

5 / 45

For critical illness polyneuropathy, best ICU wording is:

Symmetric distal weakness and reduced reflexes in ICU survivor

Critical illness polyneuropathy complicating prolonged critical illness

ICU acquired neuropathy due to sepsis and multi organ failure

Peripheral neuropathy associated with extended hospitalization

6 / 45

When acute respiratory failure and pneumonia are both present, ICU documentation should clarify:

Which condition developed first and relative clinical significance

That both conditions contributed equally to ICU admission

Whether acute respiratory failure meets criteria to be principal

That pneumonia caused respiratory compromise in vulnerable patient

7 / 45

For ventilator‑associated pneumonia, ICU notes should state:

Pneumonia in intubated patient with new infiltrates and secretions

Ventilator associated pneumonia in patient on mechanical ventilation

Hospital acquired pneumonia occurring after ICU admission

Severe pneumonia requiring prolonged ventilator support

8 / 45

In hypertensive encephalopathy, ICU documentation must clearly show:

Hypertension with headache, nausea, and confusion

Hypertensive encephalopathy with severe blood pressure elevation

Uncontrolled high blood pressure with neurologic symptoms

Hypertensive emergency affecting brain with transient deficits

9 / 45

For sepsis due to pneumonia in the ICU, optimal documentation is:

Pneumonia with SIRS and concern for sepsis in critically ill patient

Sepsis due to pneumonia with any acute organ dysfunction

Community acquired pneumonia with sepsis like physiology

Lower respiratory tract infection progressing to severe illness

10 / 45

In ICU patients with chronic ventilator dependence, documentation should specify:

Long term tracheostomy and ventilator use for respiratory failure

Chronic neuromuscular disease requiring ventilatory support

Chronic respiratory failure with ventilator dependence

Prolonged weaning after severe acute respiratory illness

11 / 45

When documenting ARDS separately from respiratory failure, the ICU note should indicate:

Severe hypoxemia refractory to oxygen therapy with bilateral infiltrates

ARDS diagnosis plus any concurrent acute respiratory failure

Diffuse pulmonary edema likely related to non cardiogenic causes

Respiratory distress with need for high PEEP and low tidal volumes

12 / 45

For postprocedural respiratory failure after surgery, best documentation is:

Acute postprocedural respiratory failure after specified operation

Hypoxic respiratory insufficiency following major surgery

Respiratory distress after anesthesia requiring overnight ventilation

Transient derangement in gas exchange associated with surgery

13 / 45

For acute hypercapnic respiratory failure in COPD, ICU documentation must link:

Worsening COPD with hypercarbia and mild respiratory acidosis

Acute hypercapnic respiratory failure due to COPD exacerbation

Chronic CO₂ retention with worsening mental status and confusion

COPD flare with elevated PaCO₂ and increasing work of breathing

14 / 45

For acute myocardial injury in sepsis without coronary thrombosis, the note should say:

Elevated troponin likely due to demand ischemia and sepsis

Myocardial injury secondary to sepsis rather than type 1 MI

Non ST elevation myocardial infarction in septic shock patient

Possible infarction with borderline troponin rise in septic state

15 / 45

To capture shock type accurately, ICU notes should distinguish:

Severity of hypotension and amount of vasopressor support

Whether shock is reversible or refractory with current treatment

Single versus multiple organ dysfunction developing with shock

Septic, cardiogenic, hypovolemic, obstructive, or distributive shock

16 / 45

For acute encephalopathy in ICU with multiple contributors, documentation should:

List all possible causes and label as multifactorial delirium

Name primary type such as metabolic encephalopathy and list contributors

Use a nonspecific encephalopathy diagnosis and expand in addendum

Focus on delirium assessment scores rather than etiologic labels

17 / 45

For anoxic brain injury after cardiac arrest, ICU documentation should read:

Severe hypoxic brain injury following prolonged cardiac arrest

Diffuse cerebral hypoxia with poor neurologic prognosis

Anoxic encephalopathy following cardiac arrest

Global hypoxic ischemic brain injury after resuscitation

18 / 45

For metabolic encephalopathy in sepsis, best documentation is:

Acute confusion likely due to ICU delirium in septic patient

Toxic metabolic encephalopathy from multiple metabolic derangements

Metabolic encephalopathy due to sepsis with altered mental status

Septic delirium with fluctuating cognition and inattention

19 / 45

For acute pulmonary edema due to heart failure, the diagnosis should state:

Pulmonary edema with respiratory distress and hypoxia

Acute decompensated heart failure with pulmonary edema

Fluid overload in setting of chronic cardiac dysfunction

Acute cardiogenic pulmonary edema in susceptible patient

20 / 45

To document postprocedural septic shock after surgery, the ICU note should state:

Severe postoperative infection with hemodynamic instability

Postoperative sepsis requiring ICU level vasopressor support

Infection following procedure with severe sepsis and septic shock

Surgical site infection complicated by systemic shock state

21 / 45

For septic shock, ICU documentation must explicitly state sepsis plus:

Persistent hypotension requiring vasopressors after adequate fluid resuscitation

Hypotension, oliguria, and rising lactate despite treatment

Multiorgan failure including renal and respiratory dysfunction

High dose vasopressor requirement to maintain adequate perfusion

22 / 45

When documenting pressure injury in ICU patients, the diagnosis must state:

Anatomic site and stage or unstageable/deep tissue injury

Size, location, and description of wound bed and exudate

Presence of possible infection complicating the pressure wound

Duration of immobilization and risk assessment scores

23 / 45

To distinguish sepsis from severe sepsis in ICU documentation, the note must show:

Proven infection with SIRS criteria and elevated lactate level

Sepsis plus acute organ dysfunction clearly linked to infection

Positive blood cultures with persistent fever and tachycardia

Infection requiring ICU admission and broad spectrum antibiotics

24 / 45

For acute respiratory failure with hypoxia on mechanical ventilation, best ICU diagnosis wording is:

Respiratory distress with low oxygen needs and tachypnea

Acute hypoxic respiratory failure requiring mechanical ventilation

Acute respiratory insufficiency with moderate oxygen desaturation

Severe pneumonia with worsening gas exchange and dyspnea

25 / 45

For post‑ICU weakness at step‑down transfer, diagnosis should capture:

Generalized weakness following prolonged critical illness

Deconditioning after extended bed rest and immobilization

Functional decline in activities of daily living after ICU stay

ICU acquired weakness due to critical illness myopathy/neuropathy

26 / 45

For acute blood loss anemia after major GI bleed, ICU documentation should specify:

Low hemoglobin due to GI bleeding episode requiring transfusion

Symptomatic anemia from chronic and acute GI blood losses combined

Acute blood loss anemia secondary to gastrointestinal hemorrhage

Iron deficiency anemia in context of recent bleeding

27 / 45

When documenting acute on chronic respiratory failure, the note should state:

Acute deterioration in a patient with baseline respiratory impairment

Acute on chronic respiratory failure with hypoxia or hypercapnia

Worsening gas exchange requiring escalation of respiratory support

COPD or restrictive disease with acute decompensation

28 / 45

In cardiogenic shock after MI, documentation must explicitly link:

Reduced ejection fraction to acute or chronic myocardial injury

Hypotension with low cardiac output and high filling pressures

Cardiogenic shock due to acute myocardial infarction

Decompensated heart failure progressing to shock state

29 / 45

When documenting acute renal replacement therapy initiation, ICU diagnosis should read:

Acute renal dysfunction requiring temporary dialysis support

Acute kidney injury requiring renal replacement therapy

Progressive azotemia and fluid overload despite diuretics

Renal failure progressing to dialysis dependence in ICU

30 / 45

In septic shock with lactic acidosis, the ICU note should explicitly document:

Elevated lactate and metabolic acidosis consistent with tissue hypoperfusion

Septic shock with lactic acidosis as marker of hypoperfusion

Severe sepsis physiology with high lactate requiring resuscitation

Hyperlactatemia associated with vasopressor dependent shock

31 / 45

When documenting nutrition status in ICU, which diagnosis captures highest severity when appropriate?

Risk for malnutrition due to reduced intake during ICU stay

Moderate malnutrition in critically ill patient needing supplements

Severe protein calorie malnutrition meeting clinical criteria

Underweight BMI with decreased muscle mass and weakness

32 / 45

An ICU quality project finds organ failures often missing from discharge summaries. What should the ICU team standardize?

A mandatory “ICU diagnoses” section listing each acute organ failure with cause

A policy that only consultants, not intensivists, document organ failures

Removal of problem lists from ICU notes to reduce redundancy

Reliance on daily progress notes rather than summaries for diagnosis detail

33 / 45

To capture delirium separately from encephalopathy in coding, ICU documentation should:

Use delirium generically when mental status fluctuates in ICU

Document both encephalopathy and superimposed delirium when present

Reserve encephalopathy for coma and delirium for confusion only

Avoid dual terms to prevent coding confusion and denials

34 / 45

To differentiate acute from chronic respiratory failure, documentation should state:

. Severity of dyspnea and oxygen requirement on admission

Acute, chronic, or acute on chronic respiratory failure

ABG values demonstrating hypoxemia and/or hypercapnia

Baseline home oxygen use and prior respiratory admissions

35 / 45

For DIC in sepsis, documentation must demonstrate:

Coagulopathy with elevated INR and thrombocytopenia

Disseminated intravascular coagulation due to sepsis

Bleeding tendency and microvascular thrombosis in shock

Consumption coagulopathy associated with severe infection

36 / 45

To differentiate SIRS from sepsis in ICU, documentation must clarify:

Number of abnormal vital signs and lab abnormalities

Presence or absence of suspected or proven infection

Degree of organ dysfunction present at time of ICU admission

Response to fluid resuscitation and antibiotic therapy

37 / 45

For mixed shock states, ICU documentation should:

Pick the predominant type and omit others for coding simplicity

Describe combined shock types such as septic and cardiogenic

Use nonspecific shock terminology to avoid overcomplication

Assign one primary shock label and ignore minor contributors

38 / 45

For acute limb ischemia requiring emergent intervention, ICU documentation should read:

Threatened limb perfusion due to arterial occlusion or thrombosis

Acute limb ischemia with threatened viability of affected limb

Severe peripheral vascular disease with rest pain and pallor

Ischemic extremity needing urgent revascularization procedures

39 / 45

For ICU patients with documented do‑not‑resuscitate orders, the chart should:

Mention DNR only in admission orders and not in daily notes

Include code status and any limitations on life sustaining therapy

Rely on nursing documentation to reflect DNR status accurately

Document DNR at discharge only if status remains unchanged

40 / 45

For acute kidney injury in septic shock, ICU documentation should link:

Rising creatinine and oliguria in critically ill patient

Acute kidney injury due to sepsis or septic shock

Acute tubular necrosis likely from prolonged hypotension

Renal dysfunction in the context of multiorgan failure

41 / 45

To capture acute alcohol withdrawal with delirium in ICU, documentation should read:

Alcohol withdrawal with agitation and confusion requiring sedation

Alcohol withdrawal delirium in chronic alcohol dependent patient

Severe withdrawal syndrome with risk for seizures and arrhythmias

Delirium in patient with long history of alcohol use disorder

42 / 45

To document acute liver failure in a septic ICU patient, you should state:

Transaminase elevation and coagulopathy in severe sepsis

Acute hepatic failure due to sepsis with or without encephalopathy

Acute liver injury likely related to shock and ischemic hepatitis

Abnormal liver tests secondary to drug toxicity and hypotension

43 / 45

For toxic encephalopathy from medication overdose, documentation should read:

Acute confusional state likely related to sedative accumulation

Delirium of uncertain etiology in the setting of polypharmacy

Toxic encephalopathy due to specific drug or toxin exposure

Neurotoxicity suspected from high drug levels and organ failure

44 / 45

When distinguishing hepatic encephalopathy from metabolic encephalopathy, the ICU note should:

Describe underlying liver disease and elevated ammonia level

Specify hepatic encephalopathy versus other metabolic encephalopathy

Attribute encephalopathy to multifactorial metabolic disturbances

Focus on neurologic exam and EEG findings over etiology

45 / 45

When severe sepsis is present on admission, sequencing rules require that the principal diagnosis be:

Severe sepsis code followed by the underlying infection

R65.2 code alone since it captures severe sepsis fully

Underlying systemic infection code followed by R65.2 code

Local infection first, then severe sepsis and systemic infection

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