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1. The patient case pertains to the following 10 questions: AB is a 78-year-old male nursing home resident with a past medical history of type 2 diabetes, asthma, hypertension, depression, and mild dementia. His nurse reported progressive shortness of breath over the past few days and called emergency medical services when she realized his oxygen saturation was 68%. When he arrived in the emergency department, he was emergently intubated for acute respiratory failure and transferred to the intensive care unit. Subsequent chest radiography showed severe bilateral pneumonia.

Which of the following risk factors puts AB at higher risk for developing PICS?

A. Age B. Sex C. Depression D. Age and depression E. Unsure

2. If one of AB's family members develops PICS-F, they may experience all of the following EXCEPT:

A. Delirium B. Clinical anxiety C. Worsening of her own medical conditions D. Post-traumatic stress symptoms E. Unsure

3. AB has now been admitted to the intensive care unit for 4 days. He remains mechanically ventilated and has developed severe acute respiratory distress syndrome, for which he has been pharmacologically paralyzed. Several of his home medications have also been resumed. His current medication profile includes propofol, fentanyl, cisatracurium and regular insulin continuous infusions; scheduled ceftriaxone, azithromycin, subcutaneous heparin, famotidine, albuterol/ipratropium, methylprednisolone, atorvastatin, donepezil; and as-needed oxycodone, diphenhydramine, haloperidol, ondansetron, acetaminophen, and cyclobenzaprine. He has a urinary catheter, a central intravenous line, two peripheral intravenous lines, and an arterial line for continuous blood pressure monitoring. He also has sequential compression devices on his bilateral lower extremities and is in 2-point restraints due to intermittent agitation. He is receiving blood glucose checks every hour for titrating his regular insulin infusion and is receiving scheduled medications at 6 time points throughout the day.

Which of AB’s as-needed medications can cause delirium?

A. Acetaminophen and cyclobenzaprine B. Ondansetron and haloperidol C. Acetaminophen and oxycodone D. Diphenhydramine and cyclobenzaprine E. Unsure

4. Given AB's current status on hospital day 4, which of the following puts him at higher risk of developing physical impairment after critical illness?

A. Adequate sedation B. Young age C. Neuromuscular blocking agent D. Stress ulcer prophylaxis E. Unsure

5. AB has not responded to empiric antibiotics, and the medical team would like to broaden antibiotics to include coverage of Pseudomonas. Which antibiotic would be the best choice to avoid delirium?

A. Cefepime B. Levofloxacin C. Piperacillin/tazobactam D. Ciprofloxacin E. Unsure

6. AB has multiple risk factors for ICU delirium. Which of the following factors is NOT required to diagnose AB with ICU delirium?

A. Change from baseline mental status B. Inattention C. Hyperactivity D. Altered level of consciousness or disorganized thinking E. Unsure

7. Which of the following scoring systems can be used to identify ICU delirium?

A. CAM-ICU B. CPOT C. ICDSC D. CAM-ICU and ICDSC E. CPOT and ICDSC F. Unsure

8. One of the medical residents is concerned about AB's risk of developing PICS and inquires about the ICU Liberation Bundle. Which of the following is TRUE regarding the ICU Liberation Bundle?

A. It is also called the ABC Bundle. B. It is associated with a longer duration of mechanical ventilation. C. It encourages early mobility and exercise. D. It focuses solely on the patient rather than the family. E. Unsure

9. Which of the following strategies should NOT be implemented to decrease AB's risk of PICS?

A. Help AB walk around the ICU while intubated B. Refer AB to a postdischarge ICU follow-up clinic C. Engage AB and his family in shared decision-making D. Order quetiapine for delirium prophylaxis E. Unsure

10. AB has been discharged from the hospital after 9 days in the ICU and 7 days of mechanical ventilation. An ICU diary kept by the nursing staff provides AB with

A. Only medical information B. Observations of nursing staff at discharge C. A daily account of the ICU admission D. Messages from visitors to the unit E. Unsure