Supplemental Data – Analysis of Varied Responses from Artificial Intelligence (AI) Tools to the ERC Pre-Course Advanced Life

Support
Multiple-Choice Questions (MCQ)

a. Pre-Course Advanced Life Support MCQ ERC ERC ALS ChatGPT 4 ChatGPT 3.5 Bard Copilot
Guidelines Manual Google Microsoft
2021 GPT 2021 GPT
1. ST-segment-elevation myocardial infarction (STEMI): Correct Correct Correct Correct Correct Correct
a) Is always accompanied by chest pain
b) Rarely causes VF.
c) May present with ST depression in leads V1‒3 of a
12-lead ECG.
d) May never present with new left bundle branch
block (LBBB) on the ECG.
2. When using transcutaneous pacing: Correct Correct Correct Incorrect Correct Correct
a) Electrical capture typically occurs with a current of
5‒10 amps.
b) May be unsuccessful in a patient with
hyperkalaemia.
c) Movement artefact will not inhibit the pacemaker.
d) Electrical capture and generation of a QRS complex
ensures return of a pulse.
3. With regard to the ECG: Correct Incorrect Correct Incorrect Incorrect Incorrect
a) Continuous monitoring via self-adhesive pads is
preferable to using ECG electrodes.
b) If adhesive electrodes are used for 3-lead
monitoring, they should be applied over bone rather
than muscle.
c) The normal PR interval is more than 0.2 s.
d) The normal QRS complex has a duration > 0.12 s.
4. In drowning: Unable to Correct Correct Incorrect Correct Correct
a) There is immediate entry of water into the victim’s confirm the
lungs. correct answer
b) Submersion duration is the strongest predictor of
outcome.
c) Following submersion, respiratory arrest does not
precede cardiac arrest.
d) Prophylactic antibiotic therapy should be given
routinely.
5. You arrive at the bedside 4 min after the cardiac arrest Correct Correct Correct Correct Correct Correct
 of a 70 kg woman. An IV line is in place, there is no
pulse.
The ECG confirms asystole. Two nurses are performing
CPR competently. You would recommend:
a) Delivery of a 150 J shock.
b) Sodium bicarbonate 500 mmol IV.
c) Calcium chloride 5 mL 10% solution
d) Adrenaline 1 mg IV.
6. A 55-year-old man on CCU has a witnessed, monitored Correct Correct Correct Correct Correct Correct
VF cardiac arrest. After the 3rd shock he develops sinus
rhythm with a pulse and starts to breathe
spontaneously. He is given oxygen via a reservoir mask
with a flow of 15 L-1. Analysis of blood gas shows:
Normal range:
PaO2 22.6 kPa(FiO2 85%)
pH 7.11
PaCO2 7.2 kPa
Bicarbonate 14 mmol L-1
Base exces -10.6 mmol L-1
a) These results suggest that the patient has an
acidaemia.
b) These results suggest that oxygenation is
appropriate for the inspired concentration.
c) These results suggest that the patient has a
compensatory metabolic alkalosis.
d) These results suggest that 50 mmol of 8.4% sodium
bicarbonate IV is required.
7. Pulseless electrical activity (PEA): Correct Correct Correct Incorrect Incorrect Correct
a) Is rarely the first monitored rhythm in a cardiac
arrest.
b) Is characterised by evidence of ventricular activity
on the ECG that would normally be associated with
a pulse.
c) Should be treated by giving 300 mg amiodarone IV.
d) Is rarely the cardiac arrest rhythm in patients with
severe hypovolaemia.

8. With regard to decisions about CPR: Correct Correct Correct Correct Incorrect Correct
 a) The best time to make an anticipatory decision
about whether or not to attempt CPR is when a
patient is admitted to hospital.
b) If you consider that a patient should be ‘for CPR’
you should still discuss the decision with the patient.
c) If it is agreed that a patient is ‘for CPR’ there is no
need to document anything in the health records.
d) If a DNACPR decision is made with a person who
has an implanted cardioverter-defibrillator (ICD) the
shock function of the ICD should then be
deactivated.
9. Adrenaline: Unable to Correct Correct Correct Correct Correct
a) Has purely alpha-adrenergic effects. confirm the
b) Is associated with any long-term benefit to patients correct answer
when given during a cardiac arrest.
c) Decreases systemic vasoconstriction.
d) Improves coronary and cerebral perfusion
pressures during CPR.
10. When monitoring the cardiac rhythm: Unable to Correct Correct Correct Correct Correct
a) A ventricular rate of between 60‒100 beats min-1 is confirm the
considered normal. correct answer
b) Asystole presents as a completely straight line.
c) At a standard paper speed of 25 mm s-1 the
ventricular rate is calculated by dividing the number
of large squares between consecutive R waves by
60.
d) A ventricular tachycardia will always require
immediate cardioversion.
11. A 55-year-old woman presents with a 1 h history of Correct Correct Correct Incorrect Correct Correct
crushing central chest pain, nausea and sweating. Her
pulse rate is 38 min-1, BP 75/45 mmHg. The ECG
monitor shows sinus bradycardia. You would
recommend that:
a) Atropine 500 mcg IV should be given.
b) An adrenaline infusion, 20‒100 mcg min-1, may be
required.
c) Opioid analgesia is contraindicated.
d) 24% oxygen via a mask should be given until the
results of arterial blood gas analysis are known.
12. During CPR: Correct Correct Correct Incorrect Incorrect Correct
a) There is a high risk of transmission of HIV virus
from patient to rescuer.
b) Personal protective equipment (PPE) should be
worn if the patient has SARS-CoV-2.
c) Wearing latex gloves provides sufficient protection
from the electrical current during defibrillation.
d) If ventilating with high-flow oxygen via an LMA, it
must be disconnected and placed at least 1 m away
before defibrillation.
13. Following successful resuscitation from VF cardiac Correct Correct Correct Correct Incorrect Correct
arrest:
a) All patients should be given as close to 100%
oxygen as possible.
b) Intubated patient’s lungs should be ventilated to
achieve a PaCO2 < 4.5 kPa.
c) Targeted temperature management (TTM) is
recommended for adults after in-hospital cardiac
arrest who remain unresponsive after ROSC.
d) Absence of both pupillary light and corneal reflexes
at 48 h can not be used to help predict outcome in
comatose patients 48 h after cardiac arrest.
14. Giving 8.4% sodium bicarbonate: Correct Correct Correct Correct Incorrect Correct
a) Does not exacerbate an intracellular acidosis.
b) Is recommended after 5 min of CPR if ROSC has
not been achieved.
c) Should be considered as a treatment for
arrhythmias due to tricyclic antidepressant
overdose.
d) Facilitates release of oxygen to the tissues.
15. Immediate primary percutaneous coronary intervention Correct Correct Correct Correct Correct Correct
(PPCI):
a) Is the preferred treatment for a patient with chest
pain lasting more than 20 min and ST segment
depression in leads V4‒V6 on their ECG.
b) Is the preferred treatment for a patient with chest
pain lasting more than 20 min and acute ST
segment elevation in leads V4‒V6 on their ECG.
c) Is the first line treatment for unstable angina.
d) Should be achieved within 24h of the call for help
whenever possible.
16. The correct management of an adult patient in Incorrect Correct Correct Incorrect Correct Incorrect
ventricular fibrillation includes:
a) Digoxin 500 mcg IV.
b) Adrenaline, 1 mg IV after every shock.
c) Atropine 3 mg after 2 loops.
d) An initial shock energy of at least 120 J.
17. The following statement are correct: Incorrect Incorrect Correct Incorrect Correct Correct
a) Adrenaline 1 mg IV should be given to all patients in
cardiac arrest as soon as possible.
b) Lidocaine 100 mg is the treatment of choice for all
patients in broad complex regular tachycardia (VT).
c) Adenosine is effective in the treatment of regular
tachycardias.
d) The initial dose of amiodarone for shock refractory
ventricular fibrillation is 150 mg IV.
18. Chest compressions: Unable to Correct Correct Correct Correct Correct
a) Should not be interrupted even when an organised confirm the
rhythm is seen during a 2min period of CPR unless correct answer
patient shows signs of ROSC
b) Are interrupted for ventilation after tracheal
intubation has occurred.
c) Should be performed at a rate of 60 min-1 in adults.
d) Should be interrupted to palpate a pulse in any
unresponsive patient with agonal breathing.
19. In acute severe asthma: Unable to Correct Correct Correct Incorrect Correct
a) Cardiac arrest is mainly secondary to hypercapnia. confirm the
b) Oxygen should be titrated to achieve an SpO2 of correct answer
88‒90%.
c) A PaCO2 of 6 kPa is a sign of good outcome.
d) Magnesium sulfate 2 g (8 mmol of Mg++) IV may
produce bronchodilatation.
20. In a patient with suspected anaphylaxis: Correct Correct Correct Incorrect Incorrect Correct
a) Skin and mucosal changes are uncommon features.
b) Adrenaline 0.5 mg IM is the first line treatment of
choice.
c) Steroids must be given early.
d) Colloids are preferred to crystalloids for restoring
the circulation.
21. A 65-year-old man with a 2 h history of central chest Unable to Incorrect Correct Incorrect Correct Correct
pain develops a broad QRS tachyarrhythmia that confirm the
appears regular with a rate of approximately 180 beats correct answer
min-1. His blood pressure is 86/54. The following
treatment should be given:
a) Immediate cardioversion should be attempted.
b) If there were no adverse signs, and the QRS
complex were narrow and regular, amiodarone 300
mg IV should be given.
c) As he has no adverse signs, the QRS complex is >
0.12 s and regular, adenosine 6 mg IV should be
given.
d) If there were no adverse signs, and the QRS
complex were broad and regular verapamil 10 mg
IV should be given.
22. Severe hyperkalaemia: Unable to Incorrect Correct Incorrect Incorrect Incorrect
a) Is defined as a plasma potassium concentration of > confirm the
5.5 mmol L-1. correct answer
b) Causes tall, peaked T waves and ST depression on
the ECG.
c) May be caused by heart failure.
d) Can be treated by giving 10 mL 1% calcium chloride
IV.
23. With regard to decisions about CPR: Correct Incorrect Correct Correct Correct Correct
1) The only indication for not starting CPR in a patient
is the presence of a recorded, valid DNACPR
decision.
2) Any patient is entitled to receive CPR in the event of
cardiac arrest if they insist on it.
3) Overall responsibility for decisions about CPR rests
with the senior clinician in charge of the patient’s
care.
4) If a patient lacks capacity to make a decision about
CPR their family must be asked to decide whether
or not CPR should be attempted.
24. In second-degree atrioventricular (AV) heart block Unable to Correct Correct Correct Correct Correct
a) There are always more QRS complexes than P confirm the
waves. correct answer
b) The PR interval is always regular.
c) Immediate treatment for a bradycardia will be
required.
d) When it is Mobitz type II there is a risk of asystole.
25. During advanced life support (ALS): Unable to Incorrect Incorrect Incorrect Incorrect Incorrect
a) Higher defibrillation energies may be required in confirm the
patients whose cardiac arrest has been caused by correct answer
asthma.
b) The amplitude of the VF waveform is relevant in
determining the need for a shock.
c) Self-adhesive pads must be placed always in the
antero-posterior position in a patient with an
implantable cardioverter-defibrillator (ICD).
d) If you notice a rhythm change during ventilations
from asystole to VF, a shock should immediately be
given.
26. In a patient suspected of having an acute coronary Unable to Correct Correct Correct Incorrect Incorrect
syndrome (ACS): confirm the
a) A single, normal 12-lead ECG excludes this as a correct answer
possible diagnosis.
b) Troponin values above the normal range always
indicate myocardial infarction.
c) Thrombolysis is contraindicated if the patient has
had a surgical procedure within the last month.
d) Fibrinolytic therapy is less effective than PCI.
27. A 28-year-old man, known to have asthma has been Unable to Correct Correct Correct Incorrect Incorrect
very wheezy for 6 h and has had no relief from his confirm the
inhalers. On examination he is breathless at rest, unable correct answer
to complete sentences and has a respiratory rate of 36
min-1, there is poor air entry and wheeze throughout
both lung fields. While breathing oxygen from a
reservoir mask (flow 15 L min-1), analysis of an arterial
blood sample shows:
PaO2 11 kPa (FiO2 80%)
pH 7.22
PaCO2 5,96 kPa
Bicarbonate 16.3 mmol L-1
Base excess -7 mmol L-1
a) Oxygenation is higher than predicted from the
inspired concentration.
b) As PaCO2 is normal, we could expect a good
outcome.
c) These suggest that the patient has a compensatory
metabolic alkalosis.
d) These suggest that the patient is getting tired.
28. A 35-year-old lady is on the ward following a Unable to Correct Correct Correct Incorrect Correct
cholecystectomy. She complains of abdominal pain and confirm the
appears pale and sweaty: correct answer
a) A respiratory rate of 30 breaths min-1 may be a sign
of deterioration.
b) Her early warning score (EWS) will not detect
evidence of deterioration.
c) A normal systolic blood pressure rules out the
possibility of shock.
d) Looking for a source of hypovolaemia is the first
priority.
29. The effectiveness of a resuscitation team may be Unable to Correct Correct Correct Correct Correct
improved by: confirm the
a) Early identification of a team leader. correct answer
b) The team leader carrying out all the necessary
interventions.
c) Meeting and assigning roles during the arrest.
d) Ensuring that the most senior person acts as the
team leader.
30. Following successful resuscitation from a cardiac arrest: Incorrect Incorrect Correct Incorrect Incorrect Correct
a) The patient may be hyperkalaemic.
b) Maintain the patient’s blood glucose between 4.0‒
8.0 mmol L-1.
c) Cerebral perfusion returns to normal immediately
with ROSC.
d) Seizures occur in > 50% of patients who remain
comatose.

31. With reference to the 12-lead ECG: Correct Correct Correct NA Incorrect Unable
to
confirm
the
correct
answer

a) Sinus bradycardia is present.

b) Primary PCI may be indicated.
c) Cardiac monitoring is optional.
d) Aspirin should be avoided.
32. With reference to the rhythm strip: Correct Correct Correct NA Correct Correct

a) This rhythm can be associated with a spontaneous

circulation.
b) Adrenaline 1 mg IV is the initial treatment of choice.
c) A precordial thump is always indicated.
d) Defibrillation is the treatment of choice in the
pulseless patient.
33. With reference to the rhythm strip (paper speed Incorrect Incorrect Unable to NA Incorrect Unable
25mm/s): confirm the to
correct answer confirm
the
a) The ventricular rate is in the range 90‒110 min-1. correct
b) The rhythm is regular. answer
c) The rhythm is supraventricular in origin.
d) The rhythm is atrial flutter.
34. With reference to the rhythm strip: Correct Incorrect Unable to NA Correct Unable
confirm the to
correct answer confirm
the
a) The rhythm is regular.
correct
b) The rhythm originates in the ventricles.
answer
c) P waves are clearly present.
d) Heart rate is under 100 beats per minute
35. With reference to the rhythm strip: Correct Correct Unable to NA Incorrect Unable
confirm the to
correct answer confirm
a) The ventricular rate is in the range of 35‒45 min-1. the
b) Atropine may be indicated. correct
c) The atrial rate is in the range 40‒50 min-1. answer
d) The duration of the QRS complex is normal.
36. With reference to the rhythm strip: Correct Correct Correct NA Correct Unable
to
confirm
the
a) This rhythm is always associated with
correct
unconsciousness.
answer
b) A patient with this rhythm will not have a pulse.
c) If the patient is dyspnoeic and hypotensive, systolic
blood pressure 80 mmHg, transvenous pacing may
be appropriate.
d) The patient is not at risk of developing asystole.
37. With reference to the rhythm strip: Correct Correct Unable to NA Correct Unable
confirm the to
correct answer confirm
the
a) The ventricular rate is in the range 50‒60 min-1. correct
b) The PR interval is normal. answer
c) Atropine 0.5 mg IV is the initial treatment of this
rhythm in a patient with adverse signs.
d) Adrenaline is contraindicated in the presence of this
rhythm.
38. With reference to the rhythm strip: Correct Correct Correct NA Correct Unable
to
confirm
the
a) The ventricular rate is greater than 200 min-1. correct
b) The rhythm is irregular. answer
c) The QRS complex is normal.
d) P waves are clearly visible.
39. With reference to the rhythm strip: Correct Correct Correct NA Correct Unable
to
confirm
the
a) Atropine may be appropriate treatment for this correct
rhythm. answer
b) If the patient is conscious, this rhythm does not
require any treatment.
c) In the presence of a systolic blood pressure of 70
mmHg, a synchronised cardioversion is the
treatment of choice.
d) Amiodarone is the first option to treat adverse
features.
40. With reference to the rhythm strip: Correct Correct Correct NA Correct Unable
to
confirm
the
a) The ventricular rate is in the range 60‒80 min-1. correct
b) The rhythm is complete heart block. answer
c) External pacing may be indicated.
d) Amiodarone 300 mg IV should be given.