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FCCS REVIEW QUESTIONS AND ANSWERS
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FCCS REVIEW QUESTIONS AND ANSWERS
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FCCS REVIEW QUESTIONS AND ANSWERSWhat is the most important sign in a critically ill pt? Why? - Answers -Tachypnea
Indicates metabolic acidosis w/ respiratory alkalosis compensation
A pt misses dialysis for a few days and comes in with fluid overload. He's tachycardic
and tachypneic. On physical exam, you find JVD, pulsus paradoxus (20 mmHg drop
during inspiration), and HoTN (80/40) with distant, muffled heart sounds. Lungs are
clear to auscultation. What is the dx? - Answers -Cardiac tamponade; obstructive shock
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? -
Answers -Difficult airway w/ an anteriorly displaced larynx
A COPD pt comes in with difficulty breathing. He then becomes apneic and
unresponsive. How would you ventilate this pt? - Answers -BVM
A pt arrives after falling from a ladder and has a frontal laceration. On examination, you
find papilledema and labored breathing w/o being able to clear secretions. What is your
biggest concern when intubating this pt? - Answers -Cerebral edema/increasing ICP
Intubation tends to cause an increase in ICP. Administer lidocaine prior to intubation to
inhibit vagal stimulation.
An ESRD pt w/ hyperkalemia develops dyspnea and requires intubation. Which
paralytic agent/NMB should you avoid and why? - Answers -Succinylcholine
Worsens hyperkalemia
A pt is admitted after an OD. He starts to have apneic episodes and his SpO2 is
dropping. You place him on a non-rebreather mask w/ 100% O2, yet his SpO2 remains
at 80%. Why is it not being corrected?
Then, if you try a BVM and it also fails, and video laryngoscopy is unavailable, what is
your next best choice for an airway? - Answers -The pt is having apneic episodes,
which means that administering high-flow O2 will be ineffective.
Choose an LMA if the BVM fails.
What intervention improves outcomes with ROSC after cardiac arrest? - Answers -
Targeted temperature management.
32-36 C
A shunt means there is perfusion without ventilation. What disease process is an
example of a shunt? - Answers -Pneumonia
, Which type of respiratory failure occurs with CNS depression after an OD? - Answers -
Acute hypercapnic respiratory failure --> mixed
A 50 y/o pt is having a COPD exacerbation. You have tried steroids, bronchodilators,
etc. with no improvement. PCO2 is in the 90s, pH is 7.20. You decide to intubate. Vent
settings are: VT 375, RR 20, FiO2 .35, PEEP 5. CXR is normal. A few minutes later, his
BP drops to 70/40. Lungs are clear/equal. Vent shows peak airway pressure of 55
(high) and plateau pressure of 15. End expiratory hold gives auto-peep of 15.
What is the cause of this pt's HoTN and why? - Answers -Auto-peep is the cause.
COPD pts have difficulty exhaling --> pressure buildup in alveoli.
We use PEEP for the pressure and to improve oxygenation. Auto-peep comes from
breath-stacking --> intrinsic peep. Alveoli enlarge --> high peak airway pressure. All
leads to low venous return --> low CO --> HoTN
A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt is tx w/
bronchodilators, steroids, and Abx. ABG was normal 1 hr ago, but now the peak airway
pressure is up to 55 and plateau pressure is also high at 50. Pt becomes hypotensive at
70/40. You observe tracheal deviation to the R. Normal breath sounds on the right,
diminished on the left. No wheezing. WBC is normal.
What is the dx and treatment? - Answers -Tension pneumothorax
Needle decompression/chest tube
A 70 y/o pt has been hospitalized for 15 days. He had a cholecystectomy and abscess
formation which was tx appropriately. He has a central line in the right IJ. The site looks
visibly infected, and he has a fever, is tachy, and hypotensive. WBCs are high. Blood
culture and initial gram stain reveals G(+) cocci.
What is the dx?
What is the MC pathogen?
What is the tx? - Answers -1. line-related infection
2. coag (-) staph epidermis
3. vanco + zosyn + ceftriaxone
if MRSA: vanco + ceftriaxone
if MSSA: zosyn + ceftriaxone
What is the tx for meningitis? - Answers -young pt: ceftriaxone + vanco
> 50 pt: add ampicillin
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