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FCCS Review 2023 Questions with correct Answers
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FCCS Review 2023 Questions withcorrect Answers
What is the most important sign in a critically ill pt? Why? - -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? - -Cardiac tamponade; obstructive shock
-If a pt has a thyromental distance of 2 cm, what can you expect about their
airway? - -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? - -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? - -
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? - -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? - -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? - -
Targeted temperature management.
32-36 C
-A shunt means there is perfusion without ventilation. What disease process
is an example of a shunt? - -Pneumonia
-Which type of respiratory failure occurs with CNS depression after an OD? -
-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? - -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? - -Tension pneumothorax
Needle decompression/chest tube
-A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2 is 88%.
Peak airway pressure and plateau are both high. VT is 5 ml/kg.
How can you decrease the airway pressures? - -Decrease the PEEP, even
though it will decrease PaO2.
(Note: you can't decrease the VT because it is already on the low end).
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