FCCS CERT EXAM REVIEW 2024-2025
ACTUAL EXAM 120 LATEST UPDATED
EXAM QUESTIONS AND VERIFIED
ANSWERS. ALREADY GRADED A+
1. What is the most important sign in a critically ill pt? Why?: Tachypnea
Indicates metabolic acidosis (often w/ respiratory alkalosis compensation)
2. 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
3. If a pt has a thyromental distance of 2 cm, what can you expect about
their airway?: Difficult airway w/ an anteriorly displaced larynx
4. A COPD pt comes in with difficulty breathing. He then becomes
apneic and unresponsive. How would you ventilate this pt?: BVM
5. 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.
6. An ESRD pt w/ hyperkalemia develops dyspnea and requires
intubation. Which paralytic agent/NMB should you avoid and why?:
Succinylcholine
Worsens hyperkalemia
7. 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.
8. What intervention improves outcomes with ROSC after cardiac
arrest?: Targeted temperature management.
32-36 C
9. A shunt means there is perfusion without ventilation. What disease
process is an example of a shunt?: Pneumonia
10. Which type of respiratory failure occurs with CNS depression after
an
OD?: Acute hypercapnic respiratory failure --> mixed
, 11. 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
12. 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
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