FCCS Exam 2023/ 39 Questions with
100% Correct Answer.
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.
100% Correct Answer.
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.
