ACCS Oakes practice Exam with correct answers
A difficult intubation is anticipated with an obese pt. The decision is made to
intubate by video laryngoscopy. Which of the following is LEAST likely to be
needed:
A) Cook's Exchanger
B) Rigid Stylet
C) Cuffed Endotracheal Tube
D) Video-enabled Laryngoscope Answer✔✔ A) cook's exchanger
Video laryngoscopy involves use of a normal ET Tube with the addition of a rigid
stylet, as well as a video-enabled laryngoscope and other normal intubation
equipment.
A Cook's Tube Exchanger is not necessary - this is used to exchange tubes already
in place.
A 5'6" female has been transferred from Intermediate Care to Intensive Care in
respiratory distress. She is intubated with a silver-coated #7.0 Endotracheal tube.
CXR immediately following intubation shows Right Upper Lobe infiltrate with
bibasilar atelectasis. The ET Tube is noted to be approximately 4 cm above the
carina.
The Respiratory Therapist would BEST recommend:
A) Initiation of broad-spectrum antibiotics for probably pneumonia
B)Withdraw Endotracheal tube at least 3 cm
C) Use tube exchanger to replace Endotracheal tube from silver-coated to a low-
pressure/high-volume cuffed tube
,D) Immediate V/Q Scan Answer✔✔ Correct answer is A
This pt has gone into respiratory failure, requiring intubation. The X-ray is
consistent with a possible pneumonia diagnosis. The best option therefore is to
start antibiotics.
Withdrawing ET Tube is not indicated as 4 cm is likely adequate. Pulling back 3
cm could result in inadvertent extubation and would cause harm to patient
Use of tube exchanger is unnecessary. A silver-coated endotracheal tube is
intended to help prevent VAP
Immediate V/Q scan is not indicated - it is a poor use of resources for what is
needed right away.
You are part of Physician Rounding this morning, and consulting on a patient who
is currently on APRV. They were originally admitted with a pneumonia which
developed into ARDS with a P/F ratio as low as 110. The patient was transitioned
to APRV from PC due to an elevated Plateau Pressure required to maintain VT
around 4 cc/kg IBW. The patient is arousable and taking breaths on their own. The
physician has asked you what should be done to address the patient's latest ABG.
Ph 7.16
PaCo2 49
PaO2 88 torr
HCO3 19
Mode- APRV
Phigh- 24
, Plow- 0
Thigh- 5.0 sec
Tlow- o.5 sec
PS- 26
FiO2- 80%
A) Increase Phigh to 28 cmH2O
B) Decrease Phigh to 20 cmH2O
C) Increase sedation
D) Increase Thigh to 6.0 sec Answer✔✔ Correct answer is A
This ABG may look deceptively metabolic but is truly a mixed Respiratory and
Metabolic Acidosis. The PaCO2 has risen, slightly, as a result of the Metabolic
Acidosis. The correct solution is to increase Phigh to 28 cmH2O (increasing your
delta-P to increase minute volume. Decreasing Phigh will decrease minute volume.
Increasing Thigh will increase MAP (good if oxygenation), but will also lower the
number of "releases" - which are primarily responsible for dumping CO2.
Increasing sedation in a patient who is spontaneously breathing on APRV will
result in a lowered minute volume and worsening acidosis. While controversy
exists, you may also consider increasing PS if the pt is breathing spontaneously.
A 56-year old woman was admitted for rapid development of respiratory failure
following a suspected aspiration. Her past medical history includes Diabetes,
medication-controlled Hypertension, and she has a 30-pack year smoking history.
She has been intubated and placed on a Ventilator.
Patient data
Ph 7.19
A difficult intubation is anticipated with an obese pt. The decision is made to
intubate by video laryngoscopy. Which of the following is LEAST likely to be
needed:
A) Cook's Exchanger
B) Rigid Stylet
C) Cuffed Endotracheal Tube
D) Video-enabled Laryngoscope Answer✔✔ A) cook's exchanger
Video laryngoscopy involves use of a normal ET Tube with the addition of a rigid
stylet, as well as a video-enabled laryngoscope and other normal intubation
equipment.
A Cook's Tube Exchanger is not necessary - this is used to exchange tubes already
in place.
A 5'6" female has been transferred from Intermediate Care to Intensive Care in
respiratory distress. She is intubated with a silver-coated #7.0 Endotracheal tube.
CXR immediately following intubation shows Right Upper Lobe infiltrate with
bibasilar atelectasis. The ET Tube is noted to be approximately 4 cm above the
carina.
The Respiratory Therapist would BEST recommend:
A) Initiation of broad-spectrum antibiotics for probably pneumonia
B)Withdraw Endotracheal tube at least 3 cm
C) Use tube exchanger to replace Endotracheal tube from silver-coated to a low-
pressure/high-volume cuffed tube
,D) Immediate V/Q Scan Answer✔✔ Correct answer is A
This pt has gone into respiratory failure, requiring intubation. The X-ray is
consistent with a possible pneumonia diagnosis. The best option therefore is to
start antibiotics.
Withdrawing ET Tube is not indicated as 4 cm is likely adequate. Pulling back 3
cm could result in inadvertent extubation and would cause harm to patient
Use of tube exchanger is unnecessary. A silver-coated endotracheal tube is
intended to help prevent VAP
Immediate V/Q scan is not indicated - it is a poor use of resources for what is
needed right away.
You are part of Physician Rounding this morning, and consulting on a patient who
is currently on APRV. They were originally admitted with a pneumonia which
developed into ARDS with a P/F ratio as low as 110. The patient was transitioned
to APRV from PC due to an elevated Plateau Pressure required to maintain VT
around 4 cc/kg IBW. The patient is arousable and taking breaths on their own. The
physician has asked you what should be done to address the patient's latest ABG.
Ph 7.16
PaCo2 49
PaO2 88 torr
HCO3 19
Mode- APRV
Phigh- 24
, Plow- 0
Thigh- 5.0 sec
Tlow- o.5 sec
PS- 26
FiO2- 80%
A) Increase Phigh to 28 cmH2O
B) Decrease Phigh to 20 cmH2O
C) Increase sedation
D) Increase Thigh to 6.0 sec Answer✔✔ Correct answer is A
This ABG may look deceptively metabolic but is truly a mixed Respiratory and
Metabolic Acidosis. The PaCO2 has risen, slightly, as a result of the Metabolic
Acidosis. The correct solution is to increase Phigh to 28 cmH2O (increasing your
delta-P to increase minute volume. Decreasing Phigh will decrease minute volume.
Increasing Thigh will increase MAP (good if oxygenation), but will also lower the
number of "releases" - which are primarily responsible for dumping CO2.
Increasing sedation in a patient who is spontaneously breathing on APRV will
result in a lowered minute volume and worsening acidosis. While controversy
exists, you may also consider increasing PS if the pt is breathing spontaneously.
A 56-year old woman was admitted for rapid development of respiratory failure
following a suspected aspiration. Her past medical history includes Diabetes,
medication-controlled Hypertension, and she has a 30-pack year smoking history.
She has been intubated and placed on a Ventilator.
Patient data
Ph 7.19
