FCCs Oracle Certification Exam (2024/ 2025)
Questions and Verified Answers| 100% Correct |
Grade A
What is the most important sign in a critically ill pt? Why? - ANSWERTachypnea
Indicates metabolic acidosis (often 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? - ANSWERCardiac tamponade; obstructive
shock
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? -
ANSWERDifficult 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? - ANSWERBVM
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? - ANSWERCerebral
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? - ANSWERSuccinylcholine
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? - ANSWERThe 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? -
ANSWERTargeted temperature management.
,32-36 C
A shunt means there is perfusion without ventilation. What disease process is an
example of a shunt? - ANSWERPneumonia
Which type of respiratory failure occurs with CNS depression after an OD? -
ANSWERAcute 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? - ANSWERAuto-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? - ANSWERTension 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? - ANSWERDecrease the PEEP, even
though it will decrease PaO2.
(Note: you can't decrease the VT because it is already on the low end).
A young asthmatic pt is on the vent. His lungs are very tight. He is on the AC setting
and there is a lot of auto-PEEP. You correct it by reducing the rate, giving him more
time to exhale and making sure he has enough flow. FiO2 is at .50. He is sedated and
seems comfortable. On ABG the pH is 7.24, CO2 is 65, O2 is 80, and bicarb is 29.
,What would you do with the vent settings in this case? - ANSWERKeep the settings
where they are.
You can't hyperventilate the pt to blow off CO2 b/c the asthma will worsen. As long
as the pH is > 7.2, the settings are okay as they are. CO2 will correct over time.
Which two conditions are the most indicated for BiPAP? - ANSWERCOPD
exacerbation
Cardiogenic pulmonary edema
A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34, SpO2 90% on
8L O2. CXR reveals infiltrates in a bat wing pattern. She also has LE edema. She is dx
with a CHF exacerbation w/ respiratory failure. Her ABG shows pH 7.3, PO2 64, CO2
50.
What is the best tx for this pt? - ANSWERNon-invasive BiPAP.
A pt comes in w/ a femur fx and a rod is placed. Post-op he develops dyspnea and
fever. HR 140, RR 30, SpO2 92% on non-rebreather. He is transferred to the ICU
where you intubate, place a central line, and start resuscitating him. Hb 8.2, lactate
3.2, SVO2 is 52%.
Why is his SVO2 low? How can we improve it? - ANSWERDecreased O2 delivery and
increased consumption.
(normal is 65-70)
Administer packed RBCs - 1U of blood will change his Hb from 8.2 to 9.2. O2, fluid,
and VT would not work.
A young pt after an MVA comes to the ER hypotensive and tachycardic. CXR is clear.
He has a contusion on his chest wall and torso. He is unconscious. What will give you
the best insight on what is causing his shock?
Hb
SCV
Urine Output
FAST exam - ANSWERFAST exam
41 y/o pt in the SICU following debridement of b/l lower extremities for necrotizing
fasciitis is intubated on AC. Temp 102, HR 116, RR 16, BP 92/46. ABG shows pH 7.23,
PO2 133, PCO2 38, Na 139, K 3.7, Cl 102, Bicarb 16, lactate 4. Dx is metabolic acidosis
w/ anion gap d/t infection.
What is the most appropriate intervention?
, Increase VT
Continue resuscitation
Decrease RR
Administer bicarb - ANSWERContinue resuscitation. Don't need to increase VT bc the
pt doesn't have respiratory acidosis. If you decrease the RR, the pt will go into
respiratory acidosis.
A pt has obstructive uropathy. A catheter is placed d/t the obstructive kidney injury.
After the cath is placed, he has massive diuresis to the point where he is
hypotensive, tachy, and lactate is 2x the ULN from decreased perfusion.
How would you correct this? - ANSWERFluids - LR
When treating hyponatremia, what is the first thing to assess?
When do you give 3% NaCl?
How do you correct it? - ANSWER1. fluid status
2. seizures or changes in mental status
3. slowly, 8-12 meq over 24 hr
What are the classifications of hemorrhagic shock? - ANSWERI: <15%; HR <100, BP
normal, RR normal
II: 15-30%; HR >100, BP normal, RR 20-30
III: 30-40%; HR >120, BP low, RR 30-40
IV: >40%; HR >140, BP low, RR >40
An 84 y/o pt fell down the stairs. He is moaning and crying. He has a C-collar in place.
His neck is painful and he has bruising on his face. He is tachy but BP is okay. You
administer 2L O2 bc SpO2 was 92%. Shortly after he deteriorates, becoming altered
and then comatose. His left pupil > the right. He is herniating from cerebral edema.
How do you treat him? - ANSWERIntubate and ventilate, maintaining c-spine
precautions. Administer mannitol.
A pt comes in with several cardiovascular RFs: elderly, DM, and HTN. He is having
chest pain, SOB, and is diaphoretic. What diagnosis do you need to re-perfuse him
immediately? - ANSWERSTEMI
What is the most appropriate management for both STEMI and non-STEMI?
nitro if bp >80
morphine q 30 min
bb
oxygen if sats are <94% - ANSWEROxygen
Questions and Verified Answers| 100% Correct |
Grade A
What is the most important sign in a critically ill pt? Why? - ANSWERTachypnea
Indicates metabolic acidosis (often 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? - ANSWERCardiac tamponade; obstructive
shock
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? -
ANSWERDifficult 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? - ANSWERBVM
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? - ANSWERCerebral
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? - ANSWERSuccinylcholine
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? - ANSWERThe 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? -
ANSWERTargeted temperature management.
,32-36 C
A shunt means there is perfusion without ventilation. What disease process is an
example of a shunt? - ANSWERPneumonia
Which type of respiratory failure occurs with CNS depression after an OD? -
ANSWERAcute 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? - ANSWERAuto-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? - ANSWERTension 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? - ANSWERDecrease the PEEP, even
though it will decrease PaO2.
(Note: you can't decrease the VT because it is already on the low end).
A young asthmatic pt is on the vent. His lungs are very tight. He is on the AC setting
and there is a lot of auto-PEEP. You correct it by reducing the rate, giving him more
time to exhale and making sure he has enough flow. FiO2 is at .50. He is sedated and
seems comfortable. On ABG the pH is 7.24, CO2 is 65, O2 is 80, and bicarb is 29.
,What would you do with the vent settings in this case? - ANSWERKeep the settings
where they are.
You can't hyperventilate the pt to blow off CO2 b/c the asthma will worsen. As long
as the pH is > 7.2, the settings are okay as they are. CO2 will correct over time.
Which two conditions are the most indicated for BiPAP? - ANSWERCOPD
exacerbation
Cardiogenic pulmonary edema
A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34, SpO2 90% on
8L O2. CXR reveals infiltrates in a bat wing pattern. She also has LE edema. She is dx
with a CHF exacerbation w/ respiratory failure. Her ABG shows pH 7.3, PO2 64, CO2
50.
What is the best tx for this pt? - ANSWERNon-invasive BiPAP.
A pt comes in w/ a femur fx and a rod is placed. Post-op he develops dyspnea and
fever. HR 140, RR 30, SpO2 92% on non-rebreather. He is transferred to the ICU
where you intubate, place a central line, and start resuscitating him. Hb 8.2, lactate
3.2, SVO2 is 52%.
Why is his SVO2 low? How can we improve it? - ANSWERDecreased O2 delivery and
increased consumption.
(normal is 65-70)
Administer packed RBCs - 1U of blood will change his Hb from 8.2 to 9.2. O2, fluid,
and VT would not work.
A young pt after an MVA comes to the ER hypotensive and tachycardic. CXR is clear.
He has a contusion on his chest wall and torso. He is unconscious. What will give you
the best insight on what is causing his shock?
Hb
SCV
Urine Output
FAST exam - ANSWERFAST exam
41 y/o pt in the SICU following debridement of b/l lower extremities for necrotizing
fasciitis is intubated on AC. Temp 102, HR 116, RR 16, BP 92/46. ABG shows pH 7.23,
PO2 133, PCO2 38, Na 139, K 3.7, Cl 102, Bicarb 16, lactate 4. Dx is metabolic acidosis
w/ anion gap d/t infection.
What is the most appropriate intervention?
, Increase VT
Continue resuscitation
Decrease RR
Administer bicarb - ANSWERContinue resuscitation. Don't need to increase VT bc the
pt doesn't have respiratory acidosis. If you decrease the RR, the pt will go into
respiratory acidosis.
A pt has obstructive uropathy. A catheter is placed d/t the obstructive kidney injury.
After the cath is placed, he has massive diuresis to the point where he is
hypotensive, tachy, and lactate is 2x the ULN from decreased perfusion.
How would you correct this? - ANSWERFluids - LR
When treating hyponatremia, what is the first thing to assess?
When do you give 3% NaCl?
How do you correct it? - ANSWER1. fluid status
2. seizures or changes in mental status
3. slowly, 8-12 meq over 24 hr
What are the classifications of hemorrhagic shock? - ANSWERI: <15%; HR <100, BP
normal, RR normal
II: 15-30%; HR >100, BP normal, RR 20-30
III: 30-40%; HR >120, BP low, RR 30-40
IV: >40%; HR >140, BP low, RR >40
An 84 y/o pt fell down the stairs. He is moaning and crying. He has a C-collar in place.
His neck is painful and he has bruising on his face. He is tachy but BP is okay. You
administer 2L O2 bc SpO2 was 92%. Shortly after he deteriorates, becoming altered
and then comatose. His left pupil > the right. He is herniating from cerebral edema.
How do you treat him? - ANSWERIntubate and ventilate, maintaining c-spine
precautions. Administer mannitol.
A pt comes in with several cardiovascular RFs: elderly, DM, and HTN. He is having
chest pain, SOB, and is diaphoretic. What diagnosis do you need to re-perfuse him
immediately? - ANSWERSTEMI
What is the most appropriate management for both STEMI and non-STEMI?
nitro if bp >80
morphine q 30 min
bb
oxygen if sats are <94% - ANSWEROxygen
