FCCS Review ACTUAL UPDATED QUESTIONS AND CORRECT 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 Cardiac tamponade; obstructive shock
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?
If a pt has a thyromental distance of 2 cm, what can you Difficult airway w/ an anteriorly displaced larynx
expect about their airway?
A COPD pt comes in with difficulty breathing. He then BVM
becomes apneic and unresponsive. How would you
ventilate this pt?
, A pt arrives after falling from a ladder and has a frontal Cerebral edema/increasing ICP
laceration. On examination, you find papilledema and
labored breathing w/o being able to clear secretions. Intubation tends to cause an increase in ICP. Administer lidocaine prior to
What is your biggest concern when intubating this pt? intubation to inhibit vagal stimulation.
An ESRD pt w/ hyperkalemia develops dyspnea and Succinylcholine
requires intubation. Which paralytic agent/NMB should
you avoid and why? Worsens hyperkalemia
A pt is admitted after an OD. He starts to have apneic The pt is having apneic episodes, which means that administering high-flow O2
episodes and his SpO2 is dropping. You place him on a will be ineffective.
non-rebreather mask w/ 100% O2, yet his SpO2 remains at
80%. Why is it not being corrected? Choose an LMA if the BVM fails.
Then, if you try a BVM and it also fails, and video
laryngoscopy is unavailable, what is your next best
choice for an airway?
What intervention improves outcomes with ROSC after Targeted temperature management.
cardiac arrest?
32-36 C
A shunt means there is perfusion without ventilation. What Pneumonia
disease process is an example of a shunt?
Which type of respiratory failure occurs with CNS Acute hypercapnic respiratory failure --> mixed
depression after an OD?
A 50 y/o pt is having a COPD exacerbation. You have Auto-peep is the cause.
tried steroids, bronchodilators, etc. with no improvement.
PCO2 is in the 90s, pH is 7.20. You decide to intubate. COPD pts have difficulty exhaling --> pressure buildup in alveoli.
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 We use PEEP for the pressure and to improve oxygenation. Auto-peep comes
are clear/equal. Vent shows peak airway pressure of 55 from breath-stacking --> intrinsic peep. Alveoli enlarge --> high peak airway
(high) and plateau pressure of 15. End expiratory hold pressure. All leads to low venous return --> low CO --> HoTN
gives auto-peep of 15.
What is the cause of this pt's HoTN and why?
A COPD pt is admitted to the ICU for exacerbation. Pt is Tension pneumothorax
on a vent. Pt is tx w/ bronchodilators, steroids, and Abx.
ABG was normal 1 hr ago, but now the peak airway Needle decompression/chest tube
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?
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 Cardiac tamponade; obstructive shock
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?
If a pt has a thyromental distance of 2 cm, what can you Difficult airway w/ an anteriorly displaced larynx
expect about their airway?
A COPD pt comes in with difficulty breathing. He then BVM
becomes apneic and unresponsive. How would you
ventilate this pt?
, A pt arrives after falling from a ladder and has a frontal Cerebral edema/increasing ICP
laceration. On examination, you find papilledema and
labored breathing w/o being able to clear secretions. Intubation tends to cause an increase in ICP. Administer lidocaine prior to
What is your biggest concern when intubating this pt? intubation to inhibit vagal stimulation.
An ESRD pt w/ hyperkalemia develops dyspnea and Succinylcholine
requires intubation. Which paralytic agent/NMB should
you avoid and why? Worsens hyperkalemia
A pt is admitted after an OD. He starts to have apneic The pt is having apneic episodes, which means that administering high-flow O2
episodes and his SpO2 is dropping. You place him on a will be ineffective.
non-rebreather mask w/ 100% O2, yet his SpO2 remains at
80%. Why is it not being corrected? Choose an LMA if the BVM fails.
Then, if you try a BVM and it also fails, and video
laryngoscopy is unavailable, what is your next best
choice for an airway?
What intervention improves outcomes with ROSC after Targeted temperature management.
cardiac arrest?
32-36 C
A shunt means there is perfusion without ventilation. What Pneumonia
disease process is an example of a shunt?
Which type of respiratory failure occurs with CNS Acute hypercapnic respiratory failure --> mixed
depression after an OD?
A 50 y/o pt is having a COPD exacerbation. You have Auto-peep is the cause.
tried steroids, bronchodilators, etc. with no improvement.
PCO2 is in the 90s, pH is 7.20. You decide to intubate. COPD pts have difficulty exhaling --> pressure buildup in alveoli.
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 We use PEEP for the pressure and to improve oxygenation. Auto-peep comes
are clear/equal. Vent shows peak airway pressure of 55 from breath-stacking --> intrinsic peep. Alveoli enlarge --> high peak airway
(high) and plateau pressure of 15. End expiratory hold pressure. All leads to low venous return --> low CO --> HoTN
gives auto-peep of 15.
What is the cause of this pt's HoTN and why?
A COPD pt is admitted to the ICU for exacerbation. Pt is Tension pneumothorax
on a vent. Pt is tx w/ bronchodilators, steroids, and Abx.
ABG was normal 1 hr ago, but now the peak airway Needle decompression/chest tube
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?
