FCCS ACTUAL CERTIFICATION PAPER
2026 QUESTIONS WITH ANSWERS FULL
SOLUTION.
◍ Which type of respiratory failure occurs with CNS depression after an
OD? Answer: 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? Answer: 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? Answer: 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? Answer: Decrease 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.
2026 QUESTIONS WITH ANSWERS FULL
SOLUTION.
◍ Which type of respiratory failure occurs with CNS depression after an
OD? Answer: 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? Answer: 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? Answer: 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? Answer: Decrease 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.
