FCCS TEST UPDATED COMPREHENSIVE STUDY
GUIDE 2026
◉ A 52yoM presents to the ED with SOB and new-onset lower
extremity edema. Vitals: temp 37 (98.6F), HR 114, RR 28, BP 86/62,
SpO2 92% on nonrebreather. Transferred to ICU, intubated, and
central line is placed. TTE shows significantly reduced LV function.
Hgb 9.2, lactic acid 4.2, and central venous oxygen saturation 43%.
Which of the following interventions will significantly improve
oxygen delivery?
A) administer a 1L fluid bolus and start antibiotics
B) start inotropes to increase cardiac contractility
C) start vasopressors to increase SBP
D) transfuse RBCs to a goal of 10 g/dL.
Answer: B) start inotropes to increase cardiac contractility
◉ Patients presenting with which of the following conditions should
be triaged to the cath lab as soon as possible for early. reperfusion
with PCI or CABG?
A) NSTEMI with hemodynamic stability
B) NSTE-ACS with atrial bigeminy
C) NSTE-ACS with shock
D) NSTEMI with a thrombolysis in MI risk score of 2.
,Answer: C) NSTE-ACS with shock
◉ A 65yoM admitted to the ICU for BRBPR and hemorrhagic shock.
PMHx AAA s/p endovascular aneurysm repair 2 years ago. Intubated
and sedated on mechanical ventilation. Received 6 units PRBCs, 6
units FFP, 5 units platelets, 2 units cyroprecipitate. Corrected
calcium is 10, normothermic with pH 7.35, lactate 4. He continues to
have BRBPR. An NG tube is placed with non-bloody return.
Which of the following is the most appropriate next step?
A) gastrointestinal consultation for endoscopy
B) surgical consultation
C) IV PPI
D) IV octreotide.
Answer: B) surgical consultation
◉ An otherwise healthy 46yoF with no significant PMHx presents to
the ED for dyspnea. She is hypotensive, tachycardic, and hypoxic.
Vitals: BP 80/40, HR 160, SpO2 88% on RA. Conversational dyspnea
and in moderate respiratory distress. CTa of chest demonstrates
bilateral pulmonary emboli at level of main pulmonary artery. Labs:
lactate 7. Administered 500mL IVF with no hemodynamic
improvement. Started on norepinephrine for hemodynamic support.
POCUS demonstrates large hypokinetic RV and hyperdynamic LV.
Which of the following is the most appropriate intervention for her
pulmonary embolism?
, A) suction thrombectomy
B) catheter-directed thrombolysis
C) systemic thrombolysis
D) inferior vena cava filter.
Answer: C) systemic thrombolysis
◉ A 60kg (154lb), 170cm (67in), 69yoF with severe COPD is
admitted to the ICU for acute COPD exacerbation. Despite albuterol,
ipratropium, and IV methylprednisolone, she has become
somnolent. ABG on FiO2 0.35 shows pH 7.2, PCO2 110, PO2 108. ICU
physician decides invasive ventilation is needed. Patient receives IV
ketamine, 120 mg, to facilitate endotracheal intubation which is
accomplished easily. Ventilator is set to assist control/volume
control, with TV 440, rate 24, PEEP 5, FiO2 0.35, and orders a CXR.
15 min later, BP has fallen to 70/40. Breath sounds equal, chest rise
symmetrical. Ppeak 59, Pplat 18. Airway after end-expiratory hold is
18. Emergent ECG and cardiac enzymes normal.
Which of the following is the most likely explanation for her
hypotension?
A) myocardial ischemia
B) tension pneumothroax
C) intrinsic PEEP (auto-PEEP)
D) intubation medication.
Answer: C) intrinsic PEEP (auto-PEEP)
GUIDE 2026
◉ A 52yoM presents to the ED with SOB and new-onset lower
extremity edema. Vitals: temp 37 (98.6F), HR 114, RR 28, BP 86/62,
SpO2 92% on nonrebreather. Transferred to ICU, intubated, and
central line is placed. TTE shows significantly reduced LV function.
Hgb 9.2, lactic acid 4.2, and central venous oxygen saturation 43%.
Which of the following interventions will significantly improve
oxygen delivery?
A) administer a 1L fluid bolus and start antibiotics
B) start inotropes to increase cardiac contractility
C) start vasopressors to increase SBP
D) transfuse RBCs to a goal of 10 g/dL.
Answer: B) start inotropes to increase cardiac contractility
◉ Patients presenting with which of the following conditions should
be triaged to the cath lab as soon as possible for early. reperfusion
with PCI or CABG?
A) NSTEMI with hemodynamic stability
B) NSTE-ACS with atrial bigeminy
C) NSTE-ACS with shock
D) NSTEMI with a thrombolysis in MI risk score of 2.
,Answer: C) NSTE-ACS with shock
◉ A 65yoM admitted to the ICU for BRBPR and hemorrhagic shock.
PMHx AAA s/p endovascular aneurysm repair 2 years ago. Intubated
and sedated on mechanical ventilation. Received 6 units PRBCs, 6
units FFP, 5 units platelets, 2 units cyroprecipitate. Corrected
calcium is 10, normothermic with pH 7.35, lactate 4. He continues to
have BRBPR. An NG tube is placed with non-bloody return.
Which of the following is the most appropriate next step?
A) gastrointestinal consultation for endoscopy
B) surgical consultation
C) IV PPI
D) IV octreotide.
Answer: B) surgical consultation
◉ An otherwise healthy 46yoF with no significant PMHx presents to
the ED for dyspnea. She is hypotensive, tachycardic, and hypoxic.
Vitals: BP 80/40, HR 160, SpO2 88% on RA. Conversational dyspnea
and in moderate respiratory distress. CTa of chest demonstrates
bilateral pulmonary emboli at level of main pulmonary artery. Labs:
lactate 7. Administered 500mL IVF with no hemodynamic
improvement. Started on norepinephrine for hemodynamic support.
POCUS demonstrates large hypokinetic RV and hyperdynamic LV.
Which of the following is the most appropriate intervention for her
pulmonary embolism?
, A) suction thrombectomy
B) catheter-directed thrombolysis
C) systemic thrombolysis
D) inferior vena cava filter.
Answer: C) systemic thrombolysis
◉ A 60kg (154lb), 170cm (67in), 69yoF with severe COPD is
admitted to the ICU for acute COPD exacerbation. Despite albuterol,
ipratropium, and IV methylprednisolone, she has become
somnolent. ABG on FiO2 0.35 shows pH 7.2, PCO2 110, PO2 108. ICU
physician decides invasive ventilation is needed. Patient receives IV
ketamine, 120 mg, to facilitate endotracheal intubation which is
accomplished easily. Ventilator is set to assist control/volume
control, with TV 440, rate 24, PEEP 5, FiO2 0.35, and orders a CXR.
15 min later, BP has fallen to 70/40. Breath sounds equal, chest rise
symmetrical. Ppeak 59, Pplat 18. Airway after end-expiratory hold is
18. Emergent ECG and cardiac enzymes normal.
Which of the following is the most likely explanation for her
hypotension?
A) myocardial ischemia
B) tension pneumothroax
C) intrinsic PEEP (auto-PEEP)
D) intubation medication.
Answer: C) intrinsic PEEP (auto-PEEP)
