FCCS EXAM PREP QUESTIONS ANSWERS STUDY GUIDE VERIFIED SOLUTION
Question:
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
Question:
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
Question:
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
, Question:
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
Question:
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)
Question:
A 24yoM admitted to ICU after falling from roof. Admission CT reveals left frontal lobe contusion.
No intubation is required. Patient on 3L NC. Observed to have a generalized seizure. Which of the
following best characterizes the most appropriate initial management? A) phenytoin, 18-20 mg/kg
IV, should be administered as rapidly as possible B) no drug therapy indicated unless ICP exceeds
25 mmHg C) IV benzodiazepine, such as lorazepam, 0.1 mg/kg, administered at the onset of seizure
activity, may terminate the seizure D) IV neuromuscular relaxant such as vecuronium (10,g) should
be administered to decrease the cerebral oxygen requirement
Question:
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
Question:
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
Question:
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
, Question:
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
Question:
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)
Question:
A 24yoM admitted to ICU after falling from roof. Admission CT reveals left frontal lobe contusion.
No intubation is required. Patient on 3L NC. Observed to have a generalized seizure. Which of the
following best characterizes the most appropriate initial management? A) phenytoin, 18-20 mg/kg
IV, should be administered as rapidly as possible B) no drug therapy indicated unless ICP exceeds
25 mmHg C) IV benzodiazepine, such as lorazepam, 0.1 mg/kg, administered at the onset of seizure
activity, may terminate the seizure D) IV neuromuscular relaxant such as vecuronium (10,g) should
be administered to decrease the cerebral oxygen requirement
