FCCS REVIEW EXAM / 40+ QUESTIONS AND CORRECT ANSWERS 2023/2024 GRADED A+.

FCCS REVIEW EXAM / 40+ QUESTIONS AND CORRECT ANSWERS 2023/2024 GRADED A+. 2023 1. What is the most important sign in a critically ill pt? Why?: Tachypnea Indicates metabolic acidosis w/ respiratory alkalosis compensation 2. 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?: Cardiac tamponade; obstructive shock 3. If a pt has a thyromental distance of 2 cm, what can you expect about their airway?: Difficult airway w/ an anteriorly displaced larynx 4. A COPD pt comes in with difficulty breathing. He then becomes apneic and unresponsive. How would you ventilate this pt?: BVM 5. 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?: Cerebral edema/increasing ICP Intubation tends to cause an increase in ICP. Administer lidocaine prior to intubation to inhibit vagal stimulation. 6. An ESRD pt w/ hyperkalemia develops dyspnea and requires intubation. Which paralytic agent/NMB should you avoid and why?: Succinylcholine Worsens hyperkalemia 7. 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?: The pt is having apneic episodes, which means that administering high-flow O2 will be ineffective. Choose an LMA if the BVM fails. 8. What intervention improves outcomes with ROSC after cardiac arrest?: Targeted temperature management. 32-36 C 9. A shunt means there is perfusion without ventilation. What disease process is an example of a shunt?: Pneumonia 1 / 7 FCCS Review 2023 10. Which type of respiratory failure occurs with CNS depression after an OD?: Acute hypercapnic respiratory failure -- mixed 11. 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?: 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 12. 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?: Tension pneumothorax Needle decompression/chest tube 13. A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2 is 88%. Peak airway pressure and plateau ar