FCCS REVIEW EXAM | QUESTIONS AND
ANSWER GRADED A+
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 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
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? -
Difficult airway w/ an anteriorly displaced larynx
A COPD pt comes in with difficulty breathing. He then becomes apneic and
unresponsive. How would you ventilate this pt? - BVM
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.
An ESRD pt w/ hyperkalemia develops dyspnea and requires intubation. Which
paralytic agent/NMB should you avoid and why? - Succinylcholine
Worsens hyperkalemia
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.
What intervention improves outcomes with ROSC after cardiac arrest? - Targeted
temperature management.
, 32-36 C
A shunt means there is perfusion without ventilation. What disease process is an
example of a shunt? - Pneumonia
Which type of respiratory failure occurs with CNS depression after an OD? - 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? - 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? - 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? - 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.
ANSWER GRADED A+
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 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
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? -
Difficult airway w/ an anteriorly displaced larynx
A COPD pt comes in with difficulty breathing. He then becomes apneic and
unresponsive. How would you ventilate this pt? - BVM
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.
An ESRD pt w/ hyperkalemia develops dyspnea and requires intubation. Which
paralytic agent/NMB should you avoid and why? - Succinylcholine
Worsens hyperkalemia
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.
What intervention improves outcomes with ROSC after cardiac arrest? - Targeted
temperature management.
, 32-36 C
A shunt means there is perfusion without ventilation. What disease process is an
example of a shunt? - Pneumonia
Which type of respiratory failure occurs with CNS depression after an OD? - 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? - 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? - 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? - 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.
