FCCS Review
41 y/o pt in the SICU following debridement of b/l lower extremities for necrotizing fasciitis is
intubated on AC. Temp 102, HR 116, RR 16, BP 92/46. ABG shows pH 7.23, PO2 133, PCO2
38, Na 139, K 3.7, Cl 102, Bicarb 16, lactate 4. Dx is metabolic acidosis w/ anion gap d/t
infection.
What is the most appropriate intervention?
Increase VT
Continue resuscitation
Decrease RR
Administer bicarb - ANS-Continue resuscitation. Don't need to increase VT bc the pt doesn't
have respiratory acidosis. If you decrease the RR, the pt will go into respiratory acidosis.
A 22 y/o pt ingested drugs >4 hours ago. She came to the ICU obtunded w/ arousal to tactile
stimulation. She is hemodynamically stable. RR 8 with an NG tube in place. What is the next
step for tx of the ingestion? - ANS-Monitor / watchful waiting.
The pt ingested the drugs more than 4 hours ago. Monitor RR and intubate if necessary.
A 24 y/o male comes in following a concussion. CT reveals a frontal lobe contusion. He does
not require intubation and is kept on 3 L O2 NC. He then suddenly has a generalized seizure.
What is the DOC?
What do you give after the seizure?
What med class is an absolute contraindication for seizures? - ANS-1. lorazepam IV
2. dilantin
3. NMB
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? - ANS-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 55 y/o male comes in with AMS and diffuse abdominal pain. He takes HCTZ and a
multivitamin. HR 120 sinus tach. He is moaning in pain and unable to articulate what is
happening. CT reveals lytic lesions in the vertebrae. You administer a 3L NS bolus which shows
mild improvement.
What is the dx and what is causing his symptoms?
How do you tx? - ANS-Dx: multiple myeloma
The hypercalcemia is what is causing the symptoms.
Tx: Fluids, then diuretic or bisphosphonate if symptoms persist.
A 70 y/o pt has been hospitalized for 15 days. He had a cholecystectomy and abscess
formation which was tx appropriately. He has a central line in the right IJ. The site looks visibly
infected, and he has a fever, is tachy, and hypotensive. WBCs are high. Blood culture and initial
gram stain reveals G(+) cocci.
What is the dx?
What is the MC pathogen?
What is the tx? - ANS-1. line-related infection
2. coag (-) staph epidermis
3. vanco + zosyn + ceftriaxone
if MRSA: vanco + ceftriaxone
if MSSA: zosyn + ceftriaxone
A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34, SpO2 90% on 8L O2.
CXR reveals infiltrates in a bat wing pattern. She also has LE edema. She is dx with a CHF
exacerbation w/ respiratory failure. Her ABG shows pH 7.3, PO2 64, CO2 50.
What is the best tx for this pt? - ANS-Non-invasive BiPAP.
A 70 y/o pt with COPD comes in with an exacerbation. He is rapidly becoming more hypoxic. To
rule out PE, what test should you order? - ANS-CT
A chemotherapy pt becomes septic. You suspect a neutropenic fever. What is the tx? -
ANS-broad spectrum abx (vanco/zosyn)
obtain blood, urine, and sputum culture
CXR + CT
A COPD pt comes in with difficulty breathing. He then becomes apneic and unresponsive. How
would you ventilate this pt? - ANS-BVM
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
41 y/o pt in the SICU following debridement of b/l lower extremities for necrotizing fasciitis is
intubated on AC. Temp 102, HR 116, RR 16, BP 92/46. ABG shows pH 7.23, PO2 133, PCO2
38, Na 139, K 3.7, Cl 102, Bicarb 16, lactate 4. Dx is metabolic acidosis w/ anion gap d/t
infection.
What is the most appropriate intervention?
Increase VT
Continue resuscitation
Decrease RR
Administer bicarb - ANS-Continue resuscitation. Don't need to increase VT bc the pt doesn't
have respiratory acidosis. If you decrease the RR, the pt will go into respiratory acidosis.
A 22 y/o pt ingested drugs >4 hours ago. She came to the ICU obtunded w/ arousal to tactile
stimulation. She is hemodynamically stable. RR 8 with an NG tube in place. What is the next
step for tx of the ingestion? - ANS-Monitor / watchful waiting.
The pt ingested the drugs more than 4 hours ago. Monitor RR and intubate if necessary.
A 24 y/o male comes in following a concussion. CT reveals a frontal lobe contusion. He does
not require intubation and is kept on 3 L O2 NC. He then suddenly has a generalized seizure.
What is the DOC?
What do you give after the seizure?
What med class is an absolute contraindication for seizures? - ANS-1. lorazepam IV
2. dilantin
3. NMB
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? - ANS-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 55 y/o male comes in with AMS and diffuse abdominal pain. He takes HCTZ and a
multivitamin. HR 120 sinus tach. He is moaning in pain and unable to articulate what is
happening. CT reveals lytic lesions in the vertebrae. You administer a 3L NS bolus which shows
mild improvement.
What is the dx and what is causing his symptoms?
How do you tx? - ANS-Dx: multiple myeloma
The hypercalcemia is what is causing the symptoms.
Tx: Fluids, then diuretic or bisphosphonate if symptoms persist.
A 70 y/o pt has been hospitalized for 15 days. He had a cholecystectomy and abscess
formation which was tx appropriately. He has a central line in the right IJ. The site looks visibly
infected, and he has a fever, is tachy, and hypotensive. WBCs are high. Blood culture and initial
gram stain reveals G(+) cocci.
What is the dx?
What is the MC pathogen?
What is the tx? - ANS-1. line-related infection
2. coag (-) staph epidermis
3. vanco + zosyn + ceftriaxone
if MRSA: vanco + ceftriaxone
if MSSA: zosyn + ceftriaxone
A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34, SpO2 90% on 8L O2.
CXR reveals infiltrates in a bat wing pattern. She also has LE edema. She is dx with a CHF
exacerbation w/ respiratory failure. Her ABG shows pH 7.3, PO2 64, CO2 50.
What is the best tx for this pt? - ANS-Non-invasive BiPAP.
A 70 y/o pt with COPD comes in with an exacerbation. He is rapidly becoming more hypoxic. To
rule out PE, what test should you order? - ANS-CT
A chemotherapy pt becomes septic. You suspect a neutropenic fever. What is the tx? -
ANS-broad spectrum abx (vanco/zosyn)
obtain blood, urine, and sputum culture
CXR + CT
A COPD pt comes in with difficulty breathing. He then becomes apneic and unresponsive. How
would you ventilate this pt? - ANS-BVM
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
