FCCS Questions
1. A 76yoF PMHx CHF, HTN is admitted with AMS and mild upper respiratory sxs. According to family, her mental status gradually
declined over the last 3 days. Because generalized weakness and upper respiratory sxs, limited amount of food/drink in the last
72hrs. Home meds: metoprolol, lisinopril, furosemide.
Family states she's compliant.
Vitals: HR 118, BP 96/53, RR 14, SpO2 98% RA
Dry mucous membranes, poor skin turgor, absence of JVD. Clear on auscultation. Opens eyes to voice, mumbles incomprehensible
sounds, generalized weakness. 2 minute tonic-clonic seizure in ED which resolves without intervention.
Na 110, K 4.5, Cl 80, Bicarb 26, BUN 57, Cr 1.2, glucose 89.
Most appropriate next step?
A) free water restriction
B) hypertonic (3%) saline, 100mL for rapid early correction, goal serum Na 118 in 24 hrs
C) Normal saline bolus, 1L over 10 min, repeat for goal serum Na 128 in 24hrs
D) oral tolvaptan, 15mg: B) Hypertonic (3%) saline, 100 mL for rapid early correction, with goal serum sodium of 118 mEq/L in 24
hours
2. A 72yoF PMHx HTN, T2DM, smoking develops sudden-onset severe CP associated with difficulty breathing and diaphoresis.
Vitals on arrival in ED: BP 165/92, HR 101, RR 29, SpO2 96% RA.
Which of the following ECG findings is most significant indicator for immediate reperfusion in this patient?
A) ST segment depression
B) ST segment elevation
C) T wave inversions
D) Peaked T waves: B) ST segment elevation
3. A 72yoM presents to ED with CHF exacerbation. Awake and alert but in distress. Using accessory respiratory muscles and says
it's hard to breathe.
Vitals: HR 120, BP 120/80, RR 34, SpO2 90% on 8L simple face maks.
PE: bilateral lower extremity edema, crackles in posterior lung fields.
CXR: bilateral fluffy infiltrates consistent with pulmonary edema
ABG: pH 7.3, PCO2 50, PO2 64
In addition to diuresis, which of the following is the best next step in this patient's management?
A) intubate and initiate invasive mechanical ventilation
, FCCS Questions
B) initiate noninvasive positive pressure ventilation
C) switch to nonrebreather oxygen mask
D) switch to high-flow, high-humidity oxygen: B) initiate noninvasive positive pressure ventilation 4. A 27yoM admitted to ICU
with SAH after MVC. Initial GCS 8 with labored respirations. He was intubated in the ED and placed on a ventilator. Shortly
after arrival to the unit, SpO2 reads 57% with HR 46 and no pulse.
Which of the following is the safest and most immediate method to verify correct ET tube placement?
A) palpation over the epigastrum for abdominal distention
B) manual bag-mask breathing
C) qualitative exhaled carbon dioxide monitor or detector
D) portable chest radiograph: C) qualitative exhaled carbon dioxide monitor or detector
5. A 52yoM presents after a MVC with hypotension and obvious signs of hemorrhagic shock. FAST exam is positive, and an
emergent surgical consult is obtained for operative intervention. While awaiting surgeon and transport to OR for definitive
hemorrhage control, his BP continues to decline and resuscitation begins.
Which of the following is the best strategy for resuscitation in this setting of massive hemorrhage?
A) infusion of packed red blood cells only until laboratory results are available to assess for the presence of coagulopathy
and thrombocytopenia
B) balanced resuscitation using a combination of packed red blood cells, fresh frozen plasma, and platelets in a 1:1:1 ratio
C) limited infusion of IV fluids or blood products until definitive control of hemorrhage is achieved, regardless of blood
pressure or hemodynamic status
D) aggressive isotonic crystalloid infusion to maintain normal blood pressure: B)
balanced resuscitation using a combination of packed red blood cells, fresh frozen plasma, and platelets in a 1:1:1 ratio
6. A 75yoF is admitted to the ED with AMS. A CTH shows intracranial hemorrhage. Decision is made to intubate her, but there is
concern fro increased ICP. Which of the following pretreatment agents is most appropriate before performing RSI?
A) cisatracurium
B) succinylcholine
C) lidocaine
D) rocuronium: B) succinylcholine
7. A patient arrives in the ED with RR 4. She is not intubated. Overdose with a centrally acting nervous system depressant is
suspected.
Which of the following is the most likely finding on the initial blood gas?
1. A 76yoF PMHx CHF, HTN is admitted with AMS and mild upper respiratory sxs. According to family, her mental status gradually
declined over the last 3 days. Because generalized weakness and upper respiratory sxs, limited amount of food/drink in the last
72hrs. Home meds: metoprolol, lisinopril, furosemide.
Family states she's compliant.
Vitals: HR 118, BP 96/53, RR 14, SpO2 98% RA
Dry mucous membranes, poor skin turgor, absence of JVD. Clear on auscultation. Opens eyes to voice, mumbles incomprehensible
sounds, generalized weakness. 2 minute tonic-clonic seizure in ED which resolves without intervention.
Na 110, K 4.5, Cl 80, Bicarb 26, BUN 57, Cr 1.2, glucose 89.
Most appropriate next step?
A) free water restriction
B) hypertonic (3%) saline, 100mL for rapid early correction, goal serum Na 118 in 24 hrs
C) Normal saline bolus, 1L over 10 min, repeat for goal serum Na 128 in 24hrs
D) oral tolvaptan, 15mg: B) Hypertonic (3%) saline, 100 mL for rapid early correction, with goal serum sodium of 118 mEq/L in 24
hours
2. A 72yoF PMHx HTN, T2DM, smoking develops sudden-onset severe CP associated with difficulty breathing and diaphoresis.
Vitals on arrival in ED: BP 165/92, HR 101, RR 29, SpO2 96% RA.
Which of the following ECG findings is most significant indicator for immediate reperfusion in this patient?
A) ST segment depression
B) ST segment elevation
C) T wave inversions
D) Peaked T waves: B) ST segment elevation
3. A 72yoM presents to ED with CHF exacerbation. Awake and alert but in distress. Using accessory respiratory muscles and says
it's hard to breathe.
Vitals: HR 120, BP 120/80, RR 34, SpO2 90% on 8L simple face maks.
PE: bilateral lower extremity edema, crackles in posterior lung fields.
CXR: bilateral fluffy infiltrates consistent with pulmonary edema
ABG: pH 7.3, PCO2 50, PO2 64
In addition to diuresis, which of the following is the best next step in this patient's management?
A) intubate and initiate invasive mechanical ventilation
, FCCS Questions
B) initiate noninvasive positive pressure ventilation
C) switch to nonrebreather oxygen mask
D) switch to high-flow, high-humidity oxygen: B) initiate noninvasive positive pressure ventilation 4. A 27yoM admitted to ICU
with SAH after MVC. Initial GCS 8 with labored respirations. He was intubated in the ED and placed on a ventilator. Shortly
after arrival to the unit, SpO2 reads 57% with HR 46 and no pulse.
Which of the following is the safest and most immediate method to verify correct ET tube placement?
A) palpation over the epigastrum for abdominal distention
B) manual bag-mask breathing
C) qualitative exhaled carbon dioxide monitor or detector
D) portable chest radiograph: C) qualitative exhaled carbon dioxide monitor or detector
5. A 52yoM presents after a MVC with hypotension and obvious signs of hemorrhagic shock. FAST exam is positive, and an
emergent surgical consult is obtained for operative intervention. While awaiting surgeon and transport to OR for definitive
hemorrhage control, his BP continues to decline and resuscitation begins.
Which of the following is the best strategy for resuscitation in this setting of massive hemorrhage?
A) infusion of packed red blood cells only until laboratory results are available to assess for the presence of coagulopathy
and thrombocytopenia
B) balanced resuscitation using a combination of packed red blood cells, fresh frozen plasma, and platelets in a 1:1:1 ratio
C) limited infusion of IV fluids or blood products until definitive control of hemorrhage is achieved, regardless of blood
pressure or hemodynamic status
D) aggressive isotonic crystalloid infusion to maintain normal blood pressure: B)
balanced resuscitation using a combination of packed red blood cells, fresh frozen plasma, and platelets in a 1:1:1 ratio
6. A 75yoF is admitted to the ED with AMS. A CTH shows intracranial hemorrhage. Decision is made to intubate her, but there is
concern fro increased ICP. Which of the following pretreatment agents is most appropriate before performing RSI?
A) cisatracurium
B) succinylcholine
C) lidocaine
D) rocuronium: B) succinylcholine
7. A patient arrives in the ED with RR 4. She is not intubated. Overdose with a centrally acting nervous system depressant is
suspected.
Which of the following is the most likely finding on the initial blood gas?
