FCCS Review Complete Critical Care Study
Guide 2025/ 2026 with Solution Detailed
Answers
What is the most important sign in a critically ill pt? Why? - ANSWER- 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? - ANSWER- Cardiac
tamponade; obstructive shock
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? - ANSWER- Targeted
temperature management.
32-36 C
A shunt means there is perfusion without ventilation. What disease process is an example of a shunt? -
ANSWER- Pneumonia
Which type of respiratory failure occurs with CNS depression after an OD? - ANSWER- 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? - ANSWER- Auto-peep is the cause.
COPD pts have difficulty exhaling --> pressure buildup in alveoli.
Guide 2025/ 2026 with Solution Detailed
Answers
What is the most important sign in a critically ill pt? Why? - ANSWER- 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? - ANSWER- Cardiac
tamponade; obstructive shock
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? - ANSWER- Targeted
temperature management.
32-36 C
A shunt means there is perfusion without ventilation. What disease process is an example of a shunt? -
ANSWER- Pneumonia
Which type of respiratory failure occurs with CNS depression after an OD? - ANSWER- 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? - ANSWER- Auto-peep is the cause.
COPD pts have difficulty exhaling --> pressure buildup in alveoli.
