FCCS Questions Complete Critical Care
Study Pack 2025/ 2026 with Solution
Detailed Answers
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 - ANSWER- B) Hypertonic (3%) saline, 100 mL for rapid early correction, with
goal serum sodium of 118 mEq/L in 24 hours
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 - ANSWER- B) ST segment elevation
, 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
B) initiate noninvasive positive pressure ventilation
C) switch to nonrebreather oxygen mask
D) switch to high-flow, high-humidity oxygen - ANSWER- B) initiate noninvasive positive pressure
ventilation
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 - ANSWER- C) qualitative exhaled carbon dioxide monitor or detector
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
Study Pack 2025/ 2026 with Solution
Detailed Answers
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 - ANSWER- B) Hypertonic (3%) saline, 100 mL for rapid early correction, with
goal serum sodium of 118 mEq/L in 24 hours
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 - ANSWER- B) ST segment elevation
, 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
B) initiate noninvasive positive pressure ventilation
C) switch to nonrebreather oxygen mask
D) switch to high-flow, high-humidity oxygen - ANSWER- B) initiate noninvasive positive pressure
ventilation
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 - ANSWER- C) qualitative exhaled carbon dioxide monitor or detector
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
