FCCS REVIEW EXAM SET QUESTIONS AND ANSWERS
SURE A+
✔✔A 65yoM admitted to the ICU for BRBPR and hemorrhagic shock. PMHx AAA s/p
endovascular aneurysm repair 2 years ago. Intubated and sedated on mechanical
ventilation. Received 6 units PRBCs, 6 units FFP, 5 units platelets, 2 units
cyroprecipitate. Corrected calcium is 10, normothermic with pH 7.35, lactate 4. He
continues to have BRBPR. An NG tube is placed with non-bloody return.
Which of the following is the most appropriate next step?
A) gastrointestinal consultation for endoscopy
B) surgical consultation
C) IV PPI
D) IV octreotide - ✔✔B) surgical consultation
✔✔An 18yoM college student is evaluated in the ED for fever and headache. He had
been healthy until yesterday when he started to have headaches and was reported to
have periods of confusion. Vitals: temp 38.9 (102F), HR 125, BP 140/90, RR 29. On
exam, he is anxious and has dry mucous membranes, no focal neuro deficits, lungs
clear to auscultation, soft abdomen, positive bowel sounds, inability to touch chin to
chest on passive neck flexion. Head CT, blood cultures, lumbar puncture pending.
Which of the following is the proper antibiotic regimen to follow for this patient?
A) ampicillin plus either cefotaxime or an aminoglycoside
B) IV gentamicin plus clindamycin
C) supportive therapy without immediate antibiotic therapy unless cultures are positive
D) vancomycin plus a 3rd gen cephalosporin - ✔✔D) vancomycin plus a third
generation cephalosporin
✔✔An 80kg (176lb), 55yoM was in a house fire and sustained circumferential burns to
the entire RUE, anterior chest, and anterior abdomen. After initiating LR at 500 mL/hr,
what is the estimated weight-based fluid volume for this patient in the first 24 hours?
A) 2160 mL
B) 4320 mL
C) 5760 mL
D) 8640 mL - ✔✔B) 4320 mL
the American Burn Association recommends fluids in patients older than 14 years
initiated at 500 mL/hr with rapid titration to weight-based fluid infusion rates. Adults and
older children should receive 2 mL/kg per percent total body surface area (TBSA).
Based on the rule of nines, this patient has an estimated 27% TBSA (2 × 80 × 27 =
4320 mL).
✔✔A 32yoF is evaluated in the ED for acute onset dyspnea, wheezing, progressive
respiratory distress. PMHx severe persistent asthma with 4 previous admissions to the
ICU, 2 requiring intubation. Preadmission meds are high-dose inhaled corticosteroid,
salmeterol, 4x daily albuterol via nebulizer. SHe does not respond to aggressive
, bronchodilator therapy or IV corticosteroids. On exam she is in distress and anxious.
Temp 37 (98.6F), BP 156/110, HR 136, RR 45. Bilateral breath sounds reveal very faint
wheezing. ABG shows PCO2 95, PO2 50, pH 7.1. CXR shows hyperinflation but no
infiltrates. Undergoes RSI and started on mechanical ventilation. What is the most
important consideration in improving this patient's overall ventilatory status?
A) decreased inspiratory flow
B) increased minute ventilation
C) prolonged expiratory time
D) prolonged inspiratory time - ✔✔C) prolonged expiratory time
✔✔Which of the following additional parameters does the oxygen index take into
account compared to the P/F ratio?
A) mean airway pressure
B) positive end-expiratory pressure
C) peak inspiratory pressure
D) respiratory rate - ✔✔A) mean airway pressure
✔✔A 68yoF with no significant PMHx has 2 day history of productive cough, fever,
rigors. Vitals: temp 39 (102.2F), HR 120, BP 70/40, RR 20, SpO2 95% on 3L NC. Exam
significant for rhonchi appreciated by auscultation over right chest. Labs: WBC 12, Na
132, K 5.3, glucose 62. CXR reveals right middle and lower lobe air space disease.
Administered 3L crystalloid resuscitation and admitted to ICU for management of septic
shock due to pneumonia. Administered broad-spectrum antibiotics, norepinephrine,
vasopressin via central line for hypotension. Vasopressor requirement and lab values
are unchanged.
Which of the following interventions is most likely to improve her condition?
A) 5% albumin IV bolus
B) D50 (25g in 50mL) IV bolus
C) dobutamine continuous infusion
D) hydrocortisone 200mg/day - ✔✔D) hydrocortisone 200mg/day
✔✔A 60kg (154lb), 170cm (67in), 69yoF with severe COPD is admitted to the ICU for
acute COPD exacerbation. Despite albuterol, ipratropium, and IV methylprednisolone,
she has become somnolent. ABG on FiO2 0.35 shows pH 7.2, PCO2 110, PO2 108.
ICU physician decides invasive ventilation is needed. Patient receives IV ketamine, 120
mg, to facilitate endotracheal intubation which is accomplished easily. Ventilator is set to
assist control/volume control, with TV 440, rate 24, PEEP 5, FiO2 0.35, and orders a
CXR. 15 min later, BP has fallen to 70/40. Breath sounds equal, chest rise symmetrical.
Ppeak 59, Pplat 18. Airway after end-expiratory hold is 18. Emergent ECG and cardiac
enzymes normal.
Which of the following is the most likely explanation for her hypotension?
A) myocardial ischemia
B) tension pneumothroax
C) intrinsic PEEP (auto-PEEP)
D) intubation medication - ✔✔C) intrinsic PEEP (auto-PEEP)
SURE A+
✔✔A 65yoM admitted to the ICU for BRBPR and hemorrhagic shock. PMHx AAA s/p
endovascular aneurysm repair 2 years ago. Intubated and sedated on mechanical
ventilation. Received 6 units PRBCs, 6 units FFP, 5 units platelets, 2 units
cyroprecipitate. Corrected calcium is 10, normothermic with pH 7.35, lactate 4. He
continues to have BRBPR. An NG tube is placed with non-bloody return.
Which of the following is the most appropriate next step?
A) gastrointestinal consultation for endoscopy
B) surgical consultation
C) IV PPI
D) IV octreotide - ✔✔B) surgical consultation
✔✔An 18yoM college student is evaluated in the ED for fever and headache. He had
been healthy until yesterday when he started to have headaches and was reported to
have periods of confusion. Vitals: temp 38.9 (102F), HR 125, BP 140/90, RR 29. On
exam, he is anxious and has dry mucous membranes, no focal neuro deficits, lungs
clear to auscultation, soft abdomen, positive bowel sounds, inability to touch chin to
chest on passive neck flexion. Head CT, blood cultures, lumbar puncture pending.
Which of the following is the proper antibiotic regimen to follow for this patient?
A) ampicillin plus either cefotaxime or an aminoglycoside
B) IV gentamicin plus clindamycin
C) supportive therapy without immediate antibiotic therapy unless cultures are positive
D) vancomycin plus a 3rd gen cephalosporin - ✔✔D) vancomycin plus a third
generation cephalosporin
✔✔An 80kg (176lb), 55yoM was in a house fire and sustained circumferential burns to
the entire RUE, anterior chest, and anterior abdomen. After initiating LR at 500 mL/hr,
what is the estimated weight-based fluid volume for this patient in the first 24 hours?
A) 2160 mL
B) 4320 mL
C) 5760 mL
D) 8640 mL - ✔✔B) 4320 mL
the American Burn Association recommends fluids in patients older than 14 years
initiated at 500 mL/hr with rapid titration to weight-based fluid infusion rates. Adults and
older children should receive 2 mL/kg per percent total body surface area (TBSA).
Based on the rule of nines, this patient has an estimated 27% TBSA (2 × 80 × 27 =
4320 mL).
✔✔A 32yoF is evaluated in the ED for acute onset dyspnea, wheezing, progressive
respiratory distress. PMHx severe persistent asthma with 4 previous admissions to the
ICU, 2 requiring intubation. Preadmission meds are high-dose inhaled corticosteroid,
salmeterol, 4x daily albuterol via nebulizer. SHe does not respond to aggressive
, bronchodilator therapy or IV corticosteroids. On exam she is in distress and anxious.
Temp 37 (98.6F), BP 156/110, HR 136, RR 45. Bilateral breath sounds reveal very faint
wheezing. ABG shows PCO2 95, PO2 50, pH 7.1. CXR shows hyperinflation but no
infiltrates. Undergoes RSI and started on mechanical ventilation. What is the most
important consideration in improving this patient's overall ventilatory status?
A) decreased inspiratory flow
B) increased minute ventilation
C) prolonged expiratory time
D) prolonged inspiratory time - ✔✔C) prolonged expiratory time
✔✔Which of the following additional parameters does the oxygen index take into
account compared to the P/F ratio?
A) mean airway pressure
B) positive end-expiratory pressure
C) peak inspiratory pressure
D) respiratory rate - ✔✔A) mean airway pressure
✔✔A 68yoF with no significant PMHx has 2 day history of productive cough, fever,
rigors. Vitals: temp 39 (102.2F), HR 120, BP 70/40, RR 20, SpO2 95% on 3L NC. Exam
significant for rhonchi appreciated by auscultation over right chest. Labs: WBC 12, Na
132, K 5.3, glucose 62. CXR reveals right middle and lower lobe air space disease.
Administered 3L crystalloid resuscitation and admitted to ICU for management of septic
shock due to pneumonia. Administered broad-spectrum antibiotics, norepinephrine,
vasopressin via central line for hypotension. Vasopressor requirement and lab values
are unchanged.
Which of the following interventions is most likely to improve her condition?
A) 5% albumin IV bolus
B) D50 (25g in 50mL) IV bolus
C) dobutamine continuous infusion
D) hydrocortisone 200mg/day - ✔✔D) hydrocortisone 200mg/day
✔✔A 60kg (154lb), 170cm (67in), 69yoF with severe COPD is admitted to the ICU for
acute COPD exacerbation. Despite albuterol, ipratropium, and IV methylprednisolone,
she has become somnolent. ABG on FiO2 0.35 shows pH 7.2, PCO2 110, PO2 108.
ICU physician decides invasive ventilation is needed. Patient receives IV ketamine, 120
mg, to facilitate endotracheal intubation which is accomplished easily. Ventilator is set to
assist control/volume control, with TV 440, rate 24, PEEP 5, FiO2 0.35, and orders a
CXR. 15 min later, BP has fallen to 70/40. Breath sounds equal, chest rise symmetrical.
Ppeak 59, Pplat 18. Airway after end-expiratory hold is 18. Emergent ECG and cardiac
enzymes normal.
Which of the following is the most likely explanation for her hypotension?
A) myocardial ischemia
B) tension pneumothroax
C) intrinsic PEEP (auto-PEEP)
D) intubation medication - ✔✔C) intrinsic PEEP (auto-PEEP)
