FCCS TEST UPDATED CORE CRITICAL CARE
CONCEPTS REVIEW 2026
◉ A 52yoM presents to the ED with SOB and new-onset lower
extremity edema. Vitals: temp 37 (98.6F), HR 114, RR 28, BP 86/62,
SpO2 92% on nonrebreather. Transferred to ICU, intubated, and
central line is placed. Hgb 9.2, lactic acid 4.2, SpO2 improved to 98%,
central venous oxygen saturation 43%. This ScvO2 level indicates
which of the following findings?
A) decreased oxygen delivery and/or decreased oxygen
consumption
B) decreased oxygen delivery and/or increased oxygen consumption
C) increased oxygen delivery and/or decreased oxygen consumption
D) increased oxygen delivery and/or increased oxygen consumption.
Answer: B) decreased oxygen delivery and/or increased oxygen
consumption
◉ 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 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?
A) chronic hypercapnic respiratory failure only
B) acute hypoxemic respiratory failure only
C) mixed hypoxemic and hypercapnic respiratory failure
D) acute hypercapnic respiratory failure only.
Answer: D) acute hypercapnic respiratory failure only
◉ 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.
Answer: C) prolonged expiratory time
◉ A 55 yoM with PMHx ESRD on hemodialysis presents to the ED
with lightheadedness and dizziness. He undergoes dialysis sessions
regularly every M/W/F, but he was told that he has received "lower
doses" because his Bs have been too low. He is due for dialysis
tomorrow. HR 65, BP 87/49, RR 22, and SpO2 92% on 6L NC. His
ECG is shown.
While waiting for laboratory results, which of the following is the
most appropriate next step in management?
A) IV calcium chloride, 10% solution
B) initiation of hemodialysis
CONCEPTS REVIEW 2026
◉ A 52yoM presents to the ED with SOB and new-onset lower
extremity edema. Vitals: temp 37 (98.6F), HR 114, RR 28, BP 86/62,
SpO2 92% on nonrebreather. Transferred to ICU, intubated, and
central line is placed. Hgb 9.2, lactic acid 4.2, SpO2 improved to 98%,
central venous oxygen saturation 43%. This ScvO2 level indicates
which of the following findings?
A) decreased oxygen delivery and/or decreased oxygen
consumption
B) decreased oxygen delivery and/or increased oxygen consumption
C) increased oxygen delivery and/or decreased oxygen consumption
D) increased oxygen delivery and/or increased oxygen consumption.
Answer: B) decreased oxygen delivery and/or increased oxygen
consumption
◉ 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 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?
A) chronic hypercapnic respiratory failure only
B) acute hypoxemic respiratory failure only
C) mixed hypoxemic and hypercapnic respiratory failure
D) acute hypercapnic respiratory failure only.
Answer: D) acute hypercapnic respiratory failure only
◉ 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.
Answer: C) prolonged expiratory time
◉ A 55 yoM with PMHx ESRD on hemodialysis presents to the ED
with lightheadedness and dizziness. He undergoes dialysis sessions
regularly every M/W/F, but he was told that he has received "lower
doses" because his Bs have been too low. He is due for dialysis
tomorrow. HR 65, BP 87/49, RR 22, and SpO2 92% on 6L NC. His
ECG is shown.
While waiting for laboratory results, which of the following is the
most appropriate next step in management?
A) IV calcium chloride, 10% solution
B) initiation of hemodialysis
