FCCS CERTIFICATION EVALUATION TEST
2026 COMPREHENSIVE QUESTIONS WITH
SOLUTIONS GRADED A+
⩥ 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.
, We use PEEP for the pressure and to improve oxygenation. Auto-peep
comes from breath-stacking --> intrinsic peep. Alveoli enlarge --> high
peak airway pressure. All leads to low venous return --> low CO -->
HoTN
⩥ A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt
is tx w/ bronchodilators, steroids, and Abx. ABG was normal 1 hr ago,
but now the peak airway pressure is up to 55 and plateau pressure is also
high at 50. Pt becomes hypotensive at 70/40. You observe tracheal
deviation to the R. Normal breath sounds on the right, diminished on the
left. No wheezing. WBC is normal.
What is the dx and treatment?
Answer: Tension pneumothorax
Needle decompression/chest tube
⩥ A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2
is 88%. Peak airway pressure and plateau are both high. VT is 5 ml/kg.
How can you decrease the airway pressures?
Answer: Decrease the PEEP, even though it will decrease PaO2.
(Note: you can't decrease the VT because it is already on the low end).
2026 COMPREHENSIVE QUESTIONS WITH
SOLUTIONS GRADED A+
⩥ 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.
, We use PEEP for the pressure and to improve oxygenation. Auto-peep
comes from breath-stacking --> intrinsic peep. Alveoli enlarge --> high
peak airway pressure. All leads to low venous return --> low CO -->
HoTN
⩥ A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt
is tx w/ bronchodilators, steroids, and Abx. ABG was normal 1 hr ago,
but now the peak airway pressure is up to 55 and plateau pressure is also
high at 50. Pt becomes hypotensive at 70/40. You observe tracheal
deviation to the R. Normal breath sounds on the right, diminished on the
left. No wheezing. WBC is normal.
What is the dx and treatment?
Answer: Tension pneumothorax
Needle decompression/chest tube
⩥ A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2
is 88%. Peak airway pressure and plateau are both high. VT is 5 ml/kg.
How can you decrease the airway pressures?
Answer: Decrease the PEEP, even though it will decrease PaO2.
(Note: you can't decrease the VT because it is already on the low end).
