FCCS (Fundamentals of Critical Care Support)
Actual Questions and Revised Correct
Answers
Society of Critical Care Medicine (SCCM) | FCCS Course Examination Preparation
100% Guarantee Pass | 100 Questions with Comprehensive Rationales
Section 1: Recognition and Assessment of the Seriously Ill Patient
(Initial Assessment, Triage, Diagnostic Testing, and Stabilization)
Q1: A 68-year-old man presents to the emergency department with acute onset dyspnea, diaphoresis, and
hypotension (BP 82/50 mmHg). His heart rate is 128 bpm, respiratory rate 28/min, and SpO2 is 88% on room air.
Which of the following is the MOST appropriate initial diagnostic test to guide immediate management?
A. A. Complete metabolic panel
B. B. Portable chest radiograph
C. C. 12-lead electrocardiogram [CORRECT]
D. D. CT angiography of the chest
Correct Answer: C
Rationale: A 12-lead ECG is the most appropriate initial diagnostic test in this patient presenting with signs of cardiogenic shock
(hypotension, tachycardia, dyspnea, diaphoresis). The ECG can rapidly identify ST-elevation myocardial infarction (STEMI), which
requires immediate reperfusion therapy. While a chest radiograph and metabolic panel are important adjuncts, they should not delay
ECG acquisition. CT angiography is inappropriate as the initial test in this unstable patient. The FCCS curriculum emphasizes that the
ECG should be obtained within 10 minutes of first medical contact for patients with suspected acute coronary syndromes.
Q2: A 45-year-old woman is brought to the emergency department after a motor vehicle collision. She is alert but
complains of abdominal pain. Her vital signs are: BP 98/62 mmHg, HR 112 bpm, RR 22/min, SpO2 97% on room air.
Which of the following findings on the FAST (Focused Assessment with Sonography for Trauma) examination would
warrant immediate surgical consultation?
A. A. Free fluid in Morison's pouch [CORRECT]
B. B. Compressed gallbladder without wall thickening
C. C. Normal hepatic parenchyma with homogeneous echotexture
D. D. Bilateral pleural effusions without peritoneal fluid
Correct Answer: A
Rationale: Free fluid in Morison's pouch (hepatorenal recess) on FAST examination indicates hemoperitoneum, which in the setting of
hypotension and tachycardia suggests significant intra-abdominal hemorrhage warranting immediate surgical consultation. The FCCS
curriculum highlights that a positive FAST in an unstable trauma patient is an indication for emergent operative intervention. Compressed
gallbladder and normal hepatic parenchyma are non-acute findings. Bilateral pleural effusions without peritoneal fluid may indicate
other pathology but do not mandate emergent surgery in this context.
Q3: A 72-year-old man with known COPD presents with worsening dyspnea over 2 days. On examination, he is using
accessory muscles, his respiratory rate is 32/min, and he appears cachectic. Arterial blood gas on room air shows: pH
7.28, PaCO2 68 mmHg, PaO2 52 mmHg, HCO3- 28 mEq/L. Which of the following best classifies this patient's
,respiratory failure?
A. A. Acute hypoxemic respiratory failure
B. B. Acute-on-chronic hypercapnic respiratory failure [CORRECT]
C. C. Acute respiratory distress syndrome (ARDS)
D. D. Perioperative respiratory failure
Correct Answer: B
Rationale: This patient has acute-on-chronic hypercapnic respiratory failure. The elevated PaCO2 (68 mmHg) with a pH of 7.28 indicates
acute respiratory acidosis superimposed on chronic CO2 retention (the HCO3- of 28 mEq/L suggests renal compensation for chronic
hypercapnia). This pattern is classic for an acute COPD exacerbation. Hypoxemic respiratory failure (Type I) would present with low
PaO2 but normal or low PaCO2. ARDS requires specific criteria including bilateral infiltrates and a PaO2/FiO2 ratio less than 300
mmHg without evidence of left atrial hypertension.
Q4: A 55-year-old woman presents with severe acute pancreatitis. Her vital signs are: temperature 38.9 degrees C,
HR 118 bpm, BP 88/52 mmHg, RR 24/min. Her laboratory results show WBC 18,500/microL, lactate 4.2 mmol/L,
and creatinine 2.1 mg/dL (baseline 0.9 mg/dL). According to the revised Sepsis-3 criteria, which of the following
BEST describes this patient's condition?
A. A. Sepsis without organ dysfunction
B. B. Sepsis with organ dysfunction (septic shock) [CORRECT]
C. C. Systemic inflammatory response syndrome (SIRS) only
D. D. Severe sepsis with multiple organ dysfunction syndrome
Correct Answer: B
Rationale: This patient meets criteria for septic shock as defined by Sepsis-3: suspected infection (severe pancreatitis with fever and
leukocytosis), persistent hypotension requiring vasopressors (BP 88/52), and serum lactate greater than 2 mmol/L (4.2 mmol/L). Sepsis-3
defines septic shock as a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with higher mortality. The term
'severe sepsis' has been retired in the Sepsis-3 framework. SIRS criteria alone are no longer used to define sepsis under the updated
Surviving Sepsis Campaign guidelines integrated into the FCCS curriculum.
Q5: A critically ill patient in the ICU develops sudden onset of agitation, diaphoresis, and tachypnea. The nurse
reports the patient was stable 30 minutes earlier. Which of the following is the MOST appropriate FIRST step in the
systematic assessment of this patient?
A. A. Order a STAT CT scan of the head
B. B. Perform a focused physical examination and review vital signs trends [CORRECT]
C. C. Administer intravenous lorazepam for agitation control
D. D. Obtain a comprehensive metabolic panel and wait for results
Correct Answer: B
Rationale: The FCCS curriculum emphasizes a systematic approach to recognizing patient deterioration. The most appropriate first step
is a focused physical examination with review of vital sign trends. This 'bedside assessment first' approach allows rapid identification of
the most likely cause of deterioration (e.g., airway compromise, pneumothorax, cardiac arrhythmia, or sepsis) and guides targeted
diagnostic testing and intervention. Ordering a CT head without clinical assessment, administering sedation without identifying the cause,
or waiting for laboratory results are all inappropriate first steps that may delay life-saving interventions.
Q6: A 35-year-old man is admitted to a community hospital ICU with acute respiratory distress syndrome (ARDS)
secondary to community-acquired pneumonia. His PaO2/FiO2 ratio is 98 mmHg on FiO2 0.8 and PEEP 12 cmH2O.
The hospital does not have extracorporeal membrane oxygenation (ECMO) capability. Which of the following is the
MOST appropriate next step in management?
A. A. Increase FiO2 to 1.0 and observe
B. B. Initiate prone positioning and optimize low tidal volume ventilation [CORRECT]
C. C. Transfer the patient to an ECMO-capable center without further stabilization
D. D. Administer high-dose IV corticosteroids immediately
,Correct Answer: B
Rationale: This patient has severe ARDS (PaO2/FiO2 ratio less than 100) and requires optimization of mechanical ventilation with
evidence-based interventions before considering transfer. Prone positioning for more than 16 hours per day has been shown to
significantly reduce mortality in severe ARDS and should be initiated along with continued low tidal volume ventilation (6 mL/kg
predicted body weight). The FCCS curriculum emphasizes that patients should be stabilized with best available therapy before transfer,
and that transfer decisions should involve communication with the receiving center. Simply increasing FiO2 without optimizing PEEP and
position is inadequate.
Q7: A 60-year-old woman with a history of heart failure presents with progressive dyspnea on exertion, orthopnea,
and bilateral lower extremity edema. Her B-type natriuretic peptide (BNP) level is 1,200 pg/mL. Which of the
following bedside findings would be MOST consistent with volume overload in this patient?
A. A. Clear lung fields on auscultation
B. B. Presence of hepatojugular reflux [CORRECT]
C. C. Cold, clammy extremities with delayed capillary refill
D. D. Spontaneous inspiratory effort with abdominal paradox
Correct Answer: B
Rationale: Hepatojugular reflux (HJR) is a bedside physical examination finding that is highly specific for volume overload and elevated
right-sided filling pressures. When firm pressure is applied over the liver, a sustained rise in jugular venous pressure indicates impaired
cardiac function and volume overload. Clear lung fields would suggest the dyspnea is not from pulmonary edema. Cold, clammy
extremities with delayed capillary refill suggest low cardiac output (cardiogenic shock) rather than isolated volume overload. Abdominal
paradox suggests diaphragmatic dysfunction or severe respiratory muscle fatigue.
Q8: An 80-year-old nursing home resident is brought to the emergency department with altered mental status, fever
(39.2 degrees C), and tachycardia (HR 110 bpm). Her blood pressure is 100/60 mmHg. She has no indwelling urinary
catheter. Which of the following is the MOST appropriate initial diagnostic approach?
A. A. Chest radiograph, urinalysis with culture, and blood cultures before initiating antibiotics [CORRECT]
B. B. CT scan of the head, abdomen, and pelvis with contrast
C. C. Lumbar puncture and brain MRI
D. D. Sputum culture and throat swab only
Correct Answer: A
Rationale: In elderly patients with fever and altered mental status, the most common sources of infection are pneumonia, urinary tract
infection, and primary bacteremia. The FCCS curriculum emphasizes obtaining appropriate cultures (blood, urine, and sputum if
applicable) BEFORE initiating empiric antibiotics, but antibiotics should not be delayed beyond 1 hour of presentation. A targeted
diagnostic approach based on the most likely sources is more appropriate than pan-imaging with CT scans, which would delay treatment.
Lumbar puncture may be considered if meningitis is suspected, but it should not be the primary initial diagnostic test without clinical
suspicion of central nervous system infection.
Q9: A 42-year-old man with no significant medical history presents to a rural emergency department with crushing
substernal chest pain that began 45 minutes ago. The 12-lead ECG shows ST-segment elevation in leads II, III, and
aVF. The nearest PCI-capable hospital is 90 minutes away by ground transport. Which of the following is the MOST
appropriate reperfusion strategy?
A. A. Administer thrombolytic therapy within 30 minutes of presentation [CORRECT]
B. B. Transfer immediately by ground ambulance for primary PCI
C. C. Administer aspirin only and observe for 2 hours
D. D. Request helicopter transport and wait for arrival before any intervention
Correct Answer: A
Rationale: According to the ACC/AHA guidelines endorsed in the FCCS curriculum, when the expected first medical contact-to-device
time for primary PCI exceeds 120 minutes, fibrinolytic therapy should be administered within 30 minutes of hospital presentation (the
'door-to-needle' time goal). This patient's expected PCI time would be well over 120 minutes (90-minute transport plus door-to-balloon
time), making thrombolytic therapy the most appropriate choice. The FCCS emphasizes the importance of systems-based approaches to
, reperfusion and the concept of 'time is myocardium' in STEMI management.
Q10: A 28-year-old woman at 32 weeks of gestation presents to the emergency department with severe headache,
visual disturbances, and epigastric pain. Her blood pressure is 168/108 mmHg, and she has 3+ proteinuria on urine
dipstick. Which of the following is the MOST appropriate initial management?
A. A. Administer magnesium sulfate and antihypertensive therapy, and prepare for delivery [CORRECT]
B. B. Order an MRI of the brain to rule out intracranial hemorrhage
C. C. Administer acetaminophen and observe for 6 hours
D. D. Immediate cesarean delivery without medical stabilization
Correct Answer: A
Rationale: This patient presents with severe preeclampsia with severe features (headache, visual disturbances, epigastric pain, severe
hypertension, and significant proteinuria). The most appropriate management includes immediate initiation of magnesium sulfate for
seizure prophylaxis, antihypertensive therapy to reduce blood pressure to a safe range (typically less than 160/110 mmHg), and
preparation for delivery, which is the definitive treatment. The FCCS curriculum covers critical care in pregnancy and emphasizes that
stabilization with magnesium sulfate and blood pressure control should precede delivery, and that imaging should not delay treatment
when the clinical diagnosis is clear.
Q11: A 65-year-old man with end-stage liver disease presents with increasing abdominal girth, confusion, and fever.
His vital signs are: BP 82/48 mmHg, HR 122 bpm, RR 26/min, temperature 38.4 degrees C. Abdominal paracentesis
reveals a WBC count of 450 cells/microL with 80% neutrophils. Which of the following is the MOST likely diagnosis?
A. A. Spontaneous bacterial peritonitis [CORRECT]
B. B. Pancreatic ascites with secondary infection
C. C. Tuberculous peritonitis
D. D. Malignant ascites with portal vein thrombosis
Correct Answer: A
Rationale: The ascitic fluid analysis showing an elevated neutrophil count (80% of 450 cells/microL = 360 neutrophils/microL, which is
greater than the diagnostic threshold of 250 neutrophils/microL) in a patient with end-stage liver disease and clinical signs of infection
(fever, hypotension, tachycardia, confusion) is diagnostic of spontaneous bacterial peritonitis (SBP). The FCCS curriculum highlights that
SBP is a common and life-threatening complication of cirrhosis requiring prompt recognition and treatment with empiric antibiotic
therapy. Pancreatic ascites would show elevated amylase, and tuberculous peritonitis typically has a lymphocytic predominance.
Q12: A 50-year-old man is found unresponsive at home by paramedics. He is apneic and pulseless. CPR is initiated.
The cardiac monitor shows ventricular fibrillation. Which of the following interventions should be performed FIRST
after initiating high-quality CPR?
A. A. Administer intravenous epinephrine
B. B. Attempt defibrillation [CORRECT]
C. C. Establish an advanced airway
D. D. Obtain intraosseous access
Correct Answer: B
Rationale: According to the ACLS algorithm as taught in the FCCS curriculum, when ventricular fibrillation (VF) is identified, the first
intervention after initiating high-quality CPR is immediate defibrillation. Early defibrillation is the most critical intervention for
VF/pulseless VT, as the probability of successful defibrillation decreases rapidly over time. Epinephrine should be administered after the
first defibrillation attempt (or after the second shock per updated guidelines), and advanced airway management should not interrupt or
delay chest compressions and defibrillation. The priority is shock delivery as soon as possible.
Q13: A critically ill patient has the following arterial blood gas results on mechanical ventilation (FiO2 0.5): pH 7.52,
PaCO2 28 mmHg, PaO2 92 mmHg, HCO3- 22 mEq/L. Which of the following is the MOST likely cause of this
acid-base disturbance?
A. A. Metabolic acidosis with respiratory compensation
B. B. Acute respiratory alkalosis [CORRECT]
Actual Questions and Revised Correct
Answers
Society of Critical Care Medicine (SCCM) | FCCS Course Examination Preparation
100% Guarantee Pass | 100 Questions with Comprehensive Rationales
Section 1: Recognition and Assessment of the Seriously Ill Patient
(Initial Assessment, Triage, Diagnostic Testing, and Stabilization)
Q1: A 68-year-old man presents to the emergency department with acute onset dyspnea, diaphoresis, and
hypotension (BP 82/50 mmHg). His heart rate is 128 bpm, respiratory rate 28/min, and SpO2 is 88% on room air.
Which of the following is the MOST appropriate initial diagnostic test to guide immediate management?
A. A. Complete metabolic panel
B. B. Portable chest radiograph
C. C. 12-lead electrocardiogram [CORRECT]
D. D. CT angiography of the chest
Correct Answer: C
Rationale: A 12-lead ECG is the most appropriate initial diagnostic test in this patient presenting with signs of cardiogenic shock
(hypotension, tachycardia, dyspnea, diaphoresis). The ECG can rapidly identify ST-elevation myocardial infarction (STEMI), which
requires immediate reperfusion therapy. While a chest radiograph and metabolic panel are important adjuncts, they should not delay
ECG acquisition. CT angiography is inappropriate as the initial test in this unstable patient. The FCCS curriculum emphasizes that the
ECG should be obtained within 10 minutes of first medical contact for patients with suspected acute coronary syndromes.
Q2: A 45-year-old woman is brought to the emergency department after a motor vehicle collision. She is alert but
complains of abdominal pain. Her vital signs are: BP 98/62 mmHg, HR 112 bpm, RR 22/min, SpO2 97% on room air.
Which of the following findings on the FAST (Focused Assessment with Sonography for Trauma) examination would
warrant immediate surgical consultation?
A. A. Free fluid in Morison's pouch [CORRECT]
B. B. Compressed gallbladder without wall thickening
C. C. Normal hepatic parenchyma with homogeneous echotexture
D. D. Bilateral pleural effusions without peritoneal fluid
Correct Answer: A
Rationale: Free fluid in Morison's pouch (hepatorenal recess) on FAST examination indicates hemoperitoneum, which in the setting of
hypotension and tachycardia suggests significant intra-abdominal hemorrhage warranting immediate surgical consultation. The FCCS
curriculum highlights that a positive FAST in an unstable trauma patient is an indication for emergent operative intervention. Compressed
gallbladder and normal hepatic parenchyma are non-acute findings. Bilateral pleural effusions without peritoneal fluid may indicate
other pathology but do not mandate emergent surgery in this context.
Q3: A 72-year-old man with known COPD presents with worsening dyspnea over 2 days. On examination, he is using
accessory muscles, his respiratory rate is 32/min, and he appears cachectic. Arterial blood gas on room air shows: pH
7.28, PaCO2 68 mmHg, PaO2 52 mmHg, HCO3- 28 mEq/L. Which of the following best classifies this patient's
,respiratory failure?
A. A. Acute hypoxemic respiratory failure
B. B. Acute-on-chronic hypercapnic respiratory failure [CORRECT]
C. C. Acute respiratory distress syndrome (ARDS)
D. D. Perioperative respiratory failure
Correct Answer: B
Rationale: This patient has acute-on-chronic hypercapnic respiratory failure. The elevated PaCO2 (68 mmHg) with a pH of 7.28 indicates
acute respiratory acidosis superimposed on chronic CO2 retention (the HCO3- of 28 mEq/L suggests renal compensation for chronic
hypercapnia). This pattern is classic for an acute COPD exacerbation. Hypoxemic respiratory failure (Type I) would present with low
PaO2 but normal or low PaCO2. ARDS requires specific criteria including bilateral infiltrates and a PaO2/FiO2 ratio less than 300
mmHg without evidence of left atrial hypertension.
Q4: A 55-year-old woman presents with severe acute pancreatitis. Her vital signs are: temperature 38.9 degrees C,
HR 118 bpm, BP 88/52 mmHg, RR 24/min. Her laboratory results show WBC 18,500/microL, lactate 4.2 mmol/L,
and creatinine 2.1 mg/dL (baseline 0.9 mg/dL). According to the revised Sepsis-3 criteria, which of the following
BEST describes this patient's condition?
A. A. Sepsis without organ dysfunction
B. B. Sepsis with organ dysfunction (septic shock) [CORRECT]
C. C. Systemic inflammatory response syndrome (SIRS) only
D. D. Severe sepsis with multiple organ dysfunction syndrome
Correct Answer: B
Rationale: This patient meets criteria for septic shock as defined by Sepsis-3: suspected infection (severe pancreatitis with fever and
leukocytosis), persistent hypotension requiring vasopressors (BP 88/52), and serum lactate greater than 2 mmol/L (4.2 mmol/L). Sepsis-3
defines septic shock as a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with higher mortality. The term
'severe sepsis' has been retired in the Sepsis-3 framework. SIRS criteria alone are no longer used to define sepsis under the updated
Surviving Sepsis Campaign guidelines integrated into the FCCS curriculum.
Q5: A critically ill patient in the ICU develops sudden onset of agitation, diaphoresis, and tachypnea. The nurse
reports the patient was stable 30 minutes earlier. Which of the following is the MOST appropriate FIRST step in the
systematic assessment of this patient?
A. A. Order a STAT CT scan of the head
B. B. Perform a focused physical examination and review vital signs trends [CORRECT]
C. C. Administer intravenous lorazepam for agitation control
D. D. Obtain a comprehensive metabolic panel and wait for results
Correct Answer: B
Rationale: The FCCS curriculum emphasizes a systematic approach to recognizing patient deterioration. The most appropriate first step
is a focused physical examination with review of vital sign trends. This 'bedside assessment first' approach allows rapid identification of
the most likely cause of deterioration (e.g., airway compromise, pneumothorax, cardiac arrhythmia, or sepsis) and guides targeted
diagnostic testing and intervention. Ordering a CT head without clinical assessment, administering sedation without identifying the cause,
or waiting for laboratory results are all inappropriate first steps that may delay life-saving interventions.
Q6: A 35-year-old man is admitted to a community hospital ICU with acute respiratory distress syndrome (ARDS)
secondary to community-acquired pneumonia. His PaO2/FiO2 ratio is 98 mmHg on FiO2 0.8 and PEEP 12 cmH2O.
The hospital does not have extracorporeal membrane oxygenation (ECMO) capability. Which of the following is the
MOST appropriate next step in management?
A. A. Increase FiO2 to 1.0 and observe
B. B. Initiate prone positioning and optimize low tidal volume ventilation [CORRECT]
C. C. Transfer the patient to an ECMO-capable center without further stabilization
D. D. Administer high-dose IV corticosteroids immediately
,Correct Answer: B
Rationale: This patient has severe ARDS (PaO2/FiO2 ratio less than 100) and requires optimization of mechanical ventilation with
evidence-based interventions before considering transfer. Prone positioning for more than 16 hours per day has been shown to
significantly reduce mortality in severe ARDS and should be initiated along with continued low tidal volume ventilation (6 mL/kg
predicted body weight). The FCCS curriculum emphasizes that patients should be stabilized with best available therapy before transfer,
and that transfer decisions should involve communication with the receiving center. Simply increasing FiO2 without optimizing PEEP and
position is inadequate.
Q7: A 60-year-old woman with a history of heart failure presents with progressive dyspnea on exertion, orthopnea,
and bilateral lower extremity edema. Her B-type natriuretic peptide (BNP) level is 1,200 pg/mL. Which of the
following bedside findings would be MOST consistent with volume overload in this patient?
A. A. Clear lung fields on auscultation
B. B. Presence of hepatojugular reflux [CORRECT]
C. C. Cold, clammy extremities with delayed capillary refill
D. D. Spontaneous inspiratory effort with abdominal paradox
Correct Answer: B
Rationale: Hepatojugular reflux (HJR) is a bedside physical examination finding that is highly specific for volume overload and elevated
right-sided filling pressures. When firm pressure is applied over the liver, a sustained rise in jugular venous pressure indicates impaired
cardiac function and volume overload. Clear lung fields would suggest the dyspnea is not from pulmonary edema. Cold, clammy
extremities with delayed capillary refill suggest low cardiac output (cardiogenic shock) rather than isolated volume overload. Abdominal
paradox suggests diaphragmatic dysfunction or severe respiratory muscle fatigue.
Q8: An 80-year-old nursing home resident is brought to the emergency department with altered mental status, fever
(39.2 degrees C), and tachycardia (HR 110 bpm). Her blood pressure is 100/60 mmHg. She has no indwelling urinary
catheter. Which of the following is the MOST appropriate initial diagnostic approach?
A. A. Chest radiograph, urinalysis with culture, and blood cultures before initiating antibiotics [CORRECT]
B. B. CT scan of the head, abdomen, and pelvis with contrast
C. C. Lumbar puncture and brain MRI
D. D. Sputum culture and throat swab only
Correct Answer: A
Rationale: In elderly patients with fever and altered mental status, the most common sources of infection are pneumonia, urinary tract
infection, and primary bacteremia. The FCCS curriculum emphasizes obtaining appropriate cultures (blood, urine, and sputum if
applicable) BEFORE initiating empiric antibiotics, but antibiotics should not be delayed beyond 1 hour of presentation. A targeted
diagnostic approach based on the most likely sources is more appropriate than pan-imaging with CT scans, which would delay treatment.
Lumbar puncture may be considered if meningitis is suspected, but it should not be the primary initial diagnostic test without clinical
suspicion of central nervous system infection.
Q9: A 42-year-old man with no significant medical history presents to a rural emergency department with crushing
substernal chest pain that began 45 minutes ago. The 12-lead ECG shows ST-segment elevation in leads II, III, and
aVF. The nearest PCI-capable hospital is 90 minutes away by ground transport. Which of the following is the MOST
appropriate reperfusion strategy?
A. A. Administer thrombolytic therapy within 30 minutes of presentation [CORRECT]
B. B. Transfer immediately by ground ambulance for primary PCI
C. C. Administer aspirin only and observe for 2 hours
D. D. Request helicopter transport and wait for arrival before any intervention
Correct Answer: A
Rationale: According to the ACC/AHA guidelines endorsed in the FCCS curriculum, when the expected first medical contact-to-device
time for primary PCI exceeds 120 minutes, fibrinolytic therapy should be administered within 30 minutes of hospital presentation (the
'door-to-needle' time goal). This patient's expected PCI time would be well over 120 minutes (90-minute transport plus door-to-balloon
time), making thrombolytic therapy the most appropriate choice. The FCCS emphasizes the importance of systems-based approaches to
, reperfusion and the concept of 'time is myocardium' in STEMI management.
Q10: A 28-year-old woman at 32 weeks of gestation presents to the emergency department with severe headache,
visual disturbances, and epigastric pain. Her blood pressure is 168/108 mmHg, and she has 3+ proteinuria on urine
dipstick. Which of the following is the MOST appropriate initial management?
A. A. Administer magnesium sulfate and antihypertensive therapy, and prepare for delivery [CORRECT]
B. B. Order an MRI of the brain to rule out intracranial hemorrhage
C. C. Administer acetaminophen and observe for 6 hours
D. D. Immediate cesarean delivery without medical stabilization
Correct Answer: A
Rationale: This patient presents with severe preeclampsia with severe features (headache, visual disturbances, epigastric pain, severe
hypertension, and significant proteinuria). The most appropriate management includes immediate initiation of magnesium sulfate for
seizure prophylaxis, antihypertensive therapy to reduce blood pressure to a safe range (typically less than 160/110 mmHg), and
preparation for delivery, which is the definitive treatment. The FCCS curriculum covers critical care in pregnancy and emphasizes that
stabilization with magnesium sulfate and blood pressure control should precede delivery, and that imaging should not delay treatment
when the clinical diagnosis is clear.
Q11: A 65-year-old man with end-stage liver disease presents with increasing abdominal girth, confusion, and fever.
His vital signs are: BP 82/48 mmHg, HR 122 bpm, RR 26/min, temperature 38.4 degrees C. Abdominal paracentesis
reveals a WBC count of 450 cells/microL with 80% neutrophils. Which of the following is the MOST likely diagnosis?
A. A. Spontaneous bacterial peritonitis [CORRECT]
B. B. Pancreatic ascites with secondary infection
C. C. Tuberculous peritonitis
D. D. Malignant ascites with portal vein thrombosis
Correct Answer: A
Rationale: The ascitic fluid analysis showing an elevated neutrophil count (80% of 450 cells/microL = 360 neutrophils/microL, which is
greater than the diagnostic threshold of 250 neutrophils/microL) in a patient with end-stage liver disease and clinical signs of infection
(fever, hypotension, tachycardia, confusion) is diagnostic of spontaneous bacterial peritonitis (SBP). The FCCS curriculum highlights that
SBP is a common and life-threatening complication of cirrhosis requiring prompt recognition and treatment with empiric antibiotic
therapy. Pancreatic ascites would show elevated amylase, and tuberculous peritonitis typically has a lymphocytic predominance.
Q12: A 50-year-old man is found unresponsive at home by paramedics. He is apneic and pulseless. CPR is initiated.
The cardiac monitor shows ventricular fibrillation. Which of the following interventions should be performed FIRST
after initiating high-quality CPR?
A. A. Administer intravenous epinephrine
B. B. Attempt defibrillation [CORRECT]
C. C. Establish an advanced airway
D. D. Obtain intraosseous access
Correct Answer: B
Rationale: According to the ACLS algorithm as taught in the FCCS curriculum, when ventricular fibrillation (VF) is identified, the first
intervention after initiating high-quality CPR is immediate defibrillation. Early defibrillation is the most critical intervention for
VF/pulseless VT, as the probability of successful defibrillation decreases rapidly over time. Epinephrine should be administered after the
first defibrillation attempt (or after the second shock per updated guidelines), and advanced airway management should not interrupt or
delay chest compressions and defibrillation. The priority is shock delivery as soon as possible.
Q13: A critically ill patient has the following arterial blood gas results on mechanical ventilation (FiO2 0.5): pH 7.52,
PaCO2 28 mmHg, PaO2 92 mmHg, HCO3- 22 mEq/L. Which of the following is the MOST likely cause of this
acid-base disturbance?
A. A. Metabolic acidosis with respiratory compensation
B. B. Acute respiratory alkalosis [CORRECT]
