FCCS Review test with 100% Correct Answers 2023

How do you diagnose airway obstruction? - Correct answer-FEV1/FVC <70% Once airway obstruction is diagnosed, how do you determine whether it is d/t asthma or COPD? - Correct answer-Give pt bronchodilator. if >12% improvement of FEV1 then asthma The *Global* initiate for Chronic *Obstructive Lung Disease* (GOLD) categorizes airflow limitation into how many stages? - Correct answer-4 stages of COPD GOLD 1 spirometric findings - Correct answer-mild: FEV1/FVC = <70% FEV1 >80% predicted GOLD 2 spirometric findings - Correct answer-moderate: FEV1/FVC = <70% FEV1 between 50% & 80% predicted GOLD 3 spirometric findings - Correct answer-severe: FEV1/FVC = <70% FEV1 between 30% and 50% predicted GOLD 4 spirometric findings - Correct answer-very severe: FEV1/FVC = <70% FEV1 <30% predicted How do you diagnose airway obstruction? - Correct answer-TLC (total lung capacity) <80% Dx of airway restriction is dependent on - Correct answer-ht, wt, race can be d/t intrathoraic and extrathoracic causes Intrathoracic causes of airway restriction - Correct answer-pulmonary fibrosis, asbestos, interstitial lung dz, sarcoidosis Extrathoracic causes of airway obstruction - Correct answer-central obesity, scoliosis, phrenic nerve paralysis, GB, MG, MS During pregnancy what will decrease? - Correct answer-Functional Residual Capacity - the amount of air left in lung after normal expiration Why is decreased FRC in preggers a problem? - Correct answer-if you run into complications while intubating the pregger pt will crash quicker d/t less reserve in lungs How to ensure ET tube is placed properly? - Correct answer-GS: capnography device. will change from purple to gold/yellow once pt exhales CO2 also: bilateral chest rise auscultation lungs/stomach CXR A child presents to the ER with sudden onset of SOB. CXR shows the hyperinflation of only one lung - what does this suggest? - Correct answer-foreign body aspiration Pt is admitted to ICU after falling off roof. He has a frontal lobe contusion and has a generalized seizure. How do you treat? - Correct answer-IV benzodiazepines -> Lorazepam Why do you give IV benzodiazepines for generalized seizures and not phenytoin? - Correct answer-benzos work IMMEDIATELY phenytoin is good to control recurrent seizures not immediate ones. it also takes 20 mins to work Hx & PE of aortic dissection - Correct answer-central, crushing chest pain radiating to the back unequal pulsess in upper and lower extremities aortic regurg murmur different BP in each arm (usually hypertensive) Best imaging to confirm diagnosis of Aortic dissection? - Correct answer-CT #1 priority when treating aortic dissection? - Correct answer-*lower HR* Treatment of aortic dissection depending on type - Correct answer-Type A: Emergency Type B: Non-emergancy. Meds: IV BB Labetolol lower HR & BP avoid drugs that give reflex tachycardia (when BP lowers and sympathetic NS compensates) What is contraindicated in. aortic dissection? - Correct answer-No ACEi, CCBs, nitroglycerine, nitroprusside If a patient ingested drugs (OD) >4 hours ago and now presents to the ED what can you do for them? - Correct answer-nothing best study to r/o PE - Correct answer-CTA: computed tomography angiography How do you treat DKA? - Correct answer-IV fluids - 1st IV insulin potassium supplementation regulate electrolytes Give glucose when BS is <250 How do you know when someone is no longer in DKA? - Correct answer-when anion gap is normal <12 then you add long acting insulin turn off IV insulin drip MUST add long acting insulin BEFORE d/c of drip Pt presents with PNA, sepsis & shock. How do you treat? - Correct answer-1) 30 mL/kg (bolus) IV crystalloid bolus then 150mL/hour 2) IV vasopressors if still low give NE 3) steroids if refractory hypotension fluids given in cardiogenic shock can result in - Correct answer-pulmonary edema How to treat hyperkalemia with EKG changes? - Correct answer-calcium gluconate also CBIGKDIE Pt presents w/CA and sepsis (fever, chills, febrile), hypotensive, and low WBC #. What does he have and how do you treat? - Correct answer-neutropenic fever 1) blood, urine, sputum culture first 2) CXR 3) empiric txt w/broad spectrum abx (w/in 30-60mins) 4) once culture comes back, narrow and drop abx always draw culture THEN hang abx DM pt comes with fever, scrotal area presents w/ erythema, induration, redness, swelling, RF and lethargy. PMH: shows cutaneous gangrene. When you *palpate area you feel gas*- what does this pt have? - Correct answer-Dx: Necrotizing fasciitis Txt: call surgery ASAP(do not delay) and abx IV Vanco (MRSA) + piptazo (pseudo) + clinda (toxins) PA college student presents to ER w/ha + fever. temp 102F, HR 125. on PE pt is unable to touch chin to chest w/out pain (stiff neck). What does this patient have? - Correct answer-Dx: Meningitis Txt: Ceftriaxone/Rocephin + Vanco One drug that improves mortality after stemi MI - Correct answer-ACEi What patient goes to the Cath lab with chest pain? - Correct answer-STEMI: door to ballon -> 90 mins door to needle -> 30 mins NSTEMI +hemodynamically unstable What kind of MI pt should get immediate reperfusion? - Correct answer-STEMI What is ALWAYS given w/chest pain? - Correct answer-O2 Pt w/central venous line for 3 days. Site of catheter placement is erythmatous, discharge, septic. What does this patient have? - Correct answer-Dx: Central venous line infection Txt: remove line + IV Vanco (MRSA-> staph) Pt has PNA and is in hospital being treated with abx. Grandma visits 2 days later with diffuse and pain & diarrhea - Correct answer-Dx: cdiff Txt: PO metronidazole + Vanco + fluids activated charcoal only works within - Correct answer-first 3 hours Pt has fallen, bruises on forehead. O2 sat 85%, responds only to painful stimuli, pupils unequal. How do you txt? - Correct answer-intubate, stabilize, transport No bYPAP b/c unstable Best diagnostic test for patient in shock with abdominal trauma? - Correct answer-FAST exam -> US!!!! Pt in shock with abdominal trauma has bleed and is crashing in OR. What fluids do you give? - Correct answer-massive transfusion protocol must give clotting factors with blood or will dilute pts blood. 1 unit fresh frozen packed RBCs 1 unit platlets 1 unit fresh frozen plasma (1:1:1) MVA pt presents in shock, low BP 86/82 & HR 126 what class of hemorrhage? - Correct answer-class 3 Pt of vent crashes, intubate pt. BP suddenly drops and HR rises. Breath sounds absent on L. side. What does this patient have? - Correct answer-Dx: PTX Txt: needle decompression First step in txt pt with elevated ICP? - Correct answer-elevate HOB Pt with stroke. neg CT for hemorrhage. What is the window for tPA? - Correct answer4.5 hours Pt with HF on diuretics. Na 110 (hyponatremia) and seizures how do you treat? - Correct answer-3% NaCl Hypertonic solution 100 bolus 3% only given when seizures are present How fast can you correct hyponatremia? What is the AE if done too quickly? - Correct answer-8meq/24 hours central pontine myelysis PT has obstructive uropathy, catheter, massive amounts of urine output. Pt now is hypotensive how do we treat? - Correct answer-IV fluids Pt presents in massive trauma & shock. Best diagnostic test? - Correct answer-FAST exam -> US ScVO2 is low. (norm 65-70) How can we treat this? - Correct answer-blood can help What is permissive hypercapnia? - Correct answer-Aware of hypercapnia but allowing it anyway Pt on vent is septic. ABG 7.23 pCO2 Na 129 Cl 102 Bicarb 16 K 3.9 what is anion gap? - Correct answer-AG = 129 - (102 + 16) Metabolic: do not touch vent Focus on management with fluids & abx Low SVO2 is d/t either - Correct answer-not getting enough or consuming too much - decreased delivery - increased consumption Pt with HF and O2 sat 90% on 8L via O2 mask. Lower extremities edema, crackles on auscultation, tachypnea. In addition to diuretics what else can you do for O2? - Correct answer-CPAP or ByPAP (noninvasive) intubate ONLY if in shock What does the *Peak airway pressure* alarm signify? - Correct answer-retaining of CO2 air building up in lungs -> airway pressure increases -> breath stacking -> auto PEEP how do you treat AUTO peep? - Correct answer-d/c vent press on pts chest to let air out ( decrease P = increase VR) sedate patient ( decrease RR , low TV) decrease rate & acceleration permissive hypercapnia (CO2 will come down on its own) ARDS & hypoxic pt. How do you treat? - Correct answer-place on vent then either: 100% O2 increase PEEP Pt on vent with COPD exacerbation, suddenly crashes, PEEP pressure high, plateu high. No breath sounds on one side. and trachea deviation. What does this pt have? - Correct answer-Dx: PTX Txt: needle decompression What type of respiratory failure happens with OD? - Correct answer-hypercapnic Classical example of shunt as a cause for V/Q mismatch? - Correct answer-anything that causes dz in alveoli PNA atelectasis alveoli filled with anything other than air -> blood, pus, fluid Pt has cardiac arrest, CPT, unresponsive. What do you do? - Correct answer-target temperature management. (cool to *33-36 C*)