ACCS REVIEW PRACTICE 2024
EXAM
ANSWER ALL QUESTIONS IN THIS SECTION
QUESTION 1
An unrestrained 26 y.o. female involved in a motor vehicle crash is admitted to the
ED. She has a left parietal scalp laceration with controlled bleeding. The patient is
awake and complaining of neck pain. She is immobilized on a backboard with a
rigid cervical collar in place. Vital signs are as follows:
HR 64
RR 24 with shallow breathing
BP 94/55
Oral temp 102.2*F
She appears dusky and her skin is warm and dry to the touch. Oxygen is being
administered via a non-rebreather. She has a loss of noxious stimuli sensation, loss
of temperature control, and loss of crude sensation to the right side. Based on this
assessment, what problem should the ACCS suggest to the attending physician?
A. closed head injury with cerebral edema
B. stroke
C. spinal cord injury
END OF
PAGE 1
, ACCS REVIEW PRACTICE 2024
EXAM
D. subluxation of C-5 with phrenic nerve damage - ANSWERS-C. spinal cord
injury
QUESTION 2
Candy, an 18 y.o. female, in previously good health, has noticed that in the past
month, she is increasingly thirsty. She gets up several times each night to urinate,
and finds herself gulping down glasses of water. She has lost 5 pounds in the past
month without trying. In the past three days, she has become nauseated and
vomited on three occasions. Her urine tested positive for glucose and for ketone
bodies. Blood glucose level is 534 mg/dL and blood pH is 7.23. ABG results are
pending. What acid/base balance should the ACCS expect to find? - ANSWERS-
Metabolic acidosis
QUESTION 3
A 32 y.o. male went to cardiac arrest following a seizure. Despite appropriate
resuscitation efforts, he was asystolic for approximately 5 mins. Results of urine
toxicology and alcohol screens were negative. His CSF analysis was inconclusive.
He never awakened and he progressively lost neurologic function. Which of the
following criteria should the ACCS use to establish the diagnosis of clinical brain
death?
1. Pupils nonreactive at 4-mm diameter
2. Paco2 of 70 torr during apnea test
3. Lack of ocular reflexes to ice water
END OF
PAGE 2
, ACCS REVIEW PRACTICE 2024
EXAM
4. Cerebral angiogram with prominent hemispheric perfusion. - ANSWERS-1, 2,
& 3 only
QUESTION 4
A 25 y.o. old man with a history of Croh's disease and pulmonary
coccidioidomycosis is admitted because of abdominal pain, vomiting, diarrhea,
fatigue, and decreased oral intake. On physical examination, the patient is in mild
to moderate distress with a heart rate of 140/min, blood pressure of 80/40 mmHg,
RR of 18, and temp of 99.8*F.
His mucous membranes are dry, BUN is normal but creatinine is elevated. His
abdominal exam reveals diffuse tenderness to palpation with hyperactive bowel
sounds. Which of the following is he MOST appropriate intervention?
A. administer dobutamine HCl (Dobutrex)
B. Administer norepinephrine
C. Initiate rapid infusion of normal saline
D. Initiate renal dialysis - ANSWERS-C. Initiate rapid infusion of normal saline
QUESTION 5
END OF
PAGE 3
, ACCS REVIEW PRACTICE 2024
EXAM
A 58 y.o. male is admitted to the ICU following an ATV collision in which he hit a
tree and flipped over. On admission, he is alert and oriented by anxious. He states
that he feels weak and cannot feel his legs Chest radiographs is within normal
limits. His temperature is 98*F; heart rate is 56, RR is 26/min, blood pressure is
102/76 and his SPO2 Is 88% on a NRB at 10lpm. The ACCS should inform the ED
attending that the patient is suffering from which type of shock? - ANSWERS-
Distributive
QUESTION 6
A 50 y.o. female was admitted to the ED with a chief complaint of a cough and
fever for past 5 days. She has a history of hypertension, Type II diabetes, renal
insufficiency and dementia. Home medications include aspirin, furosemide,
tolterodine tartrate, memantine, Valsartan, metformin, Lovastatin and niacin. She
presented w/ a temp of 37.9*, BP of 70/30, and HR of 130.
Lab results are:
WBC 16.7
RBC 3.3.
Hgb 9.2
BUN 40
Creatinine 1.6
Albumin 2.7
END OF
PAGE 4
EXAM
ANSWER ALL QUESTIONS IN THIS SECTION
QUESTION 1
An unrestrained 26 y.o. female involved in a motor vehicle crash is admitted to the
ED. She has a left parietal scalp laceration with controlled bleeding. The patient is
awake and complaining of neck pain. She is immobilized on a backboard with a
rigid cervical collar in place. Vital signs are as follows:
HR 64
RR 24 with shallow breathing
BP 94/55
Oral temp 102.2*F
She appears dusky and her skin is warm and dry to the touch. Oxygen is being
administered via a non-rebreather. She has a loss of noxious stimuli sensation, loss
of temperature control, and loss of crude sensation to the right side. Based on this
assessment, what problem should the ACCS suggest to the attending physician?
A. closed head injury with cerebral edema
B. stroke
C. spinal cord injury
END OF
PAGE 1
, ACCS REVIEW PRACTICE 2024
EXAM
D. subluxation of C-5 with phrenic nerve damage - ANSWERS-C. spinal cord
injury
QUESTION 2
Candy, an 18 y.o. female, in previously good health, has noticed that in the past
month, she is increasingly thirsty. She gets up several times each night to urinate,
and finds herself gulping down glasses of water. She has lost 5 pounds in the past
month without trying. In the past three days, she has become nauseated and
vomited on three occasions. Her urine tested positive for glucose and for ketone
bodies. Blood glucose level is 534 mg/dL and blood pH is 7.23. ABG results are
pending. What acid/base balance should the ACCS expect to find? - ANSWERS-
Metabolic acidosis
QUESTION 3
A 32 y.o. male went to cardiac arrest following a seizure. Despite appropriate
resuscitation efforts, he was asystolic for approximately 5 mins. Results of urine
toxicology and alcohol screens were negative. His CSF analysis was inconclusive.
He never awakened and he progressively lost neurologic function. Which of the
following criteria should the ACCS use to establish the diagnosis of clinical brain
death?
1. Pupils nonreactive at 4-mm diameter
2. Paco2 of 70 torr during apnea test
3. Lack of ocular reflexes to ice water
END OF
PAGE 2
, ACCS REVIEW PRACTICE 2024
EXAM
4. Cerebral angiogram with prominent hemispheric perfusion. - ANSWERS-1, 2,
& 3 only
QUESTION 4
A 25 y.o. old man with a history of Croh's disease and pulmonary
coccidioidomycosis is admitted because of abdominal pain, vomiting, diarrhea,
fatigue, and decreased oral intake. On physical examination, the patient is in mild
to moderate distress with a heart rate of 140/min, blood pressure of 80/40 mmHg,
RR of 18, and temp of 99.8*F.
His mucous membranes are dry, BUN is normal but creatinine is elevated. His
abdominal exam reveals diffuse tenderness to palpation with hyperactive bowel
sounds. Which of the following is he MOST appropriate intervention?
A. administer dobutamine HCl (Dobutrex)
B. Administer norepinephrine
C. Initiate rapid infusion of normal saline
D. Initiate renal dialysis - ANSWERS-C. Initiate rapid infusion of normal saline
QUESTION 5
END OF
PAGE 3
, ACCS REVIEW PRACTICE 2024
EXAM
A 58 y.o. male is admitted to the ICU following an ATV collision in which he hit a
tree and flipped over. On admission, he is alert and oriented by anxious. He states
that he feels weak and cannot feel his legs Chest radiographs is within normal
limits. His temperature is 98*F; heart rate is 56, RR is 26/min, blood pressure is
102/76 and his SPO2 Is 88% on a NRB at 10lpm. The ACCS should inform the ED
attending that the patient is suffering from which type of shock? - ANSWERS-
Distributive
QUESTION 6
A 50 y.o. female was admitted to the ED with a chief complaint of a cough and
fever for past 5 days. She has a history of hypertension, Type II diabetes, renal
insufficiency and dementia. Home medications include aspirin, furosemide,
tolterodine tartrate, memantine, Valsartan, metformin, Lovastatin and niacin. She
presented w/ a temp of 37.9*, BP of 70/30, and HR of 130.
Lab results are:
WBC 16.7
RBC 3.3.
Hgb 9.2
BUN 40
Creatinine 1.6
Albumin 2.7
END OF
PAGE 4
