FCCS Review UPDATED ACTUAL Exam
Questions and CORRECT Answers
What is the most important sign in a critically ill pt? Why? - CORRECT ANSWER -
Tachypnea
Indicates metabolic acidosis (often w/ respiratory alkalosis compensation)
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? - CORRECT ANSWER - Cardiac tamponade; obstructive
shock
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? - CORRECT
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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT
ANSWER - Targeted temperature management.
32-36 C
A shunt means there is perfusion without ventilation. What disease process is an example of a
shunt? - CORRECT ANSWER - Pneumonia
Which type of respiratory failure occurs with CNS depression after an OD? - CORRECT
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? - CORRECT 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? - CORRECT 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? - CORRECT 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).
A young asthmatic pt is on the vent. His lungs are very tight. He is on the AC setting and there is
a lot of auto-PEEP. You correct it by reducing the rate, giving him more time to exhale and
making sure he has enough flow. FiO2 is at .50. He is sedated and seems comfortable. On ABG
the pH is 7.24, CO2 is 65, O2 is 80, and bicarb is 29.
What would you do with the vent settings in this case? - CORRECT ANSWER - Keep the
settings where they are.
Questions and CORRECT Answers
What is the most important sign in a critically ill pt? Why? - CORRECT ANSWER -
Tachypnea
Indicates metabolic acidosis (often w/ respiratory alkalosis compensation)
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? - CORRECT ANSWER - Cardiac tamponade; obstructive
shock
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? - CORRECT
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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT
ANSWER - Targeted temperature management.
32-36 C
A shunt means there is perfusion without ventilation. What disease process is an example of a
shunt? - CORRECT ANSWER - Pneumonia
Which type of respiratory failure occurs with CNS depression after an OD? - CORRECT
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? - CORRECT 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? - CORRECT 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? - CORRECT 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).
A young asthmatic pt is on the vent. His lungs are very tight. He is on the AC setting and there is
a lot of auto-PEEP. You correct it by reducing the rate, giving him more time to exhale and
making sure he has enough flow. FiO2 is at .50. He is sedated and seems comfortable. On ABG
the pH is 7.24, CO2 is 65, O2 is 80, and bicarb is 29.
What would you do with the vent settings in this case? - CORRECT ANSWER - Keep the
settings where they are.
