FCCS STUDY EXAM GUIDE QUESTIONS AND ANSWERS
SURE A+
✔✔A 75yo patient with severe COPD has cardiac arrest due to ventricular fibrillation
and requires CPR. Ventilated at 10 breaths/min as CPR ensues. Med student believes
patient has a DNR order. THe nurse is concerned the patient only has 1 working IV.
Which is most appropriate approach?
A) increase ventilation to 15 breaths/min because of history of COPD
B) stop CPR because of the DNR order
C) ensure quantitative end-tidal CO2 monitoring during CPR
D) pause CPR to place more IV access - ✔✔C) ensure quantitative end-tidal CO2
monitoring during CPR
✔✔A 35yoM admitted with fever, AMS, ans swelling with redness on his abdomen x6
days. Hx poorly controlled diabetes, chronic renal insufficiency. On exam, he is
lethargic. Vital signs: HR 89, BP 80/40, RR 33, SpO2 92%, temp 39C (102.2F).
Abdomen has erythema and air is felt with palpation of soft tissue. He yells out in
extreme pain, 10/10. Labs: WBC 33 with 18% bands, Hgb 12.5, glucose 320, Na 145, K
4, Cr 3.5 (baseline 2.2), lactate 6.5. IV fluids started for aggressive resuscitation. High
flow oxygen started, blood cultures obtained.
Which of the following is the most appropriate strategy in this patient's management?
A) initiate empiric antibiotics and wait until hemodynamically stable for surgical consult
B) obtain surgical consult and initiate empiric antibiotics
C) only initiate antibiotics at this time
D) only obtain surgical consult at this time; antibiotics not yet warranted - ✔✔B) obtain
surgical consultation and initiate empiric antibiotics
✔✔A 24yoM admitted to ICU after falling from roof. Admission CT reveals left frontal
lobe contusion. No intubation is required. Patient on 3L NC. Observed to have a
generalized seizure.
Which of the following best characterizes the most appropriate initial management?
A) phenytoin, 18-20 mg/kg IV, should be administered as rapidly as possible
B) no drug therapy indicated unless ICP exceeds 25 mmHg
C) IV benzodiazepine, such as lorazepam, 0.1 mg/kg, administered at the onset of
seizure activity, may terminate the seizure
D) IV neuromuscular relaxant such as vecuronium (10,g) should be administered to
decrease the cerebral oxygen requirement - ✔✔C) an IV benzodiazepine, such as
lorazepam, 0.1 mg/kg, administered at the onset of seizure activity, may terminate the
seizure.
✔✔A patient is neurologically devastated, mechanically ventilated, and undergoing
dialysis. Neurology. says no expectation of neurologic recovery or improvement. The
family is resistant to any decision regarding limiting or stopping life-sustaining treatment.
Multiple discussion have occurred in the past 6 weeks.
Which of the following is the most appropriate next step?
, A) begin the formal conflict-resolution process
B) continue to offer every medical and surgical treatment
C) stop all life-sustaining therapy
D) file a unilateral do-not-attempt-resuscitation order - ✔✔A) begin the formal conflict-
resolution process
✔✔An 84yoM with unknown PMHx brought to ED after falling down flight of stairs. Initial
HR 101, BP 109/76, SpO2 on RA is 98%. GCS 15. He has neck pain and irritation of C-
spine collar. Large laceration over left temporal side of head that is hemostatic, and a
ridge along this area is palpated. On secondary survey, he becomes somnolent, SpO2
decreases to 92%, BP decreases to 104/72, and HR 112. He only opens his eyes to
painful stimuli, and he grunts and localizes pain with his right arm only. Left pupil is now
larger than right.
Which of the following is the most appropriate next step for this patient?
A) administer naloxone, 0.4 mg IV bolus
B) consult neurosurgery and, if not available, transfer to a tertiary facility
C) secure the patient's airway by endotracheal intubation with in-line cervical
stabilization
D) initiate noninvasive positive pressure ventilation - ✔✔C) secure the patient's airway
by endotracheal intubation with in-line cervical stabilization
✔✔A 19yoF transferred from a critical access hospital after presenting with fever,
tachycardia, and hypotension. Underwent laparoscopic appendectomy 8 days ago. CT
abdomen/pelvis reveals 5x6cm rim-enhancing fluid collection in RLQ. WBC is 18, temp
38.9 (102F), HR 124, lactic acid 4.8.
In addition to fluid resuscitation and broad-spectrum antibiotics, which of the following
interventions will be most beneficial in treating her sepsis?
A) IV hydrocortisone
B) norepinephrine infusion
C) percutaneous abscess drainage
D) sodium bicarbonate infusion - ✔✔C) percutaneous abscess drainage
✔✔A 52yoM presents to the ED with SOB and new-onset lower extremity edema.
Vitals: temp 37 (98.6F), HR 114, RR 28, BP 86/62, SpO2 92% on nonrebreather.
Transferred to ICU, intubated, and central line is placed. TTE shows significantly
reduced LV function. Hgb 9.2, lactic acid 4.2, and central venous oxygen saturation
43%.
Which of the following interventions will significantly improve oxygen delivery?
A) administer a 1L fluid bolus and start antibiotics
B) start inotropes to increase cardiac contractility
C) start vasopressors to increase SBP
D) transfuse RBCs to a goal of 10 g/dL - ✔✔B) start inotropes to increase cardiac
contractility
SURE A+
✔✔A 75yo patient with severe COPD has cardiac arrest due to ventricular fibrillation
and requires CPR. Ventilated at 10 breaths/min as CPR ensues. Med student believes
patient has a DNR order. THe nurse is concerned the patient only has 1 working IV.
Which is most appropriate approach?
A) increase ventilation to 15 breaths/min because of history of COPD
B) stop CPR because of the DNR order
C) ensure quantitative end-tidal CO2 monitoring during CPR
D) pause CPR to place more IV access - ✔✔C) ensure quantitative end-tidal CO2
monitoring during CPR
✔✔A 35yoM admitted with fever, AMS, ans swelling with redness on his abdomen x6
days. Hx poorly controlled diabetes, chronic renal insufficiency. On exam, he is
lethargic. Vital signs: HR 89, BP 80/40, RR 33, SpO2 92%, temp 39C (102.2F).
Abdomen has erythema and air is felt with palpation of soft tissue. He yells out in
extreme pain, 10/10. Labs: WBC 33 with 18% bands, Hgb 12.5, glucose 320, Na 145, K
4, Cr 3.5 (baseline 2.2), lactate 6.5. IV fluids started for aggressive resuscitation. High
flow oxygen started, blood cultures obtained.
Which of the following is the most appropriate strategy in this patient's management?
A) initiate empiric antibiotics and wait until hemodynamically stable for surgical consult
B) obtain surgical consult and initiate empiric antibiotics
C) only initiate antibiotics at this time
D) only obtain surgical consult at this time; antibiotics not yet warranted - ✔✔B) obtain
surgical consultation and initiate empiric antibiotics
✔✔A 24yoM admitted to ICU after falling from roof. Admission CT reveals left frontal
lobe contusion. No intubation is required. Patient on 3L NC. Observed to have a
generalized seizure.
Which of the following best characterizes the most appropriate initial management?
A) phenytoin, 18-20 mg/kg IV, should be administered as rapidly as possible
B) no drug therapy indicated unless ICP exceeds 25 mmHg
C) IV benzodiazepine, such as lorazepam, 0.1 mg/kg, administered at the onset of
seizure activity, may terminate the seizure
D) IV neuromuscular relaxant such as vecuronium (10,g) should be administered to
decrease the cerebral oxygen requirement - ✔✔C) an IV benzodiazepine, such as
lorazepam, 0.1 mg/kg, administered at the onset of seizure activity, may terminate the
seizure.
✔✔A patient is neurologically devastated, mechanically ventilated, and undergoing
dialysis. Neurology. says no expectation of neurologic recovery or improvement. The
family is resistant to any decision regarding limiting or stopping life-sustaining treatment.
Multiple discussion have occurred in the past 6 weeks.
Which of the following is the most appropriate next step?
, A) begin the formal conflict-resolution process
B) continue to offer every medical and surgical treatment
C) stop all life-sustaining therapy
D) file a unilateral do-not-attempt-resuscitation order - ✔✔A) begin the formal conflict-
resolution process
✔✔An 84yoM with unknown PMHx brought to ED after falling down flight of stairs. Initial
HR 101, BP 109/76, SpO2 on RA is 98%. GCS 15. He has neck pain and irritation of C-
spine collar. Large laceration over left temporal side of head that is hemostatic, and a
ridge along this area is palpated. On secondary survey, he becomes somnolent, SpO2
decreases to 92%, BP decreases to 104/72, and HR 112. He only opens his eyes to
painful stimuli, and he grunts and localizes pain with his right arm only. Left pupil is now
larger than right.
Which of the following is the most appropriate next step for this patient?
A) administer naloxone, 0.4 mg IV bolus
B) consult neurosurgery and, if not available, transfer to a tertiary facility
C) secure the patient's airway by endotracheal intubation with in-line cervical
stabilization
D) initiate noninvasive positive pressure ventilation - ✔✔C) secure the patient's airway
by endotracheal intubation with in-line cervical stabilization
✔✔A 19yoF transferred from a critical access hospital after presenting with fever,
tachycardia, and hypotension. Underwent laparoscopic appendectomy 8 days ago. CT
abdomen/pelvis reveals 5x6cm rim-enhancing fluid collection in RLQ. WBC is 18, temp
38.9 (102F), HR 124, lactic acid 4.8.
In addition to fluid resuscitation and broad-spectrum antibiotics, which of the following
interventions will be most beneficial in treating her sepsis?
A) IV hydrocortisone
B) norepinephrine infusion
C) percutaneous abscess drainage
D) sodium bicarbonate infusion - ✔✔C) percutaneous abscess drainage
✔✔A 52yoM presents to the ED with SOB and new-onset lower extremity edema.
Vitals: temp 37 (98.6F), HR 114, RR 28, BP 86/62, SpO2 92% on nonrebreather.
Transferred to ICU, intubated, and central line is placed. TTE shows significantly
reduced LV function. Hgb 9.2, lactic acid 4.2, and central venous oxygen saturation
43%.
Which of the following interventions will significantly improve oxygen delivery?
A) administer a 1L fluid bolus and start antibiotics
B) start inotropes to increase cardiac contractility
C) start vasopressors to increase SBP
D) transfuse RBCs to a goal of 10 g/dL - ✔✔B) start inotropes to increase cardiac
contractility
