FREC 4 ADVANCED CLINICAL
ASSESSMENT AND MANAGEMENT
EXAM QUESTIONS AND ANSWERS
1. Which of the following describes the physiological mechanism of ‘Cushing’s Triad’ in a
patient with increased intracranial pressure (ICP)?
A. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
B. Tachycardia, hypotension, and irregular respirations
C. Bradycardia, hypotension, and tachypnea
D. Tachycardia, hypertension, and Cheyne-Stokes breathing
Answer: A
Conceptual Explanation: Cushing’s Triad consists of bradycardia, hypertension (widening
pulse pressure), and irregular respirations (such as Cheyne-Stokes), indicating late-stage
brain stem compression due to high ICP.
2. In the context of acid-base balance, a patient with a pH of 7.25 and a high PaCO2 is most
likely experiencing:
A. Metabolic Alkalosis
,B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis, and an elevated PaCO2
indicates a respiratory origin, as the lungs are failing to remove CO2 adequately.
3. A 65-year-old male presents with crushing chest pain radiating to the jaw. The ECG shows
ST-segment elevation in leads II, III, and aVF. Which wall of the heart is affected?
A. Inferior wall
B. Septal wall
C. Anterior wall
D. Lateral wall
Answer: A
Conceptual Explanation: ST elevation in leads II, III, and aVF is indicative of an Inferior
wall MI, usually involving the Right Coronary Artery (RCA).
4. What is the primary physiological objective of administering high-flow oxygen to a patient
with a suspected Carbon Monoxide (CO) poisoning?
A. To stimulate the respiratory center in the medulla
B. To increase the rate of CO dissociation from hemoglobin
, C. To induce peripheral vasoconstriction
D. To prevent the formation of methemoglobin
Answer: B
Conceptual Explanation: High-flow oxygen reduces the half-life of carboxyhemoglobin by
competing for the binding sites on the hemoglobin molecule, speeding up CO clearance.
5. According to the Parkland Formula, how much fluid should be administered in the first 8
hours to a 70kg patient with 30% Total Body Surface Area (TBSA) burns?
A. 4200ml
B. 8400ml
C. 2100ml
D. 5250ml
Answer: A
Conceptual Explanation: Parkland Formula: 4ml x weight (kg) x %TBSA. Total = 4 x 70 x
30 = 8400ml. Half (4200ml) is given in the first 8 hours.
6. Which heart rhythm is characterized by a ‘sawtooth’ pattern on the ECG?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Supraventricular Tachycardia
ASSESSMENT AND MANAGEMENT
EXAM QUESTIONS AND ANSWERS
1. Which of the following describes the physiological mechanism of ‘Cushing’s Triad’ in a
patient with increased intracranial pressure (ICP)?
A. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
B. Tachycardia, hypotension, and irregular respirations
C. Bradycardia, hypotension, and tachypnea
D. Tachycardia, hypertension, and Cheyne-Stokes breathing
Answer: A
Conceptual Explanation: Cushing’s Triad consists of bradycardia, hypertension (widening
pulse pressure), and irregular respirations (such as Cheyne-Stokes), indicating late-stage
brain stem compression due to high ICP.
2. In the context of acid-base balance, a patient with a pH of 7.25 and a high PaCO2 is most
likely experiencing:
A. Metabolic Alkalosis
,B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis, and an elevated PaCO2
indicates a respiratory origin, as the lungs are failing to remove CO2 adequately.
3. A 65-year-old male presents with crushing chest pain radiating to the jaw. The ECG shows
ST-segment elevation in leads II, III, and aVF. Which wall of the heart is affected?
A. Inferior wall
B. Septal wall
C. Anterior wall
D. Lateral wall
Answer: A
Conceptual Explanation: ST elevation in leads II, III, and aVF is indicative of an Inferior
wall MI, usually involving the Right Coronary Artery (RCA).
4. What is the primary physiological objective of administering high-flow oxygen to a patient
with a suspected Carbon Monoxide (CO) poisoning?
A. To stimulate the respiratory center in the medulla
B. To increase the rate of CO dissociation from hemoglobin
, C. To induce peripheral vasoconstriction
D. To prevent the formation of methemoglobin
Answer: B
Conceptual Explanation: High-flow oxygen reduces the half-life of carboxyhemoglobin by
competing for the binding sites on the hemoglobin molecule, speeding up CO clearance.
5. According to the Parkland Formula, how much fluid should be administered in the first 8
hours to a 70kg patient with 30% Total Body Surface Area (TBSA) burns?
A. 4200ml
B. 8400ml
C. 2100ml
D. 5250ml
Answer: A
Conceptual Explanation: Parkland Formula: 4ml x weight (kg) x %TBSA. Total = 4 x 70 x
30 = 8400ml. Half (4200ml) is given in the first 8 hours.
6. Which heart rhythm is characterized by a ‘sawtooth’ pattern on the ECG?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Supraventricular Tachycardia
