FCCS Review exam with 100% correct answers/guaranteed success

FCCS
Review
exam
with
100%
correct
answers/guaranteed
success
What
is
the
most
important
sign
in
a
critically
ill
pt?
Why?
-
ANS
Tachypnea
Indicates
metabolic
acidosis
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?
-
ANS
Cardiac
tamponade;
obstructive
shock
If
a
pt
has
a
thyromental
distance
of
2
cm,
what
can
you
expect
about
their
airway?
-
ANS
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?
-
ANS
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?
-
ANS
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?
-
ANS
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?
-
ANS
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?
-
ANS
Targeted
temperature
management.
32-36
C
A
shunt
means
there
is
perfusion
without
ventilation.
What
disease
process
is
an
example
of
a
shunt?
-
ANS
Pneumonia
Which
type
of
respiratory
failure
occurs
with
CNS
depression
after
an
OD?
-
ANS
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?
-
ANS
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?
-
ANS
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?
-
ANS
Decrease
the
PEEP,
even
though
it
will
decrease
PaO2.
(Note:
you
can't
decrease
the
VT
because
it
is
already
on
the
low
end).