ACCS Review Exam with Accurate
Answers
The four critical life functions - ✔✔1. Ventilation
2. Oxygenation
3. Circulation
4. Perfusion
How is ventilation assessed - ✔✔RR, Vt, chest movement, breath sounds, ETCO2, PaCO2
How is oxygenation assessed - ✔✔HR, color, sensorium, SpO2, PaO2
How is circulation assessed - ✔✔HR and strength, cardiac output
Perfusion - ✔✔BP, sensorium, temp, urine output, hemodynamics
How to prioritize life functions during an emergency - ✔✔1. Ventilation 2. Oxygenation 3.
Circulation 4. Perfusion
Of the life functions, the most common problem is... - ✔✔Oxygenation
Pack per day formula - ✔✔# packs/per day x # of years smoked, 20 cigarettes in a pack
Normal urine output - ✔✔40-80 mL/hr or 1-2 L/day
Sensible water loss - ✔✔Urine, vomiting
,Insensible water loss - ✔✔From lungs and skin
Sensible vs insensible water loss - ✔✔Sensible water loss are typical routes of excretion,
insensible less so
If fluid intake exceeds output then... - ✔✔Weight gain, electrolyte imbalance, increased
hemodynamic pressures, decreased lung compliance
Decreased CVP (<2 mmHg) - ✔✔Hypovolemia, treat with fluid challenge
Increased CVP (>6 mmHg) - ✔✔Hypervolemia, treat with diuretics
levels of consciousness (LOC) or sensorium - ✔✔1. Alert and responsive
2. Lethargic/somnolent/sleepy - Arouses easily, responds appropriately when aroused (drug
overdose or sleep apnea)
3. Stuporous/confused - Does not awaken completely, responds to pain (drug overdose,
intoxication)
4. Semicomatose - Respond only to painful stimuli
5. Obtunded - Awakens only with difficulty, may be unable to protect airway
6. Come - Does not respond to painful stimuli
Glascow Coma Scale (GCS) - ✔✔
Assess the emotional state - ✔✔1. Anxiety/nervousness - Asthma, resp distress, hypoxemia
2. Depressed
3. Anger/combative/irritable - Electrolyte imbalance
4. Euphoria - Drug overdose
,5. Panic - Pneumothorax, hypoxia, status asthmaticus
Grades of Dyspnea - ✔✔Grade 1- dyspnea after unusual exertion
Grade 2- breathlessness after hills or stairs
Grade 3- dyspnea while walking at normal speed
Grade 4- dyspnea slowly walking short distance
Grade 5- dyspnea at rest, shaving, dressing
Types of syncope - ✔✔1. Vasovagal
2. Orthostatic hypotension
3. Cartoid sinus - hypersensitive cartoid sinus, more common in elderly
4. Cough/tussive
FUO - ✔✔fever of unknown origin (poss sepsis)
Normal adult HR - ✔✔60-100 bpm
Normal adult RR - ✔✔12-20 breaths/min
Normal adult temperature - ✔✔97-99.5 F or 36.5 - 37.5 C
Normal adult BP - ✔✔120/80 mmHg (90/60 - 140/90)
Hemiparesis posture - ✔✔Abnormal posturing, could indicate brain injury
Decorticate posture - ✔✔The body is rigid, the arms are stiff and bent, the fists are tight, and
the legs are straight out.
, PERRLA - ✔✔pupils equal, round, reactive to light and accommodation
Abnormal pupil findings caused by - ✔✔Head trauma
Tumors
CNS disease
Medications (such as atropine, opioids)
Miosis - ✔✔constricted pupils
Ptosis - ✔✔drooping of upper lids
Diplopia - ✔✔blurred or double vision
Nystagmus - ✔✔Cyclic movement of the eyeballs
Peripheral edema caused by - ✔✔1. CHF
2. PHTN
3. Venous insufficiency
4. Renal Failure
Levels of edema - ✔✔1. 1+= 2mm (slight pitting, disappears rapidly)
2. 2+= 4mm (deeper than 1+, disappears in 10-15 sec)
3. 3+= 6mm (deep and lasts more than 1 min)
4. 4+= 8mm (deepest, last for 2-5 min)
brawny (non-pitting edema) - fluid can no longer be displaced secondarily - feels hard to touch
Answers
The four critical life functions - ✔✔1. Ventilation
2. Oxygenation
3. Circulation
4. Perfusion
How is ventilation assessed - ✔✔RR, Vt, chest movement, breath sounds, ETCO2, PaCO2
How is oxygenation assessed - ✔✔HR, color, sensorium, SpO2, PaO2
How is circulation assessed - ✔✔HR and strength, cardiac output
Perfusion - ✔✔BP, sensorium, temp, urine output, hemodynamics
How to prioritize life functions during an emergency - ✔✔1. Ventilation 2. Oxygenation 3.
Circulation 4. Perfusion
Of the life functions, the most common problem is... - ✔✔Oxygenation
Pack per day formula - ✔✔# packs/per day x # of years smoked, 20 cigarettes in a pack
Normal urine output - ✔✔40-80 mL/hr or 1-2 L/day
Sensible water loss - ✔✔Urine, vomiting
,Insensible water loss - ✔✔From lungs and skin
Sensible vs insensible water loss - ✔✔Sensible water loss are typical routes of excretion,
insensible less so
If fluid intake exceeds output then... - ✔✔Weight gain, electrolyte imbalance, increased
hemodynamic pressures, decreased lung compliance
Decreased CVP (<2 mmHg) - ✔✔Hypovolemia, treat with fluid challenge
Increased CVP (>6 mmHg) - ✔✔Hypervolemia, treat with diuretics
levels of consciousness (LOC) or sensorium - ✔✔1. Alert and responsive
2. Lethargic/somnolent/sleepy - Arouses easily, responds appropriately when aroused (drug
overdose or sleep apnea)
3. Stuporous/confused - Does not awaken completely, responds to pain (drug overdose,
intoxication)
4. Semicomatose - Respond only to painful stimuli
5. Obtunded - Awakens only with difficulty, may be unable to protect airway
6. Come - Does not respond to painful stimuli
Glascow Coma Scale (GCS) - ✔✔
Assess the emotional state - ✔✔1. Anxiety/nervousness - Asthma, resp distress, hypoxemia
2. Depressed
3. Anger/combative/irritable - Electrolyte imbalance
4. Euphoria - Drug overdose
,5. Panic - Pneumothorax, hypoxia, status asthmaticus
Grades of Dyspnea - ✔✔Grade 1- dyspnea after unusual exertion
Grade 2- breathlessness after hills or stairs
Grade 3- dyspnea while walking at normal speed
Grade 4- dyspnea slowly walking short distance
Grade 5- dyspnea at rest, shaving, dressing
Types of syncope - ✔✔1. Vasovagal
2. Orthostatic hypotension
3. Cartoid sinus - hypersensitive cartoid sinus, more common in elderly
4. Cough/tussive
FUO - ✔✔fever of unknown origin (poss sepsis)
Normal adult HR - ✔✔60-100 bpm
Normal adult RR - ✔✔12-20 breaths/min
Normal adult temperature - ✔✔97-99.5 F or 36.5 - 37.5 C
Normal adult BP - ✔✔120/80 mmHg (90/60 - 140/90)
Hemiparesis posture - ✔✔Abnormal posturing, could indicate brain injury
Decorticate posture - ✔✔The body is rigid, the arms are stiff and bent, the fists are tight, and
the legs are straight out.
, PERRLA - ✔✔pupils equal, round, reactive to light and accommodation
Abnormal pupil findings caused by - ✔✔Head trauma
Tumors
CNS disease
Medications (such as atropine, opioids)
Miosis - ✔✔constricted pupils
Ptosis - ✔✔drooping of upper lids
Diplopia - ✔✔blurred or double vision
Nystagmus - ✔✔Cyclic movement of the eyeballs
Peripheral edema caused by - ✔✔1. CHF
2. PHTN
3. Venous insufficiency
4. Renal Failure
Levels of edema - ✔✔1. 1+= 2mm (slight pitting, disappears rapidly)
2. 2+= 4mm (deeper than 1+, disappears in 10-15 sec)
3. 3+= 6mm (deep and lasts more than 1 min)
4. 4+= 8mm (deepest, last for 2-5 min)
brawny (non-pitting edema) - fluid can no longer be displaced secondarily - feels hard to touch
