FCCS Questions with Complete
Solutions17
A 65yoF evaluated in the ED for severe abdominal pain and elevated amylase. CT reveals
inflammatory infiltration of the pancreas without involvement of other organs. She is admitted
to the ICU. Management should include:
A) early operative debridement of inflamed tissues
B) goal-directed therapy with crystalloid fluids
C) parenteral nutrition within 24 hours to prevent malnutrition
D) prophylactic antibiotics to prevent possible infectious complications - ANSWERS-B) goal-
directed therapy with crystalloid fluids
A 22yoM is admitted to hospital after MCC. He was wearing a helmet that sustained obvious
damage. On initial exam, he will not open eyes to painful stimuli but makes incomprehensible
sounds; he withdraws from pain but cannot localize it. Vitals: RR 14, HR 88, BP 110/60, SpO2
93% on high flow oxygen face mask. During initial management, patient is cleared for spinal
cord injury, intubated, and placed on assist control ventilation. Initial CT brain shows small
subdural hematoma and evidence of increased ICP. Neurosurgical consult obtained, ICP device
placed. Which of the following is the most appropriate initial management for this patient?
A) administration of corticosteroids to decrease ICP
B) maintain PaCO2 25-30 by mild hyperventilation
C) elevation of head of bed 30-45 while maintaining head and neck in neutral position
D) maintenance of SBP < 90 - ANSWERS-C) elevation of the head of bed 30-45° while
maintaining the head and neck in neutral position
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. Hgb 9.2, lactic acid 4.2, SpO2 improved to 98%, central venous oxygen
saturation 43%. This ScvO2 level indicates which of the following findings?
,A) decreased oxygen delivery and/or decreased oxygen consumption
B) decreased oxygen delivery and/or increased oxygen consumption
C) increased oxygen delivery and/or decreased oxygen consumption
D) increased oxygen delivery and/or increased oxygen consumption - ANSWERS-B) decreased
oxygen delivery and/or increased oxygen consumption
A 62yoM with ESRD and HTN is evaluated in the ED for weakness and poor appetite. He has not
had dialysis in several days because he has trouble finding transportation. On exam, he appears
in moderate distress, with BP 80/40, HR 128, RR 34. He has JVD while sitting upright and pulsus
paradoxus of 20 mmHg. Chest auscultation reveals clear bilateral breath sounds and muffled
heart sounds. Which of the following diagnoses is most likely responsible for this patient's
elevated pulsus paradoxus?
A) asthma exacerbation
B) cardiac tamponade
C) profound hypovolemia
D) pulmonary embolism - ANSWERS-B) cardiac tamponade
A 76yoF PMHx CHF, HTN is admitted with AMS and mild upper respiratory sxs. According to
family, her mental status gradually declined over the last 3 days. Because generalized weakness
and upper respiratory sxs, limited amount of food/drink in the last 72hrs. Home meds:
metoprolol, lisinopril, furosemide. Family states she's compliant.
Vitals: HR 118, BP 96/53, RR 14, SpO2 98% RA
Dry mucous membranes, poor skin turgor, absence of JVD. Clear on auscultation. Opens eyes to
voice, mumbles incomprehensible sounds, generalized weakness. 2 minute tonic-clonic seizure
in ED which resolves without intervention.
Na 110, K 4.5, Cl 80, Bicarb 26, BUN 57, Cr 1.2, glucose 89.
Most appropriate next step?
A) free water restriction
B) hypertonic (3%) saline, 100mL for rapid early correction, goal serum Na 118 in 24 hrs
C) Normal saline bolus, 1L over 10 min, repeat for goal serum Na 128 in 24hrs
, D) oral tolvaptan, 15mg - ANSWERS-B) Hypertonic (3%) saline, 100 mL for rapid early correction,
with goal serum sodium of 118 mEq/L in 24 hours
A 72yoF PMHx HTN, T2DM, smoking develops sudden-onset severe CP associated with difficulty
breathing and diaphoresis.
Vitals on arrival in ED: BP 165/92, HR 101, RR 29, SpO2 96% RA.
Which of the following ECG findings is most significant indicator for immediate reperfusion in
this patient?
A) ST segment depression
B) ST segment elevation
C) T wave inversions
D) Peaked T waves - ANSWERS-B) ST segment elevation
A 72yoM presents to ED with CHF exacerbation. Awake and alert but in distress. Using accessory
respiratory muscles and says it's hard to breathe.
Vitals: HR 120, BP 120/80, RR 34, SpO2 90% on 8L simple face maks.
PE: bilateral lower extremity edema, crackles in posterior lung fields.
CXR: bilateral fluffy infiltrates consistent with pulmonary edema
ABG: pH 7.3, PCO2 50, PO2 64
In addition to diuresis, which of the following is the best next step in this patient's
management?
A) intubate and initiate invasive mechanical ventilation
B) initiate noninvasive positive pressure ventilation
C) switch to nonrebreather oxygen mask
D) switch to high-flow, high-humidity oxygen - ANSWERS-B) initiate noninvasive positive
pressure ventilation
Solutions17
A 65yoF evaluated in the ED for severe abdominal pain and elevated amylase. CT reveals
inflammatory infiltration of the pancreas without involvement of other organs. She is admitted
to the ICU. Management should include:
A) early operative debridement of inflamed tissues
B) goal-directed therapy with crystalloid fluids
C) parenteral nutrition within 24 hours to prevent malnutrition
D) prophylactic antibiotics to prevent possible infectious complications - ANSWERS-B) goal-
directed therapy with crystalloid fluids
A 22yoM is admitted to hospital after MCC. He was wearing a helmet that sustained obvious
damage. On initial exam, he will not open eyes to painful stimuli but makes incomprehensible
sounds; he withdraws from pain but cannot localize it. Vitals: RR 14, HR 88, BP 110/60, SpO2
93% on high flow oxygen face mask. During initial management, patient is cleared for spinal
cord injury, intubated, and placed on assist control ventilation. Initial CT brain shows small
subdural hematoma and evidence of increased ICP. Neurosurgical consult obtained, ICP device
placed. Which of the following is the most appropriate initial management for this patient?
A) administration of corticosteroids to decrease ICP
B) maintain PaCO2 25-30 by mild hyperventilation
C) elevation of head of bed 30-45 while maintaining head and neck in neutral position
D) maintenance of SBP < 90 - ANSWERS-C) elevation of the head of bed 30-45° while
maintaining the head and neck in neutral position
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. Hgb 9.2, lactic acid 4.2, SpO2 improved to 98%, central venous oxygen
saturation 43%. This ScvO2 level indicates which of the following findings?
,A) decreased oxygen delivery and/or decreased oxygen consumption
B) decreased oxygen delivery and/or increased oxygen consumption
C) increased oxygen delivery and/or decreased oxygen consumption
D) increased oxygen delivery and/or increased oxygen consumption - ANSWERS-B) decreased
oxygen delivery and/or increased oxygen consumption
A 62yoM with ESRD and HTN is evaluated in the ED for weakness and poor appetite. He has not
had dialysis in several days because he has trouble finding transportation. On exam, he appears
in moderate distress, with BP 80/40, HR 128, RR 34. He has JVD while sitting upright and pulsus
paradoxus of 20 mmHg. Chest auscultation reveals clear bilateral breath sounds and muffled
heart sounds. Which of the following diagnoses is most likely responsible for this patient's
elevated pulsus paradoxus?
A) asthma exacerbation
B) cardiac tamponade
C) profound hypovolemia
D) pulmonary embolism - ANSWERS-B) cardiac tamponade
A 76yoF PMHx CHF, HTN is admitted with AMS and mild upper respiratory sxs. According to
family, her mental status gradually declined over the last 3 days. Because generalized weakness
and upper respiratory sxs, limited amount of food/drink in the last 72hrs. Home meds:
metoprolol, lisinopril, furosemide. Family states she's compliant.
Vitals: HR 118, BP 96/53, RR 14, SpO2 98% RA
Dry mucous membranes, poor skin turgor, absence of JVD. Clear on auscultation. Opens eyes to
voice, mumbles incomprehensible sounds, generalized weakness. 2 minute tonic-clonic seizure
in ED which resolves without intervention.
Na 110, K 4.5, Cl 80, Bicarb 26, BUN 57, Cr 1.2, glucose 89.
Most appropriate next step?
A) free water restriction
B) hypertonic (3%) saline, 100mL for rapid early correction, goal serum Na 118 in 24 hrs
C) Normal saline bolus, 1L over 10 min, repeat for goal serum Na 128 in 24hrs
, D) oral tolvaptan, 15mg - ANSWERS-B) Hypertonic (3%) saline, 100 mL for rapid early correction,
with goal serum sodium of 118 mEq/L in 24 hours
A 72yoF PMHx HTN, T2DM, smoking develops sudden-onset severe CP associated with difficulty
breathing and diaphoresis.
Vitals on arrival in ED: BP 165/92, HR 101, RR 29, SpO2 96% RA.
Which of the following ECG findings is most significant indicator for immediate reperfusion in
this patient?
A) ST segment depression
B) ST segment elevation
C) T wave inversions
D) Peaked T waves - ANSWERS-B) ST segment elevation
A 72yoM presents to ED with CHF exacerbation. Awake and alert but in distress. Using accessory
respiratory muscles and says it's hard to breathe.
Vitals: HR 120, BP 120/80, RR 34, SpO2 90% on 8L simple face maks.
PE: bilateral lower extremity edema, crackles in posterior lung fields.
CXR: bilateral fluffy infiltrates consistent with pulmonary edema
ABG: pH 7.3, PCO2 50, PO2 64
In addition to diuresis, which of the following is the best next step in this patient's
management?
A) intubate and initiate invasive mechanical ventilation
B) initiate noninvasive positive pressure ventilation
C) switch to nonrebreather oxygen mask
D) switch to high-flow, high-humidity oxygen - ANSWERS-B) initiate noninvasive positive
pressure ventilation
