ACCS RESPIRATORY PRACTICE EXAM
QUESTIONS AND ANSWERS|REVISION|
Normal urine output - ✔✔40 mL/hr (<30mL/hr is significant )
Polyuria - ✔✔Excessive urine output >300mL/hr (e.g. brain death)
Oliguria - ✔✔<400ml of urine and in 24hrs (e.g. ARDS, Sepsis)
Anuria - ✔✔<100mL of urine in 24hrs
CRRT (continuous renal replacement therapy) - ✔✔Not as likely to decrease BP like dialysis.
Use when hemodynamically unstable.
apnea testing - ✔✔Patient must have no spontaneous movement, core temp >35*c, no sedation
and absence of all brain stem reflexes before you perform test.
Therapeutic Hypothermia - ✔✔Catheter can be placed in inferior vena cava via femoral vein;
target temp 32-34*C. (E.g. Cardiac arrest, Stroke, and spinal cord injury)
Neurogenic Shock - ✔✔Distributive shock resulting in hypotension pain w/ occasional
bradycardia. (E.g. Spinal cord injury) Decrease BP caused by decrease in systemic vascular
resistance, resulting in pooling of blood in the extremities.
Brain perfusion study - ✔✔Study stands on its own to determine brain death.
SDH (subdural hematoma) - ✔✔No anticoagulants, if patient has clots use IVC filter to block
clots and prevent PE
, Decorticate posturing - ✔✔(Abnormal Flexion) indicates severe brain stem injury
Pinpoint pupils - ✔✔Sign of too much sedation (excess opiates such as morphine)
CPP (Cerebral Perfusion Pressure) - ✔✔Net pressure gradient causing cerebral blood flow to the
brain; decreased blood flow can lead to ischemia, elevated pressure can cause increased intra
cranial pressure. Normal CPP is 70mmhg to 90mmhg. CPP=MAP-ICP
CBF Cerebral Blood Flow - ✔✔Increases with hypercapnia and hypoxia
Increased ICP due to what? - ✔✔Inceased CO2 -> increases vasodilation-> increases Cerebral
blood flow -> increases ICP
Intraventricular Monitors - ✔✔Gold Standard for ICP monitoring. Can be used as a drain also.
What to avoid with Increased ICP - ✔✔Large shifts in BP (Especially hypotension b/c this
decreases blood flow to the brain
Managing increased ICP - ✔✔Elevate HOB, Hyperventilation (30-40mmhg)short term fix ,IV
Mannitol
Benefits of HOB elevation - ✔✔Decreased ICP, Increases FRC, Decreases chance of aspiration,
May improve V/Q matching
Hypoventilation w/ Spinal cord injury - ✔✔Intubate instead of NPPV
Normal BP - ✔✔120/80 (Sys <90 is critical; possible sepsis)
QUESTIONS AND ANSWERS|REVISION|
Normal urine output - ✔✔40 mL/hr (<30mL/hr is significant )
Polyuria - ✔✔Excessive urine output >300mL/hr (e.g. brain death)
Oliguria - ✔✔<400ml of urine and in 24hrs (e.g. ARDS, Sepsis)
Anuria - ✔✔<100mL of urine in 24hrs
CRRT (continuous renal replacement therapy) - ✔✔Not as likely to decrease BP like dialysis.
Use when hemodynamically unstable.
apnea testing - ✔✔Patient must have no spontaneous movement, core temp >35*c, no sedation
and absence of all brain stem reflexes before you perform test.
Therapeutic Hypothermia - ✔✔Catheter can be placed in inferior vena cava via femoral vein;
target temp 32-34*C. (E.g. Cardiac arrest, Stroke, and spinal cord injury)
Neurogenic Shock - ✔✔Distributive shock resulting in hypotension pain w/ occasional
bradycardia. (E.g. Spinal cord injury) Decrease BP caused by decrease in systemic vascular
resistance, resulting in pooling of blood in the extremities.
Brain perfusion study - ✔✔Study stands on its own to determine brain death.
SDH (subdural hematoma) - ✔✔No anticoagulants, if patient has clots use IVC filter to block
clots and prevent PE
, Decorticate posturing - ✔✔(Abnormal Flexion) indicates severe brain stem injury
Pinpoint pupils - ✔✔Sign of too much sedation (excess opiates such as morphine)
CPP (Cerebral Perfusion Pressure) - ✔✔Net pressure gradient causing cerebral blood flow to the
brain; decreased blood flow can lead to ischemia, elevated pressure can cause increased intra
cranial pressure. Normal CPP is 70mmhg to 90mmhg. CPP=MAP-ICP
CBF Cerebral Blood Flow - ✔✔Increases with hypercapnia and hypoxia
Increased ICP due to what? - ✔✔Inceased CO2 -> increases vasodilation-> increases Cerebral
blood flow -> increases ICP
Intraventricular Monitors - ✔✔Gold Standard for ICP monitoring. Can be used as a drain also.
What to avoid with Increased ICP - ✔✔Large shifts in BP (Especially hypotension b/c this
decreases blood flow to the brain
Managing increased ICP - ✔✔Elevate HOB, Hyperventilation (30-40mmhg)short term fix ,IV
Mannitol
Benefits of HOB elevation - ✔✔Decreased ICP, Increases FRC, Decreases chance of aspiration,
May improve V/Q matching
Hypoventilation w/ Spinal cord injury - ✔✔Intubate instead of NPPV
Normal BP - ✔✔120/80 (Sys <90 is critical; possible sepsis)
