FCCS Review Exam Questions and Correct Correct Correct Answers July 2023 Score 100% 41 y/o pt in the SICU following debridement of b/l lower extremities for necrotizing fasciitis is intubated on AC. Temp 102, HR 116, RR 16, BP 92/46. ABG shows pH 7.23, PO2 133, PCO2 38, Na 139, K 3.7, Cl 102, Bicarb 16, lactate 4. Dx is metabolic acidosis w/ anion gap d/t infection.
What is the most appropriate intervention?
Increase VT Continue resuscitation Decrease RR Administer bicarb - Correct AnsContinue resuscitation. Don't need to increase VT bc the pt doesn't have respiratory acidosis. If you decrease the RR, the pt will go into respiratory acidosis.
A 22 y/o pt ingested drugs >4 hours ago. She came to the ICU obtunded w/ arousal to tactile stimulation. She is hemodynamically stable. RR 8 with an NG tube in place. What is the next step for tx of the ingestion? - Correct AnsMonitor / watchful waiting.
The pt ingested the drugs more than 4 hours ago. Monitor RR and intubate if necessary.
A 24 y/o male comes in following a concussion. CT reveals a frontal lobe contusion. He does not require intubation and is kept on 3 L O2 NC. He then suddenly has a generalized seizure.
What is the DOC?
What do you give after the seizure?
What med class is an absolute contraindication for seizures? - Correct Ans1. lorazepam IV
- dilantin
3. NMB
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.
- / 2
What is the cause of this pt's HoTN and why? - Correct AnsAuto-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 55 y/o male comes in with AMS and diffuse abdominal pain. He takes HCTZ and a multivitamin. HR 120 sinus tach. He is moaning in pain and unable to articulate what is happening. CT reveals lytic lesions in the vertebrae. You administer a 3L NS bolus which shows mild improvement.
What is the dx and what is causing his symptoms?
How do you tx? - Correct AnsDx: multiple myeloma
The hypercalcemia is what is causing the symptoms.
Tx: Fluids, then diuretic or bisphosphonate if symptoms persist.
A 70 y/o pt has been hospitalized for 15 days. He had a cholecystectomy and abscess formation which was tx appropriately. He has a central line in the right IJ. The site looks visibly infected, and he has a fever, is tachy, and hypotensive. WBCs are high. Blood culture and initial gram stain reveals G(+) cocci.
What is the dx?What is the MC pathogen?What is the tx? - Correct Ans1. line-related infection
- coag (-) staph epidermis
- vanco + zosyn + ceftriaxone
if MRSA: vanco + ceftriaxone
if MSSA: zosyn + ceftriaxone
A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34, SpO2 90% on 8L O2. CXR reveals infiltrates in a bat wing pattern. She also has LE edema. She is dx with a CHF exacerbation w/ respiratory failure. Her ABG shows pH 7.3, PO2 64, CO2 50.
What is the best tx for this pt? - Correct AnsNon-invasive BiPAP.
A 70 y/o pt with COPD comes in with an exacerbation. He is rapidly becoming more hypoxic. To rule out PE, what test should you order? - Correct AnsCT
- / 2