FCCS PRETEST AND POST TEST<\/p>\n\n\n\n
A 75-year-old man with a history of hypertension is evaluated in the
emergency department for nausea, vomiting, and abdominal pain. He is
lethargic but can answer questions appropriately. His pulse is 130
beats\/min, blood pressure 70\/30 mm Hg, and respiratory rate 28
breaths\/min. On physical examination, he is noted to have dry
mucous membranes, poor capillary refill, and a distended abdomen with
rebound tenderness. Arterial blood gas analysis reveals: pH 7.32, PCO2
28 mmHg, PO2 74 mm Hg, bicarbonate 13 mmol\/L. Serum lactate is 8.0
mEq\/L. Which of the following findings has been shown to correlate
with a worse prognosis in a patient with this clinical
picture?
A. Hypotension
B. Acidemia on blood gas analysis
C. Elevated serum lactic acid
D. Tachypnea – ANSWER- C
A 65-year-old man is septic, with perforated diverticulitis. He undergoes
emergent colectomy with creation of a colostomy. Multiple areas of<\/p>\n\n\n\n
purulence are identified in the peritoneal cavity. Postoperatively, he
continues to be febrile and hypotensive. Chest radiograph is clear.
Central venous pressure is 18 mm Hg, and hemoglobin is 13g\/dL. Which
of the following vasoactive drugs is most appropriate to administer next?
A. Epinephrine
B. Phenylephrine
C. Norepinephrine
D. Dobutamine – ANSWER- C
A 76-year-old woman with a history of congestive heart failure and
hypertension is admitted with altered mental status and mild upper
respiratory symptoms. According to family, her mental status has been
gradually declining over the past three to four days. Because of
generalized weakness and upper respiratory symptoms, she has had a
limited amount of food and drink for the past 72 hours. Her home
medications include metoprolol, lisinopril, and furosemide. Her family
states that she has been compliant with these medications. On physical
examination, vital signs are: heart rate 118 beats\/min, blood pressure
96\/53 mm Hg, respiratory rate 14 breaths\/min, and oxygen saturation
98% on room air. Other findings included dry mucous membranes, poor
skin turgor, and the absence of jugular venous distention. Pulmonary
examination is clear on auscultation. She opens her eyes to voice, but
mumbles incomprehensible sounds and has – ANSWER- B
While fighting a house fire, a 38-year-old man fell 10 feet through a
burning roof into an actively burning bedroom. On arrival at the
emergency department two hours later, he has abdominal pain. His
focused assessment with sonography in trauma (FAST) examination<\/p>\n\n\n\n
shows fluid between his spleen and left kidney. His voice is hoarse, and
he has carbonaceous sputum. He has blistering burns on his face and
insensate burns over his anterior chest, abdomen, and his entire left
upper extremity circumferentially. His respiratory rate is 24-28
breaths\/min, pulse 108 beats\/min, blood pressure 131\/73 mm Hg, and
oxygen saturation as measured by pulse oximetry 98% on 2 liters nasal
cannula. His estimated weight is 75 kg (165 lb). Which of the following
is the most appropriate next intervention for this patient?
A. Endotracheal intubation with in-line stabilization for cervical spine
protection and 100% oxygen for probable carbon – ANSWER- A
A 72-year-old woman with a history of hypertension, type 2 diabetes
mellitus, and smoking develops sudden-onset severe chest pain
associated with difficulty breathing and diaphoresis. Her vital signs on
arrival in the emergency department are: blood pressure 165\/92 mm Hg,
heart rate 101 beats\/min, respiratory rate 29 breaths\/min, and oxygen
saturation as measured by pulse oximetry 96% on room air. Which of
the following ECG findings is the 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 – ANSWER- B
A 45-year-old man is admitted to the hospital with fever, altered mental
status, and swelling and redness in the upper thigh and scrotal area of<\/p>\n\n\n\n
four days’ duration. He has a history of poorly controlled diabetes and
chronic renal insufficiency. On examination, he is lethargic. Vital signs
are: heart rate 79 beats\/min, blood pressure 90\/40 mm Hg, respiratory
rate 33 breaths\/min, SpO2 88%, and temperature 39\u00b0C (102.2\u00b0F). The
right thigh has erythema and cutaneous gangrene. Air is felt by palpation
of the soft tissue. Laboratory test results include a white blood cell count
of 31,000\/\u00b5L with 15% bands, hemoglobin 11.5 g\/dL, glucose 520
mg\/dL, sodium 150 meq\/L, potassium 4 meq\/L, creatinine 2.5 mg\/dL
(baseline 2.2 mg\/dL), and lactate 4.5 meq\/L. IV fluids are started for
aggressive resuscitation, and he is intubated. Blood cultures are
obtained. Which of the following is the most appropriate strategy in this
patient’s ma – ANSWER- B
Which of the following parameters may be a late sign of cardiovascular
disturbance signaling failure of the compensatory mechanisms?
A. Tachycardia
B. Bradycardia
C. Hypotension
D. Hypertension – ANSWER- C
Investigative tests should be based on the patient’s history and physical
examination as well as on previous tests. Which of the following is one
of the most important indicators of critical illness?
A. Respiratory acidosis
B. Metabolic acidosis
C. Elevated creatinine<\/p>\n\n\n\n