ACCS ACCS Neurological and Renal Care 2 — Questions and Answers
Question 1: Which clinical sign is most specific for herniation syndrome in a comatose ICU patient?
- Bilateral pinpoint pupils
- Unilateral fixed and dilated pupil (Correct answer)
- Bilateral reactive pupils
- Cheyne-Stokes respirations
Correct answer: Unilateral fixed and dilated pupil
A unilateral fixed and dilated pupil indicates compression of CN III from uncal herniation, a neurosurgical emergency.
Question 2: What is the primary goal of osmotic therapy with mannitol in elevated ICP management?
- Increase cerebral blood volume
- Reduce cerebral edema by creating an osmotic gradient (Correct answer)
- Lower systemic blood pressure
- Increase cerebrospinal fluid production
Correct answer: Reduce cerebral edema by creating an osmotic gradient
Mannitol draws water out of brain tissue into the vasculature via osmosis, reducing cerebral edema and ICP.
Question 3: A patient with oliguric AKI has a fractional excretion of sodium (FeNa) of 0.8%. What does this suggest?
- Intrinsic renal failure
- Post-renal obstruction
- Pre-renal azotemia (Correct answer)
- Acute tubular necrosis
Correct answer: Pre-renal azotemia
FeNa <1% indicates the kidneys are avidly retaining sodium, consistent with pre-renal azotemia and intact tubular function.
Question 4: Which neuromuscular blocking agent is preferred for rapid sequence intubation in a patient with suspected elevated potassium?
- Succinylcholine
- Rocuronium (Correct answer)
- Vecuronium
- Atracurium
Correct answer: Rocuronium
Rocuronium is preferred when hyperkalemia is suspected because succinylcholine can dangerously elevate potassium levels.
Question 5: What is the target serum sodium range when treating hyponatremia-related cerebral edema with hypertonic saline in the ICU?
- 115–120 mEq/L
- 125–130 mEq/L (Correct answer)
- 130–135 mEq/L
- 140–145 mEq/L
Correct answer: 125–130 mEq/L
In symptomatic hyponatremia with cerebral edema, sodium is corrected toward 125–130 mEq/L to relieve edema while avoiding osmotic demyelination.
Question 6: Which dialysis prescription parameter most directly determines small solute clearance in CRRT?
- Blood flow rate
- Effluent dose (mL/kg/hr) (Correct answer)
- Membrane surface area
- Anticoagulation type
Correct answer: Effluent dose (mL/kg/hr)
Effluent dose, expressed as mL/kg/hr, is the primary determinant of small solute clearance in CRRT.
ACCS ACCS Neurological and Renal Care 2
Which clinical sign is most specific for herniation syndrome in a comatose ICU patient?