ACCS ACCS Neurological and Renal Care 2

Question 1

Which clinical sign is most specific for herniation syndrome in a comatose ICU patient?

Accepted Answer

Unilateral fixed and dilated pupil

Answer

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?

Accepted Answer

Reduce cerebral edema by creating an osmotic gradient

Answer

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?

Accepted Answer

Pre-renal azotemia

Answer

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?

Accepted Answer

Rocuronium

Answer

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?

Accepted Answer

125–130 mEq/L

Answer

In symptomatic hyponatremia with cerebral edema, sodium is corrected toward 125–130 mEq/L to relieve edema while avoiding osmotic demyelination.

(ACCS) Adult Critical Care Specialty Practice Test