Clinical Knowledge and Skills Flashcards
7 cards from real ACCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Clinical Knowledge and Skills flashcards as text
A patient with acute kidney injury has urine output of 15 mL/hour despite adequate fluid resuscitation. Urine sodium is 8 mEq/L and fractional excretion of sodium (FENa) is 0.4%. What is the most likely diagnosis?
Answer: Prerenal azotemia
FENa <1% and low urine sodium indicate the tubules are intact and avidly conserving sodium, consistent with prerenal azotemia from reduced renal perfusion.
Which intervention is most effective at reducing ventilator-associated pneumonia (VAP) in the ICU?
Answer: Daily sedation interruption and oral decontamination with chlorhexidine
Daily sedation interruptions, chlorhexidine oral care, head-of-bed elevation, and subglottic drainage are core VAP prevention bundle elements, with oral decontamination being a key modifiable factor.
A patient with massive pulmonary embolism develops hemodynamic collapse. CT pulmonary angiography confirms bilateral saddle PE. What is the definitive treatment?
Answer: Systemic thrombolysis with alteplase
Massive PE with hemodynamic instability is an indication for systemic thrombolysis (alteplase 100 mg IV) when there are no contraindications, as anticoagulation alone is insufficient.
Which cerebral perfusion pressure target is recommended for traumatic brain injury management?
Answer: 60-70 mmHg
Brain Trauma Foundation guidelines recommend maintaining cerebral perfusion pressure between 60-70 mmHg to balance adequate perfusion against risk of exacerbating cerebral edema.
A patient receiving vancomycin develops acute onset flank pain, hematuria, and rising creatinine. Urinalysis shows eosinophiluria. What is the most likely diagnosis?
Answer: Acute interstitial nephritis
Acute interstitial nephritis from drug hypersensitivity (commonly antibiotics including vancomycin) presents with eosinophiluria, hematuria, and acute kidney injury.
Which rhythm requires immediate synchronized cardioversion in a hemodynamically unstable patient?
Answer: Atrial fibrillation with rapid ventricular response and BP 70/40 mmHg
Hemodynamically unstable atrial fibrillation requires immediate synchronized cardioversion to restore sinus rhythm and improve cardiac output.
A burn patient has 40% total body surface area burns. Using the Parkland formula, how much Lactated Ringer's should be given in the first 8 hours post-burn (patient weighs 80 kg)?
Answer: 6,400 mL
Parkland formula: 4 mL × kg × %TBSA = 4 × 80 × 40 = 12,800 mL total; half (6,400 mL) is given in the first 8 hours from the time of injury.