ACCS Patient Management and Care 3

Question 1

A patient with acute liver failure develops cerebral edema. Which intervention is the priority to reduce intracranial pressure?

Accepted Answer

Elevate head of bed to 30° and give hypertonic saline or mannitol

Answer

Administer furosemide 40 mg IV

Answer

Initiate therapeutic hypothermia to 32°C

Answer

Start lactulose via NGT

Question 2

A patient with pulmonary embolism is hemodynamically unstable. Systolic BP is 80 mmHg despite fluids. What is the most appropriate intervention?

Accepted Answer

Perform systemic thrombolysis with alteplase

Answer

Anticoagulate with unfractionated heparin alone

Answer

Place an IVC filter

Answer

Start therapeutic anticoagulation and monitor

Question 3

Which parameter best guides fluid resuscitation in a mechanically ventilated patient with septic shock?

Accepted Answer

Pulse pressure variation (PPV)

Answer

Central venous pressure (CVP)

Answer

Mean arterial pressure (MAP)

Answer

Heart rate trend

Question 4

A patient in the ICU develops Clostridioides difficile colitis not responding to oral vancomycin. What is the next best treatment?

Accepted Answer

Oral fidaxomicin

Answer

IV metronidazole

Answer

Fecal microbiota transplant

Answer

Cholestyramine

Question 5

A trauma patient receives massive transfusion. Which electrolyte abnormality is most commonly associated with rapid packed RBC transfusion?

Accepted Answer

Hypocalcemia

Answer

Hyperkalemia

Answer

Hypernatremia

Answer

Hypomagnesemia

Question 6

Which approach is recommended when weaning vasopressors in a patient recovering from septic shock?

Accepted Answer

Wean adjunctive vasopressors before reducing norepinephrine

Answer

Stop all vasopressors simultaneously once MAP >65 mmHg for 1 hour

Answer

Wean norepinephrine first before removing adjunctive agents

Answer

Transition directly to oral midodrine before stopping IV vasopressors

Question 7

A patient with severe TBI has an ICP of 28 mmHg and CPP of 55 mmHg despite head elevation and sedation. What is the next step?

Accepted Answer

Administer hyperosmolar therapy (mannitol or hypertonic saline)

Answer

Administer prophylactic anticonvulsants

Answer

Perform decompressive craniectomy immediately

Answer

Increase FiO2 to 100%