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

Head-of-bed elevation with osmotic therapy (mannitol or hypertonic saline) is the first-line approach to lower ICP in acute liver failure.

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

Massive PE with hemodynamic instability is an indication for systemic thrombolysis with alteplase unless contraindicated.

Question 3

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

Accepted Answer

Pulse pressure variation (PPV)

Answer

Pulse pressure variation >13% in a fully ventilated patient reliably predicts fluid responsiveness, unlike static measures like CVP.

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

Fidaxomicin is preferred over vancomycin for non-severe CDI and has shown superiority in recurrence reduction; it is the appropriate escalation.

Question 5

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

Accepted Answer

Hypocalcemia

Answer

Citrate in banked blood chelates ionized calcium, causing hypocalcemia during massive transfusion, which impairs cardiac contractility.

(ACCS) Adult Critical Care Specialty Practice Test