ACCS Patient Management and Care 4

Question 1

A patient develops heparin-induced thrombocytopenia (HIT) confirmed by positive PF4 antibody. What is the appropriate management?

Accepted Answer

Discontinue heparin and start argatroban or bivalirudin

Answer

Switch to low-molecular-weight heparin

Answer

Administer platelet transfusion and continue heparin at lower dose

Answer

Switch to warfarin immediately

Question 2

A critically ill patient on mechanical ventilation has peak airway pressure of 42 cmH2O and plateau pressure of 28 cmH2O. What does this suggest?

Accepted Answer

Increased airway resistance

Answer

Decreased lung compliance

Answer

Auto-PEEP accumulation

Answer

Pneumothorax

Question 3

Which nutritional approach is recommended for critically ill patients who cannot tolerate enteral feeding within 72 hours of ICU admission?

Accepted Answer

Permit permissive underfeeding until day 7-10 before starting PN

Answer

Begin parenteral nutrition immediately on day 1

Answer

Start full-dose trophic enteral feeds regardless of tolerance

Answer

Administer dextrose solutions only for the first 2 weeks

Question 4

An ICU patient develops acute adrenal insufficiency. Which steroid regimen is preferred in septic shock not responding to vasopressors?

Accepted Answer

Hydrocortisone 200–300 mg/day in divided doses or continuous infusion

Answer

Dexamethasone 10 mg IV daily

Answer

Methylprednisolone 1 g IV daily

Answer

Fludrocortisone 100 mcg PO daily alone

Question 5

A ventilated ARDS patient is placed in prone position. After 16 hours, SpO2 improves from 88% to 96%. When should prone positioning be discontinued?

Accepted Answer

When PaO2/FiO2 ratio exceeds 150 mmHg on PEEP ≤10 for two consecutive supine assessments

Answer

After the first 16-hour session regardless of response

Answer

After 3 days of continuous proning

Answer

Once vasopressors are weaned

Question 6

A patient in the ICU develops new-onset atrial fibrillation with rapid ventricular response and hemodynamic compromise. What is the immediate treatment?

Accepted Answer

Synchronized cardioversion

Answer

IV amiodarone infusion

Answer

Rate control with IV metoprolol

Answer

Anticoagulation with heparin drip

Question 7

Which scoring tool is most widely used in the ICU to assess delirium in mechanically ventilated patients?

Accepted Answer

Confusion Assessment Method for the ICU (CAM-ICU)

Answer

Glasgow Coma Scale (GCS)

Answer

Ramsay Sedation Scale

Answer

Richmond Agitation-Sedation Scale (RASS)