ACCS Technological and Procedural Proficiency 2

Question 1

When performing a bronchoscopy-guided percutaneous tracheostomy, which landmark is most critical to identify before dilation?

Accepted Answer

Tracheal rings 2-3 interspace

Answer

Cricothyroid membrane

Answer

Tracheal rings 1-2 interspace

Answer

Carina

Question 2

A patient on volume-controlled ventilation develops a sudden increase in peak airway pressure with unchanged plateau pressure. What is the most likely cause?

Accepted Answer

Increased secretions or bronchospasm

Answer

Pneumothorax

Answer

ARDS progression

Answer

Auto-PEEP

Question 3

During placement of a pulmonary artery catheter, the waveform transitions from a right ventricular trace to a pulmonary artery waveform. Which change confirms this transition?

Accepted Answer

Appearance of a dicrotic notch and elevated diastolic pressure

Answer

Loss of diastolic dip

Answer

Decrease in systolic pressure

Answer

Widening of pulse pressure

Question 4

Which ventilator setting is MOST directly associated with ventilator-induced lung injury (VILI) in ARDS patients?

Accepted Answer

Tidal volume > 8 mL/kg IBW

Answer

FiO2 > 0.6

Answer

PEEP < 5 cmH2O

Answer

Respiratory rate > 20 breaths/min

Question 5

An ICU patient's arterial line waveform shows marked respiratory variation in pulse pressure (>13%). What does this most likely indicate?

Accepted Answer

Fluid responsiveness in a mechanically ventilated patient

Answer

Cardiac tamponade

Answer

Aortic regurgitation

Answer

Peripheral vascular disease

Question 6

During continuous renal replacement therapy (CRRT), a sudden rise in transmembrane pressure (TMP) most likely indicates:

Accepted Answer

Filter clotting

Answer

Catheter kinking

Answer

Electrolyte imbalance

Answer

Air embolism

Question 7

When using ultrasound to place a central venous catheter in the internal jugular vein, which maneuver best distinguishes the vein from the carotid artery?

Accepted Answer

Applying gentle probe compression to collapse the vessel

Answer

Color Doppler flow direction

Answer

Measuring vessel diameter

Answer

Identifying pulsatility