Mixed Deck — All FFICM Topics Flashcards

During a hospital surge in disaster conditions, Crisis Standards of Care (CSC) allow ICU teams to do which of the following that would be unacceptable under normal conditions?

Answer: Reallocate a ventilator from a patient unlikely to survive to one with better prognosis

Crisis Standards of Care permit ventilator reallocation using pre-established triage protocols when supply is critically exceeded, with oversight by an independent triage team, not the bedside clinician.

The Emax model of pharmacodynamics predicts that doubling the dose above the EC90 will:

Answer: Yield minimal additional effect as the response approaches the maximum

The sigmoidal Emax model plateaus near the maximum effect; above EC90, the dose–response curve is nearly flat and large dose increases produce little additional benefit.

A researcher calculates the number needed to treat (NNT) from a trial where 30% of controls and 20% of treatment patients died. What is the NNT?

Answer: 10

NNT = 1 / absolute risk reduction = 1 / (0.30 − 0.20) = 1 / 0.10 = 10.

What is the primary pathophysiology of Type 1 hepatorenal syndrome (HRS-AKI)?

Answer: Severe renal vasoconstriction from portal hypertension-driven splanchnic vasodilation

HRS-AKI results from extreme renal vasoconstriction triggered by compensatory neurohormonal activation in response to effective arterial underfilling from splanchnic vasodilation in cirrhosis.

A patient on clopidogrel requires emergency CABG. The most appropriate management regarding antiplatelet reversal is:

Answer: Delay surgery 5–7 days to allow new platelet generation if clinically safe

Clopidogrel irreversibly inhibits P2Y12 receptors on platelets; since platelet lifespan is ~7–10 days, waiting 5–7 days allows sufficient new platelet generation to reduce bleeding risk.

During rapid sequence intubation (RSI) in a hemodynamically unstable trauma patient, which induction agent best preserves cardiovascular stability?

Answer: Ketamine 1–2 mg/kg

Ketamine maintains sympathetic tone, making it the preferred induction agent in hemodynamically unstable patients requiring emergency RSI.

Which parameter is measured by a pulmonary artery catheter to assess left heart preload?

Answer: Pulmonary artery wedge pressure

Pulmonary artery wedge pressure (PAWP) reflects left atrial pressure and is used as a surrogate for left ventricular end-diastolic pressure.

According to the ARDSNet protocol, what tidal volume is recommended for lung-protective ventilation in ARDS?

Answer: 6 ml/kg predicted body weight

The ARDSNet protocol recommends 6 ml/kg predicted body weight, reducible to 4 ml/kg if needed to keep plateau pressure ≤30 cmH2O.

A patient with hepatic failure is prescribed a drug with high hepatic extraction ratio (E > 0.7). What is the expected pharmacokinetic consequence?

Answer: Markedly increased oral bioavailability due to reduced first-pass effect

High extraction ratio drugs undergo extensive first-pass hepatic metabolism, so liver failure dramatically increases their systemic bioavailability after oral dosing.

A patient on mechanical ventilation develops sudden hypotension, decreased SpO2, and absent breath sounds on the right. After ETT displacement is excluded, what is the most urgent next step?

Answer: Perform needle thoracostomy on the right at the 2nd intercostal space midclavicular line

These findings indicate tension pneumothorax, which is a clinical diagnosis requiring immediate needle thoracostomy without waiting for imaging.

A patient with a known advance directive refusing intubation is admitted unconscious following a drug overdose. The most appropriate action is:

Answer: Review the advance directive's scope, consult the next of kin, and apply clinical judgment about reversibility before proceeding

Advance directives require contextual interpretation; their applicability to a potentially reversible overdose must be carefully assessed with family and clinical judgment.

Which of the following is an example of a 'never event' related to patient safety in ICU infection control?

Answer: Central line insertion without using sterile gloves

Central line insertion without sterile gloves violates a fundamental, preventable safety standard and represents a never event—an inexcusable breach of aseptic technique.

In cardiogenic shock, which hemodynamic pattern distinguishes it from distributive shock?

Answer: Low cardiac output with elevated pulmonary capillary wedge pressure

Cardiogenic shock is characterized by low cardiac output and elevated filling pressures (PCWP >18 mmHg), reflecting pump failure rather than vasodilation.

A therapeutic drug monitoring level is taken 6 hours after an IV dose of vancomycin. The result is best described as:

Answer: An area-under-the-curve surrogate correlating with bactericidal activity

Modern vancomycin monitoring uses AUC/MIC ratio as the pharmacodynamic target; a mid-interval level can be used to estimate AUC when combined with another sample.

How often should high-touch surfaces in clinical areas be cleaned?

Answer: At least daily and after known contamination

High-touch surfaces harbor pathogens and should be cleaned at least daily, with additional cleaning after contamination events.

Which pharmacokinetic parameter is most relevant when evaluating whether a drug achieves adequate concentrations at the site of infection in critically ill patients with augmented renal clearance?

Answer: Time above MIC (T>MIC)

For time-dependent antibiotics (e.g., beta-lactams), the percentage of time the free drug concentration exceeds the MIC is the primary pharmacodynamic target.

Which of the following is the most appropriate analgesic choice for a mechanically ventilated ICU patient with anuria and rhabdomyolysis?

Answer: Fentanyl infusion, as it does not accumulate active metabolites in renal failure

Fentanyl is preferred in renal failure as it has no clinically significant active metabolites; morphine's M6G metabolite accumulates in renal impairment causing prolonged sedation and respiratory depression.

During an initial assessment, what should be documented first?

Answer: Chief complaint and history of present illness

The chief complaint and history of present illness establish the reason for the visit and provide context for the examination.

Which electrolyte abnormality most commonly complicates continuous renal replacement therapy requiring supplementation?

Answer: Hypophosphatemia

Phosphate is efficiently removed by CRRT and is not present in standard replacement fluids, making hypophosphatemia the most common electrolyte complication requiring supplementation.

How long must professional records typically be maintained?

Answer: According to state and federal regulations, often 7-10 years or longer

Record retention is governed by state and federal laws, with most requiring 7-10 years, and longer for minors.