FFICM Clinical Procedures and Protocols 2 — Questions and Answers
Question 1: When performing an arterial line insertion via the radial artery, which test is used to assess collateral circulation before cannulation?
- Allen's test (Correct answer)
- Buerger's test
- Doppler ultrasound only
- Capillary refill time
Correct answer: Allen's test
Allen's test assesses ulnar collateral flow to the hand before radial artery cannulation, though its predictive value is debated.
Question 2: During central venous catheter insertion via the right internal jugular vein, ultrasound guidance is recommended primarily because it:
- Eliminates the need for post-procedure chest X-ray
- Reduces arterial puncture and overall complication rates (Correct answer)
- Allows real-time pressure monitoring
- Enables simultaneous blood sampling
Correct answer: Reduces arterial puncture and overall complication rates
NICE guidance and evidence consistently show ultrasound guidance significantly reduces arterial puncture, haematoma, and failed cannulation rates.
Question 3: A patient requires urgent needle decompression for tension pneumothorax. The recommended landmark for needle thoracocentesis is:
- 5th intercostal space, anterior axillary line
- 2nd intercostal space, midclavicular line (Correct answer)
- 3rd intercostal space, midaxillary line
- 4th intercostal space, midclavicular line
Correct answer: 2nd intercostal space, midclavicular line
The 2nd intercostal space midclavicular line is the traditional landmark; insertion should be over the superior rib border to avoid neurovascular bundle.
Question 4: During endotracheal intubation in a critically ill patient, which manoeuvre reduces the risk of aspiration of gastric contents?
- Sellick's manoeuvre (cricoid pressure) (Correct answer)
- Jaw thrust without head tilt
- BURP manoeuvre
- Bimanual laryngoscopy
Correct answer: Sellick's manoeuvre (cricoid pressure)
Cricoid pressure (Sellick's manoeuvre) compresses the oesophagus against the cricoid cartilage to reduce passive regurgitation during RSI.
Question 5: Which ventilator mode delivers a set tidal volume regardless of the airway pressure required?
- Pressure Support Ventilation (PSV)
- Volume Control Ventilation (VCV) (Correct answer)
- Pressure Control Ventilation (PCV)
- Airway Pressure Release Ventilation (APRV)
Correct answer: Volume Control Ventilation (VCV)
Volume Control Ventilation delivers a fixed tidal volume with variable airway pressure, risking barotrauma if compliance decreases.
Question 6: A patient on CRRT develops citrate toxicity. Which blood gas finding is most characteristic?
- High anion gap metabolic acidosis with low ionised calcium
- Metabolic alkalosis with low ionised calcium (Correct answer)
- Respiratory alkalosis with high ionised calcium
- Normal anion gap acidosis with high ionised calcium
Correct answer: Metabolic alkalosis with low ionised calcium
Citrate accumulation causes metabolic alkalosis as citrate is metabolised to bicarbonate, with low ionised calcium due to citrate chelation.
Question 7: When inserting a percutaneous tracheostomy using the Seldinger technique, the trachea should be entered between which tracheal rings?
- 1st and 2nd
- 2nd and 3rd or 3rd and 4th (Correct answer)
- 4th and 5th
- Cricothyroid membrane level
Correct answer: 2nd and 3rd or 3rd and 4th
Percutaneous tracheostomy is performed between the 2nd/3rd or 3rd/4th tracheal rings to avoid subglottic stenosis and tracheal injury.
FFICM Clinical Procedures and Protocols 2
When performing an arterial line insertion via the radial artery, which test is used to assess collateral circulation before cannulation?