FFICM Clinical Procedures and Protocols 3 — Questions and Answers
Question 1: A femoral venous catheter is inserted for vascular access. Compared to internal jugular or subclavian routes, the femoral site has a higher risk of:
- Pneumothorax
- Arterial puncture
- Catheter-related bloodstream infection (Correct answer)
- Air embolism
Correct answer: Catheter-related bloodstream infection
Femoral catheters have significantly higher rates of catheter-related bloodstream infection due to proximity to perineal flora.
Question 2: During bronchoscopy-guided percutaneous tracheostomy, the endoscope is advanced to visualise the needle entry point. The main advantage of bronchoscopic guidance is:
- Faster procedure time
- Avoidance of posterior tracheal wall injury and malposition (Correct answer)
- Reduced need for analgesia
- Ability to perform simultaneous BAL
Correct answer: Avoidance of posterior tracheal wall injury and malposition
Bronchoscopic guidance confirms midline needle placement and visualises the posterior tracheal wall, significantly reducing posterior wall perforation.
Question 3: In the FFICM exam context, the FASCIA protocol refers to an ultrasound-guided approach for:
- Femoral nerve block in post-operative pain
- Focused assessment of critically ill patients (cardiac, lung, vascular, abdominal) (Correct answer)
- Fasciotomy guidance in compartment syndrome
- Fluid assessment in septic shock using IVC collapsibility
Correct answer: Focused assessment of critically ill patients (cardiac, lung, vascular, abdominal)
FASCIA is a structured point-of-care ultrasound protocol covering cardiac, lung, vascular, and abdominal assessments in ICU patients.
Question 4: Which of the following is the correct position for placing a chest drain for a large pleural effusion?
- 2nd intercostal space, midclavicular line
- Safe triangle: 4th–5th intercostal space, anterior to latissimus dorsi, lateral to pectoralis major (Correct answer)
- 7th intercostal space, posterior axillary line
- Subxiphoid approach under fluoroscopic guidance
Correct answer: Safe triangle: 4th–5th intercostal space, anterior to latissimus dorsi, lateral to pectoralis major
The safe triangle (bounded by pectoralis major, latissimus dorsi, and axilla base) at 4th–5th ICS minimises neurovascular and organ injury.
Question 5: A patient requires a suprapubic catheter insertion. Which ultrasound finding confirms it is safe to proceed?
- Bladder volume > 300 mL with no bowel interposition (Correct answer)
- Absence of prostate enlargement
- Bladder volume > 100 mL with posterior shadowing
- Presence of ureteric jets
Correct answer: Bladder volume > 300 mL with no bowel interposition
A bladder volume >300 mL ensures the bladder is adequately distended above the pubic symphysis, with no overlying bowel in the path.
Question 6: Regarding lumbar puncture in the ICU, which coagulation parameter is the most critical contraindication to consider?
- INR > 1.5
- Platelet count < 50 × 10⁹/L (Correct answer)
- APTT > 1.5× normal
- Fibrinogen < 1.5 g/L
Correct answer: Platelet count < 50 × 10⁹/L
A platelet count below 50 × 10⁹/L is generally considered a contraindication due to risk of spinal haematoma.
Question 7: During renal replacement therapy, pre-dilution fluid replacement compared to post-dilution is associated with:
- Higher solute clearance but increased filter lifespan
- Lower solute clearance but increased filter lifespan (Correct answer)
- Higher solute clearance and shorter filter lifespan
- No significant difference in either parameter
Correct answer: Lower solute clearance but increased filter lifespan
Pre-dilution reduces haemoconcentration in the filter, prolonging filter life, but dilutes the blood before filtration, reducing solute clearance efficiency.
FFICM Clinical Procedures and Protocols 3
A femoral venous catheter is inserted for vascular access.
Compared to internal jugular or subclavian routes, the femoral site has a higher risk of: