FFICM Patient Assessment and Evaluation 2 — Questions and Answers
Question 1: A 68-year-old ICU patient has a urine output of 0.3 mL/kg/hr for 8 hours. Which KDIGO stage of acute kidney injury does this represent?
- Stage 1 (Correct answer)
- Stage 2
- Stage 3
- No AKI — within acceptable limits
Correct answer: Stage 1
KDIGO Stage 1 AKI includes urine output <0.5 mL/kg/hr for 6–12 hours.
Question 2: When assessing a mechanically ventilated patient, which parameter best reflects respiratory system compliance?
- Peak airway pressure
- Plateau pressure minus PEEP divided by tidal volume (Correct answer)
- Mean airway pressure
- Driving pressure alone
Correct answer: Plateau pressure minus PEEP divided by tidal volume
Static compliance = tidal volume / (plateau pressure − PEEP), reflecting the elastic properties of the respiratory system.
Question 3: A patient's arterial blood gas shows pH 7.22, PaCO₂ 50 mmHg, HCO₃⁻ 20 mEq/L. What is the primary acid-base disorder?
- Metabolic acidosis with partial respiratory compensation
- Respiratory acidosis with metabolic acidosis (Correct answer)
- Pure respiratory acidosis
- Mixed alkalosis
Correct answer: Respiratory acidosis with metabolic acidosis
Expected HCO₃⁻ for acute respiratory acidosis with PaCO₂ 50 would be ~24 mEq/L; the low HCO₃⁻ indicates a concurrent metabolic acidosis.
Question 4: Which physical examination finding is most specific for cardiac tamponade in a critically ill patient?
- Jugular venous distension
- Muffled heart sounds
- Pulsus paradoxus >10 mmHg (Correct answer)
- Hypotension
Correct answer: Pulsus paradoxus >10 mmHg
Pulsus paradoxus >10 mmHg is the most specific bedside sign of hemodynamically significant tamponade.
Question 5: A SOFA score is being calculated for a patient with PaO₂/FiO₂ of 180 mmHg requiring mechanical ventilation. What respiratory SOFA subscore should be assigned?
- 1
- 2
- 3 (Correct answer)
- 4
Correct answer: 3
A PaO₂/FiO₂ of 100–199 on respiratory support corresponds to a respiratory SOFA subscore of 3.
Question 6: In assessing volume responsiveness, a straight leg raise test is positive when it produces which hemodynamic change?
- An increase in heart rate >10 bpm
- An increase in cardiac output or pulse pressure ≥10% (Correct answer)
- A decrease in CVP >3 mmHg
- A rise in MAP >20 mmHg
Correct answer: An increase in cardiac output or pulse pressure ≥10%
A passive leg raise is considered positive (fluid responsive) if cardiac output or pulse pressure increases by ≥10%.
Question 7: Which finding on point-of-care ultrasound indicates severe left ventricular dysfunction in an ICU patient?
- E/A ratio >2
- Mitral annular plane systolic excursion (MAPSE) <8 mm (Correct answer)
- Left ventricular end-diastolic diameter >55 mm
- IVC diameter <2 cm with full collapsibility
Correct answer: Mitral annular plane systolic excursion (MAPSE) <8 mm
MAPSE <8 mm measured by M-mode at the lateral mitral annulus is associated with severely reduced LV systolic function.
FFICM Patient Assessment and Evaluation 2
A 68-year-old ICU patient has a urine output of 0.3 mL/kg/hr for 8 hours.
Which KDIGO stage of acute kidney injury does this represent?