FFICM Patient Assessment and Evaluation 3 — Questions and Answers
Question 1: A patient with septic shock has a ScvO₂ of 58%. Which physiological mechanism best explains this finding?
- Increased cardiac output with normal oxygen extraction
- Impaired oxygen delivery relative to demand (Correct answer)
- Left-to-right intracardiac shunt
- Hyperoxia-induced vasoconstriction
Correct answer: Impaired oxygen delivery relative to demand
ScvO₂ <70% indicates increased oxygen extraction by tissues due to inadequate oxygen delivery relative to metabolic demand.
Question 2: Which clinical scoring tool is specifically validated for predicting ICU mortality and incorporates chronic health evaluation points?
- NEWS2
- APACHE II (Correct answer)
- qSOFA
- MEWS
Correct answer: APACHE II
APACHE II (Acute Physiology and Chronic Health Evaluation II) was designed and validated to predict ICU mortality and includes chronic health comorbidity points.
Question 3: A 55-year-old intubated ICU patient has absent cough and gag reflexes, fixed pupils, and no motor response to pain. Which assessment should be performed next to evaluate for brain death?
- CT head with contrast
- Continuous EEG monitoring
- Apnea test after confirming prerequisites (Correct answer)
- Transcranial Doppler
Correct answer: Apnea test after confirming prerequisites
The apnea test is a mandatory component of brain death determination after clinical criteria are met and confounders are excluded.
Question 4: In an ICU patient with suspected abdominal compartment syndrome, which measurement confirms the diagnosis?
- Abdominal girth >100 cm
- Intra-abdominal pressure ≥20 mmHg with new organ dysfunction (Correct answer)
- CT findings of bowel wall thickening
- Serum lactate >4 mmol/L with abdominal distension
Correct answer: Intra-abdominal pressure ≥20 mmHg with new organ dysfunction
Abdominal compartment syndrome is defined as sustained intra-abdominal pressure ≥20 mmHg associated with new organ dysfunction.
Question 5: Which clinical feature most reliably differentiates neurogenic pulmonary edema from cardiogenic pulmonary edema in a head-injured patient?
- Bilateral infiltrates on chest X-ray
- Frothy pink sputum
- Temporal association with central nervous system injury (Correct answer)
- Elevated BNP level
Correct answer: Temporal association with central nervous system injury
Neurogenic pulmonary edema characteristically develops rapidly after a CNS insult (e.g., SAH, TBI) in the absence of primary cardiac disease.
Question 6: A patient's thermodilution cardiac output is 2.8 L/min with a BSA of 1.9 m². What is the cardiac index, and how should it be interpreted?
- 1.47 L/min/m² — severely reduced (Correct answer)
- 1.47 L/min/m² — normal
- 5.32 L/min/m² — elevated
- 2.8 L/min/m² — normal when indexed
Correct answer: 1.47 L/min/m² — severely reduced
Cardiac index = CO/BSA = 2.8/1.9 = 1.47 L/min/m²; normal is 2.2–4.0 L/min/m², so this is severely reduced.
Question 7: In a patient with suspected pulmonary embolism in the ICU, which finding on point-of-care echocardiography most strongly supports the diagnosis?
- Dilated left atrium
- Right ventricular dilation with septal D-sign (paradoxical septal motion) (Correct answer)
- Pericardial effusion
- Hyperdynamic left ventricle
Correct answer: Right ventricular dilation with septal D-sign (paradoxical septal motion)
RV dilation with flattening and paradoxical motion of the interventricular septum (D-sign) is a hallmark of acute cor pulmonale from massive PE.
FFICM Patient Assessment and Evaluation 3
A patient with septic shock has a ScvO₂ of 58%.
Which physiological mechanism best explains this finding?