ACCS ACCS Neurological and Renal Care 1 — Questions and Answers
Question 1: A critically ill patient has a Glasgow Coma Scale (GCS) score of 8. What is the priority intervention?
- Administer IV fluids
- Secure the airway with endotracheal intubation (Correct answer)
- Obtain a CT scan immediately
- Start empiric antibiotics
Correct answer: Secure the airway with endotracheal intubation
A GCS of 8 or below indicates inability to protect the airway, making immediate intubation the priority.
Question 2: Which finding on a head CT is most consistent with increased intracranial pressure (ICP) requiring urgent intervention?
- Diffuse cerebral atrophy
- Midline shift greater than 5 mm (Correct answer)
- Small subdural hematoma without mass effect
- Mild cerebral edema
Correct answer: Midline shift greater than 5 mm
Midline shift greater than 5 mm indicates significant mass effect and raised ICP requiring urgent neurosurgical evaluation.
Question 3: What is the recommended cerebral perfusion pressure (CPP) target in patients with traumatic brain injury?
- 40–50 mmHg
- 50–60 mmHg
- 60–70 mmHg (Correct answer)
- 80–90 mmHg
Correct answer: 60–70 mmHg
Current guidelines recommend maintaining CPP between 60–70 mmHg to ensure adequate cerebral oxygen delivery.
Question 4: A patient with acute kidney injury (AKI) in the ICU develops a potassium level of 6.8 mEq/L with peaked T waves on ECG. What is the first-line emergency treatment?
- Sodium bicarbonate IV
- Calcium gluconate IV (Correct answer)
- Furosemide IV
- Kayexalate (sodium polystyrene sulfonate)
Correct answer: Calcium gluconate IV
Calcium gluconate stabilizes the cardiac membrane and is the first-line treatment for hyperkalemia with ECG changes.
Question 5: According to the KDIGO criteria, which of the following defines Stage 3 acute kidney injury?
- Creatinine increase ≥0.3 mg/dL within 48 hours
- Creatinine increase ≥1.5× baseline within 7 days
- Creatinine increase ≥3× baseline or initiation of renal replacement therapy (Correct answer)
- Urine output <0.5 mL/kg/hr for 6 hours
Correct answer: Creatinine increase ≥3× baseline or initiation of renal replacement therapy
KDIGO Stage 3 AKI is defined by a creatinine increase ≥3× baseline, creatinine ≥4 mg/dL, or initiation of renal replacement therapy.
Question 6: Which continuous renal replacement therapy (CRRT) mode removes both solutes by diffusion and convection?
- Continuous venovenous hemofiltration (CVVH)
- Continuous venovenous hemodialysis (CVVHD)
- Continuous venovenous hemodiafiltration (CVVHDF) (Correct answer)
- Slow continuous ultrafiltration (SCUF)
Correct answer: Continuous venovenous hemodiafiltration (CVVHDF)
CVVHDF combines diffusion (dialysis) and convection (filtration) to maximize solute clearance across all molecular sizes.
ACCS ACCS Neurological and Renal Care 1
A critically ill patient has a Glasgow Coma Scale (GCS) score of 8.
What is the priority intervention?