Flattening of the diaphragms on chest x-ray is generally consistent with which clinical entity?

a. bronchiectasis

b. bronchiolitis 

c. emphysema

d. scarcoidosis

e. scoliosis

A positive Tensilon test is indicative of:

a. poliomyelitis

b. muscular dystrophy

c. amyotropic lateral sclerosis

d. myasthenia gravis

e. Guillain-Barre syndrome

Which of the following determinations would provide the earliest indication of respiratory impairment in a patient with Guillain-Barre syndrome?

a. vital capacity

b. residual volume

c. closing volume

d. Pa02

e. PaC02

Mr. Black came to the ER with Guillaan-Barre Syndrome. Which of the following results would most indicate his need for ventilatory support?

a.         an increased DLCO

b.         a decreased FEV 1

c.         a VC equal to VT

d.         an increased mid-expiratory flow rate

e.         an increased FRC

Your patient had her spleen removed 2 days ago and is awake and cooperative but is still reluctant to take a deep breath. The physician asks for your recommendation to prevent the development of atelectasis. You would suggest which of the following?

a.         small-volume nebulizer with a bronchodilator

b.         incentive spirometry

c.         intermittent positive pressure breathing

d.         bedside spirometry

Croup is usually caused by which microorganism?

a.        respiratory syncytial virus

b.        diplococcus pneumoniae

c.        staphylococcus aureus

d.        streptococcus pyogenes

e.        haemophilus influenzae

Which of the following is a characteristic of emphysema?

a.         loss of elastic tissue

b.         gradual destruction of large airways

c.         decrease in lung size

d.         decrease in airway resistance

e.        decrease in lung compliance

The x-ray study of a premature infant with hyaline membrane disease will show what typical appearance?

a. multifocal densities

b. hyperaeration

c. ground-glass appearance

d. densities in the lower lobes

e. fluffy infiltrates bilaterally

C

The depression of the diaphragm in the chest x-ray study of a patient with emphysema is due to:

a.         poor patient cooperation during the x-ray examination

b.         shunting and hypoventilation

c.         infiltrates in the right upper lobe

d.        check-valve obstructions in the airways causing lung hyperinflation

e.      muscle weakness

Which of the following diseases is genetically transferred?

a.         asthma

b.         panlobular emphysema

c.         cystic fibrosis

d.         hyaline membrane disease

e.         scoliosis

Which of the following diseases can cause paralysis of the respiratory system?

a. scoliosis

b. myasthenia gravis

c. pectus excavatum

d. kyphoscoliosis

e.  cystic fibrosis

Which of the following blood gas measurements determines how well a patient is ventilating?

a. pH

b. Paco2

c. Pao2

d. HC03

What would be the most appropriate recommendation for a patient suffering from obstructive sleep apnea?

a. sleep in the supine position

b. sleep in the Trendelenburg's position

c.  sleep with nonrebreathing mask

d. sleep in Reverse Trendelenburg position

Which of these refers to a localized collection of pus in the pleural space?

a. pulmonary edema

b. lung abscess

c. cyst

d. empyema

Digital clubbing is the result of:

a. chronic hypercapnia

b. chronic hypoxemia

c. acute hypercapnia

d. acute hypoxemia

Sputum culture and sensitivity would be most helpful for evaluating which of the following clinical conditions?

a. pneumonitis

b. pleural effusion

c. pneumothorax

d. pulmonary edema

Which of the following mediations would be of the most benefit in the treatment of a patient with post-extubation stridor?

a. hypotonic saline

b. acetylcysteine (Mucomyst)

c. pancuronium bromide (Pavulon)

d. racemic epinephrine (microNefrin, Vaponefrin)

Which of the following would best determine the diagnosis of asthma versus emphysema?

a. pre and post bronchodilator study

b. oxygen saturation monitoring

c. sputum culture

d. complete blood count

Inadequate alveolar ventilation caused by an airway obstruction is an example of which type of hypoxia?

a.           anemic hypoxia

b.         histotoxic hypoxia

c.         circulatory hypoxia

d.        hypoxemic hypoxia

Inspiratory stridor as found in croup, is the major clinical sign of:

a. tracheal malacia

b. tracheal stenosis

c. glottic edema

d. laryngotracheal web

As inspired air reaches the carina, it should be 100% saturated at body temperature, which represents how many milligrams of water per liter of air?

a. 32

b. 44

c. 47

d. 54

A COPD patient breathing spontaneously on an F 102 of 0.6 becomes drowsy and unresponsive. The patient's reaction is most likely the result of:

a. insufficient oxygenation

b. decreased venous return

c. increased Paco2

d. excessive ventilation

While performing chest wall percussion on a ventilator patient, you notice an area of hyper-resonance. This is diagnostic for which of the following conditions?

a. pleural effusion

b. pneumothorax

c. pulmonary edema

d. consolidation

Which of the following is not a hazard of oxygen administration?

a. hypoventilation

b. absorption atelectasis

c. retrolentral fibroplasis

d. hyperventilation

Which of the following types of hypoxia is most frequently associated with an increase in the mixed venous 02?

a. hypoxemic

b. anemic

c. circulatory

d. histotoxic

e.   A and C are correct

Common effects of hypoxemia include all of the following except:

a. tachycardia

b. pulmonary vasoconsstriction

c. hyperventilation

d. decreased cardiac output

Which pulmonary function variable would increase in a person with emphysema?

a. FEV 1

b. RV

c. FEF 200-1200

d. FEF 25-75

The best and most cost effective monitor of patient improvement in the patient with asthma would be:

a. Serial pulmonary functions

b. Serial flow volume Loops

c. Serial peak flows

d. Serial blood gas analysis

Refractory Hypoxemia is:

a. Hypercapnia non-respondent to oxygen

b. Hyperoxemia non-respondent to oxygen

c. Hypoxemia non-respondent to oxygen

d. Hypoxemia respondent to oxygen

Polycythemia in a person with emphysema could possibly be due to:

a. Chronic anemia

b. Chronic hypoxia

c. Chronic cough

d. Chronic hemoglobemia

The most common symptom of thromboembolism is:

a. Hemoptysis

b. Cough

c. Leg pain

d. Dyspnea

The term "status asthmaticus" describes:

a. Asthma during childhood

b. A resolved asthmatic condition

c. Asthma when bronchospasm no longer responds to bronchodilators d. An emotional asthmatic trigger

Corticosteriods would be of benefit in the asthmatic patient due to its:

a. Increase in airway caliber

b. Anti-inflammatory effect

c. Cusshingnoid syndrome

d. Bronchodilatory effect

A pulmonary function test used to determine reactivity of the airways and therefore determine if the patient was suffering from atypical asthma would be:

a. Flow volume loop

b. Forced vital capacity

c. Methacholine challenge

d. DLCO

Which of the following would not be an abnormality found in the pulmonary function of an asthmatic patient?

a. Reduced or normal FVC

b. Reduced FEV 1

c. Reduced peak flow

d. Decreased RV

Which of the following could not be a causative factor bringing on an increased incidence of an intrinsic asthma attack?

a. Infection

b. Pollen

c. Emotional upset

d. Exercise

When the patient develops atelectasis what happens to V/Q?

a. Increased

b. Decreased

c. Not affected

In chronic C02 retainers (such as chronic bronchitis):

a. The CSF pH is restored to normal

b. The central chemoreceptor drive becomes blunted

c.  Response to increase in Co2 is decreased

d. Ventilation is maintained via the hypoxic stimulus

e. All of above

Which of the following are clinical entities resulting in a decrease thoracic expansion?

a. Kyphosis

b. Scoliosis

c. Atelectasis

d. Lobar pneumonia

e. All of above

Which of the following modalities are initially indicated for a patient having an acute asthma attack?

I. Oxygen

II. Bronchodilators

III. Mechanical ventilation

IV. Hydration

a. I and II only     b. I and III only     c. I, II and III only 

d. I, II and IV only     e. II and III only

Which patient(s) would be (a) good candidate(s) for home oxygen therapy?

I.          A patient with coal worker's pneumoconiosis

II.          A patient with Hamman-Rich syndrome

III.         A patient with severe anemia

IV.        A patient with a significant pulmonary shunt

a. I and II only

b. II only

c. II, III and IV only

d. III only

e. III and IV only

A patient is seen in the pulmonary function laboratory. She is 50 years of age and complains of shortness of breath. The PFT values are observed as listed below:

I. VC = 3500 ml          II.   FEV 1 = 1900 ml 

 III. FVC=3100 ml            IV. TLC = 6000 ml

The most likely interpretation based on this information is:

a. COPD

b.  Restrictive lung disease

c. A normal spirogram

d. Hamman-Rich syndrome

e. Pulmonary edema

Rib spreading, an increase in radiolucency, and lowering of the diaphragm seen on a chest x-ray would indicate:

a. A tension pneumothorax

b. COPD

c. A pneumonectomy

d. Chest trauma

e. Congestive heart failure

An adult asthmatic patient is admitted to the emergency room in severe distress. Consciousness is impaired and the chest is silent. Peak expiratory flow is 25% baseline and PaC02 is 49 torr. You would recommend:

I. Nebulized B2 agonists Q30-60 minutes     II. IV steroids

III. IV aminophylline      IV. Intubation and mechanical ventilation

V. Supplemental 02

a.         I,II and III only

b.         II, III and V only

c.         I and V only

d.         All of above

As compared to predicted normals, a patient has a normal FEV 1%, normal FEF25­75, but a markedly reduced FVC. Test results are repeatable. Which of the following is the most likely underlying problem?

a.         poor patient effort during the test procedure

b.         a restrictive disorder of the lungs or chest wall

c.         combined restrictive and obstructive disease

d.         peripheral (small) airway obstruction

What does phase IV of the following nitrogen elimination study demonstrate?

a. FRC

b. Tidal volume

c. Anatomical deadspace

d. Mixing of inspired gases

e. Closing volume

In an obstructive disorder which of the following would you most expect to be reduced?

a. FVC

b. FEV 1

c. TLC

d. Tidal volume

. In a restrictive disorder which of the following would you expect to be reduced?

a. FVC

b. FEV 1

c. Tidal volume

d. FEF 200 - 1200

Which of the following cannot be determined with direct methods?

I. total lung capacity TLC

II. inspiratory capacity IC

III. vital capacity VC

IV. functional residual capacity FRC

a. I        b. IV        c. II and IV      d. I and IV       e. II, III and IV

Oxygen therapy offers little benefit to which of the following?

I. histotoxic hypoxia

II. deadspace disorders

III. right to left shunts

IV. circulatory or (stagnant) hypoxia

a.         I and II

b.         III only

c.         I and III

d.         I, III and IV

Characteristics of all obstructive disorders is a:

a. decrease in lung volumes

b. increase in lung volumes

c. decrease in flow rates

d. decrease in work of breathing

While reviewing the flow sheet of a patient following a motor vehicle accident, you note a progressive rise in heart rate over the last two hours. Which of the following actions would you recommend to help identify the cause of this problem?

a. measure the patient's inspiratory force

b. obtain a sputum sample for culture

c. draw and analyze an arterial blood gas

d. check the patient's intake and output record

In terms of other volumes and capacities, the vital capacity (VC) can be defined as:

a.         TLC - ERV

b.      VT + IRV + ERV

c.         ERV + RV

d.         IC + RV

Which of the following is a true statement?

a. VC = IRV + VT + ERV

b. VC = FRC + VT

c. VC = TV + IRV + RV

d. FRC = TV + ERV

A

An average size (170 lb) adult male patient exhibits a total lung capacity of 3000 ml. What, if anything can you conclude from this test result?

a. the patient has severe air trapping

b. the patient has a restrictive pulmonary disorder

c. the patient has an obstructive pulmonary disorder

d. the patient has a decrease in lung compliance

Definitive diagnosis of pleural effusion is made by:

a. a normal chest x-ray

b.  physical assessment

c. bronchoscopy

d. thoracentesis

A patient with emphysema has a reduced TLC, and a decreased FEV 1 %. Test results are repeatable. Which of the following is the most likely underlying problem?

a. combined restrictive and obstructive disease

b. poor patient effort during the test procedure

c. a restrictive disorder of the lungs or chest wall

d. peripheral (small) airway obstruction

A greater than normal number of eosinophils in a sputum sample is most suggestive of

a. asthma

b. bronchiectasis

c. emphysema

d. lobar pneumonia

e. cancer

An asthmatic attack that persists for hours and is unresponsive to medical management is referred to as:

a.         extrinsic asthma

b.         status asthmaticus

c.         intrinsic asthma

d.         allergic asthma

e.         bronchial asthma

Shunting can be defined as:

a          perfusion in excess of ventilation

b.         perfusion without ventilation

c.         ventilation without perfusion

d.         lack of respiration

e.         a and b are correct

Before drawing a blood gas sample from the radial artery, you should perform which test of adequate perfusion?

a. Allen's test

b. Modified Allen's test

c. Measure a blood pressure

d. P(A - a)O2

A patient is brought into the emergency room after being rescued from a house fire. She is unconscious and has facial burns. The physician believes that she is suffering form smoke inhalation. What would you recommend as the best way to evaluate her?

a. ABGs analyzed through a CO-oximetry

b. Pulse oximetry

c. ABGs analyzed through a standard blood gas analyzer

d. Ptc02 monitor

You are working in the intensive care unit when you notice that an arterial blood sample has been sitting out for 20 min. It was not put in ice water. You could expect the blood gas analysis to be affected in which ways?

I.         Increased Pa02

II.        Increased PaC02

III.      Decreased Pa02

IV.        Decreased PaC02

V.         Increased pH

VI.        Decreased pH

a. I, II, VI       b. III, IV, V      c.II, III, VI      d. III, IV, VI

An air bubble in an arterial blood sample will never:

a.         Increase the P02

b.         Decrease the P02

c.         Increase the PC02

d.         Decrease the PC02

A room air blood gas has a large air bubble in it. You would expect the P02 of the sample to be:

a. about 40 torr

b. higher than expected

c. lower than expected

d. about 255 torr

e. you will not be able to detect a change

During bag mask ventilation the fastest and easiest way to evaluate the effectiveness of ventilation is:

a. observe the rise and fall of the chest

b. Arterial blood gases

c. auscultation

d. x-ray

A patient can be awakened only with extreme difficulty. When awakened the patient responds correctly. This condition would be defined as

a. lethargic

b. delirious 

c. obtunded

d. confused

. All of the following statements about the use of a Lukens trap are true EXCEPT:

a. a vacuum source is needed

b. all connections must be tight for it to work properly

c. either a suction catheter or bronchoscope are also needed

d. it is used to collect a sputum sample from a patient with a strong, productive cough

The properly sized suction catheter should be no larger than what fraction of the ID of a patient's endotracheal tube?

a. 1/4

b. 1/2

C. 2/3

d. 3/4

Placing a suction catheter into your patient's trachea and applying vacuum causes:

I. transient hypoxemia

Il. removal of secretions

III. stopping of the hypoxic drive because of vagal stimulation

IV. removal of air from the lungs

a. I, IV      b. I,II       c. III

d. III, IV           e. I, II, IV

Making sure that a central vacuum system is working properly includes all of the following steps EXCEPT:

a. setting the vacuum control to Full

b. screwing a 500-mL collection bottle tightly onto the vacuum connector

c. attaching 3 feet of vacuum tubing to the tubing connector on the collection jar

d. pinching closed the vacuum tubing when the vacuum is turned on to measure the vacuum level

If during an arterial blood gas you notice the patient has practically no reflex this could be defined as:

a. confused

b. stuperous

c. comatose

d. asleep

Following the removal of an endotracheal tube, cool high humidity therapy would be given to prevent the following:

I. Laryngeal edema and inflammation

II. Bronchospasm    III. Hypoxia       IV. Infection

a. I only

b. I, II only

c. I, II, III only

d. II, III, IV only

e. I, II, III, IV

You are suctioning your patient when the vacuum is lost. You should do all of the following except:

a. Make sure the vacuum system is working

b. Make sure a tight connection exists between the suction catheter and the vacuum tubing

c. Check the catheter to make sure it is not obstructed

d. Get a larger suction catheter

In order to demonstrate adequate diaphragmatic function the patient should be able to generate a minimum negative inspiratory pressure of.

a. 10 cmH20

b. 20 cmH20

c. 40 cmH20

d. 60 cmH20

e. 80 cmH20

Which of the following agents and/or methods are sterilization techniques?

I. 2% glutaraldehyde II. pasteurization III. ethylene oxide IV. alcohol

V. gamma irradiation

a. I, II, and III only      b. II, III, and IV only

c.  III, IV, and V only      d.I, III, and V only

e. I, II, and IV only

The respiratory care practitioner is using a 12 Fr suction catheter to suction a female patient who is intubated with a 7.0 mm ET tube. The practitioner is having difficulty the thick secretions. Which of the following should be done to help improve secretion clearance?

a. instill 5 ml of normal saline down the ET tube prior to suctioning

b. change to a 14 Fr suction catheter

c. increase the suction pressure to -140 mm Hg

d. change to a 10 French suction catheter

A frail 78-year-old woman complains of pain and discomfort during chest percussion and postural drainage. The practitioner should recommend which of the following modifications to therapy?

a. Decrease the frequency of the treatment

b. Place the patient on 2 L/min nasal cannula during the treatment

c. Recommend morphine for pain prior to the treatment

d. Discontinue the therapy and begin intrapulmonary percussive ventilation

A patient's respirations are characterized by a gradual increase and then decrease in the depth and rate of respiration. This is followed by a period of apnea. This pattern of breathing is called:

a. Biot's

b. Cheyne-Stokes

c. Kussmals

d. Paradoxical

e. Apneustic

To ensure that a vacuum regulator is set at the proper pressure, the practitioner should read the manometer while:

a. Occluding the connecting tubing

b. Adjusting the vacuum control to the maximum level

c. Occluding the tip of the catheter

d. Opening one of the ports on the collection bottle

A normal subject produces the following FVC results during quality control assessment of a portable spirometer. The subject's established FVC is 4.50 L with a SD of ± 0.18 L.

FVC #1 = 4.42 L FVC #2 = 4.48 L FVC #3 = 4.41 L

The respiratory therapist should conclude that the:

a.         subject's efforts were submaximal

b.         spirometer has unacceptable signal correction

c.         spirometer performance is within acceptable limits

d.         subject's efforts do not meet repeatability standards

The respiratory therapist is reviewing the pulmonary function report in a patient's chart. The 60-year-old patient weighs 73 kg (161 lbs), is 178 cm (5 ft 10 in) tall, and has moderate dyspnea. The chest radiograph report indicates the patient has flattened diaphragms, severe hyperinflation, and a small cardiothoracic ratio. The pulmonary function test results are:

FVC      2.45 L

FEV 1/FVC%    48%

FEF15-75%       1.24 L/sec

FRC (helium dilution)     3.75 L RV/TLC% 45% DLco       12 mL/min/mmHg

To help corroborate the severity of the patient's disease which of the following results should the respiratory therapist review?

a. CO-oximetry

b. bronchoprovocation

c. bronchodilator response

d. body plethysmography

A normal 20 year old should be able to exhale what % of the vital capacity in the first one second of trying?

a. 60%

b. 83%

c. 94%

d. 97%

Which of the following forced expired flows is a reflective index of the effectiveness of the large airways?

a. FEV3

b. FEF 200 - 1200

c. FEF 25 - 75

d. MVV

Which of the following measurements reflects the status of the medium to small airways?

a. FEF 200 - 1200

b. PEFR

c. MVV

d. FEF 25 - 75

The normal MVV in a healthy man age 20 is:

a. 601/min

b. 100

c. 170

d. 240

A pre- and postbronchodilator study on a twenty-one year old male shows the following results:

This patient has been given two puffs of Atrovent. Fifteen minutes later, the postbronchodilator FVC (forced vital capacity) maneuver was performed. Which of the conditions listed below would most reasonably explain the above results?

a. the amount of Atrovent administered was insufficient

b. the postbronchodilator study was performed too soon after the medication was given

c. a different bronchodilator should have been used

d. the patient is unresponsive to bronchodilators

Which of the following physiologic components influence the DLco value derived from either the steady state or single-breath lung diffusion capacity study?

I.          blood bicarbonate level

II. pulmonary capillary blood volume

III. rate of reaction between carbon monoxide and hemoglobin

IV. thickness and surface area of the alveolar-capillary membrane

a. I, II, III, IV

b.  I, IV only

c. II, IV only

d. II, III, IV only

Which of the following situations can produce erroneous results for the FEF 25-75% obtained from a FVC (forced vital capacity) maneuver?

a. maximum forced expiratory effort to residual volume

b. termination of the FVC between the FRC and the residual volume

c. complete exhalation to RV with a submaximal effort

d. Incomplete inspiratory effort less than TLC before maximal exhalation to RV

Which method of determining the FRC of a pulmonary emphysema patient will render the largest FRC value?

a. closed-circuit helium dilution

b. open-circuit nitrogen washout

c. body plethysmography

d. single-breath nitrogen washout

You note a high-pitched sound during expiration of a pediatric patient in the emergency room. This sound is probably:

a. wheezing

b. grunting

c. snoring

d. stridor

Which of the following breathing patterns are associated with a decreased pulmonary compliance in a spontaneously breathing patient?

I. rapid, shallow breathing II. slow, deep breathing III. accessory muscle usage IV. a prolonged expiratory time

a. II, IV only      b. II, III only     c. III, IV only      d. I, III only

The pulmonary function data in the following chart were obtained from a 41-year­old, 77 kg male with a 1-year complaint of tachypnea:

Which of the following conditions are consistent with these data?

I. pulmonary emphysema      II. chronic bronchitis     

 III. kyphoscoliosis      IV. asbestosis

a. I, III only      b. III, IV only      c. II, III, IV only      d. I, II only

The average urine output for the normal individual is between:

a. 0.5 to 1.0 ml/kg/hr

b. 10 to 20 ml/kg/hr

c. 40 to 50 ml/kg/hr

d. 50 to 80 ml/kg/hr

Stridor may be treated by all of the following methods except?

a. steroids

b. warm mist

c. oxygen

d. nebulized racemic epinephrine

Which of the following conditions is likely to cause an abnormal elevation of the right hemidiaphragm?

I. pulmonary emphysema

II. right phrenic nerve damage

III. fibrosis or scarring of the right lung

IV. left-sided pneumothorax

a. I, II only      b. II, III only      c. III, IV only      d. I, II, III, IV

Croup is usually caused by which microorganism?

a. respiratory syncytial virus

b. diplococcus pneumoniae

c. staphylococcus aureus

d. streptococcus pyogenes

e. haemophilus influenza