When you are going through your patient’s home medication use under inhaled medications you see Pentamidine isethionate 300mg every 4 weeks. What would the patient receiving this for?
Severe asthma with an eosinophilic phenotype
The correct answer is 3, HIV/ Aids Pentamidine is used to prevent PCP an infection caused by HIV/Aids. This is an example of an application type of TMC question. For more information on the types of questions on the TMC and how to study for each click here.
A patient you are caring for is having shortness of breath. An x ray was taken, the results show a butterfly pattern. Which is most likely the patient’s condition?
The correct answer is pulmonary edema. This question is an example of a recall style question. It is testing your knowledge of x ray findings. Recall style questions are typically the easiest style and the second most common on the exam.
For more information on the type of TMC questions and strategies for each type click here.
The correct answer is 3. The FEV1 and FEV1/ FVC make it obstructive (FEV1/FVC <75% and FEV1 <80%) Asthma is also an obstructive disorder but emphysema is the only obstructive disorder that has a decreased DLCO.
You at the delivery of a term infant delivery the mother has no risk factors. At one minute of age the baby has a hr of 35, irregular rr effort, is limp ,has no reflexes and has a pale blue body. What would you recommend?
Warm and stimulate the baby
Monitor the baby to see if it improves on it’s own
Apply blow by oxygen
Start resuscitative efforts
For this question we need to know how to score an apgar and how to treat each apgar score.
Apgar scores are done at 1 and 5 minutes of birth. A number is given to the newborn’s condition, all the values are added up.and the number provides evaluation of the infant and provides a guide for interventions.
Slight flexion ofextremities
Cry, cough or sneeze
Pale blue colorCentral cyanosis
Body pink but, extremities are blue acrocyanosis
Apgar of 7-10, monitor patient
Apgar of 4-6 Dry and stimulate, provide oxygen with a bag and mask,CPAP
Apgar of 0-3 Provide resuscitation efforts
When do the apgar score it is 2, one point is for a hr less than 100 and one point for irregular respiratory effort. All rest of the categories score 0. With a an apgar of 2 we need to begin resuscitation efforts.
You are called to a delivery because there is suspected meconium. You arrive approximately 2 minutes after the baby was born, the neonatal nurse says that the Apgar score was 9 at one minute of age, you examine the baby and agree with her assessment. What would you do?
Warm and stimulate the baby
Monitor the baby
Apply blow by oxygen
Start resuscitation efforts
First we need to know what the range of apgar scores are and how we care for the infant in each range, see below.
Apgar of 7-10, monitor patient Apgar of 4-6 Dry and stimulate, provide oxygen with a bag and mask,CPAP Apgar of 0-3 Provide resuscitation efforts
The infant has an apgar of 9 so we would monitor the patient.
Just a reminder you need to know normal values and how to treat abnormal values for all conditions and diseases. Knowing the normal values aren’t enough. This was an example of an application style question, the most common type of question on the exam. For more information on the type of questions on the types of questions and how to study for here are my tips.
A patient complains that they have trouble breathing when they lay flat, the doctor orders a chest x ray and asks what further testing you would recommend.
Pulmonary Function Test
This question is seeing if you understand orthopnea. Orthopnea is when you lay flat and have difficulty breathing, it is caused by CHF. The only test that relates to CHF is a BNP so that is the correct answer. It is trying to throw you off by offering test that are associated with pulmonary disease, if you didn’t know what orthopnea was you would probably guess one of those options. As a reminder when you are studying a condition you need to memorize what tests are used to diagnose it, how it is treated and any other names it might be known as. In this example the scenario could be”A doctor thinks his patient might have orthopnea, he has ordered a chest x ray but would like to know what other tests you recommend?”
After surgery a 170 lb male is receiving mechanical ventilation using the following settings:
ABGs are just resulted:
Which should the respiratory therapist recommend?
Increase fio2 to 55%
Increase rate to 14
Increase peep to 7
Increase TV to 580
First evaluate the scenario and the laboratory results. The patient is receiving mechanical ventilation following surgery, no pulmonary history is given. The patient’s pH,co2 and Po2 are abnormal. Ventilation is necessary for survival so we need to address this before the hypoxia is addressed. The two ways to address the ventilation are to increase the TV and increase the RR. You always want to adjust the tidal volume first before adjusting the rr.
A 27 year old hospitalized male with pneumonia has the following laboratory results, the results were obtained when the patient was on 1lpm NC
pH7.36 RBC 6.5 mil/mm3
Bp 128/ 78
What should the respiratory therapist recommend?
Initiate non invasive positive pressure therapy
Initiate pep/ flutter
Increase nc to 4lpm
First think we do is analyze the information and ask the following questions in the following order
Is the patient ventilating? Yes the abg reveals a normal pH and Co2
Is the patient oxygenating? No paO2 is 59 (normal is80-100) Hypoxia must be addressed immediately.
Is the patient circulating and perfusing? Yes
Treating the underlying issue
The correct answer is to increase the NC to 4lpm. Starting antibiotics is also right but oxygenation is an emergency and must be treated before we move on to treating the underlying issue of pneumonia with antibiotics and flutter. If the patient’s oxygenation had been normal we would check the patient’s perfusion and move onto the underlying issue since they are circulating and perfusing.
Below is a sample question, similar to ones you might find on the tmc exam. This type of question is an analysis type of question , they are the hardest and the least common type of question on the exam . Analysis questions often give people the most trouble on the exam and is the area that causes most people to fail. Practicing analysis type questions will help you prepare for the exam because it requires you to know the normal values and equipment and how to apply each. This will help you on all the other exam questions.
Following surgery a 39 female, that is 5’6”,145 lbs is receiving mechanical ventilation at the following settings:
The following patient values are available
CVP 8 cmHG
The respiratory therapist should recommend the following change
Increase the peep to 8
Increase Fio2 to 55%
Increase TV to 600
Increase RR to 16
The first thing you do is analyze the information and ask:
Is the patient ventilating? Yes, her co2 and pH are normal
Is the patient oxygenating? No, her pO2 i s 63 so she hypoxic, this must be treated. Two answers here address hypoxia, peep and fio2 since the fio2 is below 60 we address that first. The correct answer is to increase the fio2 to 55%