TMC Application Style Question

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?

  1. Cystic fibrosis
  2. Pulmonary fibrosis
  3. HIV/Aids
  4. 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.

TMC Style Question and Explanation 4

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.  

  1.  BNP
  2.  Pulmonary Function Test
  3. Polysomnography 
  4. ABG

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?”

TMC Style Question and Explanation 3

After surgery a 170 lb male is receiving mechanical ventilation using the following settings:

  • Mode AC/VC
  • TV 450
  • F 12
  • FIO2 .45
  • Peep 5

ABGs are just resulted:

  • pH 7.16
  • PCO2 69
  • Po2 58
  • HCO3- 23
  • Sao2 91

Which should the respiratory therapist recommend?

  1. Increase fio2 to 55%
  2. Increase rate to 14
  3. Increase peep to 7
  4. 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.

TMC Style Question and Explanation Example 2

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
  • paCO2  45Hb
  • paO2 59
  • Sao2 88
  • HCO3-  23
  • Hb 15
  • Hct 47
  • WBC 2500/mm3
  • Temp 39C
  • Bp 128/ 78

What should the respiratory therapist recommend?

  1. Administer antibiotics
  2. Initiate non invasive positive pressure therapy
  3. Initiate pep/ flutter
  4. Increase nc to 4lpm

First think we do is analyze the information and ask the following questions in the following order

  1. Is the patient ventilating? Yes the abg reveals a normal pH and Co2
  2. Is the patient oxygenating? No paO2 is 59 (normal is80-100) Hypoxia must be addressed immediately.
  3. Is the patient circulating and perfusing? Yes
  4. 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.