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 Recall Example and Explination

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?

  1. Bronchiectasis
  2. Pulmonary Edema
  3. Pneumonia
  4. Asthma

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.

PFT TMC exam style example and explination

A patient’s pulmonary function results are:

%of predicted

  • SVC 61
  • FVC     63
  • FEV1 83
  • FEV1/FVC% 81
  • DLCO 26

What is most likely this patient’s condition?

  1. Chronic Bronchitis
  2. Asthma
  3. The patient doesn’t have a restrictive or obstructive condition
  4. Pulmonary fibrosis

The correct answer is 4- pulmonary fibrosis

The first thing we want to look at is the FEV1/FVC% and FEV1, both are normal so there is no obstructive disorder. An abnormal FEV1/FVC% is<70, an abnormal FEV1 is below 80.

After we look a the FEV1FVC% and FEV1 look at the SVC and FVC, both are low indicating a restrictive disorder. The only restrictive disorder that is an option is pulmonary fibrosis.

PFT TMC Example style question

A patient’s pulmonary function results are:

%of predicted

  • SVC 85
  • FVC 82
  • FEV1 72
  • FEV1/FVC% 61
  • DLCO 18

Which is the patient’s disease?

  1. Pulmonary Fibrosis
  2. Asthma
  3. Emphysema
  4. Myasthenia gravis

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.

RRT Style Question And Apgar Scores Explanation Example 2

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?

  1. Warm and stimulate the baby
  2. Monitor the baby to see if it improves on it’s own
  3. Apply blow by oxygen
  4. 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.


012
HRAbsent<100 bpm>100 bpm
Respiratory AbsentSlow, irregularCrying
Muscle toneLimpSlight flexion ofextremitiesWell flexed
ReflexNo responseGrimaceCry, cough or sneeze
ColorPale blue colorCentral cyanosisBody pink but, extremities are blue acrocyanosispink
  • 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.

TMC Style Question And Apgar Scores Explanation Example 1

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?

  1. Warm and stimulate the baby
  2. Monitor the baby
  3. Apply blow by oxygen
  4. 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.

You want to achieve your RRT but you are overwhelmed, start here.

If you want to achieve your RRT but don’t know where to start, don’t be overwhelmed. Break down the overwhelming goal of pass the RRT into small more manageable steps. A more manageable goal might be to study 10 minutes a day. You can apply SMART goals to passing the RRT. SMART goals are Specific, Measurable, Achievable, Realistic, Time bound. An example could be I am going to learn the alveolar air equation this week, I will be able to do an example, write out the use of the equation and the normal values. It is achievable because I have time to study 4 days this week. I recommend doing weekly goals because things are less volatile in a week than a month.

If you are still feel overwhelmed and would like a personalized plan or coaching services please contact me at RRTResults@gmail.com.

Sometimes the first thing you have to get right is your mind. I love this quote by Henry Ford “Whether you think you can, or you think you can’t – you’re right “. If you think you can’t do something you will come with a million excuses, I don’t have time to study, I have been out of school too long, I am not a good test taker etc. On the other hand if you think you can pass you will come up with a way to make it happen. You will listen to review tapes on your commute, you will study your review cards while you are waiting for your patient that is eating, you get the idea.

Start small, maybe 10 minutes a day. The people studying habits have found that people are more likely to keep going if they start small and keep doing at least a small amount every day. On days that you are busy or not feeling like studying just do 5 minutes a day. Then go back to your normal routine.

Now that you have decided you can and will pass the RRT we can get down to the how start studying. There are three types of questions on the TMC : recall, application and analysis. Recall questions are definition based questions . Application questions will require you to know what equipment or treatments are appropriate in the situation they give you. Analysis questions require to go through the given test results and situation and give the appropriate treatment. I have examples of type of questions. In general the most questions are application, followed by recall and analysis. The specific number of each type of question for each test content area is available on the NBRC website.

In addition to knowing what equipment and treatments are, you need to know how to trouble shoot it and how and when to use them. When you are reviewing equipment and treatments memorize when you use it and what conditions it is associated with. For example, polysomnography is an overnight sleep study used to diagnose sleep apnea. It would be used when a patient complains of snoring, waking up multiple times at night gasping and excessive daytime sleepiness. On the exam they might use different names for things, don’t get frustrated with this, when you are studying memorize all the possible names.

Analysis questions are the least common on the exam but generally give test takers the most problems. For analysis questions you need to know what the normal values are, how to treat the problems and in what order to treat the issues. There is a system to follow with analysis questions as outlined below. Once you get the hang of this system analysis questions will not intimidate you. Studying analysis questions helps you prepare for the exam because it has recall and application components.

You are address issues in the following order

  1. Ventilation
  2. Oxygenation
  3. Perfusion and circulation
  4. Underlying issues

If during your analysis of the situation there is a ventilation issue you address that before moving on to the next area. If there is no ventilation issue after you analyzed the situation you move on to oxygenation and go down the sequence to underlying issues. This might sound confusing you might assess the situation and think that the person has a pneumothorax, while it might be the person’s underlying issue it will affect ventilation so you treat it first.

I know it seems like a lot to do but start studying a few minutes a day, start with one flash card a day that has normal values or equipment. When you are studying think of when you would use the equipment and any other names the equipment. I have 10 free flash cards here to get you started.

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.

TMC Style Question and Explanation Example 1

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:

  • Mode AC
    • TV 500
    • F 13
    • Peep 5
    • Fio2 .45

The following patient values are available

  • pH 7.38
  • PCO2 46
  • PO2 63
  • HCO3- 23
  • CVP 8 cmHG
  • PAP 15mmHg

The respiratory therapist should recommend the following change

  1. Increase the peep to 8
  2. Increase Fio2 to 55%
  3. Increase  TV to 600
  4. 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%