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?
- Pulmonary Edema
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.
A patient’s pulmonary function results are:
- SVC 61
- FVC 63
- FEV1 83
- FEV1/FVC% 81
- DLCO 26
What is most likely this patient’s condition?
- Chronic Bronchitis
- The patient doesn’t have a restrictive or obstructive condition
- 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.
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:
- 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?
- 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.
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
- pH 7.38
- PCO2 46
- PO2 63
- HCO3- 23
- CVP 8 cmHG
- PAP 15mmHg
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%