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 85
- FVC 82
- FEV1 72
- FEV1/FVC% 61
- DLCO 18
Which is the patient’s disease?
- Pulmonary Fibrosis
- 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.
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.
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?
- Administer antibiotics
- 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
- 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%