Exam 3

A 17 year old man is brought into the emergency department. Vitals are as follows: pulse 100, RR 4, and BP 100/65. The patient was at a party, where he was discovered by his friends to be slumped in a chair and unresponsive. ABG results are as follows: pH 7.29, PaCO2 68, HCO3- 29, BE +1. The patient's acid-base status is classified as which of the following? A. Uncompensated respiratory acidosis B. Partially compensated respiratory acidosis C. Compensated respiratory acidosis D. Uncompensated metabolic acidosis

A

Which chamber normally has the largest muscle mass? A. Left atrium B. Left ventricle C. Right atrium D. Right ventricle

B

Which of the following could cause metabolic acidosis? A. Cardiovascular disease B. Renal disease C. Hypokalemia D. Vomiting

B

Which of the following diseases is not associated with a reduced DLCO? A. emphysema B. chronic bronchitis C. pulmonary embolis D. pulmonary fibrosis

B

A 32 year old man comes to the emergency department after a traffic accident with the following data: pulse 118, RR 27, BP 100/68, paradoxal chest movement on the left side, breath sounds decreased on the left, and an ABG on room air (21%) as follows: pH 7.32, PaCO2 70mm Hg, PaO2 57 mmHg, HCO3- 23, base excess 0, SaO2 86%, CaO2 15.2, Hb 13, P(A-a)O2 18 mmHg. Based on this information, what is the primary cause of the patient's hypoxemia? A. Overall hypoventilation B. V/Q mismatch C. Diffusion defect D. Shunt

A

For the test of collateral circulation in an Allen's test, "pinking up" of the hand is normal if it occurs within ____ seconds. A. 10-15 B. 15-20 C. 20-25 D. 25-30

A

The body plethysmograph uses which of the following gas laws? A. Boyle's law B. Charles' law C. Gay-Lussac's law D. Combined gas law

A

The presence of "hot spots" in a positron emission tomography (PET) scan is indicative of: A. metabolically active tumor or infection B. pneumothorax C. pulmonary embolism D. atelectasis

A

To minimize the magnification associated with portable films, how far should the patient and the film be from the source of the x-rays in a conventional chest x-ray? A. 6ft B. 8ft C. 10ft D. 12ft

A

What dysarythmia is characterized by a sawtooth pattern of waves between normal QRS complexes? A. Atrial flutter B. Atrial fibrillation C. Ventricular flutter D. Ventricular fibrillation

A

What is the direct effect of an increased PaO2 on HCO3-? A. Causes an increase B. Causes a decrease C. Does not have any effect on it D. Complicated because it has an unpredictable effect on bicarb

A

What may cause the FVC to decrease in a patient with a restrictive lung disorder? A. A decrease in lung size B. An increase in the expiratory reserve volume (ERV) C. A decrease in expiratory muscle mass D. An increase in airway resistance caused by the disease

A

What term applies to any heartbeat that originates outside the SA node? A. Ectopic impulse B. Aberrant impulse C. Eccentric impulse D. Recurrent impulse

A

Which of the following clinical or chest x-ray findings is consistent with hyperinflation caused by obstructive lung disease? A. Large retrosternal space B. Prolonged inspiratory phase C. Decreased resonance to percussion D. Decreased functional residual capacity (FRC)

A

Which of the following conditions is not a determinant of gas exchange across the membrane? A. Amount of oxygen in the blood B. Thickness of the alveolar-capillary membrane C. Diffusion coefficient of carbon monoxide in the lungs D. Surface area of the membrane

A

Which of the following is a true statement regarding the term hypoxemia? A. It occurs when the patient's PaO2 is lower than predicted B. It indicates a condition in which tissue oxygenation is inadequate C. It is always considered a severe disorder D. It is independent of the age of a patient

A

Which of the following is the most common site for arterial puncture: A. Radial B. Ulnar C. Temporal D. Jugular

A

Which of the following is the primary instrument used in performing PFT's? A. Spirometer B. Flowmeter C. Thermistor D. Spirograph

A

Which of the following is true regarding respiratory alkalosis? A. The PaCO2 is less than 35 mmHg B. An increase in HCO3- compensates the respiratory alkalosis C. It is called completely compensated if the pH is 7.52 D. It is called partially compensated if the pH is in the normal range

A

Which of the following medications is used mostly common during bronchoprovocation testing? A. Methacholine B. Isoproterenol C. Methylene blue D. Metaproterenol

A

Which of the following parameters is the respiratory component of the acid-base status? A. PaCO2 B. HCO3- C. PaO2 D. Base Excess

A

Which of the following radiologic terms confirm the presence of intrapulmonary disease? A. Sulcus sign B. Compression atelectasis C. Air bronchogram D. Platelike atelectasis

A

Which of the following views is most helpful in identifying a pneumothorax? A. Expiratory view B. AP view C. Left lateral view D. Lateral decubitus view

A

How much time is represented on the horizontal axis of the ECG paper by five large boxes? A. 0.5 sec B. 1 sec C. 3 sec D. 5 sec

B

In which of the following diseases will the open-circuit nitrogen washout method tend to underestimate the total lung volume? A. Asthma B. Emphysema C. Cystic fibrosis D. Chronic bronchitis

B

The ability of x-rays to penetrate matter is inversely proportional to which of the following physical properties of matter? A. Viscosity B. Density C. Weight D. Diffusion

B

The normal QRS complex does not exceed what time on the horizontal line? A. 0.05 sec B. 0.10 sec C. 0.5 sec D. 1 sec

B

The total lung capacity is a function of all of the following except: A. age B. birth weight C. gender D. height

B

What axis change is common in patients with chronic pulmonary hypertension? A. Left axis deviation B. Right axis deviation C. Inverted axis deviation D. Extreme left axis deviation

B

What is represented by the P wave on the ECG tracing? A. Repolarization of the atria B. Depolarization of the atria C. Repolarization of the ventricles D. Depolarization of the ventricles

B

What is the heart rate if the RR interval is five large boxes apart? A. 40bpm B. 60bpm C. 90 bpm D. 120 bpm

B

What is the normal minute ventilation of an average person at rest? A. <5 L/min B. 5-10 L/min C. 5-15 L/min D. >15 L/min

B

What is the upper limit in height of the normal P wave? A. 1mm B. 2.5mm C. 3.5mm D. 5mm

B

What is the ventricular heart rate when the AV node paces the heart? A. 20-40bpm B. 40-60bpm C. 60-80bpm D. 80-100bpm

B

What problem is indicated by elevation of the ST segment? A. Heart block B. Myocardial ischemia C. Elevation of serum potassium D. Depletion of serum potassium

B

Which of the following is a hallmark of PVC? A. The QRS complex is early but normal in appearance B. The QRS complex is wider than normal C. There is a P wave in front of the QRS complex D. The T wave moves in the same direction as the QRS complex

B

Which of the following is the best indicator of metabolic acid-base status? A. Plasma HCO3- B. Base excess C. Standard HCO3- D. T40 HCO3-

B

Which of the following may decrease the FVC in a patient with an obstructive lung disease? A. A decrease in lung size B. An increase in residual volume C. A decrease in expiratory muscle mass D. An increase in airway resistance caused by the disease

B

Which of the following terms defines high-density tissues on the x-ray film? A. Radiolucent B. Radiopaque C. Radiographic D. Tomographic

B

Which of the following would suggest that a patient has CHF? A. Low and flat diaphragm B. Increased cardiothoracic ratio C. Tracheal deviation D. Increased retrosternal air space on a lateral film

B

The ERV is limited in clinical usefulness. It may be reduced in all of the following cases except: A. obesity B. restrictive disorders C. obstructive disorders D. patients making a poor effort during testing

C

The MVV reflects all of the following except: A. airway resistance B. condition of respiratory muscles C. condition of lung tissue D. compliance of the lungs and thorax

C

The closed-system helium dilution method is used to measure: A. VC B. FVC C. FRC D. TV

C

The closing-volume (CV) test is used for early diagnosis of obstruction of airways of which of the following sizes? A. Large B. Medium C. Small D. Large and medium

C

The normal FEV1 to FVC ratio is approximately: A. 50% B. 66% C. 75% D. 90%

C

The presence of an FVC that is significantly smaller than the slow vital capacity is consistent with: A. poor inspiratory effort B. use of bronchodilator C. Air trapping D. forced exhalation

C

What breathing instruction is a patient given immediately before an AP or PA chest radiograph? A. Breathe normally B. Exhale completely C. Take a deep breath D. Do not worry about breathing

C

Which of the following are common causes of tachycardia? 1. Pain 2. Fever 3. Hypoxemia 4. Hypothyroidism A. 1,3 B. 2,4 C. 1,2,3 D. 1,2,3,4

C

Which of the following is not standard equipment in a pulmonary function laboratory? A. Spirometer B. Gas analyzer C. Oxygen source D. Body Plethysmograph

C

Which of the following tests is often uses preoperatively to evaluate whether the patient may have postoperative complications? A. ABG analysis B. IC measurement C. MVV test D. PEF test

C

A patient complaining of chest pain that has not been relieved by nitroglycerin should be treated with all of the following except: A. oxygen therapy B. thrombolytic therapy C. stress testing D. surgical intervention

C Remember MONA Morphine Oxygen Nitroglycerine Aspirin

Given the following ABG results, interpret the acid-base status: pH 7.44, PaCO2 25, HCO3- 17, BE -6 A. Compensated metabolic acidosis B. Uncompensated respiratory alkalosis C. Uncompensated respiratory acidosis D. Compensated respiratory alkalosis

D

In the terminology for three of the limb leads, what does the A stand for? A. Atrial B. Assisted C. Ambient D. Augmented

D

To determine whether there is a positive response to bronchodilator therapy, improvement must be seen in all of the following values except: A. FVC B. FEV1 C. FEF 25%-75% D. FEF 75%-85%

D

What is the normal value for PaO2 in the adult patient? A. 50-60 mmHg B. 60-70 mmHg C. 70-80 mmHg D. 80-100 mmHg

D

What is the primary method of transporting oxygen in the blood? A. Dissolved in plasma B. Bound to plasma proteins C. In the form of HCO3- D. Bound to hemoglobin

D

Which chamber is responsible for pumping blood into the pulmonary circulation? A. Left atrium B. Left ventricle C. Right atrium D. Right ventricle

D

Which level of VC is associated with an increased risk of respiratory failure? A. <50 mL/kg B. <40 mL/kg C. <20 mL/kg D. <15 mL/kg

D

Which of the following are associated with the onset of dysarrythmias? 1. Hypoxia 2. Electrolyte imbalances 3. Sympathetic stimulation 4. Pulmonary HTN A. 1,2 B. 3,4 C. 2,4 D. 1,2,3

D

Which of the following associations' standards should be met before PFT equipment is purchased? A. The American Lung Association B. The American College of Chest Physicians C. The Joint Commission D. The American Thoracic Society

D

Which of the following is a characteristic of a third degree heart block? A. There is a lengthening PR interval B. There is often a 2:1 ratio between P waves and QRS complexes C. The atrial rate is the same as the ventricular rate D. There is no relationship between the P wave and the QRS complexes

D

Which of the following is not a general purpose of performing pulmonary function tests? A. The functional status of the lungs B. The diffusion characteristics of the alveolar-capillary membrane C. How much and how fast gas can be moved in and out of the lungs D. The specific diagnosis of pulmonary disease

D

Which of the following is not a parameter that has been studied to establish normal values for PFT's? A. Gender B. Height C. Race D. Weight

D

Which of the following physiologic effects is associated with myocardial infarction? A. Arterial HTN B. Increased cardiac output C. Good blood flow to the brain D. Backup of blood into the lungs

D

Which of the following statements is not considered an indication for obtaining a radiograph? A. Determine the appropriate therapy B. Evaluate the effectiveness of treatment C. Detect alterations of the lung caused by pathologic processes D. Diagnose specific diseases

D

Which of the following tests would be used to determine at what point oxygen consumption reaches its peak? A. Exercise challenge B. Ventilatory capacity C. Anaerobic threshold D. Maximal oxygen uptake (VO2 max)

D

Why is an ECG tracing so useful? A. It reflects the heart's pumping ability B. It can identify structural abnormalities in the heart C. It can be used to diagnose malfunctioning valves D. It can aid in the diagnosis of cardiac tissue ischemia

D