153: Module VI Ch 29-32

Mixed sleep apnea has which of these traits? 1. Obstructive apnea traits 2. Central apnea traits 3. Usually begins as central apnea 4. Usually ends as central apnea

C) 1, 2, 3

Which of the following are among the therapy modalities for the patient with myasthenia gravis? 1. Acetylcholinesterase inhibitors 2. Chronic immunotherapies 3. Rapid immunotherapies 4. Monoamine oxidase inhibitors

C) 1, 2, 3

Which of the following may be used in the management of a patient with central sleep apnea? 1. Acetazolamide 2. Oxygen therapy 3. Inhaled bronchodilator medications 4. Adaptive servo-ventilation (VPAP)

C) 1, 2, 4

The peripheral nervous system problems found with Guillain-Barré syndrome (GBS) include: 1. loss of reflexes. 2. increased reflex reactions. 3. flaccid paralysis of skeletal muscles. 4. tetany of skeletal muscles.

C) 1, 3

Management of a traumatic spinal cord injury below the level of C5 involves: 1. prompt assessment to prevent addition injury. 2. immediate intubation. 3. anticoagulation therapy. 4. intravenous fluid resuscitation.

C) 1, 3, 4

Approximately what percentage of patients with GBS develop respiratory muscle paralysis? A) <5% B) 6% to 9% C) 10% to 30% D) 31% to 50%

C) 10% to 30%

The diagnosis of Guillain-Barré syndrome is based on: 1. urinalysis, which shows elevated blood urea nitrogen. 2. abnormal electromyography results. 3. cerebrospinal fluid, which shows elevated protein level. 4. clinical history.

C) 2, 3, 4

Under microscopic inspection, the skeletal muscle nerves of a Guillain-Barré patient show which of the following? 1. Hypertrophy 2. Edema 3. Inflammation 4. Demyelination

C) 2, 3, 4

What percentage of patients with only ocular myasthenia gravis are seropositive? A) <10% B) 25% C) 50% D) 90%

C) 50%

Cervical nerves _______ through _______ innervate the diaphragm. A) C1; C7 B) C1; C2 C) C3; C5 D) C5; C7

C) C3; C5

Which of the following are identified as the causative organisms of the respiratory or gastrointestinal infections that precede the onset of most cases of GBS? A) Chlamydia psittaci and Campylobacter jejuni B) Cytomegalovirus and mononucleosis C) Campylobacter jejuni and cytomegalovirus D) Mononucleosis and parainfluenza 2

C) Campylobacter jejuni and cytomegalovirus

In which clinical classification of myasthenia gravis is intubation indicated? A) Class I B) Class 1IIb C) Class V D) Class II

C) Class V

Which of the following disrupts the nerve impulse transmission in myasthenia gravis? A) MuSK B) Edrophonium C) IgG antibodies D) RNS

C) IgG antibodies

A 75-kg, 50-year-old male patient has Guillain-Barré syndrome. His most recent assessment indicates his VC is 900 mL and NIF is -16 cm H2O. What plan should the respiratory therapist recommend? A) Initiate EMG monitoring. B) Initiate continuous positive airway pressure (CPAP). C) Initiate mechanical ventilation. D) Reassess the patient each hour.

C) Initiate mechanical ventilation.

Which of the following is considered a disadvantage of the edrophonium test? A) It is associated with false-negative and false-positive results about 50% of the time. B) It should not be given to you patients with a history of asthma. C) It can be complicated by cholinergic side effects. D) Initiate mechanical ventilation per protocol is likely following the test.

C) It can be complicated by cholinergic side effects.

You are treating a patient with a proximal distribution of weakness. Which of the following NMD is most likely? A) Amyotrophic lateral sclerosis B) Facioscapulohumeral dystrophy C) Limb girdle muscular dystrophy D) Emery-Dreifuss muscular dystrophy

C) Limb girdle muscular dystrophy

What clinical change would be expected following a rest period for a patient with myasthenia gravis? A) There is no clinical change. B) Strength decreases. C) Muscle strength improves. D) Ascending paralysis descends.

C) Muscle strength improves.

Which of the following is disease in which patients may have facial wasting, hypotonia, an arched palate with progressive weakness that begins in the distal muscles? A) Amyotrophic lateral sclerosis B) Duchenne muscular dystrophy C) Myotonic dystrophy D) Emery-Dreifuss muscular dystrophy

C) Myotonic dystrophy

During a pulmonary function study, it was found that a patient has a sawtooth pattern on his flow-volume loop. What is this finding associated with? A) Central sleep apnea B) COPD C) Obstructive sleep apnea D) Laryngeal edema (epiglottitis)

C) Obstructive sleep apnea

When a person has Guillain-Barré syndrome, how are peripheral nerves affected? A) They hypertrophy. B) They fail to reproduce. C) The myelin sheath is removed. D) Schwann cells attack the peripheral nerves.

C) The myelin sheath is removed.

Which of the following may be a disadvantage of in-home portable sleep testing? A) Convenience B) Patient acceptance C) Performed over multiple nights D) Published standards for scoring or interpretation

D) Published standards for scoring or interpretation

A patient has a severe case of generalized myasthenia gravis. It is most important that the patient be monitored for: A) urine output. B) atrial fibrillation. C) hypotension. D) apnea.

D) apnea.

A patient with Guillain-Barré is paralyzed and on mechanical ventilatory support. Which of the following pulmonary complications is most likely to occur as the result of prolonged immobilization? A) Pneumonia B) Pressure sores C) Thromboembolism D) Atelectasis

C) Thromboembolism

Which of the following cardiac dysrhythmias is life threatening? A) Atrioventricular block B) Sinus bradycardia C) Ventricular tachycardia D) Premature ventricular contraction

C) Ventricular tachycardia

Signs and symptoms associated with obstructive sleep apnea include: 1. insomnia. 2. excessive daytime sleepiness. 3. hypothyroidism. 4. metabolic alkalosis.

A) 1, 2

Which of the following are associated with myasthenia gravis? 1. It interferes with acetylcholine transmission. 2. It causes weakness of voluntary muscles. 3. It is usually an ascending paralysis starting in the legs. 4. It is usually preceded by a viral infection.

A) 1, 2

Sleep apnea is associated with: 1. increased SVR. 2. decreased SVR. 3. increased PVR. 4. decreased PVR.

A) 1, 3

Which of the following NMD can be diagnosed with genetic testing of the dystrophin gene? 1. Duchenne muscular dystrophy 2. Facioscapulohumeral dystrophy 3. Becker muscular dystrophy 4. Limb girdle muscular dystrophy

A) 1, 3

You are assessing the patient-ventilator system of a patient being treated for stroke. What parameters are you most concerned with during the assessment? 1. PEEP level of 20 cm H2O 2. Frequency of 18 breaths/min 3. MAP level of 30 mm Hg 4. Peak inspiratory pressure of 21 cm H2O

A) 1, 3

You are assisting the physician with the assessment of a patient that is thought to have ALS. What clinical cues should you be most aware of? 1. Sialorrhea 2. Muscle biopsy results 3. Tongue fasciculations 4. Nerve conduction study results

A) 1, 3

The major pathologic or structural changes of the lungs associated with ventilator failure accompanying Guillain-Barré syndrome include: 1. alveolar consolidation. 2. airway distortion and dilation. 3. mucosal edema. 4. atelectasis.

A) 1, 4

Tissue plasminogen activator (TPa) should be administered within ________ of the onset of stroke symptoms. A) 4.5 hours B) 5.5 hours C) 6.5 hours D) 7.5 hours

A) 4.5 hours

Which of the following is a progressive neurologic disorder characterized by degeneration of upper and lower motor neurons? A) Amyotrophic lateral sclerosis B) Duchenne muscular dystrophy C) Myotonic dystrophy D) Emery-Dreifuss muscular dystrophy

A) Amyotrophic lateral sclerosis

Which of the following is typically not evaluated during a polysomnographic sleep study? A) Breath sounds. B) Chest and/or abdominal movement C) Electro-oculogram (EOG) D) Nasal and oral air flow

A) Breath sounds.

First-line treatment for the management of hyperventilation-related central sleep apnea includes: A) CPAP. B) adaptive servo-ventilation (VPAP). C) mechanical ventilation. D) palatopharyngoplasty.

A) CPAP.

During a myasthenia crisis, a patient was placed on mechanical ventilation but is now stable. What will the chest radiograph most likely show? A) Normal lungs B) Mediastinal shift C) Pericardial tamponade D) Ground-glass appearance

A) Normal lungs

What test is usually performed to confirm the diagnosis of myasthenia gravis? A) RNS B) PFT C) CBC D) EEG

A) RNS

Which of the following areas involved in a stroke will cause sensory and motor impairment of the lower extremities? A) Strokes of the anterior circulation B) Strokes of the midbrain C) Strokes of the posterior cerebral artery D) Strokes of the pons

A) Strokes of the anterior circulation

A physician recommended a thymectomy for a patient with generalized myasthenia gravis. The primary benefit of this procedure is to: A) eliminate the source of AChR antibodies. B) block the antigen-antibody reactions. C) remove the source of cholinesterase. D) cure the ocular myasthenia gravis.

A) eliminate the source of AChR antibodies.

The rationale behind the use of supplemental oxygen in the treatment of sleep apnea is to: A) preoxygenate the airway prior to the apneic episodes. B) stimulate the central chemoreceptors and prevent apneic episodes. C) increase the respiratory drive in the medulla. D) blow off carbon dioxide in the alveolus.

A) preoxygenate the airway prior to the apneic episodes.

The respiratory therapist can prevent increases in intracranial pressure (ICP) by: A) the administration of albuterol q4h. B) placing the patient in the Trendelenburg position. C) elevating the head of the bed at least 30 degrees. D) hypoventilating the patient.

C) elevating the head of the bed at least 30 degrees.

Typical chest assessment findings in a patient with Guillain-Barré syndrome include: 1. diminished breath sounds. 2. crackles. 3. tracheal deviation. 4. depressed diaphragms.

B) 1, 2

Which of the following values would be associated with impending ventilatory failure in a patient with myasthenia gravis? 1. NIF -15 cm H2O 2. VC 10 mL/kg 3. PaCO2 44 mm Hg 4. pH 7.36

B) 1, 2

Clinical indications that a patient has impending acute ventilatory failure include: 1. pH < 7.35. 2. FVC < 20 mL/kg. 3. PaCO2 > 45 mm Hg. 4. MEP > 40 cm H2O.

B) 1, 2, 3

Which of the following are found during rapid eye movement sleep? 1. The diaphragm functions normally. 2. The person is easy to awaken. 3. Dreaming occurs. 4. Skeletal muscles are paralyzed.

B) 1, 3, 4

Common noncardiopulmonary manifestations associated with Guillain-Barré are: 1. asymmetric muscle weakness in distal extremities. 2. leg pain. 3. distal paresthesia. 4. muscle paralysis that most often spreads downward from the face to the arms and trunk.

B) 2, 3

Elevation of what laboratory values suggest muscle damage? 1. Albumin 2. Aldolase 3. Immunoglobulin 4. Creatine kinase

B) 2, 4

Clinical disorders associated with central sleep apnea include: 1. Pickwickian syndrome. 2. depression. 3. encephalitis. 4. brain stem infarction.

B) 3, 4

Which demographic groups are most likely to develop myasthenia gravis? 1. Females >40 years of age 2. Males <35 years of age 3. Females 15 to 35 years of age 4. Males 40 to 70 years of age

B) 3, 4

Which of the following is the leading cause of death in a patient with neuromuscular disease (NMD)? A) Infections B) Breathing disorders C) Cardiac disorders D) Suicide

B) Breathing disorders

The use of hands and arms to "walk up" their own body from a squatting position is referred to as: A) limb-girdle's sign. B) Gower's sign. C) Lou Gehrig's sign. D) leg amyotrophic diplegia.

B) Gower's sign.

Which of the following is early sign of disease seen in an infant with Duchenne muscular dystrophy? A) Pseudohypertrophy B) Hypotonia C) Muscle wasting of the thighs D) Gower's sign

B) Hypotonia

Which of the following has been shown to shorten the course of a severe case of Guillain-Barré syndrome? A) Renal dialysis B) Plasmapheresis C) Blood transfusion D) NSAIDs

B) Plasmapheresis

What is the most sensitive diagnostic test for myasthenia gravis? A) Ice pack test B) SFEMG C) Edrophonium test D) PEFR

B) SFEMG

If a patient with myasthenia gravis is given edrophonium, what response would be expected? A) Diaphragmatic strength will increase for 12 to 24 hours. B) Strength will temporarily improve for 10 minutes. C) Muscle strength will increase for 48 to 72 hours. D) Muscle strength will decrease for 10 minutes.

B) Strength will temporarily improve for 10 minutes.

Continuous positive airway pressure (CPAP) is useful in the management of the patient with obstructive sleep apnea because it: A) pushes air into and out of the lungs like a mechanical ventilator. B) prevents airway collapse. C) stretches the J receptors in the chest wall to stimulate breathing. D) delivers a tidal volume breath to the patient.

B) prevents airway collapse.

A CPAP titration polysomnogram is performed to: A) find the maximum CPAP level for the functional residual capacity. B) determine the lowest possible CPAP level. C) find the CPAP level to maintain an open airway. D) determine the pressure needed for negative-pressure ventilation.

C) find the CPAP level to maintain an open airway.

A patient with Guillain-Barré syndrome developed atelectasis. His chest radiograph findings would be expected to show: A) "ground-glass" appearance. B) "honeycombing." C) increased opacity. D) blunted costophrenic angles.

C) increased opacity.

A patient with myasthenia gravis will have lung volume and capacity findings that indicate a(n): A) upper airway obstruction. B) obstructive pulmonary disorder. C) restrictive pulmonary disorder. D) combined obstructive and restrictive disorder.

C) restrictive pulmonary disorder.

Which of the following are the two main categories of stroke? A) Cellular damage or cellular death B) Transient or permanent C) Sensory or motor D) Hemorrhagic and ischemic

D) Hemorrhagic and ischemic

A 50-kg (110-pound) 30-year-old female patient has myasthenia gravis. Bedside spirometry has found her VC to be 700 mL and NIF -14 cm H2O. Vital signs show a respiratory rate of 38 breaths/min, a heart rate of 140/minute, and blood pressure of 130/90 mm Hg. What should the respiratory therapist recommend? A) Check the vital signs every hour. B) Encourage airway clearance per protocol. C) Administer supplemental oxygen per protocol. D) Initiate mechanical ventilation per protocol.

D) Initiate mechanical ventilation per protocol.

A Guillain-Barré syndrome patient has autonomic nervous system dysfunction which can result in which of the following? 1. Tachycardia 2. Hypotension 3. Urinary retention 4. Fever

D) 1, 2, 3

Diagnosis of muscular dystrophy combines: 1. physical examination. 2. laboratory testing. 3. muscle biopsy findings. 4. pulmonary function testing.

D) 1, 2, 3

General management and care of a patient with neuromuscular disease includes: 1. nutritional assessment. 2. gastrostomy tube placement. 3. mechanical ventilation. 4. weekly nerve conduction studies.

D) 1, 2, 3

The major pathologic or structural changes of the lungs associated with myasthenic crisis include: 1. alveolar consolidation. 2. airway obstruction. 3. mucus accumulation. 4. hyperinflation.

D) 1, 2, 3

The respiratory therapist is evaluating a patient for risk for obstructive sleep apnea. Which of the following are risk factors for obstructive sleep apnea? 1. Excess weight 2. Large neck size 3. Hypertension 4. Hypoglycemia

D) 1, 2, 3

Which of the following are signs and symptoms associated with myasthenia gravis? 1. Double vision 2. Weakness of neck muscles 3. Drooping of eyelids 4. Temporary muscle fatigue

D) 1, 2, 3

Complications commonly associated with long-term use of steroids in the management of myasthenia gravis include: 1. infections. 2. cataracts. 3. pulmonary edema. 4. osteoporosis.

D) 1, 2, 4

Sleep apnea would be diagnosed in a patient who has which of these findings? 1. More than 15 apnea episodes per hour of sleep. 2. More than 5 apnea episodes per hour over an 8-hour period. 3. More than 75% of the apneas are obstructive. 4. More than 75% of the apneas and hypopneas are obstructive.

D) 1, 3, 4

Scales used in the diagnosis of obstructive sleep apnea include: 1. Glasgow Coma Scale. 2. Epworth Sleepiness scale. 3. Fatigue Severity Scale. 4. Visual Analogue Fatigue Scale.

D) 2, 3, 4

In the United States and Europe, what is the most common subtype of GBS? A) Miller Fisher syndrome (MFS) B) Acute motor axonal neuropathy (AMAN) C) Acute pandysautonomic neuropathy (APN) D) Acute inflammatory demyelinating polyneuropathy (AIDP)

D) Acute inflammatory demyelinating polyneuropathy (AIDP)

In which of the following persons would Guillain-Barré syndrome most likely occur? A) African-American female—22 years of age B) Hispanic male—31 years of age C) Asian female—17 years of age D) Caucasian male—53 years of age

D) Caucasian male—53 years of age

Which of the following is transmitted in X-linked, autosomal recessive, and autosomal dominant fashions in which patients typically exhibit muscle weakness and wasting in a scapulohumeroperoneal distribution? A) Amyotrophic lateral sclerosis B) Duchenne muscular dystrophy C) Myotonic dystrophy D) Emery-Dreifuss muscular dystrophy

D) Emery-Dreifuss muscular dystrophy