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Peggy Fall Final
Cardiopulmonary Diagnostics
| Question | Answer |
|---|---|
| which of the following are indications for performing spirometry on a patient? | quantify the severity of known lung disease assess impairment and/or disability |
| which of the following is/are hazards for spirometry? | paroxysmal coughing |
| what is/are contraindications for spirometry? | unstable cardiovascular status |
| Which of the following devices are used to measure volume | Water seal spirometer Bellows spirometer Dry rolling seal spirometer wright respirometer |
| Which of the following capacities (or volumes) of air, are measured INDIRECTLY? | FRC, RV, TLC |
| what is the minimum calibration of spirometry equipment in an active pulmonary function laboratory? | Daily |
| When using a volume displacement spirometer, what special calibration check needs to be done to test the integrity of the equipment. | Leak test |
| Which of the following are correct when referring to a wright respirometer. | Operative with flow > 3Lpm Affect by flow. |
| Which of the following is correct when referring to a thermistor? | Relies temperature differential |
| what is the indication for performing static lung volumes on a patient? | Differentiate between obstrucive and restrictive disease patterns. Make preoperative assessments in patients with compromised lung function. |
| how do you calibrate a N2 analyzer for N2 washout? What gases would you use and what should the analyzers read? | N2 analyser should be 0 with 100% oxygen |
| what additional equipment is necessary when performing helium dilution studies? | CO2 absorber |
| When checking the helium analyzer, what is the maximum amount of drift allowed in a 10 minute time frame? | ≤ 0.02% |
| The difference between closing volume and nitrogen washout is that the closing volume is... | Pt take a single breath of 100% O2 |
| A body plethysmograph measures changes in which of the following? | pressure within a constant-volume chamber volume within a constant-pressure chamber airflow in and out of a constant-pressure chamber volume within a constant pressure chamber pressure withing a constant volume chamber |
| Based on the picture below, answer questions 16 - 19 Basically know the phases… | 16. Upper airway dead space I 17. Gas measured III 18. Clossing volume IV 19. Residual volume IV |
| what should be calibrated daily when using the bodyplethysmography? | mouth pressure transducer . plethysmograph signal |
| According to the AARC CPG, which of the following is/are indications for DLCO? | Differentiation of obstruction and restive Evaluation pulmonary hemorrhage |
| When performing DLCO, what is the minimum time that should lapse between attempts? | 4 minutes |
| Which of the following tests would be used to obtain a patient’s lung compliance? | Body plethysmography |
| Which of the following tests would be used to obtain a patient’s Raw? | plethysmograph |
| which of the following is/are indications for bronchial provocation studies? | Diagnosis to confirm of airway hyperreactivity. Document severely of hyperresponsiveness. Following change in hyperresponsiveness. |
| all of the following are hazards for bronchial provocation studies, EXCEPT? | Cloustrophobia. |
| Which of the following is a method that can be used to perform bronchial provocation study? | Histamine challenge |
| Which of the following statements are true concerning tumors in the upper airway? | There may be variable or fixed obstruction |
| To interface a water-sealed spirometer to a computer, which of the following is required | Variable speed Kymograph. |
| A 78 year old complains of dyspnea on exertion. His dyspnea has increased significantly over the past year and now occurs with minimal exertion. He denies cough, chest pain, or sputum production. He has a 20 pack year smoking history. His family has a | obstructive disorder |
| A subject who complains of shortness of breath has an FVC of 2.57 , a SVC of 2.99 L. These findings suggest which of the following? | Emphysema |
| A 62 year old patient with dyspnea performs three spirometry trials Trial 1 Trial 2 Trial 3 FVC (L BTPS) 4.21 4.44 4.65 FeV1 (L BTPS) 3.88 3.91 3.93 The pulmonary function technologist should do which of the following? | Perform at least one more maneuver. |
| A subject who complains of shortness of breath has an FVC of 2.57 , a SVC of 2.99 L. These findings suggest which of the following? | Emphysema |
| A 62 year old patient with dyspnea performs three spirometry trials Trial 1 Trial 2 Trial 3 FVC (L BTPS) 4.21 4.44 4.65 FeV1 (L BTPS) 3.88 3.91 3.93 The pulmonary function technologist should do which of the following? | Perform at least one more maneuver, if 2 values are not within 5% of each other. |
| After inhalation of methacholine, a patient has spirometry and specific conductance (sGaw) measured. Which of the following changes are consistent with a positive methacholine challenge test? | FeV1 decrease by 25%. SGaw decrease 50%. |
| RZ is a 47 year old carpenter whose chief complaint is dyspnea on exertion and has smoked 1 ppd for the past 10 years. He has the following spirometer result. What treatment would you recommend? | -Long acting BD -inhaled corticosteroid -smoking cessation programs |
| A small leak is introduced into the breathing circuit during the measurement of MIP and MEP to do which of the following? | Prevent artifact caused by check muscle. |
| According to AARC CPG, before bronchodilator studies, inhaled B-adrenergic agents should be withheld for how long? | 4-6 hours |
| Using Cairo, which of the following correctly describing the measurement of FRC by the closed-circuit method? | THE SYSTEM VOLUME SPIROMETER & CIRCUITY MUST BE CALCULATED, A CO2 ABSORBER IS REQUIRED A SMALL AMOUNT OF H3 IS ABSORBED BY BLOOD TISSUES |
| To measure accurately the Vtg the patient should be instructed to do which of the following? | Breathe normally during closure of the shutter . |
| Using Cairo, which of the following can alter the calibration of a spirometer that uses a pressure-differential pneumotachometer | Water droplet condensation in the resistantive element. |
| Body plethysmography is based on which of the following gas laws | Boyles law. |
| Which of the following pieces of standard PFT equipment is used to determine total lung capacity and resistance of the airways | Body plethysmography. |
| Which of the following is true regarding FRC | It is the sum of the RV+ERV Increase in obstructive disease. Decrease in restrictive disease. |
| A patient with severe hypokalemia is receiving an intravenous infusion of potassium to correct this serious disorder. What should you monitor? | Electrocardiogram |
| All of the following would be consistent with administration of a large amount of IV fluid, except? | Increase hematocrit |
| Sputum culture and sensitivity would be indicated for which of the following conditions? | Bronchitis |
| A patient presents in the emergency department with vomiting. Blood gas results reveal a metabolic alkalosis. Based on this information, you would also suggest what? | Electrolyte analysis |
| A sputum culture that is sent to the lab is likely to be rejected as saliva if? | More than 25 epithelial cell are present |
| Heavy smokers are prone to what change in the red blood cell count? | secondary polycythemia |
| Elevation of troponin is associated with what disorder? | Acute Myocardial infarction |
| A patient in the emergency department has a Chem 7 ordered and hypokalemia is present. What test should the RRT recommend? | Arterial blood gas |
| A Ziehl Neelsen stain is used to identify which of the following organisms? | Mycobacterium Tuberculous |
| Which of the following findings is consistent with pleural infection | -opaque or turbid pleura fluid |
| The middle bottle of a three bottle chest drainage system is used as a | water seal |
| The physician has asked you to determine how much of an air leak has occurred with the chest tube. Where would you look first to determine if a leak is present? | Exhale tidal volume Water seal chamber. |
| To function appropriately, the pH electrode must soak in what type of solution? | Saturated Potassium Cloride |
| When assessing the Levy-Jennings graphs for the Severinghaus electrode, your noticed a gradual increase in values when doing the quality assurance: | Protein build up on the electrode |
| Erroneous PCO2 measurements can be caused by which of the following? | A worn electrode A cracked electrode Dehydration of bicarbonate |
| According to CLIA standards, laboratory instruments used in the hospital for blood sample testing should undergo three-point calibrations at least: | Every 6 month |
| What type of calibration should be performed after an electrode is changed? | 3-point calibration |
| The two-point calibration for the pH electrode uses two buffers. Which of the following pH values are correct for these two buffers? | Ph 6.84 Ph 7.384 |
| The gold standard for quality control for PCO2 and PO2 electrodes is: | Tonometry |
| Which of the following statements is true concerning quality control of a blood gas analyzer? | protein buildup |
| Which Glasgow Coma Scale score is typically an indication for intubation? | < 9 |
| The presence of dorsiflexion of the great toe with fanning of remaining toes during testing of the plantar reflex is known as: | Babinski's |
| Which of the following is most important parameter to keep in mind when managing a patient with high ICP? | Cerebral perfusion pressure |
| All of the following are indications for monitoring ICP, except: | Determinate appropriate arterial blood pressure |
| Martin May has a blood pressure of 170/110 with an ICP of 30. What is Martin’s cerebral perfusion pressure. | CPP is MAP - ICP. MAP is systolic pressure |
| When using a fluid filled system to monitor ICPs, what particular piece of equipment is needed? | external transducers. |
| CPP should range between what numbers? | 83-93mmHg |
| Which of the following conditions is not associated with untreated obstructive sleep apnea? | Systemic hypotension |
| Which of the following factors has been shown to positively correlate with obstructive sleep apnea? | Obesity of the upper body |
| Which of the following physical exam findings is associated with obstructive sleep apnea? | Large tonsils |
| Which of the following parameters is NOT typically monitored with a polysomnogram? | Exhale PCO2 |
| Which of the following medical therapies is considered first-line treatment for obstructive sleep apnea (OSA) | CPAP |
| What is the amount of CPAP that is typically required to abolish upper airway obstruction in patients with OSA? | 7.5 to 12.5 cmH2O |
| In what way do BiPAP units differ from CPAP units? | BiPAP have different levels of pressure. |
| What stage of sleep is characterized by large eye rolls and low-amplitude waves on EEG recordings? | Stage 1 NREM |
| During which stage of sleep are skeletal muscles partially paralyzed, thus greatly affecting ventilation and maintenance of the upper airway? | REM |
| To meet the definitive criteria for sleep apnea, how many seconds of airflow cessation during sleep must be documented? | 10 second |
| What is the most common complaint of patients with obstructive sleep apnea? | Excessive daytime sleepiness |
| A patient has an AHI of 15. What would this be considered? | Mild sleep apnea |
| How would you diagnose central sleep apnea? | 10seconds apnea w/o respiratory effort during sleep. |
| Why is it important for an RT to be able to identify cardiac dysrhythmias? | Rt may serve as the first link on the chain of survival for a patient experiencing a cardiac arrest and minimize cardiac damage or prevent death. To observe an acute cardiac event or a deadly dysrhymia |
| Why is an ECG tracing so useful? | IT CAN AID IN DIAGNOSIS OF CARDIAC TISSUE ISCHEMIA |
| Which of the following symptoms is least suggestive of the need for an ECG? | Fever |
| Where does the normal electrical impulse originate for each heartbeat? | Sinus or sinoatrial (SA node) |
| At what speed does the paper travel through the ECG machine? | 25mm/s |
| Why is the electrical signal delayed slightly at the AV node? | TO ALLOW BETTER FILLIN OF THE VENTRICLES TO PROTECT THE VENTRICLES AGAINST EXCESSIVELY RAPID ATRIAL RATES |
| What is the ventricular heart rate when the AV node paces the heart? | 40 to 60beat/min |
| Which of the following physiological effects is associated with myocardial infarction? | backup of blood into the lungs |
| Which of the following are associated with the onset of dysrhythmias? | Hypoxia, ischemia, sympathetic stimulation, drugs, elecrolyte imbalances, rate, and stretch are all associated with dysrhythmia |
| What is represented by the P wave on the ECG tracing? | DEPOLARIZATION OF ATRIA |
| What is the normal range for the PR interval? | 0.12 and 0.2 second (3 to 5 small boxes) |
| The normal QRS complex does not exceed what time on the horizontal axis? | 0.12 sec 3mm |
| What part of the heart is best viewed by the chest leads V5 and V6? | Left ventricle |
| What axis change is common in patients with chronic pulmonary hypertension? | Right axis deviation |
| What problem is indicated by elevation of the ST segment? | Serious problem of O2 getting to the heart. Myocardial ischemia |
| Which of the following are common causes of tachycardia? | -fever -shock -HR >150bpm -hypotension -anxiety -Dizziness -SOB -Weakness/Fatigue -ongoing chest pain -Pulmonary congestion -CHF -anything that increases oxygen consumption -hypovolemia -hypoxemia -sepsis |
| What dysrhythmia is characterized by a sawtooth pattern of waves between normal QRS complexes on the ECG tracing? | Atrial flutter |
| Which of the following would describe the ECG of a patient with atrial fibrillation? | CHAOTIC BASELINE BTWEEN QRS COMPLEXES |
| Which of the following is a hallmark of a premature contraction (PVC)? | QRS COMPLEX IS WIDER THAN NORMAL |
| What dysrhythmia often follows untreated ventricular tachycardia? | Ventricular fibrillation |
| Which of the following dysrhythmias is associated with the lowest cardiac output? | VENTRICULAR FIBRILLATION |
| Which of the following dysrhythmias represents a dissociation of the mechanical and electrical activities of the heart? | PULSELESS ELECTRICAL ACTIVITY |
| Which of the following is a characteristic of third-degree heart block | THERE’S NO RELATIONSHIP BETWEEN P WAVES & QRS |
| What is implied by an abnormally prolonged PR interval? | ATRIOVENTRICULAR BLOCK |
| Which of the following ECG abnormalities is most life threatening? (we don’t mean what dysrhythmia) | Elevated St segment |
| What type of medications may lead to first-degree heart block? | B-BLOCKERS |
| For which of the following arrhythmias would an electronic pacemaker be indicated? | 3RD DEGREE BLOCK |
| What is a possible serious complication associated with atrial fibrillation? | atrial thrombi |
| What medication is most useful for the treatment of premature ventricular contractions? | lidocain |
| What are the indications for holter monitoring | Detect arrhythmia Identify silent ischemia Determine of arrhythmias are controlled by medication. determine if pacemaker is firing appropriately |
| What are some hazards associated with pulmonary artery catheterization? | Balloon rupture Catherer knotting Infection Bleeding |
| Which of the following is a contraindication to hemodynamic monitoring? | Hypotension |
| What veins are the most common sites for insertion of a pulmonary artery catheter? | Subclavian and internal jugular vein |
| Zero referencing the transducer involves maintaining the transducer at the level of the: | Patient heart |
| Prior to inserting the pulmonary catheter, what needs to be done? | Run sterilized fluid proximal. Test the balloon. Run sterilized fluid trough distal port. |
| The efficiency of a patient's oxygenation is considered unacceptable when the Qs/Qt rises above what percentage? | 30% |
| In order to measure the Qs/Qt occurring in the lungs, which of the following information must be known? | PAO2 CaO2 CvO2 Hb |
| Which of the following patients has the most significant problem with oxygenation? | PA02-Pa02. 390mmHg on 100% |
| The amount of O2 delivered to the tissues depends on which of the following? | CO CaO2 |
| A patient with a pulmonary artery catheter has a mean right atrial pressure of mm Hg. Which of the following are possible causes of this finding? | Tricuspid Stenoid RVF PPV |
| A patient has a mean pulmonary artery pressure of mmHg. Which of the following are possible causes of this finding? | PAP Increase PVR Left ventricular failure |
| Hemo scenario requiring your interpretation | Systemic arteria pressure decrease SVR increase QT decrease PAP decrease PAWP decrease Dehydration or hypovolemia |
| What would you recommend to help the person listed above? Now treat him | Administer IV fluid |
| Calculate CI. | CI CO /BSA |
| Calculate SVR | MAP – CVP x 80/CO |
| Calculate PVR | (MPAP) - PCWP x 80 /CO |
| Which of the following are true when referring to the proximal port of a Swan Ganz catheter? | Open to right atrial Used administrated drug Use thermo dilution |
| Central venous pressure is a reflection of which of the following? | Right atrium pressure Reflection of the right ventricle preload Right ventricle end- distolic pressure |
| Which of the following would cause the CVP to increase? | Fluid overload |
| Which of the following is the correct method of measuring CVP in a patient on mechanical ventilation with PEEP? (Think physiologic changes occurring in the thorax) | End-exhalation on the ventilator |
| Failure to deflate the balloon on a pulmonary artery catheter after taking a wedge-pressure reading can result in which of the following? | Pulmonary infarction |
| What parameter is considered to be the most accurate and reliable measure of oxygenation efficiency? | Qs/Qt) |
| What method of measuring cardiac output is most popular in ICUs around the country? | Thermodilution |
| Which of the following would increase PAP? | Severe Hypoxemia Thromboemboli Acidosis PEEP |
| Which of the following waveforms represents RAP? Which of the following waveforms represents RV pressure? Which of the following waveforms represents PAP? Which of the following waveforms represents PCWP? | look it up!! |
| What is the normal range for CO? | 4-8lpm |
| .What is the normal range for right atrial pressure for CVP as measured through the proximal port of a pulmonary artery catheter? | 2-6mmHg |
| What is the normal range for pulmonary artery systolic pressures as measured through the distal port of a pulmonary artery catheter? | 20-30mmHg |
| What is the normal range for the mean pulmonary artery pressure as measured through the distal port of a pulmonary artery catheter? | 10-20mmHg |
| What parameter is considered to be the most accurate and reliable measure of oxygenation efficiency? | Qs/Qt) |
| What will increase cardiac output? | Higher HR or SV Higher metabolic demand Higher O2 demand |
| Pulmonary artery pressure monitoring can be accomplished via the use of which of the following? | Ballon tipped flow directed catherer Pulmonary artery catheter Swang catheter |
| What does SVR measure? | Average resistance to blood flow in the systemic circulation. |
| In patients with a pulmonary artery catheter in place, Qt is usually measured by which of the following methods? | Thermodilution |
| What is the percentage of deadspace ventilation from the information found in number 45?Calculate amoutn of Dead space | Norm VD/ VT 0.2 – 0.4 or 20-40% VD/VT= PaCO2-PeCO2/PaCO2 x VT VD% = PaCO2-PeCO2/PaCO2 (move decimal 2 places) |
| What are the indications for exercise tests | Dyspnea on exertion/fatigue |
| What was the contraindication to exercise testing | CHF |
| What test can be performed to assess response to a medical or surgical intervention | 6 min walk test |
| What does the ramp test allow the patient to do? | Advance from low to high work loads |
| When would you terminate exercise test? | Development of 2 and 3 degree heart block |
| Which combination of gases would be most appropriate to check the linearity of the oxygen analyzer used for exhaled gas analysis during exercise | 12%RA and 24%O2 |
| The following values are obtained during exercise using a mixing chamber system | VO2= CO(CaO2-CvO2) CaO2=(Hb x 1.36 x SaO2) + (PaO2 x 0.003) CvO2=(Hb x 1.36 x SvO2) + (PvO2 x 0.003) |
| A subject has the following results of an exercise test Maximal Exercise Predicted HR (beats/min) 110 167 ST change (mm) 0.05 < 1.0 VO2 (ml/min/kg) 9.2 23 VE 23 26 SaO2 85 >90 Which of the following clinical diseases conditi | COPD |
| Which of the following are preliminary tests needed prior doing a stress test | MVV 12 lead EKG |
| In pulmonary disorders, what do you expect to find | Normal maximum HR Low VO2 High Ve/MVV |
| Which of the following are indications for CXRs | Determine appropriate Therapy/ Determine position of tubes |
| A lateral decubitus is indicated for which of the following: | Access pleural effusion |
| An expiratory film is indicated for which of the following: | small pneumothorax, |
| How can you determine the adequacy of exposure? | Observe the vertebral bodies down the center of the trachea Vertebral bodies through the cardiac shadows By the volume of white appearance |
| Which of the following objects will appear radiopaque | Bone Fluid |
| If the chest x-ray is taken correctly and inspiration has been deep enough, the diaphragm will drop to what rib | Posterior 10th rib, and Anterior 6th rib |
| Which of the following are proper endotracheal tube placement on a CXR | ETT should be at aortic knob tip of ETT should be 5-7cm above carina Tip of ETT shold be between T2 and T4 |
| Where should the tip of a triple lumen catheter be located on a CXR | Right atrium |
| Where should a pulmonary artery catheter be located optimally on a chest x-ray | pulmonary artery |
| On a CXR, where will you find the tip of the umbilical artery | L1 |
| An NG tube should be located where on an abdominal xray | T9 |
| If a chest tube is placed in the thorax for removal of air, where should it be found | Anterior, Top |
| Which of the following are clinical findings for a pneumothorax | decreased breath sounds |
| What will cause air bronchograms to occur | Alvelor process |
| Which of the following are clinical findings of CHF | Pleural effusions, crackles |
| Crackles A patient in CHF will have a cardiac: thoracic ratio of what | 2/3 across diaphragm |
| Which of the following are clinical findings of hyperinflation | Hyperresonant percussion Decreased Breath Sounds Barrel Chested |
| Recall the CXR findings of a patient with hyperinflation | Widened Ribs Narrow Heart boarder |
| When a silhouette sign is visible on a CXR, what does it mean ? | Right middle lobe infiltrate |
| Which of the following are indications for CTS | Lung tumors Abcesses Chronic interstial lung disease |
| What is the advantages of CTs | Visualized structure in cross section and will show irregular density Very sensitive test Clarifies confusing pattern |
| Which CAT scan cuts the slices into smaller pieces | High resolution CT scanning (HRCT) |
| Which of the following are indications for MRI | EVALUATES THE HILA BETTER EVALUATES SOFT TISSUE BETTER WHEN THE CT IS INCONCLUSIVE |
| Which of the following are hazards of MRI | Magnetic pulls |
| Which of the following are contraindications for MRI | PACEMAKERS |
| What emits a magnetic resonance signal | H+ |
| Which of the following organs can be tested with an MRI | Brain Spinal cord tenedons |
| How do ultrasounds work? | High frequency sound waves |
| This test can be done on pregnant women | Ultrasound |
| Which of the following are indications for lung scans | pulmonary embolism |
| Which of the following are true regarding the inhalation of Xe-133 | Breath hold for 3-5 min Deep inspiratory hold |
| When a patient has ventilation but no perfusion it is consistent with which pulmonary condition. | Pulmonary emboli |
| What are the hazards associated with arterial line placement? | Air embolism Bleeding Infection |
| Which of the following best describes this technique: A catheter is slide over the needle and into the artery. The needle is then removed leaving the catheter in the artery. The pressure tubing is then attached to the catheter. | Seldinger Technique |
| Which of the following best describes: It occurs with the opening of the aortic valve and contraction of the left ventricle | Volume displacement phase |
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