Review Tests Flashcards
1
Q
Which of the following is the recommended care of the ventilator circuit for prevention of VAP?
- The vent circuit must be changed every 4 days
- Closed sx systems are recommended
- Circuit condensate should be used to instill the patient
- Passive humidifiers can be safely used for 48 hours
A
2 and 4
The ventilator circuit should be changed every 7 days. Closed suction is recommended as you do not have to break the circuit in order to suction. Only distilled water should be used to instill the patient/ Passive humidifier can be used for 48 hours.
2
Q
- Which of the following is the most common cause of community acquired pneumonia?
- Staphylococcus aureus
- Pseudomonas aeruginosa
- Escherichia coli
- Diplococcus pneumonia
A
Diplococcus pneumonia
3
Q
- What question does ethics try to answer
Who is right
What treatment is best
Who benefits the most
How should we act
A
How should we act
4
Q
- A patient on mechanical ventilation has a compliance of 90 mL/cmH2O and an airway resistance of 5.0 cmH2O/L/sec. what is the calculated time constant?
- 45 sec
B.1.35 sec
C. 4.5 sec
D. 450 sec
A
a. 0.45 sec
5. 0 cmH2O/L/sec x 0.09 L/cmH2O= 0.45 seconds
5
Q
Time Constant Equation
A
Compliance x Resistance
6
Q
Which of the following best defines the term sterilization?
a. Use of chemicals to destroy pathogens
b. Process that destroys all forms of microbial life
c. Process of sanitization
d. Use of soap and water to aid in removal of soil/body secretions
A
b. Process that destroys all forms of microbial life
7
Q
During an allergic reaction there is an increase in circulating antibody
a. IgA
b. IgD
c. IgE
d. IgG
e. IgM
A
c. IgE
8
Q
- Which of the following is incorrect in regards to the body’s normal flora
a. They will not cause harm as long as they stay in the expected site
b. They are different from person to person for a given site
c. If they are removed from a site, opportunistic microorganism may take over
d. They are found on the skin and some mucous membranes
Thrush is an example of abnormal flora
A
a. They will not cause harm as long as they stay in the expected site
b. They are different from person to person for a given site
Thrush is an example of abnormal flora
9
Q
Which of the following statement is/are true regarding pressure differences
a. The apical alveoli resting volume is less than basal
b. Pleural pressure at the base is more negative than at the apex
c. Transpulmonary pressure gradient is greatest at apex
d. All state are true
A
c. Transpulmonary pressure gradient is greatest at apex
Apical should be more negative than the basal.
10
Q
Which of the following could result in a higher than normal SvO2
a. Decreased CO -would increase SvO2, more time to pull O2 out
b. Pyrexia - increase in metabolic rate, increase O2
c. Decreased oxygen extraction ratio
d. All of the above
A
c. Decreased oxygen extraction ratio
A higher than normal SvO2 means you are not extracting so a decrease CO means you have more time to pull it out.
11
Q
Which of the following best defines the term sterilization?
a. Use of chemicals to destroy pathogens
b. Process that destroys all forms of microbial life
c. Process of sanitization
d. Use of soap and water to aid in removal of soil/body secretions
A
b. Process that destroys all forms of microbial life
12
Q
During an allergic reaction there is an increase in circulating antibody
a. IgA
b. IgD
c. IgE
d. IgG
e. IgM
A
c. IgE
13
Q
Tank Calculation
A
Duration of Flow =
Oxygen Tank Conversion Factor * Remaining Tank Pressure (psi) / Continuous Flow Rate (L/min)
14
Q
Oxygen Cylinder Conversion Factors
D Tank
A
D Tank = 0.16
15
Q
Oxygen Cylinder Conversion Factors
E Tank
A
E Tank = 0.28
16
Q
Oxygen Cylinder Conversion Factors
G Tank
A
G Tank = 2.41
17
Q
Oxygen Cylinder Conversion Factors
H/K Tank
A
H/K Tank = 3.14
18
Q
Oxygen Cylinder Conversion Factors
M Tank
A
M tank = 1.56
19
Q
Total Arterial O2 Content
A
CaO2= (1.34 x Hb x SpO2) + (PaO2 x 0.003)
20
Q
How to Determine Pt Inspiratory Flow
A
Flow= Volume (L)/time (min)
21
Q
Determining the total flow in a high flow delivery device
A
If air/O2 is for example 30 then it is 8:1 so for every 1 litre of oxygen 8 L is being entrained into the device
for total flow add the two toegther (=9) and then multiple by the set flow
22
Q
Calculating Flow in Liquid Oxygen System
A
Gas Remaining= (Liquid Weight [lb]) x 860/ 2.5 L/Ib
Duration of Contents (min)= Gas Remaining (L)/ Flow (L/min)
Remeber 1 L of Liquid O2 = 2.5 lb
23
Q
PAO2 Calculation
A
[(Pbaro-47) x FiO2] - (PCO2*1.25)
Pbaro in Calgary is 670mmHg
24
Q
PA-aO2 Calculation
A
PAO2- PaO2
Normal in a young adult >4 (5-10)
The A–a gradient will increase with age. For every decade a person has lived, their A–a gradient is expected to increase by 1 mmHg.
A conservative estimate of normal A–a gradient is less than [age in years/4] + 4.
25
PAO2/ PaO2
PAO2/ PaO2
Normal \>0.60
26
P/F Ratio
PaO2/FiO2
Normal 400-500
27
CaO2 Vol%
(Hb x 1.34 x (SO2/100)) + (PO2\*0.003)
Normal 16-20
28
CvO2 Vol%
(Hb x 1.34 x (Sv2/100)) + (Pv2\*0.003)
Normal 12-15
29
C(a-v)O2
CaO2-CvO2
Normal = 5
30
CcO2
(Hb\*1.34) + (PAO2\* 0.003)
Normal = 20
31
VO2 ml/min
CO x Ca-vO2 x 10
Normal 200-300
32
VO2/ml/kg/min
(VO2/ml/min) / Pt body wieght in kg
Normal 3.5-4
33
O2 Del ml/min
CaO2 Vol% \* CO \* 10
Normal 1000
34
O2 Del/kg/min
(O2 Del ml/min) / Pt weight in Kg
Critical is 8-10
35
Qs/Qt% Classic
(CcO2-CaO2)/ (CcO2-CvO2 vol%)
Normal \<10
36
Qt (Fick) L/min
250/ (Ca-vO2\*10)
Normal 5-8
37
Normal Hemoglobin Levels
Men 13.8-17.2
Women 12.1- 15.1
38
Compliance Calculation
Complicance (ml/cmH2O)
= Vt / (Pplat-PEEP)
Normal 60 to 100 ml/cm H2O
39
Resistance Calculation
R= (PIP- Pplat)/ Flow
Use L/sec for flow
40
Minute Ventilation Calculation
MV = Rate \* Vt
On a ventilator try to aim for 10 x IBW
41
FiO2 Required
FiO2 required = (PaO2 Desired \* FiO2 Present) / PaO2 initial ABG
PaO2 Desired is usually established to give a safe SpO2 of between 90% - 95%
42
New PaCO2 Desired
New PaCO2 Desired = Present PaCO2 – [ (pH Goal – pH Present) / 0.01}
pH Goal: is usually established with the physicians orders but should be above 7.25
Note: this equation is used usually to correct for accidosis and is only an approximation
43
MV Required
MV required = (PaCO2 Initial \* MV) / PaCO2 desired
44
I:E
I:E = Ti/Ti : Te/Ti - given has whole numbers ex: 1:4.5
45
TCT
TCT = 60/Rate
46
Ti
Ti = Vt/Flow
Use L for Vt, and L/sec for flow
47
Te
Te = TCT – Ti
48
Ideal Body Weight
Men: Kg = 50 +2.3(height in inches – 60)
Women: Kg = 45.5 + 2.3(height in inches – 60)
49
PA-aO2
A measure of the difference between alveolar concentration of oxygen and the arterial concentration of oxygen.
It is used to diagnose the source of hypoxemia. The measurement helps isolate the location of the problem as either intrapulmonary (within the lungs) or extrapulmonary (elsewhere in the body).
Ex. In high altitude arterial oxygen (PaO2) is low due to the fact that alveolar oxygen PAO2 is also low, where with V/Q mismatch (pulmonary embolism or right to left shunt oxygen is not effectively transferred for alveoli
50
Increased PA-aO2
An increased PA-aO2 suggests a **defect in diffusion, V/Q mismatch, or right to left shunt**
A high A–a gradient could indicate a patient breathing hard to achieve normal oxygenation, a patient breathing normally and attaining low oxygenation, or a patient breathing hard and still failing to achieve normal oxygenation.
If lack of oxygenation is proportional to low respiratory effort, then the A–a gradient is not increased; a healthy person who hypoventilates would have hypoxia, but a normal A–a gradient.
51
A–a gradient and Respiratory Effort
CO2 is easily exchanged in the lungs and a **low PCO2 directly correlates with high minute ventilation**; therefore a low PaCO2 indicates that extra respiratory effort is being used to oxygenate the blood.
A low PaO2 indicates that the patient's current minute ventilation (whether high or normal) is not enough to allow adequate oxygen diffusion into the blood.
Therefore, the A–a gradient essentially demonstrates a high respiratory effort (low arterial PCO2) relative to the achieved level of oxygenation (arterial PO2).
At an extreme, high CO2 levels from hypoventilation can mask an existing high A-a gradient. This mathematical artifact makes A-a gradient more clinically useful in the setting of hyperventilation.
52
What RR to Set
Inital MV Goal/ Vt Goal
53
What Should Be You Inital Goal in MV
IBW x 100
54
. What type of lung unit(s) would result in a long time constant
a. Decreased airway resistance
b. Decrease Elastance
c. Decrease Compliance - causes a decrease in TC
d. Decreased Surfactant - causes a decrease in C
TC = R\*C
**b. Decrease Elastance-Will increase compliance**
TC = R\*C
Decrease Compliance - causes a decrease in TC
Decreased Surfactant - causes a decrease in C
55
Mechanical ventilation is indicated for which of the following blood gases done on room air?
a. pH 7.23, PaCO2 56 mmHg, PaO2 76 mmHg, HCO3 23 mmol/L
b. pH 7.34, PaCO2 46 mmHg, PaO2 51 mmHg, HCO3 24 mmol/L
c. pH 7.31, PaCO2 50 mmHg, PaO2 46 mmHg, HCO3 24 mmol/L
d. All of the above
e. A and B only
a. pH 7.23, PaCO2 56 mmHg, PaO2 76 mmHg, HCO3 23 mmol/L
We are just looking at the cut off of pH of \< 7.25
56
Regarding the thoracic pump, which of the following isnot true
a. During PPV there is an increase cardiac stroke volume
b. During spontaneous breathing there is increase venous return
c. During PPV there is an increased central venous pressure
d. During spontaneous breathing the thoracic pump is most effective during inspiration
a. During PPV there is an increase cardiac stroke volume
During PPV we have an increase thoracic pressure and decreased venous return so we fill up less and then via Starling Law we contract less
57
10. Positive pressure ventilation results in
a. Increase dead-space ventilation
b. Decreased dead-space ventilation
c. Decreased intrathoracic pressure
d. A and C
e. B and C
a. Increase dead-space ventilation
58
The phase variable that begins the inspiratory phase is called ___________ that ends in the inspiratory phase called the \_\_\_\_\_\_\_\_\_
a. Trigger, limit
b. Trigger, cycle
c. Cycle, trigger
d. Limit, cycle
b. Trigger, cycle
59
In a volume controlled breath, as the patient’s compliance increases the pressure _______ and the tidal volume \_\_\_\_\_\_\_\_\_
a. Decrease, Decrease
b. Increase, Remain the Same
c. Decrease, Increase
d. Decrease, Remains the Same
d. Decrease, Remains the Same
60
Starling Law of Capillaries state that
a. The volume of fluid and solutes reabsorbed is normally nearly as large as the volume filtered
b. The volume of fluid and solutes reabsorbed is normally larger than the volume filtered
c. The volume of fluid and solutes filtered at the arterial end is less than the volume of fluid and solutes filtered at the venous end
d. The pressure of the fluids and solutes filtered is normally less than the pressure reabsorbed.
a. The volume of fluid and solutes reabsorbed is normally nearly as large as the volume filtered
61
Which of the following represents the correct pathway of impulse conduction through the heart
a. AV Node, SA Node, Conduction Myofibers, purkinje fibres
b. AV Node, Bundle Branches, SA Node, Purkinje Fibers
c. SA Node, AV Node, Bundle Branches, Conduction fibres
d. SA Node, Bundle Branches, AV Node, Conduction myofibers
c. SA Node, AV Node, Bundle Branches, Conduction fibres
62
The T-Wave in lead II ECG represents
a. Onset of atrial depolarization- P wave
b. Onset of ventricular depolarization-QRS
c. Atrial repolarization-Will get lost in QRS complex
d. Ventricular repolarization
d. Ventricular repolarization
63
main pressure promoting reabsorption of fluid into the capillaries is the:
a. Osmotic pressure of interstitial fluid
b. Hydrostatic pressure of the interstitial fluid
c. Osmotic pressure of the capillary
d. Hydrostatic pressure of capillary
e. Oncotic pressure of interstitial fluid
**c.** **Osmotic** **pressure of the capillary**
## Footnote
Hydrostatic pressure of capillary - pressure due to fluid - will push fluid out
Osmotic pulls fluid in (caused by solute concentration); oncotic pushes fluid out (due to difference in protein concentration)
64
Pursed lip breathing when done properly, may result in which of the following
a. Equal pressure point moves down to smaller airways-Will move to the larger airways
b. Decreased early airway collapse
c. Increase expiratory flow rates-We are adding an obstruction to the flow
d. B and C
b. Decreased early airway collapse
65
A blending device is mixing 11.3 L of air with 4.7 L of oxygen. What FiO2 is the device producing?
a. 0.4
b. 0.45
c. 0.5
d. 0.55
b. 0.45
## Footnote
(11.3 L (air) \* 0.21 + 4.7 L (O2)) / 16 = 0.44
66
When we are using a full “D” tank oxygen cylinder for transport. The clinician set the flow rate on prongs to deliver 4 LPM; the approximate duration of flow would be
a. ~15 min
b. ~30 min
c. \>1 hour
d. \>2 hour
c. \>1 hour
## Footnote
D = 0.16 L/psi
2200 psi or (subtract 500 for safety buffer) = 1700 psi → answer works for both
67
Which of the following statement is/are true regarding cyanosis
a. Polycythemia patient may show signs of cyanosis but may not be hypoxemic
b. All polycythemic patient that show signs of cyanosis are hypoxemic
c. In anemic patients, cyanosis is an early indicator of hypoxemia
d. All of the above are true
a. Polycythemia patient may show signs of cyanosis but may not be hypoxemic
68
A patient has been admitted to the coronary care unit after a myocardial infarction involving left side of the heart. The following information is collected from ABG while the patient is on room air. Hb 154 g/L
pH 7.48, PaCO2 31 mmHg, PaO2 54 mmHg, HC3 22 mmol/L, BE -1, SaO2 87%
What are the indications for O2 therapy for this patient?
i) Hypoxemia
ii) Hypercarbia
iii) To decrease myocardial workload
iv) Anxiety
1 and 3
69
A young man presents to ER in Red Deer (667 mmHg) with neck trauma after bike crash. Given O2 via mask (FiO2 0.8). Initial ABG: 7.32/54/
A-a DO2?
388
348
362
484
362
70
Keeping the absolute humidity constant. As the temperature of the air ___ the relative humidity will \_\_\_\_\_\_.
Increase, increase
Increase, decrease
Decrease, decrease
A & C
None of the above
Increase, decrease
## Footnote
Temp increase can hold more water, but abs. Is constant
71
# Choose the true statements regarding Bourdon pressure gauges.
i) a coiled metal tube has a sub-atmospheric pressure introduced to it
ii) the display needle should periodically be “zeroed”
iii) are used to measure changes in pressure
iv) will straighten in response to an increase in pressure
ii, iii, iv
72
The CARTA code of Ethics instructs us to “guard against conflicts of professional interest” and to specifically consult the _______________________ to prevent a real or perceived conflict of interest? Who is the individual/or department that Alberta RRTs are to consult?
The Alberta Health
The CARTA Registrar
The alberta department of justice
Your employer
The CARTA Registrar
73
To maintain your clinical competency in Alberta you must complete _______ hours of practice over a five year period. How many hour of practice are needed?
a. 48
b. 500
c. 720
d. 1600
c. 720
74
Bess is a 73 year old woman who has come into the emergency department complaining of severe chest pain and SOB. SpO2 is 77% on room air. You put her on 5 LPM oxygen via nasal cannula and begin your assessment. You observe that she is a heavy set woman who is currently sitting up with her arms pressed straight down on the mattress. She has obvious accessory muscle use and is markedly cyanotic around the lips. She has a productive cough, and is bringing up thick yellow sputum. When you ask her is she normally has a productive cough, she says usually she cough up about a half a cup of grey sputum in the morning. Her cough is generally more prevalent through the winter months. She has a RR of 37 bpm and a pulse rate of 130 bpm. Her temp is 38.8 C and SpO2 is now 87%. Bess describes her chest pain as “sharp and stabbing” and gets worse with inhalation. She is speaking in 2 word sentences.
28. Based on your finding so far, what is most likely to be Bess’ underlying diagnosis
a. COPD, Chronic Bronchitis
b. COPD, emphysema
c. COPD, asthma
d. COPD, bronchiectasis
e. Cystic Fibrosis
a. COPD, Chronic Bronchitis
## Footnote
Sputum is grey, which is often seen in chronic bronchitis. Grey in the sputum indicates dead cells.
Bronchiectasis can have a dry cough or a lot of sputum
The fever hints more towards chronic bronchitis
Ways to make this question better- Add in a ABG to show and acute on chronic condition. Add into case stem that the sputum is smelling. And/or include and x-ray report which will not show any dilation.
Your will mostly find the difference between chronic bronchitis and bronchiectasis in the x-ray
75
skeptical of her asthma diagnosis. Why?
i. Asthma is usually diagnosed before the age of 40
ii. The cough she describes is a cardinal sign of bronchiectasis
iii. If she had asthma, swallowing the little pills would help
iv. The grey puffer is not usually prescribed to asthmatics
v. Cigarette smoking is not causal for asthma
I, IV, V
76
What is the root cause of the distended neck veins, severely clubbedfingers and pitting peripheral edema?
a. Severe chronic hypercapnia
B. Severe chronic acidemia
C. Severe chronic hypoxemia
D. Severe chronic hypocapnia
C. Severe chronic hypoxemia
77
Bess likely has:
Left ventricular insufficiency
Cor pulmonale
Right sided heart failure
None of the above
b and c
b and c
78
Once the CVP is in place, the transducer is leveled appropriately and zeroed. The monitor is showing a good waveform, with an a wave, …
Volume overload
Pulmonary hypertension
VSD
Pulmonary embolism
Pulmonary hypertension
79
As you are monitoring Bess you notice that her “a” wave has disappeared from her CVP waveform. This is an indication that:
a. The transducer is sitting below the level of the right atrium
b. Bess has stopped breathing
c. The tricuspid valve is incompetent causing regurgitation of blood into right atrium
d. The atria are not contracting, Bess is in atrial fibrillation
d . The atria are not contracting, Bess is in atrial fibrillation
80
Intrepret this ABG
ABG: pH 7.56, PaCO2 26 mmHg, PaO2 61 mmHg, HCO3 22 mmol/L, BE 1, SaO2 90
c. Uncompensated respiratory alkalosis
81
Minimum flow rate for simple mask
5 LPM is the minimum flow rate for a simple mask so that it can flush out the CO2.
82
) Which of the follow is recommended for initial mechanical ventilator settings? Pt is unconscious, sedated and medically paralyzed
a. CMV VC, f 16 br/min, Vt 550 mls, PEEP 5
b. IMV VC, f 14 br/min, Vt 750 mls, PEEP 5
c. CMV APV, f 18 br/min, Vt 600 mls, PEEP 3
d. CSV PC, pressure support 10 cmH2O, CPAP 5
a. CMV VC, f 16 br/min, Vt 550 mls, PEEP 5
83
It is determined the patient has a refractory hypoxemia, which of the following would be the course of action at this time
a. Increase FiO2
b. Increase RR
c. Increase the tidal volume
d. Increase the PEEP
d. Increase the PEEP
84
You are paged to the ED to assess a patient brought in
VS: Bp 158/108 mmHg, pulse 137 bpm and irregular. Her oxygen
38. Which of the following is the correct action given the patients oxygen status.
1. Apply a 50% air entrainment ventimask system to maximize forward flow
2. Apply a 70% large vol neb bc she is breathing so rapidly, she will soon become dehydrated
3. Apply a nrb bc it’s quick and easy to set up
4. Do not start O2, she may be a CO2 retainer
1. Apply a nrb bc it’s quick and easy to set up
85
Her elevated HR may be due to
Stimulation of the parasympathetic branch of the autonomic nervous system
Secondary to the pain she is in
Due to an attempt by her heart to maintain cardiac output
All of the above
b & c
b & c
86
The CXR in addition to confirming the flail, shows a large white area obscuring the lower half of the left lung and blunting of the costophrenic angle. The ED physician also makes note of these findings and asks you to assist with the insertion of a chest tube.
40. What could cause blunting of the costophrenic angle in this case?
Pneumothorax
Pneumomediastinum
Hemothorax
All of the above
A & B
Hemothorax
87
Give the substance to be drained, it is more probable that the physician will insert a large bore chest tube
Into the 2nd intercostal space, mid-clavicular line
Superiorly, as air rises
Inferiorly, as fluid is gravity dependent
Along the inferior surface of any rib
Inferiorly, as fluid is gravity dependent
88
You set up a drythoracic drainage unit. How much water will you put into the suction control chamber?
a. None
b. Fill it to 2 cm
c. Fill it to the 20 cm mark
d. Start at 10 cm and slowly
a. None
89
The patient is intubated and placed on a mechanical ventilator, during a mandatory inspiration you observe tidaling in the underwater seal of the thoracic drainage unit. Which direction is it observed?
Move towards the suction control chamber
Moves toward the patient
Moves away from the patient
Tidaling should never be observed in the underwater seal
Moves away from the patient
90
What is the mode of action of singulair
a. B2 Selective Bronchodilator
b. Anti-inflammatory Leukotriene Receptor
c. Oral Corticosteroid
d. IgI Blocker
b. Anti-inflammatory Leukotriene Receptor
91
A 25 year old female was admitted to the emergency department in hemorrhagic shock following a gunshot wound. She received fluid administration to treat her bleeding and was stabilized. Following placement of a pulmonary artery catheter the following data was collected. Interpret the hemodynamic data.
PAP 48/32 mmHg
PCWP 22 mmHg
CVP 15 mmHg
C(a-v)O2 2.6%
1. Cor pulmonale
2. Pulmonary hypertension
3. Hypervolemia
4. Hypovolemia
Hypervolemia
## Footnote
PAP is high PCWP is high CVP is high (backing up to right side of the heart). C(a-v)O2 is low. Her blood is diluted because she was given too much fluid.
92
Which of the following is/are the major characteristic of increased alveolar dead=space
Minute ventilation out of proportion to PaCO2
Decreased WOB
Hyperoxemia
FiO2 \>0.50 and PaO2 \<50 mmHg
A and C only
Minute ventilation out of proportion to PaCO2
Increase amount of air that is not participating in gas exchange so you are moving more air in and less air out, you would have increased WOB, you would have hypoxemia not hyperoxemia.
93
Which of the following is the body’s main means of heat loss at high environmental temperatures?
Evaporation
Conduction
Convection
Radiation
Evaporation
94
Which of the following statements refer to EF?
The portion of EDV ejected on each beat
Amount of blood in the ventricle at end of diastole
Amount of blood ejected into the ventricle after each atrial contraction
All of the above
A and C only
The portion of EDV ejected on each beat
Most of atrial contraction is passive which is why the amount of blood ejected into the ventricle after the atrial contraction will not be equal to portion EDV ejected.
95
Amphotericin B is used to treat:
Systemic bacterial infections
Systemic Fungal infections
Pulmonary fungal infections
B and C only
B and C only
96
Which of the following describes a mode of ventilation that would best preserve tidal volume when a patient’s lung/thorax compliance increases?
Pressure cycled
Pressure limited, time cycled mode
Volume limited, time cycled mode
Pressure limited, flow cycled mode
Volume limited, time cycled mode
If compliance decreased the answer would be the same.
97
Which of the following does not cause an increase in measured pcwp?
Hypervolemia
Left ventricular failure
Mitral stenosis
3rd spacing
3rd spacing
## Footnote
3rd spacing would result in a lower wedge pressure
98
You have a liquid system and a patient that requires a flow of 4 LPM. The liquid oxygen unit weighs 4100g. How long does the patient have for their oxygen usage?
Approximately 8.3 hours
Approximately 9.5 hours
Approximately 11 hours
Approximately 13.3 hours
None of the above
Approximately 13.3 hours
## Footnote
1 L(liq) = 1.1 kg(liq); 1L liq = 860 L gas
99
In the face of significant back-pressure, which of the following devices would read accurately?
A device with a needle valve and a multiple orifice flowmeter.
A device with a needle valve and a variable orifice flowmeter.
A regulator with a bourdon gauge pressure and flowmeter.
A regulator with a set pressure and multiple orifice flowmeter.
A device with a needle valve and a variable orifice flowmeter.
Thorpe tube
100
Which of the following cannot easily be configured to be a fixed performance device at low FiO2’s?
1. Nasal cannula
2. Large volume cold neb
3. Air entrainment mask/ventimask
4. Simple mask
1, 4
101
Of the following, the proper device to supply humidified oxygen for a spontaneously breathing patient with an endotracheal tube in place is?
Venti mask with entrained aerosol/humidity
Venti mask with trach adaptor
LVN with a trach cradle
LVN with a t-piece
LVN with a t -piece
102
. A patient is breathing a rate of 12 br/min. Their tidal volume is 450 mL/breath, and they are on a large volume nebulizer at an FiO2 of 0.35 with a set O2 flow of 12 LPM. Is this likely to be a fixed performance device AND what approximate FiO2 is the patient receiving?
Yes/=0.35
No/\<0.35
No/\>0.35
Cannot calculate
Yes/\<0.35
Yes/=0.35
## Footnote
Magic box: 64 lpm total flow rate, TCT = 5, if I:E = 1:2 (assumed), ti = 1.67s
.450L / 1.67s = 0.28L/s = 16.9 lpm
If the flow being delivered (64 lpm) is higher than the flow the patient is generating (16.9 lpm), it is a fixed device.
\* When information is given to us about a patient’s breathing pattern, it is more than just determining a fixed performance device using the “rule of 60”. We must consider how they are breathing. This patient is breathing at a slower rate, indicating that he’s not that air hungry, and so giving us a better idea that the flows that they are generating are not that high (and therefore, the flows being delivered are likely higher than what the patient is generating). If the patient was breathing at a faster rate, this would change their I:E, therefore changing the flow the patient is generating, potentially changing whether or not the device is fixed for them.
103
Patients on high FiO2s that suddenly experience mucous plugging of a large airway are in danger of:
Increased dead-space ventilation
Decreased CO
Absorption atelectasis
Absorption atelectasis
104
Entering a patient care room you see the cold neb (CN) is set to deliver 28% oxygen and the oxygen flow meter is set at 6 LPM. The total flow from the CN is:
24 LPM
32 LPM
48 LPM
60 LPM
72 LPM
60 LPM
105
What is the RH when the AH is 15 mg H2O/L and the capacity of a gas is 20.6 mg H2O/L?
15%
20%
30%
72%
72%
106
Regarding the cardiac waveform below, please identify where the distal port of the PAC catheter is sitting at the section of the waveform labeled “A”?
Pulmonary artery
Proximal port would be R. atrium
107
Application of nasal CPAP to neonates can:
Be used to treat apnea associated with intraventricular hemorrhage
Treat babies with necrotizing enterocolitis
Be used immediately post-extubation
Used immediately post-delivery in babies with congenital diaphragmatic hernia
None of the above
Be used immediately post-extubation
108
Defibrillation:
Results in depolarization of just the ventricles
Is an effective electrical treatment for ventricular fibrillation
Can be used to treat asystole
B and C only
Is an effective electrical treatment for ventricular fibrillation
109
What effect do glucocorticoids have on beta adrenergic receptors?
No effect
Stimulates B2 receptors to relax bronchial smooth muscles
restores/enhances responsiveness of B2 receptors to B2 specific agents
Inhibits mast cell release
restores/enhances responsiveness of B2 receptors to B2 specific agents
110
COPD pts who have OSA:
Have worse nocturnal desats compared to someone with only OSA
Often have nocturnal hypoventilation due to impaired ventilatory mechanics during sleep
Have a higher rate of mortality then someone who has only OSA
All of the above
A and C only
All of the above
111
Which of the following is a contraindication to hyperbaric therapy?
Cleft palate
Pleural effusion
Pneumothorax
Restrictive lung disease
Pneumothorax
112
Which of the following is considered the main mechanism by which hypertonic aerosols aid mucociliary clearance?
Increased stimulation of the irritant cough reflex
Alterations of peak insp airway resistance
Enhanced sensory somatic nervous impulses
Altering the pH level
Increased stimulation of the irritant cough reflex
113
Any device used for chest drainage must have which basic component:
A separate underwater seal chamber
Continuous low suction
Collection chamber placed below the insertion site to facilitate gravity drainage
A suction control chamber filled with water
A separate underwater seal chamber
Water seal is a one way valve
114
Which of the following statement is true regarding DPI?
They are good for all age groups
They do not require a spacing device
Laminar flow from the use during inspiration is needed to create an aerosol
They are cumbersome to carry
They do not require a spacing device
115
A 79 year old male presents to the ER, he is currently sitting on the edge of the bed leaning forward. On exam: he has an increased AP thoracic diameter, a prolonged expiratory phase, is using his accessory muscles and is pursed lip breathing. He complains of shaking chills last evening and SOB at rest. He states that he smoked 1.5 packs/day of cigarettes for 35 years but that he quit smoking 10 years ago.
30. Which of the following should be assessed first?
Sputum collection for C&S
RR
ABG
Auscultation
RR
116
Based on his initial presentation, what type of lung disease is predominate in this patient?
Restrictive lung disease due to suspected pneumonia
Obstructive lung disease due to apparent pneumonia
Infectious lung disease due to apparent pneumonia
Obstructive lung disease secondary to cigarette smoking
Restrictive lung disease secondary to cigarette smoking
Obstructive lung disease secondary to cigarette smoking
117
Coronary artery disease may be diagnosed with which of the following?
Cardiac enzymes
V/Q scan
Cardiac angiogram
All of the above
a and c only
Cardiac angiogram
118
In compensating for heart failure, the body will:
Increase blood volume
Dilate the peripheral vasculature
Decrease the HR
Increase the urine output
Increase blood volume
119
Which of the following is a risk factor for the development of an aortic aneurysm?
Systemic HTN
COPD
Family history of AAA
All of the above
a and c only
a and c only
120
Your patient has a severe tricuspid valve stenosis. A hemodynamic profile consistent with this would be:
CVP 14 mmHg, PAP 35/29 mmHg, PCWP 4 mmHg
CVP 2 mmHg, PAP 10/6 mmHg, PCWP 4 mmHg
CVP 14 mmHg, PAP 11/6 mmHg, PCWP 3 mmHg
CVP 16 mmHg, PAP 33/26 mmHg, PCWP 21 mmHg
CVP 19 mmHg, PAP 19/12 mmHg, PCWP 7 mmHg
CVP 14 mmHg, PAP 11/6 mmHg, PCWP 3 mmHg
121
The major pathophysiology seen in a near, wet-drowning is:
Non-cardiogenic pulmonary edema
Cardiogenic pulmonary edema
Hypovolemic shock
Laryngospasm
Non-cardiogenic pulmonary edema
122
Hyperventilation as a therapy for an acute head injury is used for its _____ effects and _____ cerebral blood flow.
Vasodilatory, increases
Vasoconstrictory, increases
Vasodilatory, decreases
Vasoconstrictory, decreases
Vasoconstrictory , decreases
123
Given the following data:
Mode: PRVC
FiO2: 0.80
Set Vt: 600 mL
RRset: 12
PEEP: 5
Ti: 1.20 sec
Vtexhaled: 540 mL
RRmeasured: 16
PIP: 36 cmH2O
Pplat: 26 cmH2O
The patient’s static compliance is:
17. 4 mL/cmH2O
23. 1 mL/cmH2O
25. 7 mL/cmH2O
28. 6 mL/cmH2O
25.7 mL/cmH2O
## Footnote
Vtexhaled is measured back at the ventilator, and because of the change in temperature that the exhaled gas undergoes leads to a change in volume, which is why the Vtexhaled is always lower than the Vtset. We SHOULD use the Vtset.
124
# Define volatile anesthetic agent
Molecules of a liquid that break away and enter the space at the top of the vaporizer
Pressure created when the molecules bombard the walls of the container
Molecules entering the liquid phase
Liquid that has a tendency to change to a vapor at standard temperature and pressure
Liquid that has a tendency to change to a vapor at standard temperature and pressure
125
Which of the following additives to spinal anesthesia will help provide postoperative analgesic properties?
Lidocaine
Bupivicaine
Cocaine
Fentanyl
Fentanyl
126
What stage of sleep is characterized by deep, restorative sleep?
Stage 1 NREM
Stage 2 NREM
Stage 3 NREM
REM
Stage 3 NREM
127
A rigid bronchoscope is the preferred type of scope for/if:
The removal of a large foreign body
A difficult intubation is expected
Examination of the lung apices are needed
Visualization of the lower portions of the respiratory tract is required
The removal of a large foreign body
128
Which of the following is considered therapeutic bronchoscopy?
BAL
Bronchial samples for C & S
Bronchial toileting
Needle aspiration
Bronchial toileting -same as lavage
C&S, Needle aspiration are to collect samples. Bronchial toileting is therapeutic
129
Albumin plays many essential roles in the body. 2 of these roles include:
Maintaining osmotic pressure gradients, and molecular transport
Molecular transport, and metabolizing denatured proteins
Opposing osmotic pressure gradients, and combating liver disease
Maintaining renal output, and supporting molecular transport
Maintaining osmotic pressure gradients, and molecular transport
130
The electrolyte most closely tied to cardiac arrhythmias when its level is out of normal range (either too high or low) is:
Sodium
Chloride
Potassium
Hydrogen ion
Potassium
131
Assessment of an area of consolidation in the lung would most likely reveal:
Dull percussion
Tracheal deviation
Decreased fremitus
Late inspiratory crackles
Dull percussion
## Footnote
Could be late inspiratory crackles too
132
In which of the following modes of ventilation will effective tidal volume vary the most with changes in patient resistance of compliance?
Pressure-regulated volume control
CMV with autoflow
Volume support
Pressure support
Pressure support
133
Aerosol deposition in the distal airways can be improved with:
Deep, slow insp flow breaths
Deep, fast insp flow breaths
Shallow, slow insp flow breaths
Shallow, fast insp flow breaths
Deep, slow insp flow breaths
## Footnote
MDI
The slower the movement, the less inertial impaction
134
The following pressure-time waveform indicates:
High airway resistance
135
Exercise training in patients wiht COPD improves:
Exercise capacity
Psychologic state
Pulmonary function
A and B
All of the above
A and B
## Footnote
Lung mechanics wouldn’t actually change
136
Tank Calculation
Duration of Flow =
Oxygen Tank Conversion Factor \* Remaining Tank Pressure (psi) / Continuous Flow Rate (L/min)
137
Oxygen Cylinder Conversion Factors
D Tank
D Tank = 0.16
138
Oxygen Cylinder Conversion Factors
E Tank
E Tank = 0.28
139
Oxygen Cylinder Conversion Factors
G Tank
G Tank = 2.41
140
Oxygen Cylinder Conversion Factors
H/K Tank
H/K Tank = 3.14
141
Oxygen Cylinder Conversion Factors
M Tank
M tank = 1.56
142
Total Arterial O2 Content
CaO2= (1.34 x Hb x SpO2) + (PaO2 x 0.003)
143
How to Determine Pt Inspiratory Flow
Flow= Volume (L)/time (min)
144
Determining the total flow in a high flow delivery device
If air/O2 is for example 30 then it is 8:1 so for every 1 litre of oxygen 8 L is being entrained into the device
for total flow add the two toegther (=9) and then multiple by the set flow
145
Calculating Flow in Liquid Oxygen System
Gas Remaining= (Liquid Weight [lb]) x 860/ 2.5 L/Ib
Duration of Contents (min)= Gas Remaining (L)/ Flow (L/min)
Remeber 1 L of Liquid O2 = 2.5 lb
146
How long should it take to complete on circuit of the NRP algorithm? (from birth to administration of first dose of epinephrine?
30 sec
60 sec
90 sec
120 sec
150 sec
90 sec
147
How often should you be evaluating the patient according to the NRP algorithm?
Ever minutes
Every 2 minutes
Every 15 sec
Every 30 sec
Whenever there is a change in the patient’s status
Every 30 sec
148
Restoration of adequate ventilation usually will result in _______ improvement in heart rate?
Rapid
Gradual
Slow
Rapid
149
a term newborn is apneic with a HR of 55 bpm you should?
Give supplemental oxygen
Provide positive pressure ventilation
Administer chest compressions
Both b and c
All of the above
All of the above
150
If a newborn has meconium stained amniotic fluid and has been vigorous since delivery you should?
Suction mouth and trachea
Clear mouth and nose of secretions
Dry, stimulate and reposition
Both b and c
All of the above
Both b and c
151
A newborn that is born at term, has no meconium in the amniotic fluid or on the skin, is breathing well, and has good muscle tone\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ need resuscitation.
Does
Does Not
Does Not
152
If a newborn is still not breathing after a few seconds of stimulation. The next action should be to administer\_\_\_\_\_\_\_\_\_\_
Additional stimulation
Positive Pressure ventilation
Compressions
Only b and c
All of the above
Positive Pressure ventilation
153
Which of these would be your first actions if the HR remains below 60 bpm, despite administration of ventilation and chest compressions?
Ensure ventilation is being given properly
Ensure chest compressions are being given optimally
Ensure that you are using 100% oxygen
Give the patient epinephrine.
Only a,b, and c.
Only a,b, and c.
154
What concentration of epinephrine should you use during resuscitation?
1: 10
1: 100
1: 1,000
1: 10,000
None of the above.
1:10,000
155
What dose of epinephrine should you instill through the ETT during resuscitation?
0. 1 ml/kg
0. 01 mg/kg
10 ml/kg
1.0 ml/kg
Both a and b
Both a and b
156
If you have a 4.1 kg newborn patient requiring epinephrine how much should you instill through the ETT? (type in the amount to one decimal place no need to state ml)
0.3
157
How often can you repeat the dose of epinephrine if the patient does not respond with an increased HR?
Every 30 seconds
Every minute
Every 3 minutes
Every 5 minutes
Both c and d
Both c and d
158
How soon should you check the HR after administration of epinephrine?
Every 30 seconds
Every minute
Every 3 minutes
Every 5 minutes
Both c and d
Every 30 seconds
159
What should you do if you suspect a patient’s airway is blocked due to Robin Syndrome?
Intubate the trachea
Prone position the baby
Provide PPV with increased pressures
Both b and c
Prone position the baby
160
Which of these is a contraindication for giving Naloxone?
Mother is addicted to narcotics
Mother has been given narcotics within the last 4 hours
Baby has normal HR and color with PPV
Baby presents with recurrent respiratory depression
Mother is addicted to narcotics
161
A 38 week gestation neonate (2750 g) is ventilated on the Hamilton G5. Settings:
Mode: P-CMV
PCset: 18 cmH2O
PEEP: 7 cmH2O
VtE: 14 mL
Ti: 0.40 sec
RRset: 40 bpm
RRtotal: 47 bpm
FiO2: 0.55
ABG: 7.34 / 40 / 68 / 21 / -4.2 / 94%
Based on this information, the best change to the vent settings would be:
Increase RR
Increase PC level
Decrease PC level and decrease FiO2
Decrease PC level and decrease PEEP
Decrease RR and decrease FiO2
Decrease PC level and decrease FiO2
ABG goals for term babies → pH 7.25, CO2 45-55
Decrease PCset → 18+7 = 25, would want to decrease to a total of 18 to reach into the weaning parameters
162
You are ventilating an adult patient (IBW 75 kg) who had H1N1 pneumonia. Normal ABGs and SpO2 \>/= 90% are currently targeted
Mode: APRV
PHigh: 28 cmH2O
Plow: 0 cmH2O
Thigh: 5.5 s
Tlow: 0.5s
FiO2: 0.60
VTE: 610 ml
ABG: 7.28/52/61/24/0/91%
Based on the information the best change to the ventilator settings would be:
Increase Thigh
Decrease Thigh
Increase Phigh
Decrease Phigh
Decrease Thigh
163
You are ventilating an adult patient (IBW 70 kg) in APRV. The patient had developed ARDS secondary to sepesis and is now resolving. Normal ABGs and SpO2 \>/= 90% are being targeted.
Mode: APRV
Phigh: 26 cmH2O
Plow: 0 cmH2O
Thigh: 5.0 s
Tlow: 0.5 s
FiO2: 0.40
VTE: 575 ml
ABG: 7.46/33/97/24/0/98%
Based on the information, when weaning this patient within APRV the strategy would include:
Decreasing Thigh, decreasing Phigh
Increasing Thigh, decreasing Phigh
Increasing TLow, decreasing Phigh
Increasing Thigh, increasing Tlow
Increasing Thigh, increasing Tlow
164
A neonatal patient is ventilated on the sensorimedics 3100A. If the patient’s ETT were to become kincked you would expect:
The SpO2 to decrease
The adjustable high MAP alarm to be activated\
The adjustable low MAP alarm to be activated
The dump valve to open
B and d
The SpO2 to decrease
No alarms for obstructed tubes on oscillators.
165
A 27 week neonate is ventilated on the Sensormedics 3100A
Frequency: 13 Hz
MAP: 11 cmH2O
Amplitude (change in P): 18 cmH2O
I time %: 33%
FiO2: 0.60
ABG: 7.22/58/46/23/82%
Which of the following changes to the oscillating settings would help to return the blood gas values to goal ranges?
Increased amplitude, decreased MAP
Decreased amplitude, decreased MAP
Increased amplitude, increased MAP
Decreased amplitude, increased MAP
Increased amplitude, increased MAP
166
You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change tidal volume
Decrease
167
You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change Minute volume
Decrease
168
You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change PaCO2
Increase
169
You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change PaO2
No Change
170
Prone positioning may be part of a ventilation strategy for which of the following patient conditions:
ARDS
Pneumonia
Severe asthma exacerbation
All of the above
a and b only
a and b only
171
You are ventilating a 70 kg patient with the following settings:
Mode: MMV
RRset: 12
RRtotal: 26
Vtset: 560 mL
Vtspont: 280 mL
PEEP: 10 cmH2O
FiO2: 0.45
PS: 10 cmH2O
Current orders: ventilate to pH 7.35 - 7.45, PaCO2 35 - 45, keep SpO2 \> 90%
Current ABG: 7.29 / 56 / 64 / 26 / -1 / 91%
What changes could be made to correct this ABG?
Increase RRset to 15
Increase Vtset to 690 mL
Increase PEEP to 12 cmH2O
Increase PS to 17 cmH2O
Increase PS to 17 cmH2O
172
For a healthy individual, the expected difference between points C & D (on the above diagram is 3-5mmHg of CO2, what does point D represent?
The partial pressure of CO2 dissolved in arterial blood
173
What Does the Shaded Area Represent
CO2 from alveoli experiencing decreased capillary blood flow
Not all cells of the lung participate in gas exchange, but still need O2 for metabolism, so CO2 from these cells add to the CO2 level. Shunt and alveolar deadspace contribute to the PaCO2. Everything below dotted line is due to alveolar deadspace, above the line is shunt
Vd/Vt = (PaCO2 - PECO2)/ PaCO2 → enghoff (all the shaded area)
Vd/Vt = (PACO2 - PECO2) / PACO2 --\>bohr (true alv. Deadspace -assumes gas exchange did occur)
174
Increase the % support
175
You have a pt that is complaining of chest pain and on 4 LPM O2 and nitroglycerin. He has been stable and comfortable for the last hour when you assess him he is responsive alert RR 16 and BP 138/87 with the following rhythm what should you do
Should request cardiology consult
176
A patient is symptomatic with the following rhythm what should you do
Cardiovert
177
Your patient is currently on an SBT. Approx 15 minutes into the trial you observe that his RR has increased from 18 to 25 and he seems to be working using more accessory muscles to breathe. In that same amount of time your volumetric capnograph has shown an increase in VtCO2. What should you do for patient?
This is a normal response to the imposed WOB of the SBT. Continue SBT
This is an abnormal response to the imposed WOB of the SBT. Discontinue the SBT
The increase in VtCO2 correlates with an increase in PaCO2 and the patient is failing. Discontinue the SBT
The VtCO2 is an indication of how much CO2 is present in exhaled gas at any given time and normally increases from the start of exhalation to the end of exhalation. Continue the SBT
This is a normal response to the imposed WOB of the SBT. Continue SBT
Workload goes up, CO2 goes up → appropriate change (if CO2 decreased, patient is tiring out → stop)
D. doesn’t explain the changes we saw. It’s true for every breath.
178
Calculating deadspace volume
Use Vd/Vt = (PaCO2 - PECO2)/ PaCO2
PECO2 = (Pbaro - 47) \* FECO2
→ FECO2 from etCO2
Vd/Vt \* Vt = Vd
179
You have stabilized a bradycardic patient in third degree heart block using TCP at a rate of 60 bpm. Mechanical capture has been confirmed. The patient remains hypotensive. Your next action would be to:
Increase the mA setting
Increasing the rate of pacing
Start an infusion of epinephrine
Cardiovert the patient at 50 J
Increasing the rate of pacing
180
A neonate is being managed immediately post-delivery. They are receiving ventilaion by mask with a good technique and are not improving after 2 min. The mask seal is verified yet the heart rate remains 85 bpm and there is poor chest movement. The next action should be:
Perform endotracheal intubation
Perform chest compressions
Give epinephrine
All the above
Perform endotracheal intubation
181
A baby is born and placed on the radiant warmer. You immediately note no crying, limp tone, and gasping respirations. Your first action should be to:
Dry and stimulate the baby
Provide PPV
Perform intubation
Provide O2 therapy
Dry and stimulate the baby
182
A 28 year old female is delivering a 39 week infant, pre-natal care was followed. The membranes ruptured 5 hours ago and the fluid is clear, she has received fentanyl 30 minutes prior to delivery. Baby is placed under the warmer, positioned, airway cleared, dried and stimulated. HR is 110, no tone, no respiratory effort. Which of the following is the next action?
Give narcan
Intubate
Provide tactile stimulation
PPV
Initiate chest compressions
PPV
183
A 2 year old child is seen in the ER of a local hospital and diagnosed with croup. The physician orders a dose of aerosolized epinephrine via small volume nebulizer. What size aerosol particle is most likely to provide the greatest therapeutic benefit to the patient?
Particles \> 10 um
Particles 5 - 10 um
Particles 2 - 5 um
Particles 0.8 - 3 um
Particles 5 - 10 um
184
You are delivering a mixture of 30:70 heliox continuously to a patient with a non-rebreather. The O2 flowmeter reads 12 lpm. What flow is being delivered to the patient?
12 lpm
22 lpm
19 lpm
8 lpm
19 lpm
185
A 10 kg child requires salbutamol; the order is for 0.03 mL/kg. How many mL of solution will you need?
0. 3 mL
0. 03 mL
3 mL
30 mL
0.3 mL
186
Common uses for inhaled nitric oxide include all of the following except:
ARDS
PPHN
Primary pulmonary hypertension
Status asthmaticus
Status asthmaticus
187
An asthmatic girl has been using a SVN for Ventolin treatment for the past few years. Her prescription was to use 2.5 mg. How many puffs with an MDI and spacer should she use?
2
5
8
10
5
188
Nebulized epinephrine has been ordered for a child with croup in the ED. You draw up 5 mL from a multidose vial that reads 1:1000 epinephrine. How many mg of epi is in the solution that is drawn up?
10 mg
5 mg
2. 5 mg
0. 5 mg
5 mg
189
One of these statements about methemoglobinemia is NOT correct
Causes blood to appear rusty brown
Causes SpO2 to be erroneously high
Is defined as metHg of over 10%
Can be treated with methylene blue
Is defined as metHg of over 10%
190
Deadspace Equation
191
Shunt Equation
192
Mean Airway Pressure Formula
193
Which of the following best defines the term sterilization?
a. Use of chemicals to destroy pathogens
b. Process that destroys all forms of microbial life
c. Process of sanitization
d. Use of soap and water to aid in removal of soil/body secretions
b. Process that destroys all forms of microbial life
194
During an allergic reaction there is an increase in circulating antibody
a. IgA
b. IgD
c. IgE
d. IgG
e. IgM
c. IgE
195
Which of the following statement is/are true regarding pressure differences
a. The apical alveoli resting volume is less than basal
b. Pleural pressure at the base is more negative than at the apex
c. Transpulmonary pressure gradient is greatest at apex
d. All state are true
c. Transpulmonary pressure gradient is greatest at apex
Apical should be more negative than the basal.
196
Which of the following could result in a higher than normal SvO2
a. Decreased CO
b. Pyrexia
c. Decreased oxygen extraction ratio
d. All of the above
c. Decreased oxygen extraction ratio
## Footnote
SvO2 (O2 stays in blood ) A higher than normal SvO2 means you are not extracting so a decrease CO means you have more time to pull it out.
Decreased CO -would increase SvO2, more time to pull O2 out
Pyrexia - increase in metabolic rate, increase O2
197
arterial oxygen content Calculation
CaO2 = (Hb x 1.34)SpO2 + PaO2 x 0.003
198
What type of lung unit(s) would result in a long time constant
a. Decreased airway resistance
b. Decrease Elastance-increased compliance
c. Decrease Compliance - causes a decrease in TC
d. Decreased Surfactant
b. Decrease Elastance
## Footnote
TC = R\*C
Decrease Elastance will increased compliance
Decrease Compliance will causes a decrease in TC
Decreased Surfactant - causes a decrease in C
199
. (Invasive) Mechanical ventilation is indicated for which of the following blood gases done on room air?
a. pH 7.23, PaCO2 56 mmHg, PaO2 76 mmHg, HCO3 23 mmol/L
b. pH 7.34, PaCO2 46 mmHg, PaO2 51 mmHg, HCO3 24 mmol/L
c. pH 7.31, PaCO2 50 mmHg, PaO2 46 mmHg, HCO3 24 mmol/L
d. All of the above
e. A and B only
a. pH 7.23, PaCO2 56 mmHg, PaO2 76 mmHg, HCO3 23 mmol/ L
## Footnote
We are just looking at the cut off of pH of \< 7.25
200
Regarding the thoracic pump, which of the following isnot true
a. During PPV there is an increase cardiac stroke volume
b. During spontaneous breathing there is increase venous return
c. During PPV there is an increased central venous pressure
d. During spontaneous breathing the thoracic pump is most effective during inspiration
a. During PPV there is an increase cardiac stroke volume
## Footnote
During PPV we have an increase thoracic pressure and decreased venous return so we fill up less and then via Starling Law we contract less
201
Positive pressure ventilation results in
a. Increase dead-space ventilation
b. Decreased dead-space ventilation
c. Decreased intrathoracic pressure
d. A and C
e. B and C
a . Increase dead-space ventilation
202
The phase variable that begins the inspiratory phase is called ___________ that ends in the inspiratory phase called the \_\_\_\_\_\_\_\_\_
a. Trigger, limit
b. Trigger, cycle
c. Cycle, trigger
b. Trigger, cycle
203
. In a volume controlled breath, as the patient’s compliance increases the pressure _______ and the tidal volume \_\_\_\_\_\_\_\_\_
a. Decrease, Decrease
b. Increase, Remain the Same
c. Decrease, Increase
d. Decrease, Remains the Same
d. Decrease, Remains the Same
204
Starling Law of Capillaries state that
a. The volume of fluid and solutes reabsorbed is normally nearly as large as the volume filtered
b. The volume of fluid and solutes reabsorbed is normally larger than the volume filtered
c. The volume of fluid and solutes filtered at the arterial end is less than the volume of fluid and solutes filtered at the venous end
d. The pressure of the fluids and solutes filtered is normally less than the pressure reabsorbed.
a. The volume of fluid and solutes reabsorbed is normally nearly as large as the volume filtered
205
Which of the following represents the correct pathway of impulse conduction through the heart
a. AV Node, SA Node, Conduction Myofibers, purkinje fibres
b. AV Node, Bundle Branches, SA Node, Purkinje Fibers
c. SA Node, AV Node, Bundle Branches, Conduction fibres
d. SA Node, Bundle Branches, AV Node, Conduction myofibers
c. SA Node, AV Node, Bundle Branches, Conduction fibres
206
The T-Wave in lead II ECG represents
a. Onset of atrial depolarization
b. Onset of ventricular depolarization
c. Atrial repolarization
d. Ventricular repolarization
d. Ventricular repolarization
## Footnote
Onset of atrial depolarization- P wave
Onset of ventricular depolarization-QRS
Atrial repolarization-Will get lost in QRS complex
207
The main pressure promoting reabsorption of fluid into the capillaries is the:
a. Osmotic pressure of interstitial fluid
b. Hydrostatic pressure of the interstitial fluid
c. Osmotic pressure of the capillary
d. Hydrostatic pressure of capillary
e. Oncotic pressure of interstitial fluid
c. Osmotic pressure of the capillary
## Footnote
Hydrostatic pressure of capillary - pressure due to fluid - will push fluid out
Osmotic pulls fluid in (caused by solute concentration); oncotic pushes fluid out (due to difference in protein concentration)
208
Pursed lip breathing when done properly, may result in which of the following
a. Equal pressure point moves down to smaller airways-Will move to the larger airways
b. Decreased early airway collapse
c. Increase expiratory flow rates
d. B and C
b. Decreased early airway collapse
## Footnote
Increase expiratory flow rates-We are adding an obstruction to the flow
209
A blending device is mixing 11.3 L of air with 4.7 L of oxygen. What FiO2 is the device producing?
a. 0.4
b. 0.45
c. 0.5
d. 0.55
0.45
## Footnote
(11.3 L (air) \* 0.21 + 4.7 L (O2)) / 16 = 0.44
210
When we are using a full “D” tank oxygen cylinder for transport. The clinician set the flow rate on prongs to deliver 4 LPM; the approximate duration of flow would be
a. ~15 min
b. ~30 min
c. \>1 hour
d. \>2 hour
c. \>1 hour
## Footnote
D = 0.16 L/psi
2200 psi or (subtract 500 for safety buffer) = 1700 psi → answer works for both
211
Which of the following statement is/are true regarding cyanosis
a. Polycythemia patient may show signs of cyanosis but may not be hypoxemic
b. All polycythemic patient that show signs of cyanosis are hypoxemic
c. In anemic patients, cyanosis is an early indicator of hypoxemia
d. All of the above are true
a. Polycythemia patient may show signs of cyanosis but may not be hypoxemic
212
A patient has been admitted to the coronary care unit after a myocardial infarction involving left side of the heart. The following information is collected from ABG while the patient is on room air. Hb 154 g/L
pH 7.48, PaCO2 31 mmHg, PaO2 54 mmHg, HC3 22 mmol/L, BE -1, SaO2 87%
What are the indications for O2 therapy for this patient?
i) Hypoxemia
ii) Hypercarbia
iii) To decrease myocardial workload
iv) Anxiety
i and iii
213
The amount of air entrained in a Venturi device is ________ proportional to the size of the entrainment port and _______ to the jet orifice?
a. Directly, inversly
214
Keeping the absolute humidity constant. As the temperature of the air ___ the relative humidity will \_\_\_\_\_\_.
a. Increase, decrease
215
# Choose the true statements regarding Bourdon pressure gauges.
i) a coiled metal tube has a sub-atmospheric pressure introduced to it
ii) the display needle should periodically be “zeroed”
iii) are used to measure changes in pressure
iv) will straighten in response to an increase in pressure
a. ii, iii, iv
216
The CARTA code of Ethics instructs us to “guard against conflicts of professional interest” and to specifically consult the _______________________ to prevent a real or perceived conflict of interest? Who is the individual/or department that Alberta RRTs are to consult?
a. The Alberta Health
b. The CARTA Registrar
c. The alberta department of justice
d. Your employer
b . The CARTA Registrar
217
To maintain your clinical competency in Alberta you must complete _______ hours of practice over a five year period. How many hour of practice are needed?
a. 48
b. 500
c. 720
d. 1600
c. 720
218
Once the CVP is in place, the transducer is leveled appropriately and zeroed. The monitor is showing a good waveform, with an a wave, …
a. Volume overload
b. Pulmonary hypertension
c. VSD
d. Pulmonary embolism
b. Pulmonary hypertension
219
As you are monitoring Bess you notice that her “a” wave has disappeared from her CVP waveform. This is an indication that:
a. The transducer is sitting below the level of the right atrium
b. Bess has stopped breathing
c. The tricuspid valve is incompetent causing regurgitation of blood into right atrium
d. The atria are not contracting, Bess is in atrial fibrillation
d . The atria are not contracting, Bess is in atrial fibrillation
220
Which of the follow is recommended for initial mechanical ventilator settings? Pt is unconscious, sedated and medically paralyzed
a. CMV VC, f 16 br/min, Vt 550 mls, PEEP 5
b. IMV VC, f 14 br/min, Vt 750 mls, PEEP 5
c. CMV APV, f 18 br/min, Vt 600 mls, PEEP 3 - PEEP too low
d. CSV PC, pressure support 10 cmH2O, CPAP 5
a. CMV VC, f 16 br /min, Vt 550 mls , PEEP 5
221
It is determined the patient has a refractory hypoxemia, which of the following would be the course of action at this time
a. Increase FiO2
b. Increase RR
c. Increase the tidal volume
d. Increase the PEEP
Increase PEEP
222
VS: Bp 158/108 mmHg, pulse 137 bpm and irregular. Her oxygen
38. Which of the following is the correct action given the patients oxygen status.
a. Apply a 50% air entrainment ventimask system to maximize forward flow
b. Apply a 70% large vol neb bc she is breathing so rapidly, she will soon become dehydrated
c. Apply a nrb bc it’s quick and easy to set up
d. Do not start O2, she may be a CO2 retainer
c. Apply a nrb bc it’s quick and easy to set up
223
Her elevated HR may be due to
a. Stimulation of the parasympathetic branch of the autonomic nervous system
b. Secondary to the pain she is in
c. Due to an attempt by her heart to maintain cardiac output
d. All of the above
e. b & c
e. b & c
224
The CXR in addition to confirming the flail, shows a large white area obscuring the lower half of the left lung and blunting of the costophrenic angle. The ED physician also makes note of these findings and asks you to assist with the insertion of a chest tube.
40. What could cause blunting of the costophrenic angle in this case?
a. Pneumothorax
b. Pneumomediastinum
c. Hemothorax
d. All of the above
e. A & B
c. Hemothorax
225
Give the substance to be drained, it is more probable that the physician will insert a large bore chest tube
a. Into the 2nd intercostal space, mid-clavicular line
b. Superiorly, as air rises
c. Inferiorly, as fluid is gravity dependent
d. Along the inferior surface of any rib
c. Inferiorly, as fluid is gravity dependent
226
You set up a dry thoracic drainage unit. How much water will you put into the suction control chamber?
a. None
b. Fill it to 2 cm
c. Fill it to the 20 cm mark
d. Start at 10 cm and slowly
a. None
227
The patient is intubated and placed on a mechanical ventilator, during a mandatory inspiration you observe tidaling in the underwater seal of the thoracic drainage unit. Which direction is it observed?
a. Move towards the suction control chamber
b. Moves toward the patient
c. Moves away from the patient
d. Tidaling should never be observed in the underwater seal
c. Moves away from the patient
228
What is the mode of action of singulair
a. B2 Selective Bronchodilator
b. Anti-inflammatory Leukotriene Receptor
c. Oral Corticosteroid
d. IgI Blocker
b. Anti-inflammatory Leukotriene Receptor
229
Which of the following is the recommended care of the ventilator circuit for prevention of VAP?
The vent circuit must be changed every 4 days
Closed sx systems are recommended
Circuit condensate should be used to instill the patient
Passive humidifiers can be safely used for 48 hours
2, 4
230
Which of the following is the most common cause of community acquired pneumonia?
Staphylococcus aureus
Pseudomonas aeruginosa
Escherichia coli
Diplococcus pneumonia
Diplococcus pneumonia
231
What question does ethics try to answer
Who is right
What treatment is best
Who benefits the most
How should we act
How should we act
232
A patient on mechanical ventilation has a compliance of 90 mL/cmH2O and an airway resistance of 5.0 cmH2O/L/sec. what is the calculated time constant?
a. 0.45 sec
B.1.35 sec
C. 4.5 sec
D. 450 sec
a. 0.45 sec
## Footnote
Time Constant (seconds)=Compliance (mL/cmH2O) x Resistance (cmH2O/L/sec)
5.0 cmH2O/L/sec x 0.09 L/cmH2O= 0.45 seconds
233
A 25 year old female was admitted to the emergency department in hemorrhagic shock following a gunshot wound. She received fluid administration to treat her bleeding and was stabilized. Following placement of a pulmonary artery catheter the following data was collected. Interpret the hemodynamic data.
PAP 48/32 mmHg
PCWP 22 mmHg
CVP 15 mmHg
C(a-v)O2 2.6%
Cor pulmonale
Pulmonary hypertension
Hypervolemia
Hypervolemia
## Footnote
PAP is high PCWP is high CVP is high (backing up to right side of the heart). C(a-v)O2 is low. Her blood is diluted because she was given too much fluid.
234
Which of the following is/are the major characteristic of increased alveolar dead=space
Minute ventilation out of proportion to PaCO2
Decreased WOB
Hyperoxemia
FiO2 \>0.50 and PaO2 \<50 mmHg
A and C only
Minute ventilation out of proportion to PaCO2
## Footnote
Increase amount of air that is not participating in gas exchange so you are moving more air in and less air out, you would have increased WOB, you would have hypoxemia not hyperoxemia.
235
Which of the following is the body’s main means of heat loss at high environmental temperatures?
Evaporation
Conduction
Convection
Radiation
Evaporation
236
Which of the following statements refer to EF?
The portion of EDV ejected on each beat
Amount of blood in the ventricle at end of diastole
Amount of blood ejected into the ventricle after each atrial contraction
All of the above
A and C only
The portion of EDV ejected on each beat
## Footnote
Most of atrial contraction is passive which is why the amount of blood ejected into the ventricle after the atrial contraction will not be equal to portion EDV ejected.
237
Amphotericin B is used to treat:
Systemic bacterial infections
Systemic Fungal infections
Pulmonary fungal infections
B and C only
B and C only
238
Which of the following describes a mode of ventilation that would best preserve tidal volume when a patient’s lung/thorax compliance increases?
Pressure cycled
Pressure limited, time cycled mode
Volume limited, time cycled mode
Pressure limited, flow cycled mode
Volume limited, time cycled mode
239
Which of the following does not cause an increase in measured pcwp?
Hypervolemia
Left ventricular failure
Mitral stenosis
3rd spacing
3rd spacing
240
You have a liquid system and a patient that requires a flow of 4 LPM. The liquid oxygen unit weighs 4100g. How long does the patient have for their oxygen usage?
Approximately 8.3 hours
Approximately 9.5 hours
Approximately 11 hours
Approximately 13.3 hours
None of the above
Approximately 13.3 hours
## Footnote
1 L(liq) = 1.1 kg(liq); 1L liq = 860 L gas
241
In the face of significant back-pressure, which of the following devices would read accurately?
A device with a needle valve and a multiple orifice flowmeter.
A device with a needle valve and a variable orifice flowmeter.
A regulator with a bourdon gauge pressure and flowmeter.
A regulator with a set pressure and multiple orifice flowmeter.
A device with a needle valve and a variable orifice flowmeter.
242
Which of the following cannot easily be configured to be a fixed performance device at low FiO2’s?
1. Nasal cannula
2. Large volume cold neb
3. Air entrainment mask/ventimask
4. Simple mask
1 and 4
243
Of the following, the proper device to supply humidified oxygen for a spontaneously breathing patient with an endotracheal tube in place is?
Venti mask with entrained aerosol/humidity
Venti mask with trach adaptor
LVN with a trach cradle
LVN with a t-piece
LVN with a t-piece
244
A patient is breathing a rate of 12 br/min. Their tidal volume is 450 mL/breath, and they are on a large volume nebulizer at an FiO2 of 0.35 with a set O2 flow of 12 LPM. Is this likely to be a fixed performance device AND what approximate FiO2 is the patient receiving?
Yes/=0.35
No/\<0.35
No/\>0.35
Cannot calculate
Yes/\<0.35
Yes/=0.35
## Footnote
Magic box: 64 lpm total flow rate, TCT = 5, if I:E = 1:2 (assumed), ti = 1.67s
.450L / 1.67s = 0.28L/s = 16.9 lpm
If the flow being delivered (64 lpm) is higher than the flow the patient is generating (16.9 lpm), it is a fixed device.
\* When information is given to us about a patient’s breathing pattern, it is more than just determining a fixed performance device using the “rule of 60”. We must consider how they are breathing. This patient is breathing at a slower rate, indicating that he’s not that air hungry, and so giving us a better idea that the flows that they are generating are not that high (and therefore, the flows being delivered are likely higher than what the patient is generating). If the patient was breathing at a faster rate, this would change their I:E, therefore changing the flow the patient is generating, potentially changing whether or not the device is fixed for them.
245
Patients on high FiO2s that suddenly experience mucous plugging of a large airway are in danger of:
Increased dead-space ventilation
Decreased CO
Absorption atelectasis
Absorption atelectasis
246
Entering a patient care room you see the cold neb (CN) is set to deliver 28% oxygen and the oxygen flow meter is set at 6 LPM. The total flow from the CN is:
24 LPM
32 LPM
48 LPM
60 LPM
72 LPM
60 LPM
247
What is the RH when the AH is 15 mg H2O/L and the capacity of a gas is 20.6 mg H2O/L?
15%
20%
30%
72%
72%
248
Regarding the cardiac waveform below, please identify where the distal port of the PAC catheter is sitting at the section of the waveform labeled “A”?
Pulmonary artery
249
What is the RH when the AH is 15 mg H2O/L and the capacity of a gas is 20.6 mg H2O/L?
15%
20%
30%
72%
72%
250
Common causes of weaning/liberation failure include all of the following except:
Myocardial ischemia
Ventilatory demand in excess of capacity
Psychological dependence
Secondary polycythemia
Secondary polycythemia
251
Application of nasal CPAP to neonates can:
Be used to treat apnea associated with intraventricular hemorrhage
Treat babies with necrotizing enterocolitis
Be used immediately post-extubation
Used immediately post-delivery in babies with congenital diaphragmatic hernia
None of the above
Be used immediately post-extubation
252
Defibrillation:
Results in depolarization of just the ventricles
Is an effective electrical treatment for ventricular fibrillation
Can be used to treat asystole
B and C only
Is an effective electrical treatment for ventricular fibrillation
253
What effect do glucocorticoids have on beta adrenergic receptors?
No effect
Stimulates B2 receptors to relax bronchial smooth muscles
restores/enhances responsiveness of B2 receptors to B2 specific agents
Inhibits mast cell release
restores/enhances responsiveness of B2 receptors to B2 specific agents
254
COPD pts who have OSA:
Have worse nocturnal desats compared to someone with only OSA
Often have nocturnal hypoventilation due to impaired ventilatory mechanics during sleep
Have a higher rate of mortality then someone who has only OSA
All of the above
A and C only
All of the above
255
Which of the following is a contraindication to hyperbaric therapy?
Cleft palate
Pleural effusion
Pneumothorax
Restrictive lung disease
Pneumothorax
256
Which of the following is considered the main mechanism by which hypertonic aerosols aid mucociliary clearance?
Increased stimulation of the irritant cough reflex
Alterations of peak insp airway resistance
Enhanced sensory somatic nervous impulses
Altering the pH level
Increased stimulation of the irritant cough reflex
257
Any device used for chest drainage must have which basic component:
A separate underwater seal chamber
Continuous low suction
Collection chamber placed below the insertion site to facilitate gravity drainage
A suction control chamber filled with water
A separate underwater seal chamber
258
Which of the following statement is true regarding DPI?
They are good for all age groups
They do not require a spacing device
Laminar flow from the use during inspiration is needed to create an aerosol
They are cumbersome to carry
They do not require a spacing device
259
Which of the following should be assessed first?
Sputum collection for C&S
RR
ABG
Auscultation
RR
260
Based on his initial presentation, what type of lung disease is predominate in this patient?
Restrictive lung disease due to suspected pneumonia
Obstructive lung disease due to apparent pneumonia
Infectious lung disease due to apparent pneumonia
Obstructive lung disease secondary to cigarette smoking
Restrictive lung disease secondary to cigarette smoking
Obstructive lung disease secondary to cigarette smoking
261
Coronary artery disease may be diagnosed with which of the following?
Cardiac enzymes
V/Q scan
Cardiac angiogram
All of the above
a and c only
Cardiac angiogram
262
In compensating for heart failure, the body will:
Increase blood volume
Dilate the peripheral vasculature
Decrease the HR
Increase the urine output
Increase blood volume
263
Which of the following is a risk factor for the development of an aortic aneurysm?
Systemic HTN- due to extra stress on arteries
COPD
Family history of AAA
All of the above
a and c only
a and c only
264
Your patient has a severe tricuspid valve stenosis. A hemodynamic profile consistent with this would be:
CVP 14 mmHg, PAP 35/29 mmHg, PCWP 4 mmHg
CVP 2 mmHg, PAP 10/6 mmHg, PCWP 4 mmHg
CVP 14 mmHg, PAP 11/6 mmHg, PCWP 3 mmHg
CVP 16 mmHg, PAP 33/26 mmHg, PCWP 21 mmHg
CVP 19 mmHg, PAP 19/12 mmHg, PCWP 7 mmHg
CVP 14 mmHg, PAP 11/6 mmHg, PCWP 3 mmHg
265
The major pathophysiology seen in a near, wet-drowning is:
Non-cardiogenic pulmonary edema
Cardiogenic pulmonary edema
Hypovolemic shock
Laryngospasm
Non-cardiogenic pulmonary edema
266
Hyperventilation as a therapy for an acute head injury is used for its _____ effects and _____ cerebral blood flow.
Vasodilatory, increases
Vasoconstrictory, increases
Vasodilatory, decreases
Vasoconstrictory, decreases
Vasoconstrictory , decreases
267
Given the following data:
Mode: PRVC
FiO2: 0.80
Set Vt: 600 mL
RRset: 12
PEEP: 5
Ti: 1.20 sec
Vtexhaled: 540 mL
RRmeasured: 16
PIP: 36 cmH2O
Pplat: 26 cmH2O
The patient’s static compliance is:
17. 4 mL/cmH2O
23. 1 mL/cmH2O
25. 7 mL/cmH2O
28. 6 mL/cmH2O
25.7 mL/cmH2O
## Footnote
Vtexhaled is measured back at the ventilator, and because of the change in temperature that the exhaled gas undergoes leads to a change in volume, which is why the Vtexhaled is always lower than the Vtset. We SHOULD use the Vtset.
268
# Define volatile anesthetic agent
Molecules of a liquid that break away and enter the space at the top of the vaporizer
Pressure created when the molecules bombard the walls of the container
Molecules entering the liquid phase
Liquid that has a tendency to change to a vapor at standard temperature and pressure
Liquid that has a tendency to change to a vapor at standard temperature and pressure
269
Which of the following additives to spinal anesthesia will help provide postoperative analgesic properties?
Lidocaine
Bupivicaine
Cocaine
Fentanyl
Fentanyl
270
What stage of sleep is characterized by deep, restorative sleep?
Stage 1 NREM
Stage 2 NREM
Stage 3 NREM
REM
Stage 3 NREM
271
. A rigid bronchoscope is the preferred type of scope for/if:
The removal of a large foreign body
A difficult intubation is expected
Examination of the lung apices are needed
Visualization of the lower portions of the respiratory tract is required
The removal of a large foreign body
272
Which of the following is considered therapeutic bronchoscopy?
BAL
Bronchial samples for C & S
Bronchial toileting -same as lavage
Needle aspiration
Bronchial toileting -same as lavage
273
Albumin plays many essential roles in the body. 2 of these roles include:
Maintaining osmotic pressure gradients, and molecular transport
Molecular transport, and metabolizing denatured proteins
Opposing osmotic pressure gradients, and combating liver disease
Maintaining renal output, and supporting molecular transport
Maintaining osmotic pressure gradients, and molecular transport
274
The electrolyte most closely tied to cardiac arrhythmias when its level is out of normal range (either too high or low) is:
Sodium
Chloride
Potassium
Hydrogen ion
Potassium
275
Assessment of an area of consolidation in the lung would most likely reveal:
Dull percussion
Tracheal deviation
Decreased fremitus
Late inspiratory crackles
Dull percussion
276
In which of the following modes of ventilation will effective tidal volume vary the most with changes in patient resistance of compliance?
Pressure-regulated volume control
CMV with autoflow
Volume support
Pressure support
Pressure support
277
Aerosol deposition in the distal airways can be improved with:
Deep, slow insp flow breaths
Deep, fast insp flow breaths
Shallow, slow insp flow breaths
Shallow, fast insp flow breaths
Deep, slow insp flow breaths
278
High airway resistance
279
Exercise training in patients wiht COPD improves:
Exercise capacity
Psychologic state
Pulmonary function
A and B
All of the above
A and B
280
Relative Humidity Equation
