Question 1

You are performing a physical exam on a patient with emphysema. You note that the patient has a pink hue to her skin. You should suspect:

Accepted Answer

The pink hue to the skin is likely due to increased red blood cells (polycythemia) in response to chronic hypoxia from emphysema. This is a compensatory mechanism to increase oxygen carrying capacity in the blood. Cor pulmonale would present with a different set of symptoms such as swelling in the legs and shortness of breath. Methemoglobinemia and carboxyhemoglobinemia are both uncommon conditions and would present with specific symptoms related to exposure to certain chemicals.

Question 2

You are caring for a patient with chronic bronchitis. The patient has an SpO₂ of 90%. You should:

Accepted Answer

An SpO2 reading of 90% is considered low and may indicate hypoxemia in some patients, but in patients with chronic bronchitis, an SpO2 reading of 90% may be expected. Giving too much supplemental oxygen can actually worsen the patient's condition by suppressing their respiratory drive. Therefore, administering supplemental oxygen at a low flow rate of 1-2 L/min via nasal cannula is the best option for this patient.

Question 3

Upon examining your patient, you note that he has a clubbing of the fingers. You would suspect a history of:

Accepted Answer

Clubbing of the fingers is commonly associated with chronic hypoxemia, indicating a chronic lack of oxygen supply to the extremities. It can occur in conditions such as chronic obstructive pulmonary disease (COPD), lung cancer, congenital heart disease, and other chronic respiratory conditions. Neoplasm and peripheral vascular disease may cause finger clubbing in some cases, but hypoxemia is the most likely cause. Hypertension is not typically associated with clubbing of the fingers.

Question 4

You arrive on the scene of a patient who complains of worsening shortness of breath for the past few days. The patient presents with an SpO₂ of 90%, ETCO₂ of 45, normal wave form, crackles, and a temperature of 101.5°F. You should suspect:

Accepted Answer

The patient's symptoms and physical exam findings suggest pneumonia, including crackles and an elevated temperature. CHF and COPD may also present with shortness of breath, but the crackles and fever point more towards pneumonia as the underlying cause. ARDS typically presents with lower oxygen saturation levels and more severe respiratory distress.

Question 5

Obstructive sleep apnea is an example of:

Accepted Answer

Obstructive sleep apnea occurs when the upper airway becomes partially or completely blocked during sleep, resulting in brief periods of time when a person stops breathing. This obstruction is specific to the upper airway, making choice B the most appropriate answer.

Question 6

You are called to care for a patient with severe shortness of breath. The patient has an SpO₂ of 88%, audible wheezing, and a capnography reading of 54 with a shark fin wave form. You are administering albuterol for the second time without relief. You suspect:

Accepted Answer

The patient's symptoms and lack of response to albuterol suggest status asthmaticus, which is a severe and potentially life-threatening asthma exacerbation that does not respond to standard medications. The audible wheezing and capnography reading with a shark fin wave form are characteristic of this condition. Status epilepticus would present with seizures and altered mental status, which are not mentioned in the case. Anaphylaxis would typically have other symptoms such as hives, swelling, and low blood pressure. Septic shock would have different vital sign abnormalities and symptoms such as fever or chills.

Question 7

A sudden disruption of pulmonary perfusion caused by a blood clot is known as:

Accepted Answer

A pulmonary embolism is a sudden disruption of pulmonary perfusion caused by a blood clot. Pulmonary occlusion refers to blockage of a pulmonary artery or vein. Pulmonary diffusion refers to the movement of gases (oxygen and carbon dioxide) across the alveolar-capillary membrane. Pulmonary edema refers to fluid accumulation in the lungs.

Question 8

You are called to the home of a patient who suddenly "stopped breathing." The patient has a history of a neoplasm at C-3 and C-4. You suspect:

Accepted Answer

Impingement on the phrenic nerve can cause paralysis of the diaphragm, leading to difficulty or cessation of breathing. The location of the neoplasm in this case suggests that it may be affecting the phrenic nerve which innervates the diaphragm. Cervical fractures could also be a possibility, but the patient's history of neoplasm makes impingement on the phrenic nerve more likely. Lung cancer or myocardial infarction would not be the most likely cause of sudden cessation of breathing in this case.

Question 9

Which of the following is NOT part of the respiratory status assessment?

Accepted Answer

Lung compliance is a measure of how easily the lungs can expand and is not typically included in a respiratory status assessment. The other options - mental status, color, and respiratory effort - are commonly assessed to determine a patient's respiratory status.

Question 10

You are assessing a patient who is presenting with shortness of breath, JVD, and tracheal deviation. You suspect:

Accepted Answer

The symptoms presented suggest a tension pneumothorax, which occurs when air accumulates in the pleural space under tension and displaces organs causing JVD and tracheal deviation. This condition requires immediate intervention as it can lead to cardiac arrest if left untreated. Flail chest is characterized by paradoxical movement of the chest wall, tracheal tugging is seen in respiratory distress, and subcutaneous emphysema presents as a crackling sensation under the skin.

Question 11

You are called to a patient with severe shortness of breath. Upon arrival, you find your patient in the tripod position, with pursed lips and audible wheezing. SpO₂ is at 89% and capnography shows a "shark fin" pattern with an ETCO₂ of 50. You should:

Accepted Answer

The patient is presenting with signs and symptoms of an asthma exacerbation, including audible wheezing, pursed lips, and low SpO2 levels. The "shark fin" pattern on capnography indicates bronchoconstriction, which can be treated with a beta-agonist such as albuterol to help open up the airways and improve oxygenation. Beta antagonists, alpha agonists, and alpha antagonists do not have a place in the treatment of asthma exacerbations.

Question 12

Your patient is complaining of "coughing up blood," or, in medical terms:

Accepted Answer

Hemoptysis refers to coughing up blood, whereas hemothorax refers to blood accumulation in the pleural cavity, neoplasm refers to an abnormal growth, and hemopulmonary spasm is not a recognized medical term.

Question 13

A disorder of lung diffusion that results from increased fluid in the interstitial space is known as:

Accepted Answer

ARDS (Acute Respiratory Distress Syndrome) is a disorder of lung diffusion that occurs due to increased fluid accumulation in the interstitial space, which leads to decreased oxygen exchange and respiratory failure. COPD (Chronic Obstructive Pulmonary Disease) is a chronic lung disease that causes narrowing of the airways and difficulty breathing, but it does not result from interstitial fluid accumulation. AIDS (Acquired Immunodeficiency Syndrome) is a viral infection that weakens the immune system, but it does not directly affect lung diffusion. PHTN (Pulmonary Hypertension) is a condition of increased blood pressure in the pulmonary arteries, which can lead to heart failure, but it does not result from interstitial fluid accumulation.

Question 14

You are assessing your respiratory patient. Of the following findings, which would concern you the most?

Accepted Answer

Altered mental status is the most concerning finding because it indicates a potentially severe and life-threatening condition, suggesting that the brain is not receiving enough oxygen. This could be due to respiratory failure or severe hypoxia, requiring immediate intervention.

Question 15

The hallmark treatment of ARDS is to:

Accepted Answer

The hallmark treatment of ARDS is to treat the underlying condition that caused it. This may include antibiotics for infection, stopping/adjusting medications that triggered it, or mechanical ventilation for respiratory distress. Administering corticosteroids may not be effective and may even cause harm, treating fluid with diuretics may not address the underlying issue, and renal dialysis is not indicated for ARDS.

Question 16

Which of the following is NOT a common obstructive lung disease encountered in the prehospital setting?

Accepted Answer

CHF is not a common obstructive lung disease, it is a congestive heart failure. The other three options (asthma, emphysema, and chronic bronchitis) are common obstructive lung diseases encountered in the prehospital setting.

Question 17

You respond to a patient with difficulty breathing. Upon assessment you notice that the patient is sitting in the tripod position, with marked JVD. The patient has clubbing in the fingers and new pitting edema. You should suspect:

Accepted Answer

The presence of JVD, clubbing, and pitting edema are all indicative of cor pulmonale, which is a condition in which the right side of the heart becomes enlarged and weakened due to lung disease or pulmonary hypertension. CHF and COPD may also present with difficulty breathing and the tripod position, but the presence of JVD and clubbing are specific to cor pulmonale. Pulmonary neoplasm is less likely to present with these symptoms.

Question 18

You are evaluating a patient complaining of having a productive cough. The patient states the sputum is green to brown. You suspect:

Accepted Answer

Green to brown sputum indicates the presence of pus and/or dead white blood cells, which are often the result of a bacterial infection in the lungs.

Question 19

Paradoxical movement is associated with:

Accepted Answer

Paradoxical movement occurs with flail chest, which is a condition where there is a segment of the chest wall that is detached from the rest of the thoracic cage, leading to inward movement during inspiration and outward movement during expiration.

Question 20

Pulmonary shunting can be seen in patients with suspected:

Accepted Answer

Pulmonary shunting occurs when blood flows through the lungs without being oxygenated, leading to decreased arterial oxygenation. This commonly occurs in pulmonary embolism, where a blood clot blocks blood flow through a portion of the pulmonary vasculature, causing reduced oxygenation of the blood. Tension pneumothorax, hemothorax, and hypovolemic shock are not typically associated with pulmonary shunting.

Quiz 1: Pulmonology