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 in a patient with emphysema is likely due to polycythemia or increased red blood cell production. This is a compensatory response to chronic hypoxemia caused by the emphysema. The increased red blood cells help transport oxygen to tissues that are not receiving enough due to lung damage.

Question 2

Pulmonary shunting can be seen in patients with suspected:

Accepted Answer

Pulmonary shunting refers to blood flow that bypasses functional alveoli, leading to decreased oxygenation. This is commonly seen in patients with pulmonary embolism. Tension pneumothorax, hemothorax, and hypovolemic shock can all contribute to decreased oxygenation, but pulmonary shunting is not a characteristic finding in these conditions.

Question 3

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

Accepted Answer

The green to brown sputum production is a symptom often associated with an infection in the respiratory system, especially in the lower respiratory tract. This coloration is due to the presence of inflammatory cells and bacteria. Therefore, choice A, infection, is the best choice.

Question 4

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

Accepted Answer

"Coughing up blood" is medically known as hemoptysis. Hemothorax refers to the accumulation of blood in the space between the lungs and chest wall. Neoplasm refers to an abnormal growth of cells, which may or may not cause hemoptysis. Hemopulmonary spasm is not a recognized medical term.

Question 5

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 condition that occurs when fluid accumulates in the lungs' interstitial space, resulting in difficulty breathing and impaired lung function.

Question 6

Paradoxical movement is associated with:

Accepted Answer

Paradoxical movement refers to the inward movement of a segment of the chest during inspiration instead of its normal outward movement. This is seen in flail chest, where multiple adjacent ribs are fractured in two or more places, causing a segment of the chest wall to move paradoxically during breathing. It is not typically seen in tension pneumothorax, hemothorax, or simple pneumothorax.

Question 7

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

Accepted Answer

Lung compliance is not typically included in the respiratory status assessment. The other options (mental status, color, and respiratory effort) are commonly assessed as part of the respiratory status evaluation.

Question 8

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 exhibiting signs and symptoms of an acute asthma exacerbation, which is characterized by bronchospasm and airway inflammation. Administration of a beta agonist, such as albuterol, can help relieve bronchospasm and improve ventilation. The patient's SpO2 is low, indicating hypoxia, and the "shark fin" pattern on capnography suggests bronchospasm, further supporting the use of a beta agonist.

Question 9

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

Accepted Answer

A sudden disruption of pulmonary perfusion caused by a blood clot is known as pulmonary embolism. Pulmonary occlusion refers to a blockage in the pulmonary artery, but pulmonary embolism is a more specific term for a blood clot causing this blockage. Pulmonary diffusion refers to the movement of gases across the alveolar-capillary membrane, and pulmonary edema refers to the accumulation of fluid within the lungs.

Question 10

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

Accepted Answer

CHF (congestive heart failure) is not a obstructive lung disease, it is a cardiovascular disease that can cause fluid to accumulate in the lungs and lead to respiratory distress. The other options (A, C, and D) are all common obstructive lung diseases encountered in the prehospital setting.

Question 11

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 12

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 patient's symptoms suggest cor pulmonale, which is a condition where the right ventricle of the heart becomes enlarged and weakened due to prolonged pulmonary hypertension. The tripod position, JVD (jugular venous distention), and pitting edema are all signs of right-sided heart failure, which is a common complication of cor pulmonale. The clubbing in the fingers may also indicate underlying lung disease, which can lead to cor pulmonale. CHF and COPD are also possibilities, but the presence of JVD, edema, and clubbing make cor pulmonale more likely. Pulmonary neoplasm is less likely to present with these specific symptoms.

Question 13

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

Accepted Answer

The combination of shortness of breath, JVD, and tracheal deviation are clinical signs of tension pneumothorax. In tension pneumothorax, air accumulates in the pleural space and creates pressure on the lungs, causing them to collapse. This pressure can also push the mediastinum to one side, causing tracheal deviation. The JVD is a result of the increased pressure in the chest that is pushing on the heart and vena cava. Prompt intervention, such as needle decompression or chest tube placement, is necessary to relieve the pressure and prevent further complications.

Question 14

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 usually associated with hypoxemia, a condition where there is not enough oxygen in the blood. This can be due to various underlying causes such as lung disease, heart disease, and other conditions that affect the lungs or heart. Neoplasm (cancer) and hypertension (high blood pressure) are not typically associated with clubbing of the fingers. Peripheral vascular disease may cause changes in the appearance of the fingers and hands, but it is not a common cause of clubbing.

Question 15

The hallmark treatment of ARDS is to:

Accepted Answer

The cornerstone of ARDS treatment is to identify and address the underlying condition that caused it, such as sepsis or pneumonia. There is no specific drug therapy to cure ARDS itself, and corticosteroid use is controversial as it may increase the risk of infections and gastrointestinal bleeding. Diuretics and renal dialysis are not effective for treating the underlying cause of ARDS.

Question 16

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 a severe asthma attack, known as status asthmaticus. Status epilepticus is a condition of prolonged seizures, anaphylaxis presents with a range of symptoms including difficulty breathing, hives, and low blood pressure, and septic shock is characterized by low blood pressure and organ dysfunction in response to an infection.

Question 17

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, including crackles and a fever, suggest a potential respiratory infection such as pneumonia. CHF may also present with shortness of breath, but the absence of a history of heart disease and the presence of crackles make pneumonia a more likely diagnosis. COPD and ARDS are less likely given the acute onset of symptoms.

Question 18

Obstructive sleep apnea is an example of:

Accepted Answer

Obstructive sleep apnea is caused by upper airway obstruction during sleep, leading to cessation of breathing and subsequent brief awakenings throughout the night.

Question 19

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

Accepted Answer

A SpO2 reading of 90% indicates mild to moderate hypoxemia, and supplemental oxygen should be administered to improve oxygen saturation. However, in chronic bronchitis, the patient may retain carbon dioxide due to decreased lung function. Administering supplemental oxygen at high flow could further decrease their respiratory drive and worsen their carbon dioxide retention. Therefore, low flow supplemental oxygen via nasal cannula is the safest option for this patient. The goal should be to maintain the SpO2 at 88-92% to avoid exacerbation of hypercapnia. CPAP is not indicated in this case as it is used for patients with obstructive sleep apnea and might further decrease the patient's respiratory drive.

Question 20

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

The neoplasm at C-3 and C-4 is likely compressing or impinging on the phrenic nerve, which innervates the diaphragm muscles responsible for breathing. This can lead to respiratory arrest and cessation of breathing. Cervical fractures may also cause respiratory failure but are less likely given the patient's history of neoplasm. Lung cancer and myocardial infarction are not directly related to the patient's sudden cessation of breathing.

Quiz 3: Pulmonology