CLINICAL SIMULATION EXAM
QUESTIONS AND ANSWERS 100% PASS.
COPD - ANS Preventable and treatable disease state characterized by air flow limitation that
is not fully reversible.
Emphysema - ANS Presence of permanent enlargement of the air spaces distal to the
terminal bronchioles, accompanied by destruction of their walls and without obvious fibroisis
Chronic bronchitis - ANS Chronic productive cough for three months in each of two
successive years in a pt for whom other causes of the productive cough have been excluded
Etiology of COPD - ANS - tobacco smoke
-genetic predisposition
- indoor and outdoor pollution
Pt Assessment of Emphysema Pt (Primary assessment) - ANS AKA pink puffer or Type A COPD
Body build = thin, underweight
Past medical history = Tobacco use
Cough = Less common, muciod secretions
Appearance of chest = Barrel chest, increased A-P diameter (Hoover's Sign)
Respiratory Pattern = Dyspnea, pursed-lip breathing, accessory muscle use, especially during
exacerbations
Color= Often reddish
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,Clubbing = Late stage
Diagnostic Chest Percussion = Hyperresonant/ Tympanic note
Breath Sounds = Diminished, prolonged expiration
Body build of Type A COPD (pink puffer) Emphysema - ANS Thin, underweight
Past medical history for emphysema pts - ANS Tobacco use
Cough (Emphysema) - ANS Less common, muciod secretions
Appearance of the chest (Emphysema) - ANS Barrel chest, increased A-P diameter
Respiratory pattern ( Emphysema) - ANS Dyspnea, pursed lip breathing, accessory muscle
use, especially during exacerbations
Color (Emphysema) - ANS Often reddish
Clubbing (Emphysema) - ANS Late stage
Diagnostic Chet Percussion (Emphysema) - ANS Hyperresonant/tympanic note
Breath sounds ( Emphysema) - ANS Diminished, prolonged expiration
Patient Assessment (Primary) Chronic Bronchitis - ANS AKA Blue bloater Type B COPD
Body build = Stocky, overweight
Past Medical History = Tobacco use
Cough = Productive, copious amounts, purulent secretions
Chest Appearance = Ocassionally barrel chest
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,Color = Cyanotic
Clubbing = Common
Diagnostic Chest Percussion = normal
Breath Sounds = Rhonchi, crackles , wheezing
Body build (Chronic Bronchitis) - ANS Stocky, overweight
Past Medical History (Chronic Bronchitis) - ANS Tobacco use
Cough (Chronic Bronchitis ) - ANS Productive, copious amounts of purulent secretions
Chest Appearance (Chronic Bronchitis) - ANS Occasionally barrel chest
Respiratory Pattern (Chronic Bronchitis ) - ANS Use of accessory muscles less common
Clubbing ( Chronic Bronchitis ) - ANS Common
Diagnostic Chest Percussion ( Chronic Bronchitis) - ANS Normal
Breath Sounds (Chronic Bronchitis ) - ANS Rhonchi, crackles, wheezing
Secondary Assessment Emphysema pt - ANS Chest X-ray = translucent (dark) lung fields,
depressed or flattened diaphragms, long and narrow heart, increased retrosternal air spaces,
possibly hypertrophy or right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia Severe Stages:
Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates (FEV1 , FEF 25-75%, FEF 200-1200, FEV1/FVC, and
PEFR) Decreased DLCO
CBC = Increased RBC/Hb/Hct in late stages
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, Sputum = Normal
Chest X-ray (Emphysema ) - ANS Translucent (dark) lung fields, depressed or flattened
diaphragms, long and narrow heart, increased retrosternal air space, possibly hypertrophy or
right ventricle
ABG (emphysema) - ANS Mild to moderate stages: Acute alveolar hyperventilation with
hypoxemia Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function (Emphysema ) - ANS Decreased flowrates, Decreased DLCO
CBC (Emphysema) - ANS Increased RBC/Hct/Hb in late stages
Sputum (Emphysema) - ANS Normal
Secondary Assessment Chronic Bronchitis - ANS AKA Type B Blue Bloater
Chest X-ray = translucent (dark) lung fields, depressed or flattened diaphragms, possibly
hypertrophy of right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia
Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates, DLCO normal
CBC = increased RBC/Hb/Hct in early and late stages
Sputum = Often shows ; Streptococcus pneumoniae, Haemophilus influenza, Moraxella
catarrhalis
Chest X-ray (Chronic Bronchitis) - ANS Translucent lung fields, depressed or flattened
diaphragms, possibly hypertrophy of the right ventricle
ABG ( Chronic Bronchitis) - ANS Mild to moderate stages: Acute alveolar hyperventilation
with hypoxemia
2026 STUDY MATERIAL @COPYRIGHT RESERVED 4
QUESTIONS AND ANSWERS 100% PASS.
COPD - ANS Preventable and treatable disease state characterized by air flow limitation that
is not fully reversible.
Emphysema - ANS Presence of permanent enlargement of the air spaces distal to the
terminal bronchioles, accompanied by destruction of their walls and without obvious fibroisis
Chronic bronchitis - ANS Chronic productive cough for three months in each of two
successive years in a pt for whom other causes of the productive cough have been excluded
Etiology of COPD - ANS - tobacco smoke
-genetic predisposition
- indoor and outdoor pollution
Pt Assessment of Emphysema Pt (Primary assessment) - ANS AKA pink puffer or Type A COPD
Body build = thin, underweight
Past medical history = Tobacco use
Cough = Less common, muciod secretions
Appearance of chest = Barrel chest, increased A-P diameter (Hoover's Sign)
Respiratory Pattern = Dyspnea, pursed-lip breathing, accessory muscle use, especially during
exacerbations
Color= Often reddish
2026 STUDY MATERIAL @COPYRIGHT RESERVED 1
,Clubbing = Late stage
Diagnostic Chest Percussion = Hyperresonant/ Tympanic note
Breath Sounds = Diminished, prolonged expiration
Body build of Type A COPD (pink puffer) Emphysema - ANS Thin, underweight
Past medical history for emphysema pts - ANS Tobacco use
Cough (Emphysema) - ANS Less common, muciod secretions
Appearance of the chest (Emphysema) - ANS Barrel chest, increased A-P diameter
Respiratory pattern ( Emphysema) - ANS Dyspnea, pursed lip breathing, accessory muscle
use, especially during exacerbations
Color (Emphysema) - ANS Often reddish
Clubbing (Emphysema) - ANS Late stage
Diagnostic Chet Percussion (Emphysema) - ANS Hyperresonant/tympanic note
Breath sounds ( Emphysema) - ANS Diminished, prolonged expiration
Patient Assessment (Primary) Chronic Bronchitis - ANS AKA Blue bloater Type B COPD
Body build = Stocky, overweight
Past Medical History = Tobacco use
Cough = Productive, copious amounts, purulent secretions
Chest Appearance = Ocassionally barrel chest
2026 STUDY MATERIAL @COPYRIGHT RESERVED 2
,Color = Cyanotic
Clubbing = Common
Diagnostic Chest Percussion = normal
Breath Sounds = Rhonchi, crackles , wheezing
Body build (Chronic Bronchitis) - ANS Stocky, overweight
Past Medical History (Chronic Bronchitis) - ANS Tobacco use
Cough (Chronic Bronchitis ) - ANS Productive, copious amounts of purulent secretions
Chest Appearance (Chronic Bronchitis) - ANS Occasionally barrel chest
Respiratory Pattern (Chronic Bronchitis ) - ANS Use of accessory muscles less common
Clubbing ( Chronic Bronchitis ) - ANS Common
Diagnostic Chest Percussion ( Chronic Bronchitis) - ANS Normal
Breath Sounds (Chronic Bronchitis ) - ANS Rhonchi, crackles, wheezing
Secondary Assessment Emphysema pt - ANS Chest X-ray = translucent (dark) lung fields,
depressed or flattened diaphragms, long and narrow heart, increased retrosternal air spaces,
possibly hypertrophy or right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia Severe Stages:
Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates (FEV1 , FEF 25-75%, FEF 200-1200, FEV1/FVC, and
PEFR) Decreased DLCO
CBC = Increased RBC/Hb/Hct in late stages
2026 STUDY MATERIAL @COPYRIGHT RESERVED 3
, Sputum = Normal
Chest X-ray (Emphysema ) - ANS Translucent (dark) lung fields, depressed or flattened
diaphragms, long and narrow heart, increased retrosternal air space, possibly hypertrophy or
right ventricle
ABG (emphysema) - ANS Mild to moderate stages: Acute alveolar hyperventilation with
hypoxemia Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function (Emphysema ) - ANS Decreased flowrates, Decreased DLCO
CBC (Emphysema) - ANS Increased RBC/Hct/Hb in late stages
Sputum (Emphysema) - ANS Normal
Secondary Assessment Chronic Bronchitis - ANS AKA Type B Blue Bloater
Chest X-ray = translucent (dark) lung fields, depressed or flattened diaphragms, possibly
hypertrophy of right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia
Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates, DLCO normal
CBC = increased RBC/Hb/Hct in early and late stages
Sputum = Often shows ; Streptococcus pneumoniae, Haemophilus influenza, Moraxella
catarrhalis
Chest X-ray (Chronic Bronchitis) - ANS Translucent lung fields, depressed or flattened
diaphragms, possibly hypertrophy of the right ventricle
ABG ( Chronic Bronchitis) - ANS Mild to moderate stages: Acute alveolar hyperventilation
with hypoxemia
2026 STUDY MATERIAL @COPYRIGHT RESERVED 4
