oaks ACCS/ ACCS Oakes prac ce Exam| Ques ons and
answers | Updated RATED A+ | 2026
Postural drainage
BAD LUNG UP, GOOD LUNG DOWN
Postural drainage excep on
with an area of pus/cavita on, put good lung UP to avoid draining infec ous secre ons into the
good lung
Intrapulmonary percussive ven la on (IPV)
Provide oscilla ons aimed towards the insides of the airways (CPT on the inside!)
Intrapulmonary percussive ven la on (IPV)
can be used in non-intubated pa ents or intubated pa ents.
Intrapulmonary percussive ven la on (IPV) contraindica ons:
bronchospasm, lung contusion, pneumothorax, pulmonary hemorrhage, subcutaneous
emphysema.
Mechanical cough assist
preferred when a pa ent doesn't have the mechanical ability to cough
Mechanical cough assist is used in what pts?
neuromuscular weakness, quadriplegia
Mechanical cough assist cau ons:
people who are at risk for pneumothorax (bullous emphysema)
Mechanical cough assist
can not be used on intubated pa ents without removing them from the ven lator
Therapeu c bronchoscopy
preferred choice for intubated pa ents
,Therapeu c bronchoscopy signs/ symptoms:
mucous plugging (refractory hypoxemia, worsening lung compliance
mini-BAL
tends to be less me-consuming and expensive.
mini-BAL is used for
collec on of fluid specimen
mini-BAL is a
sputum sample to test for presence of infec on (pneumonia). Can be used to loosen thick
mucus.
Complica ons of a mini- BAL
- Bronchial irrita on and/or hemorrhage
- Pneumothorax
- Vagal reflex (bradycardia, hypotension)
Nasotracheal suc oning
invasive, should not be used as a first resort for most pa ents
Intuba on
can be used to facilitate airway clearance when it is clinically apparent that a pa ent cannot
adequately manage their own secre ons, or if the pa ent has a high risk of aspira on.
Non- invasive contraindica on:
when airway clearance is a concern
What are signs of sputum produc on changes that indicate a need for airway clearance?
Increase or decrease in produc on and consistency.
What ausculta on findings may indicate a need for airway clearance?
Coarse crackles, rhonchi, decreased breath sounds, or unilateral wheezing.
What changes in secre ons indicate a need for airway clearance?
Decreased or increased secre ons that are thick or discolored.
What changes on a cxr would indicate the need for airway clearance?
, Chest X-ray changes (decreased volumes, hazy, infiltrates)
In-Exsufflator (Cof-flatorTM or Cough AssistTM) contraindica ons:
Bullous emphysema, recent barotrauma, or pa ents prone to pneumothorax or
pneumomedias num.
Risk factors of intuba on include
- History of difficult intuba ons
- Limited range of mo on (trauma, surgery)
- Airway edema
- Anatomic (disability of the jaw or oral cavity)
Awake Intuba on
the pa ent s ll has a spontaneous respiratory drive (and airway patency is intact)
Awake Intuba on types of seda on
"procedural" seda on where our goal is to make the pa ent comfortable but not unconscious.
EX Midazolam( Dexmedetomidine, fentanyl are less common op ons)
When should you do an awake intuba on?
When you suspect a poor mallampa score ( EX obese pts) or a suspected difficult airway.
Lidocaine or any drug with caine is used during
Awake intuba on
(Modified) Mallampa Scores
Pt needs to be awake and cooropera ve.
Indica ve of poten al for NORMAL intuba on
- Class 1: Visibility of hard palate, so@ palate, uvula, and tonsils
- Class 2: Visibility of hard palate, so@ palate, upper por on of uvula and tonsils
Indica ve of poten al for DIFFICULT intuba on, consider plan carefully
- Class 3; Visibility of hard palate, so@ palate, and base of uvula
- Class 4: Only hard palate is visible
What is Thyromental Distance?
Measurement from thyroid notch to the p of the jaw with the head extended.
answers | Updated RATED A+ | 2026
Postural drainage
BAD LUNG UP, GOOD LUNG DOWN
Postural drainage excep on
with an area of pus/cavita on, put good lung UP to avoid draining infec ous secre ons into the
good lung
Intrapulmonary percussive ven la on (IPV)
Provide oscilla ons aimed towards the insides of the airways (CPT on the inside!)
Intrapulmonary percussive ven la on (IPV)
can be used in non-intubated pa ents or intubated pa ents.
Intrapulmonary percussive ven la on (IPV) contraindica ons:
bronchospasm, lung contusion, pneumothorax, pulmonary hemorrhage, subcutaneous
emphysema.
Mechanical cough assist
preferred when a pa ent doesn't have the mechanical ability to cough
Mechanical cough assist is used in what pts?
neuromuscular weakness, quadriplegia
Mechanical cough assist cau ons:
people who are at risk for pneumothorax (bullous emphysema)
Mechanical cough assist
can not be used on intubated pa ents without removing them from the ven lator
Therapeu c bronchoscopy
preferred choice for intubated pa ents
,Therapeu c bronchoscopy signs/ symptoms:
mucous plugging (refractory hypoxemia, worsening lung compliance
mini-BAL
tends to be less me-consuming and expensive.
mini-BAL is used for
collec on of fluid specimen
mini-BAL is a
sputum sample to test for presence of infec on (pneumonia). Can be used to loosen thick
mucus.
Complica ons of a mini- BAL
- Bronchial irrita on and/or hemorrhage
- Pneumothorax
- Vagal reflex (bradycardia, hypotension)
Nasotracheal suc oning
invasive, should not be used as a first resort for most pa ents
Intuba on
can be used to facilitate airway clearance when it is clinically apparent that a pa ent cannot
adequately manage their own secre ons, or if the pa ent has a high risk of aspira on.
Non- invasive contraindica on:
when airway clearance is a concern
What are signs of sputum produc on changes that indicate a need for airway clearance?
Increase or decrease in produc on and consistency.
What ausculta on findings may indicate a need for airway clearance?
Coarse crackles, rhonchi, decreased breath sounds, or unilateral wheezing.
What changes in secre ons indicate a need for airway clearance?
Decreased or increased secre ons that are thick or discolored.
What changes on a cxr would indicate the need for airway clearance?
, Chest X-ray changes (decreased volumes, hazy, infiltrates)
In-Exsufflator (Cof-flatorTM or Cough AssistTM) contraindica ons:
Bullous emphysema, recent barotrauma, or pa ents prone to pneumothorax or
pneumomedias num.
Risk factors of intuba on include
- History of difficult intuba ons
- Limited range of mo on (trauma, surgery)
- Airway edema
- Anatomic (disability of the jaw or oral cavity)
Awake Intuba on
the pa ent s ll has a spontaneous respiratory drive (and airway patency is intact)
Awake Intuba on types of seda on
"procedural" seda on where our goal is to make the pa ent comfortable but not unconscious.
EX Midazolam( Dexmedetomidine, fentanyl are less common op ons)
When should you do an awake intuba on?
When you suspect a poor mallampa score ( EX obese pts) or a suspected difficult airway.
Lidocaine or any drug with caine is used during
Awake intuba on
(Modified) Mallampa Scores
Pt needs to be awake and cooropera ve.
Indica ve of poten al for NORMAL intuba on
- Class 1: Visibility of hard palate, so@ palate, uvula, and tonsils
- Class 2: Visibility of hard palate, so@ palate, upper por on of uvula and tonsils
Indica ve of poten al for DIFFICULT intuba on, consider plan carefully
- Class 3; Visibility of hard palate, so@ palate, and base of uvula
- Class 4: Only hard palate is visible
What is Thyromental Distance?
Measurement from thyroid notch to the p of the jaw with the head extended.
