Review Sheet for the TMC Exam – for 2020
December 23, 2019
The Review Sheet is divided into the following sections:
I.
Key Terminology
II. TMC Topics
III. ABG Interpretation
IV. TMC Facts and Formulas
V. Index of Review Items to TMC Detailed Content Outline
Note - at the end of the review sheet you will find the NBRC TMC
Detailed Content Outline with all review sheet items indexed by topic.
You must do Kettering Practice Exams A and B in order to succeed on the TMC
Exam. Also take the free TMC Practice Exam at www.nbrc.org and take the two
Self-Assessment Exams. There is a small fee to do so, but the gain in TMC Exam
Score is more than worth it!
I. Some Key Terminology First….
Chocolate Brown Blood indicates Methemoglobinemia – so do hemoximetry to
see how much of the various types of hemoglobin are present. One common
cause of methemoglobinemia is nitrite toxicity.Also Nitric Oxide
Therapy.Treatment of methemoglobinemia is Methylene Blue!
Hemoximetry is the same thing as CO-Oximetry, to measure carboxyhemoglobin
and other types of hemoglobin. Crucial test in Carbon Monoxide poisoning!
Empyema –(some students have confused this term with emphysema, so let’s
explain)Empyema is usually caused by an infection that spreads from the lung. It leads to a
buildup of pus in the pleural space.There can be a pint or more of infected fluid. This fluid puts
pressure on the lungs.Risk factors include pneumonia, Tuberculosis, Chest surgery, Lung abscess,
Trauma or injury to the chest. The health care provider may note decreased breath sounds or an
abnormal sound (friction rub) when listening to the chest with a stethoscope (auscultation).Tests
that may be ordered includeChest x-ray, CT scan of chest, Pleural fluid analysis, Thoracentesis.
,Goal of treatment is to cure the infection. This involves the following placing a chest tube to drain
the pus and giving antibiotics to control the infection.
Phosphotidylglycerol (PG) –obtained by amniocentesis, when it is present, it indicates that
the baby’s lungs are mature
“Thorpe Tube” – standard oxygen flowmeter, plugs into wall outlet – not good for transport
“Bourdon Gauge” – regulator– good for transport
“Eupnea” – normal breathing, no distress “Eu”
BiPAP is called NPPV (Noninvasive Positive Pressure Ventilation) or NIV (Noninvasive
Ventilation) for testing purposes
“Marked” means very severe – so do something quickly
“Oscilloscope” – an older term for a cardiac monitor or other monitoring electronic
monitoring device.
“Adventitious” lung sounds are abnormal lung sounds. If your patient has abnormal lung
sounds, you are in for an “adventure.”
“Oxygenation Index” = (FIO2 X Mean Airway Pressure) / PaO2
The oxygenation index is used to assess the intensity of ventilatory support required to
maintain oxygenation. It is used in neonates / pediatrics to assess the need for potential
ECMO therapy.
II. TMC TOPICS
1. Cardiac Output – what formula is used? Fick Equation
Normal Range for Cardiac Output – 4-8 LPM
2. Cardiac Index – what are the units? (L/min/m2) liters per minute per square meter.
That is because Cardiac Index is Cardiac Output (L/min) divided by Body Surface Area (m2)
Since Body Surface area is about 2 m2 for most patients, the Normal Range for Cardiac
Index is about 2-4 L/min/m2
3. Know all the Ventilator Waveforms and what they mean – the “beak” is overdistension, so
you would decrease tidal volume or PIP. Also review air leak, reduced compliance,
increased resistance, inadequate flow.
,4. Patient is having bleeding during bronchoscopy, what do you do? Administer Epinephrine
(a vasoconstrictor) down the scope.
5. Patient coughing during bronchoscopy, what do you do? Administer Lidocaine (topical
anesthetic) down the scope.
6. PFT’s – what volumes add up to various capacities. Ex. ERV + RV = FRC For these questions,
try to memorize the spirogram or the boxes. There is a great mnemonic device to help you
remember, and I will share later! ERV + TV + IRV = VC
7. PFT’s. Which volumes and capacities are increased or decreased in obstruction/restriction
Ex. TLC and VC decreased in restriction (less than 80% of predicted), FEV1/FVC ratio
decreased in obstruction,less than 70%, so the patient exhales less than 70% of VC in the
first second.
, Obstruction – CBABE diseases
Cystic Fibrosis, Bronchitis, Asthma, Bronchiectasis, Emphysema
8. What does PEEP(Positive End-Expiratory Pressure) really do to improve oxygenation? –it
decreases PA-aO2, meaning A-a gradient, Alveolar to arterial gradient. It also increases the
FRC (Functional Residual Capacity)
9. Acute Asthma in the ER – albuterol and prednisone are best(versus long acting agents, not
Brovana, Symbicort, etc)
10. Infant with Stridor in the ER – Racemic Epinephrine is best (will talk later about croup versus
epiglottitis)
11. TcO2 – transcutaneous oxygen – sensor temp should be 44 degrees C. If the sensor is
burning the infant, move it more often! 2-3 hours in one place, and then move it!
12. Know PEEP and its effects on venous return, cardiac output, blood pressure, lung
compliance, etc.
https://www.youtube.com/watch?v=_LZOekO5BeI
13. Heliox – when used (severe bronchospasm or airway obstruction), how to determine actual
flow when using standard oxygen flowmeter(you will be using a nonrebreather mask)
For 80/20 mixture, the ratio is 1.8. So multiply the oxygen flowmeter reading times 1.8
to get the true flowrate
For 70/30 mixture, the ratio is 1.6. So multiply the oxygen flowmeter reading times 1.6
to get the true flowrate
Ex. If the patient is on 80/20 Heliox and the oxygen flowmeter reads 10 LPM, then the
actual flow is 18 LPM
14. For Pediatrics – review setting oscillator - HFOV, Mean Airway Pressure, Amplitude
https://www.youtube.com/watch?v=bYyXOrZlN2c
December 23, 2019
The Review Sheet is divided into the following sections:
I.
Key Terminology
II. TMC Topics
III. ABG Interpretation
IV. TMC Facts and Formulas
V. Index of Review Items to TMC Detailed Content Outline
Note - at the end of the review sheet you will find the NBRC TMC
Detailed Content Outline with all review sheet items indexed by topic.
You must do Kettering Practice Exams A and B in order to succeed on the TMC
Exam. Also take the free TMC Practice Exam at www.nbrc.org and take the two
Self-Assessment Exams. There is a small fee to do so, but the gain in TMC Exam
Score is more than worth it!
I. Some Key Terminology First….
Chocolate Brown Blood indicates Methemoglobinemia – so do hemoximetry to
see how much of the various types of hemoglobin are present. One common
cause of methemoglobinemia is nitrite toxicity.Also Nitric Oxide
Therapy.Treatment of methemoglobinemia is Methylene Blue!
Hemoximetry is the same thing as CO-Oximetry, to measure carboxyhemoglobin
and other types of hemoglobin. Crucial test in Carbon Monoxide poisoning!
Empyema –(some students have confused this term with emphysema, so let’s
explain)Empyema is usually caused by an infection that spreads from the lung. It leads to a
buildup of pus in the pleural space.There can be a pint or more of infected fluid. This fluid puts
pressure on the lungs.Risk factors include pneumonia, Tuberculosis, Chest surgery, Lung abscess,
Trauma or injury to the chest. The health care provider may note decreased breath sounds or an
abnormal sound (friction rub) when listening to the chest with a stethoscope (auscultation).Tests
that may be ordered includeChest x-ray, CT scan of chest, Pleural fluid analysis, Thoracentesis.
,Goal of treatment is to cure the infection. This involves the following placing a chest tube to drain
the pus and giving antibiotics to control the infection.
Phosphotidylglycerol (PG) –obtained by amniocentesis, when it is present, it indicates that
the baby’s lungs are mature
“Thorpe Tube” – standard oxygen flowmeter, plugs into wall outlet – not good for transport
“Bourdon Gauge” – regulator– good for transport
“Eupnea” – normal breathing, no distress “Eu”
BiPAP is called NPPV (Noninvasive Positive Pressure Ventilation) or NIV (Noninvasive
Ventilation) for testing purposes
“Marked” means very severe – so do something quickly
“Oscilloscope” – an older term for a cardiac monitor or other monitoring electronic
monitoring device.
“Adventitious” lung sounds are abnormal lung sounds. If your patient has abnormal lung
sounds, you are in for an “adventure.”
“Oxygenation Index” = (FIO2 X Mean Airway Pressure) / PaO2
The oxygenation index is used to assess the intensity of ventilatory support required to
maintain oxygenation. It is used in neonates / pediatrics to assess the need for potential
ECMO therapy.
II. TMC TOPICS
1. Cardiac Output – what formula is used? Fick Equation
Normal Range for Cardiac Output – 4-8 LPM
2. Cardiac Index – what are the units? (L/min/m2) liters per minute per square meter.
That is because Cardiac Index is Cardiac Output (L/min) divided by Body Surface Area (m2)
Since Body Surface area is about 2 m2 for most patients, the Normal Range for Cardiac
Index is about 2-4 L/min/m2
3. Know all the Ventilator Waveforms and what they mean – the “beak” is overdistension, so
you would decrease tidal volume or PIP. Also review air leak, reduced compliance,
increased resistance, inadequate flow.
,4. Patient is having bleeding during bronchoscopy, what do you do? Administer Epinephrine
(a vasoconstrictor) down the scope.
5. Patient coughing during bronchoscopy, what do you do? Administer Lidocaine (topical
anesthetic) down the scope.
6. PFT’s – what volumes add up to various capacities. Ex. ERV + RV = FRC For these questions,
try to memorize the spirogram or the boxes. There is a great mnemonic device to help you
remember, and I will share later! ERV + TV + IRV = VC
7. PFT’s. Which volumes and capacities are increased or decreased in obstruction/restriction
Ex. TLC and VC decreased in restriction (less than 80% of predicted), FEV1/FVC ratio
decreased in obstruction,less than 70%, so the patient exhales less than 70% of VC in the
first second.
, Obstruction – CBABE diseases
Cystic Fibrosis, Bronchitis, Asthma, Bronchiectasis, Emphysema
8. What does PEEP(Positive End-Expiratory Pressure) really do to improve oxygenation? –it
decreases PA-aO2, meaning A-a gradient, Alveolar to arterial gradient. It also increases the
FRC (Functional Residual Capacity)
9. Acute Asthma in the ER – albuterol and prednisone are best(versus long acting agents, not
Brovana, Symbicort, etc)
10. Infant with Stridor in the ER – Racemic Epinephrine is best (will talk later about croup versus
epiglottitis)
11. TcO2 – transcutaneous oxygen – sensor temp should be 44 degrees C. If the sensor is
burning the infant, move it more often! 2-3 hours in one place, and then move it!
12. Know PEEP and its effects on venous return, cardiac output, blood pressure, lung
compliance, etc.
https://www.youtube.com/watch?v=_LZOekO5BeI
13. Heliox – when used (severe bronchospasm or airway obstruction), how to determine actual
flow when using standard oxygen flowmeter(you will be using a nonrebreather mask)
For 80/20 mixture, the ratio is 1.8. So multiply the oxygen flowmeter reading times 1.8
to get the true flowrate
For 70/30 mixture, the ratio is 1.6. So multiply the oxygen flowmeter reading times 1.6
to get the true flowrate
Ex. If the patient is on 80/20 Heliox and the oxygen flowmeter reads 10 LPM, then the
actual flow is 18 LPM
14. For Pediatrics – review setting oscillator - HFOV, Mean Airway Pressure, Amplitude
https://www.youtube.com/watch?v=bYyXOrZlN2c
