TMC Practice Exam QUESTIONS AND
ANSWERS ALL CORRECT (ii)
You note in the chart of a patient's who is receiving volume control ventilation that the plateau
pressure has been increasing over the last 6 hours, while the PEEP levels remains constant.
Which of the following would be the most likely cause of this change?
Select one:
A. development of pulmonary edema
B. water accumulation in the ventilator circuit
C. partial obstruction of the endotracheal tube
D. development of bronchospasm Correct Answer: An increase in the plateau pressure relative
to baseline (Pplat-PEEP) indicates a decrease in the patient's lung and/or thoracic compliance.
Common causes of a decrease in lung compliance are pneumothorax, pulmonary edema,
atelectasis and ARDS. Partial obstruction of the ET tube and development of bronchospasm
would increase airway resistance and thus increase PIP and the PIP-Pplat pressure difference, but
not affect Pplat.
The correct answer is: development of pulmonary edema
The difference between the mean arterial pressure (MAP) and intracranial pressure (ICP) is the:
Select one:
A. cerebral perfusion pressure
B. cerebral vascular resistance
C. blood-brain barrier pressure
D. jugular venous pressure Correct Answer: The difference between the mean arterial pressure
(MAP) and intracranial pressure (ICP) is the cerebral perfusion pressure (CPP); CPP = MAP -
ICP. As this equation makes clear, any factor that increases ICP and/or lowers MAP will
decrease CPP and thus potentially cause brain damage or death. In general perfusion is adequate
if the CPP can be maintained between 60 to 100 mm Hg.
The correct answer is: cerebral perfusion pressure
Which of the following would provide the best bedside assessment of the need for mechanical
ventilation in a patient with Guillain-Barre syndrome?
Select one:
A. FRC
B. VC
C. airway resistance
D. TLC Correct Answer: Guillain-Barre syndrome is a restrictive neuromuscular disorder that
results in hypoventilation. Airway resistance measures are not useful in diagnosing restrictive
ventilatory impairments. Restrictive ventilatory impairments are characterized by low lung
volumes. Of the volumes listed, only the vital capacity (VC) can be measured at bedside
,The correct answer is: VC
The normal range of adult blood pressure (systolic/diastolic) is about:
Select one:
A. 80-100/40-70 mm Hg
B. 100-140/60-90 mm Hg
C. 120-140/90-100 mm Hg
D. 130-150/100-110 mm Hg Correct Answer: Normal systolic pressure range from 100 to 140
mm Hg, with an average of 120 mm Hg. Normal diastolic pressures range from 60 to 90 mm Hg,
with an average of 80 mm Hg. The blood pressure is recorded with systolic listed over diastolic;
i.e., 120/80 mm Hg.
The correct answer is: 100-140/60-90 mm Hg
A patient admitted to the ED exhibits wheezing and hypoxemia on room air. Lab tests indicate a
normal B-type natriuretic peptide (BNP) level. Which of the following conclusion can you draw
from these findings?
Select one:
A. renal function likely is normal
B. a myocardial infarction is likely
C. congestive heart failure is unlikely
D. liver function likely is normal Correct Answer: B-type natriuretic peptide (BNP) is a cardiac
neurohormone secreted from membrane granules in the cardiac ventricles as a response to
ventricular volume expansion and pressure overload. BNP levels that are less than 100 pg mL
(normal is < 20 pg/mL) tend to rule out diagnosis of CHF, while values exceeding 500 pg/mL
help rule in this diagnosis. Intermediate values are less helpful and may occur in conditions with
similar symptoms, including renal insufficiency, cor pulmonale, and acute pulmonary embolism.
The correct answer is: congestive heart failure is unlikely
Normal lung compliance is approximately:
Select one:
A. 0.1 - 0.4 L/cm H2O
B. 0.4 - 0.8 L/cm H2O
C. 10 - 15 L/cm H2O
D. 15 - 20 L/cm H2O Correct Answer: Normal compliance of the adult lung ranges from 0.1 to
0.4 L/cm H2O, with an average value of about 0.2 L/cm H2O. The volume component of the
compliance is measured as the inhaled volume at any given pressure change. The pressure
component represents the difference between the alveolar and pleural pressures (the
transpulmonary pressure gradient).
The correct answer is: 0.1 - 0.4 L/cm H2O
, Within one second after initiating a forced vital capacity (FVC) maneuver, a patient with normal
lungs should be able exhale what percent of the FVC?
Select one:
A. 35-50% of the FVC
B. 50-70% of the FVC
C. 70-83% of the FVC
D. 84-93% of the FVC Correct Answer: The normal range for the FEV1 as a percent of the FVC
(FEV1%) is 70-83%. Patients with obstructive pulmonary disease will show a reduction in timed
FEV% values, while patients with restrictive disorders will generally exhibit normal (or
sometimes high) FEV% values.
The correct answer is: 70-83% of the FVC
Which of the following clinical findings would increase the probability that a patient with some
perfusion defects on a V/Q scan has a pulmonary embolism?
Deep venousthrombosis
Recent history of cancer
Prolonged immobilization
A. Yes No Yes
B. Yes Yes Yes
C. No Yes Yes
D. Yes Yes No
Select one:
A. A
B. B
C. C
D. D Correct Answer: The accuracy of V/Q scans in diagnosing pulmonary embolism (PE) can
be improved by combining a set of clinical risk factors with the V/Q results. These factors
(known as the Wells criteria) include signs and symptoms of deep venous thrombosis (DVT),
prior diagnosis of DVT or PE, tachycardia, immobilization for three or more days or surgery
during the prior month, hemoptysis and recent history of cancer.
The correct answer is: B
During auscultation of a patient's chest, you hear intermittent "bubbling" sounds at the lung
bases. Which of the following chart entries best describe this finding?
Select one:
A. "bronchial sounds heard at lung bases"
B. "wheezes heard at lung bases"
C. "rhonchi heard at lung bases"
ANSWERS ALL CORRECT (ii)
You note in the chart of a patient's who is receiving volume control ventilation that the plateau
pressure has been increasing over the last 6 hours, while the PEEP levels remains constant.
Which of the following would be the most likely cause of this change?
Select one:
A. development of pulmonary edema
B. water accumulation in the ventilator circuit
C. partial obstruction of the endotracheal tube
D. development of bronchospasm Correct Answer: An increase in the plateau pressure relative
to baseline (Pplat-PEEP) indicates a decrease in the patient's lung and/or thoracic compliance.
Common causes of a decrease in lung compliance are pneumothorax, pulmonary edema,
atelectasis and ARDS. Partial obstruction of the ET tube and development of bronchospasm
would increase airway resistance and thus increase PIP and the PIP-Pplat pressure difference, but
not affect Pplat.
The correct answer is: development of pulmonary edema
The difference between the mean arterial pressure (MAP) and intracranial pressure (ICP) is the:
Select one:
A. cerebral perfusion pressure
B. cerebral vascular resistance
C. blood-brain barrier pressure
D. jugular venous pressure Correct Answer: The difference between the mean arterial pressure
(MAP) and intracranial pressure (ICP) is the cerebral perfusion pressure (CPP); CPP = MAP -
ICP. As this equation makes clear, any factor that increases ICP and/or lowers MAP will
decrease CPP and thus potentially cause brain damage or death. In general perfusion is adequate
if the CPP can be maintained between 60 to 100 mm Hg.
The correct answer is: cerebral perfusion pressure
Which of the following would provide the best bedside assessment of the need for mechanical
ventilation in a patient with Guillain-Barre syndrome?
Select one:
A. FRC
B. VC
C. airway resistance
D. TLC Correct Answer: Guillain-Barre syndrome is a restrictive neuromuscular disorder that
results in hypoventilation. Airway resistance measures are not useful in diagnosing restrictive
ventilatory impairments. Restrictive ventilatory impairments are characterized by low lung
volumes. Of the volumes listed, only the vital capacity (VC) can be measured at bedside
,The correct answer is: VC
The normal range of adult blood pressure (systolic/diastolic) is about:
Select one:
A. 80-100/40-70 mm Hg
B. 100-140/60-90 mm Hg
C. 120-140/90-100 mm Hg
D. 130-150/100-110 mm Hg Correct Answer: Normal systolic pressure range from 100 to 140
mm Hg, with an average of 120 mm Hg. Normal diastolic pressures range from 60 to 90 mm Hg,
with an average of 80 mm Hg. The blood pressure is recorded with systolic listed over diastolic;
i.e., 120/80 mm Hg.
The correct answer is: 100-140/60-90 mm Hg
A patient admitted to the ED exhibits wheezing and hypoxemia on room air. Lab tests indicate a
normal B-type natriuretic peptide (BNP) level. Which of the following conclusion can you draw
from these findings?
Select one:
A. renal function likely is normal
B. a myocardial infarction is likely
C. congestive heart failure is unlikely
D. liver function likely is normal Correct Answer: B-type natriuretic peptide (BNP) is a cardiac
neurohormone secreted from membrane granules in the cardiac ventricles as a response to
ventricular volume expansion and pressure overload. BNP levels that are less than 100 pg mL
(normal is < 20 pg/mL) tend to rule out diagnosis of CHF, while values exceeding 500 pg/mL
help rule in this diagnosis. Intermediate values are less helpful and may occur in conditions with
similar symptoms, including renal insufficiency, cor pulmonale, and acute pulmonary embolism.
The correct answer is: congestive heart failure is unlikely
Normal lung compliance is approximately:
Select one:
A. 0.1 - 0.4 L/cm H2O
B. 0.4 - 0.8 L/cm H2O
C. 10 - 15 L/cm H2O
D. 15 - 20 L/cm H2O Correct Answer: Normal compliance of the adult lung ranges from 0.1 to
0.4 L/cm H2O, with an average value of about 0.2 L/cm H2O. The volume component of the
compliance is measured as the inhaled volume at any given pressure change. The pressure
component represents the difference between the alveolar and pleural pressures (the
transpulmonary pressure gradient).
The correct answer is: 0.1 - 0.4 L/cm H2O
, Within one second after initiating a forced vital capacity (FVC) maneuver, a patient with normal
lungs should be able exhale what percent of the FVC?
Select one:
A. 35-50% of the FVC
B. 50-70% of the FVC
C. 70-83% of the FVC
D. 84-93% of the FVC Correct Answer: The normal range for the FEV1 as a percent of the FVC
(FEV1%) is 70-83%. Patients with obstructive pulmonary disease will show a reduction in timed
FEV% values, while patients with restrictive disorders will generally exhibit normal (or
sometimes high) FEV% values.
The correct answer is: 70-83% of the FVC
Which of the following clinical findings would increase the probability that a patient with some
perfusion defects on a V/Q scan has a pulmonary embolism?
Deep venousthrombosis
Recent history of cancer
Prolonged immobilization
A. Yes No Yes
B. Yes Yes Yes
C. No Yes Yes
D. Yes Yes No
Select one:
A. A
B. B
C. C
D. D Correct Answer: The accuracy of V/Q scans in diagnosing pulmonary embolism (PE) can
be improved by combining a set of clinical risk factors with the V/Q results. These factors
(known as the Wells criteria) include signs and symptoms of deep venous thrombosis (DVT),
prior diagnosis of DVT or PE, tachycardia, immobilization for three or more days or surgery
during the prior month, hemoptysis and recent history of cancer.
The correct answer is: B
During auscultation of a patient's chest, you hear intermittent "bubbling" sounds at the lung
bases. Which of the following chart entries best describe this finding?
Select one:
A. "bronchial sounds heard at lung bases"
B. "wheezes heard at lung bases"
C. "rhonchi heard at lung bases"
