Clinical Simulation Questions and
Answers A+ Graded (2025)
COPD .- .CORRECT .ANSWER-Preventable .and .treatable .disease .state
.characterized .by .air .flow .limitation .that .is .not .fully .reversible.
Emphysema .- .CORRECT .ANSWER-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 .- .CORRECT .ANSWER-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 .- .CORRECT .ANSWER-- .tobacco .smoke
-genetic .predisposition .
- .indoor .and .outdoor .pollution
Pt .Assessment .of .Emphysema .Pt .(Primary .assessment) .- .CORRECT .ANSWER-
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 .
Clubbing .= .Late .stage
Diagnostic .Chest .Percussion .= .Hyperresonant/ .Tympanic .note
Breath .Sounds .= .Diminished, .prolonged .expiration
Body .build .of .Type .A .COPD .(pink .puffer) .Emphysema .- .CORRECT .ANSWER-
Thin, .underweight
Past .medical .history .for .emphysema .pts .- .CORRECT .ANSWER-Tobacco .use
Cough .(Emphysema) .- .CORRECT .ANSWER-Less .common, .muciod .secretions
,Appearance .of .the .chest .(Emphysema) .- .CORRECT .ANSWER-Barrel .chest,
.increased .A-P .diameter
Respiratory .pattern .( .Emphysema) .- .CORRECT .ANSWER-Dyspnea, .pursed .lip
.breathing, .accessory .muscle .use, .especially .during .exacerbations
Color .(Emphysema) .- .CORRECT .ANSWER-Often .reddish
Clubbing .(Emphysema) .- .CORRECT .ANSWER-Late .stage
Diagnostic .Chet .Percussion .(Emphysema) .- .CORRECT .ANSWER-
Hyperresonant/tympanic .note
Breath .sounds .( .Emphysema) .- .CORRECT .ANSWER-Diminished, .prolonged
.expiration
Patient .Assessment .(Primary) .Chronic .Bronchitis .- .CORRECT .ANSWER-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 .
Color .= .Cyanotic .
Clubbing .= .Common
Diagnostic .Chest .Percussion .= .normal .
Breath .Sounds .= .Rhonchi, .crackles ., .wheezing
Body .build .(Chronic .Bronchitis) .- .CORRECT .ANSWER-Stocky, .overweight
Past .Medical .History .(Chronic .Bronchitis) .- .CORRECT .ANSWER-Tobacco .use
Cough .(Chronic .Bronchitis .) .- .CORRECT .ANSWER-Productive, .copious .amounts
.of .purulent .secretions
Chest .Appearance .(Chronic .Bronchitis) .- .CORRECT .ANSWER-Occasionally
.barrel .chest
Respiratory .Pattern .(Chronic .Bronchitis .) .- .CORRECT .ANSWER-Use .of
.accessory .muscles .less .common
Clubbing .( .Chronic .Bronchitis .) .- .CORRECT .ANSWER-Common
Diagnostic .Chest .Percussion .( .Chronic .Bronchitis) .- .CORRECT .ANSWER-Normal
Breath .Sounds .(Chronic .Bronchitis .) .- .CORRECT .ANSWER-Rhonchi, .crackles,
.wheezing
Secondary .Assessment .Emphysema .pt .- .CORRECT .ANSWER-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
Sputum .= .Normal
Chest .X-ray .(Emphysema .) .- .CORRECT .ANSWER-Translucent .(dark) .lung .fields,
.depressed .or .flattened .diaphragms, .long .and .narrow .heart, .increased
.retrosternal .air .space, .possibly .hypertrophy .or .right . ventricle
ABG .(emphysema) .- .CORRECT .ANSWER-Mild .to .moderate .stages: .Acute
.alveolar .hyperventilation .with .hypoxemia .Severe .stage: .Chronic . ventilatory
.failure .with .hypoxemia
Pulmonary .Function .(Emphysema .) .- .CORRECT .ANSWER-Decreased .flowrates,
.Decreased .DLCO
CBC .(Emphysema) .- .CORRECT .ANSWER-Increased .RBC/Hct/Hb .in .late .stages
Sputum .(Emphysema) .- .CORRECT .ANSWER-Normal
Secondary .Assessment .Chronic .Bronchitis .- .CORRECT .ANSWER-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) .- .CORRECT .ANSWER-Translucent .lung .fields,
.depressed .or .flattened .diaphragms, .possibly .hypertrophy .of .the .right . ventricle
ABG .( .Chronic .Bronchitis) .- .CORRECT .ANSWER-Mild .to .moderate .stages: .Acute
.alveolar .hyperventilation .with .hypoxemia .
Severe .stage: .Chronic .ventilatory .failure .with .hypoxemia
Pulmonary .Function .( .Chronic .Bronchitis .) .- .CORRECT .ANSWER-Decreased
.flowrates, .normal .DLCO
CBC .(Chronic .Bronchitis) .- .CORRECT .ANSWER-Increased .RBC/Hb/Hct .in .early
.and .late .stages
, Sputum .(Chronic .Bronchitis .) .- .CORRECT .ANSWER-Often .shows: .Streptococcus
.pneumoniae, .Haemophilus .influenzae, .Moraxella .catarrhalis
Treatment .for .COPD .- .CORRECT .ANSWER-1. .Low .flow .o2 .therapy .
Nasal .cannula .1-2 .L/min .or .24-28% .air .entrainment .mask .
Consider .o2 .conservation .devices .for .home .use
2. .Bronchodilators .(SABA, .LABA, .and .anticholinergic) .
3. .Inhaled .corticosteroids .
4. .Antibiotics .if .indicated .by .sputum .culture
5. .Bronchial .hygiene .as .indicted .
6. .Referral .to .smoking .cessation .program, .including .nicotine .replacement
.therapy .
7. .Consider .NPPV .for .acute .exacerbations .of .ventilatory .failure .
8. .Refer .pt .family .to .pulmonary .rehab .ed .programs .which .should .include .
-Nutritional .management .
- .Avoiding .infections .
-Exercise .program
- .Methods .to .aid .in .secretion .clearance .
-Home .O2 .and .aerosol .therapy .
-Appropriate .use .of .medications .
9. .Annual .flu .vaccine
Bronchiectasis .(definition .) .- .CORRECT .ANSWER-Chronic .dilation .and .distortion
.one .of .one .or .more .bronchi .as .a .result .of .excessive .inflammation .and
.destruction .of .the .bronchial .walls, .blood .vessels, .elastic .tissue .and .smooth
.muscle. .Results .in .impaired .mucocilary .clearance .causing .accumulation .of
.copious .amounts .of .bronchial .secretions .
-one .or .both .lungs .may .be .involved .
-Commonly .limited .to .lobe .or .segment .
- .Frequently .found .in .lower .lobes .
-Can .create .an .obstructive .or .restrictive .pattern .or .a .combination .of .both
Patient .Assessment .(Primary) .for .Bronchiectasis .pt .- .CORRECT .ANSWER-Past
.Medical .History .= .Recurrent .pulmonary .infections, .Cystic .Fibrosis, .if
.Kartageners .Syndrome
Shortness .of .Breath .= .Present, .possibly .pursed .lip .breathing .
Cough .= .Productive .with .purulent .foul .smelling .sputum, .hemoptysis .and .3 .layer
.sputum, .may .be .blood .streaked .
Appearance .of .chest .= .Barrel .chest, .increased .A-P .diameter .
Respiratory .Pattern .= .Accessory .muscle .usage
Color .= .Cyanotic .
Appearance .of .the .nail .beds .= .clubbing .
Diagnostic .Chest .Percussion .= .Hyperresonant/tympanic .note .
Breath .Sounds .= .Wheezing, .diminished .breath .sounds
Past .Medical .History .( .Bronchiectasis) .- .CORRECT .ANSWER-Recurrent
.pulmonary .infections, .Cystic .Fibrosis, .or .Kartageners .Syndrome
Answers A+ Graded (2025)
COPD .- .CORRECT .ANSWER-Preventable .and .treatable .disease .state
.characterized .by .air .flow .limitation .that .is .not .fully .reversible.
Emphysema .- .CORRECT .ANSWER-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 .- .CORRECT .ANSWER-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 .- .CORRECT .ANSWER-- .tobacco .smoke
-genetic .predisposition .
- .indoor .and .outdoor .pollution
Pt .Assessment .of .Emphysema .Pt .(Primary .assessment) .- .CORRECT .ANSWER-
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 .
Clubbing .= .Late .stage
Diagnostic .Chest .Percussion .= .Hyperresonant/ .Tympanic .note
Breath .Sounds .= .Diminished, .prolonged .expiration
Body .build .of .Type .A .COPD .(pink .puffer) .Emphysema .- .CORRECT .ANSWER-
Thin, .underweight
Past .medical .history .for .emphysema .pts .- .CORRECT .ANSWER-Tobacco .use
Cough .(Emphysema) .- .CORRECT .ANSWER-Less .common, .muciod .secretions
,Appearance .of .the .chest .(Emphysema) .- .CORRECT .ANSWER-Barrel .chest,
.increased .A-P .diameter
Respiratory .pattern .( .Emphysema) .- .CORRECT .ANSWER-Dyspnea, .pursed .lip
.breathing, .accessory .muscle .use, .especially .during .exacerbations
Color .(Emphysema) .- .CORRECT .ANSWER-Often .reddish
Clubbing .(Emphysema) .- .CORRECT .ANSWER-Late .stage
Diagnostic .Chet .Percussion .(Emphysema) .- .CORRECT .ANSWER-
Hyperresonant/tympanic .note
Breath .sounds .( .Emphysema) .- .CORRECT .ANSWER-Diminished, .prolonged
.expiration
Patient .Assessment .(Primary) .Chronic .Bronchitis .- .CORRECT .ANSWER-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 .
Color .= .Cyanotic .
Clubbing .= .Common
Diagnostic .Chest .Percussion .= .normal .
Breath .Sounds .= .Rhonchi, .crackles ., .wheezing
Body .build .(Chronic .Bronchitis) .- .CORRECT .ANSWER-Stocky, .overweight
Past .Medical .History .(Chronic .Bronchitis) .- .CORRECT .ANSWER-Tobacco .use
Cough .(Chronic .Bronchitis .) .- .CORRECT .ANSWER-Productive, .copious .amounts
.of .purulent .secretions
Chest .Appearance .(Chronic .Bronchitis) .- .CORRECT .ANSWER-Occasionally
.barrel .chest
Respiratory .Pattern .(Chronic .Bronchitis .) .- .CORRECT .ANSWER-Use .of
.accessory .muscles .less .common
Clubbing .( .Chronic .Bronchitis .) .- .CORRECT .ANSWER-Common
Diagnostic .Chest .Percussion .( .Chronic .Bronchitis) .- .CORRECT .ANSWER-Normal
Breath .Sounds .(Chronic .Bronchitis .) .- .CORRECT .ANSWER-Rhonchi, .crackles,
.wheezing
Secondary .Assessment .Emphysema .pt .- .CORRECT .ANSWER-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
Sputum .= .Normal
Chest .X-ray .(Emphysema .) .- .CORRECT .ANSWER-Translucent .(dark) .lung .fields,
.depressed .or .flattened .diaphragms, .long .and .narrow .heart, .increased
.retrosternal .air .space, .possibly .hypertrophy .or .right . ventricle
ABG .(emphysema) .- .CORRECT .ANSWER-Mild .to .moderate .stages: .Acute
.alveolar .hyperventilation .with .hypoxemia .Severe .stage: .Chronic . ventilatory
.failure .with .hypoxemia
Pulmonary .Function .(Emphysema .) .- .CORRECT .ANSWER-Decreased .flowrates,
.Decreased .DLCO
CBC .(Emphysema) .- .CORRECT .ANSWER-Increased .RBC/Hct/Hb .in .late .stages
Sputum .(Emphysema) .- .CORRECT .ANSWER-Normal
Secondary .Assessment .Chronic .Bronchitis .- .CORRECT .ANSWER-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) .- .CORRECT .ANSWER-Translucent .lung .fields,
.depressed .or .flattened .diaphragms, .possibly .hypertrophy .of .the .right . ventricle
ABG .( .Chronic .Bronchitis) .- .CORRECT .ANSWER-Mild .to .moderate .stages: .Acute
.alveolar .hyperventilation .with .hypoxemia .
Severe .stage: .Chronic .ventilatory .failure .with .hypoxemia
Pulmonary .Function .( .Chronic .Bronchitis .) .- .CORRECT .ANSWER-Decreased
.flowrates, .normal .DLCO
CBC .(Chronic .Bronchitis) .- .CORRECT .ANSWER-Increased .RBC/Hb/Hct .in .early
.and .late .stages
, Sputum .(Chronic .Bronchitis .) .- .CORRECT .ANSWER-Often .shows: .Streptococcus
.pneumoniae, .Haemophilus .influenzae, .Moraxella .catarrhalis
Treatment .for .COPD .- .CORRECT .ANSWER-1. .Low .flow .o2 .therapy .
Nasal .cannula .1-2 .L/min .or .24-28% .air .entrainment .mask .
Consider .o2 .conservation .devices .for .home .use
2. .Bronchodilators .(SABA, .LABA, .and .anticholinergic) .
3. .Inhaled .corticosteroids .
4. .Antibiotics .if .indicated .by .sputum .culture
5. .Bronchial .hygiene .as .indicted .
6. .Referral .to .smoking .cessation .program, .including .nicotine .replacement
.therapy .
7. .Consider .NPPV .for .acute .exacerbations .of .ventilatory .failure .
8. .Refer .pt .family .to .pulmonary .rehab .ed .programs .which .should .include .
-Nutritional .management .
- .Avoiding .infections .
-Exercise .program
- .Methods .to .aid .in .secretion .clearance .
-Home .O2 .and .aerosol .therapy .
-Appropriate .use .of .medications .
9. .Annual .flu .vaccine
Bronchiectasis .(definition .) .- .CORRECT .ANSWER-Chronic .dilation .and .distortion
.one .of .one .or .more .bronchi .as .a .result .of .excessive .inflammation .and
.destruction .of .the .bronchial .walls, .blood .vessels, .elastic .tissue .and .smooth
.muscle. .Results .in .impaired .mucocilary .clearance .causing .accumulation .of
.copious .amounts .of .bronchial .secretions .
-one .or .both .lungs .may .be .involved .
-Commonly .limited .to .lobe .or .segment .
- .Frequently .found .in .lower .lobes .
-Can .create .an .obstructive .or .restrictive .pattern .or .a .combination .of .both
Patient .Assessment .(Primary) .for .Bronchiectasis .pt .- .CORRECT .ANSWER-Past
.Medical .History .= .Recurrent .pulmonary .infections, .Cystic .Fibrosis, .if
.Kartageners .Syndrome
Shortness .of .Breath .= .Present, .possibly .pursed .lip .breathing .
Cough .= .Productive .with .purulent .foul .smelling .sputum, .hemoptysis .and .3 .layer
.sputum, .may .be .blood .streaked .
Appearance .of .chest .= .Barrel .chest, .increased .A-P .diameter .
Respiratory .Pattern .= .Accessory .muscle .usage
Color .= .Cyanotic .
Appearance .of .the .nail .beds .= .clubbing .
Diagnostic .Chest .Percussion .= .Hyperresonant/tympanic .note .
Breath .Sounds .= .Wheezing, .diminished .breath .sounds
Past .Medical .History .( .Bronchiectasis) .- .CORRECT .ANSWER-Recurrent
.pulmonary .infections, .Cystic .Fibrosis, .or .Kartageners .Syndrome
