Pulmonary Physiology
Mock Exam
Course Introduction
Pulmonary Physiology provides an in-depth exploration of the structure, function, and regulation of the respiratory system. Students will examine the mechanics of breathing, gas exchange, ventilation-perfusion relationships, oxygen and carbon dioxide transport, and the control of respiration in health and disease. The course integrates anatomical and molecular perspectives to build a comprehensive understanding of how the lungs and associated systems maintain optimal blood gas homeostasis under varying physiological conditions. Emphasis is placed on clinical correlations and the impact of pulmonary disorders, preparing students for applications in medicine, healthcare, and biomedical research.
Recommended Textbook
Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by J M Cairo
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684 Flashcards
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Chapter 1: Basic Terms and Concepts of Mechanical Ventilation
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Sample Questions
Q1) Air accidently trapped in the lungs due to mechanical ventilation is known as which of the following?
A) Plateau pressure (P<sub>plateau</sub>)
B) Functional residual capacity (FRC)
C) Extrinsic positive end expiratory pressure (extrinsic PEEP)
D) Intrinsic positive end expiratory pressure (intrinsic PEEP)
Answer: D
Q2) The respiratory therapist should expect which of the following findings while ventilating a patient with acute respiratory distress syndrome (ARDS)?
A) An elevated plateau pressure (P<sub>plateau</sub>)
B) A decreased elastic resistance
C) A low peak inspiratory pressure (PIP)
D) A large transairway pressure (P<sub>TA</sub>)gradient
Answer: A
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3
Chapter 2: How Ventilators Work
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Q1) Modern intensive care units' (ICU)ventilators regulate gas flow to the patient by using which of the following?
A) Rotary drive pistons
B) Linear drive pistons
C) Proportional solenoids
D) Spring-loaded bellows
Answer: C
Q2) The internal circuit of a ventilator allows the gas to go directly from its power source into the patient.This is known as which of the following?
A) Single-circuit
B) Open loop
C) Closed loop
D) Double-circuit
Answer: A
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4
Chapter 3: How a Breath Is Delivered
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Sample Questions
Q1) A patient who has been sedated and paralyzed by medications is being controlled by the ventilator.The set rate is 15 breaths/min.How many seconds does it take for inspiration and expiration to occur?
A) 2 seconds
B) 4 seconds
C) 6 seconds
D) 8 seconds
Answer: B
Q2) The trigger variable in the controlled mode is which of the following?
A) Flow
B) Time
C) Pressure
D) Volume
Answer: B
Q3) How many variables can a ventilator control at one time?
A) One
B) Two
C) Three
D) Four Answer: A
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Chapter 4: Establishing the Need for Mechanical Ventilation
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Q1) A patient seen in the emergency department exhibits paralysis of the lower extremities that is getting progressively worse.Vital capacity is 6 mL/kg,maximum inspiratory pressure (MIP)is -17 cm H<sub>2</sub>O,and oxygen saturation measured by pulse oximeter (SpO<sub>2</sub>)is 89%.Arterial blood gases (ABGs)are pending.The physician suspects Guillain-Barré syndrome.The most appropriate action at this time is which of the following?
A) Intubate and mechanically ventilate.
B) Place patient on a nonrebreather mask.
C) Initiate continuous positive airway pressure.
D) Initiate noninvasive positive pressure ventilation.
Q2) Respiratory failure due to inadequate ventilation is known as which of the following?
A) Hypoxemic
B) Hypercapnic
C) Compensated
D) Chronic
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Chapter 5: Selecting the Ventilator and the Mode
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Q1) A patient with Acute Respiratory Distress Syndrome (ARDS)has developed a pneumothorax from elevating peak and plateau pressures.The patient is currently being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV)mode with a set rate of 12 bpm.However,the patient is triggering the ventilator at a rate of 25 bpm.The arterial blood gas reveals ventilator induced hyperventilation with corrected hypoxemia.The most appropriate recommendation to manage this patient on the ventilator is which of the following?
A) Sedate the patient.
B) Decrease the set ventilator rate.
C) Switch the mode to pressure-controlled synchronized mandatory ventilation (PC-SIMV).
D) Switch the mode to pressure-controlled continuous mandatory ventilation (PC-CMV).
Q2) The ventilator mode where every breath is patient triggered,pressure targeted,flow cycled with a volume target is which of the following?
A) Volume Support Ventilation (VSV)
B) Pressure Regulated Volume Control (PRVC)
C) Airway Pressure Release Ventilation (APRV)
D) Pressure Augmentation (Paug)
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Page 7
Chapter 6: Initial Ventilator Settings
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Sample Questions
Q1) A 47-year-old,6'1" male patient is admitted to the hospital due to trauma from a motor vehicle accident.Forty-eight hours post admission,the patient is suffering from respiratory distress with severe hypoxemia and is intubated.A chest x-ray,done prior to intubation ,reveals a ground glass appearance bilaterally.The physician requests the volume-controlled continuous mandatory ventilation (VC-CMV)mode for this patient.The initial settings for the ventilator should be which of the following?
A) V<sub>T</sub> = 450 mL,rate = 18 bpm,PEEP = 8 cm H<sub>2</sub>O
B) V<sub>T</sub> = 600 mL,rate = 10 bpm,PEEP = 5 cm H<sub>2</sub>O
C) V<sub>T</sub> = 750 mL,rate = 15 bpm,PEEP = 10 cm H<sub>2</sub>O
D) V<sub>T</sub> = 900 mL,rate = 12 bpm,PEEP = 5 cm H<sub>2</sub>O
Q2) A patient has a body temperature of 40° C.How should the initial minute ventilation setting be adjusted?
A) Increase it by 15%
B) Decrease it by 18%
C) Decrease it by 25%
D) Increase it by 30%
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Chapter 7: Final Considerations in Ventilator Setup
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Sample Questions
Q1) A 70-year-old,61-inch-tall,female patient was admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD).After 12 hours of oxygen therapy,bronchodilator therapy,and intravenous corticosteroids,the patient began to show signs of clinical deterioration.Her chest x-ray revealed an enlarged heart and bilateral infiltrates.Her arterial blood gas shows acute on chronic respiratory failure.It is decided that this patient requires intubation and mechanical ventilation.The most appropriate ventilator settings for this patient include which of the following?
A) Volume-controlled continuous mandatory ventilation (VC-CMV)rate 15,V<sub>T</sub> 200 mL,F<sub>I</sub>O<sub>2</sub> 100%,positive-end-expiratory pressure (PEEP)5 cm H<sub>2</sub>O
B) VC-CMV rate 12,V<sub>T</sub> 400 mL,F<sub>I</sub>O<sub>2 </sub>40%,PEEP 3 cm H<sub>2</sub>O
C) Pressure-controlled synchronized intermittent mandatory ventilation (PC-SIMV)rate 10,peak inspiratory pressure (PIP)30 cm H<sub>2</sub>O,F<sub>I</sub>O<sub>2</sub> 60%,PEEP 3cm H<sub>2</sub>O
D) PC-SIMV rate 12,PIP 35 cm H<sub>2</sub>O,F<sub>I</sub>O<sub>2</sub> 30%,PEEP 8 cm H<sub>2</sub>O
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Chapter 8: Initial Patient Assessment
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Q1) How often should the fractional inspired oxygen (F<sub>I</sub>O<sub>2</sub>)of an adult be measured with an oxygen analyzer?
A) Twice daily
B) Continuously
C) Every patient-ventilator system check
D) Every other patient-ventilator system check
Q2) The operational verification procedure (OVP)involves checking the ventilator circuit for leaks.Ventilator settings that could be used to perform this procedure include which of the following?
A) Tidal volume (V<sub>T</sub>)<sub> </sub>= 500 mL,Flow rate = 60 L/min,High pressure limit = 50 cm H<sub>2</sub>O
B) V<sub>T </sub>= 1000 mL,Flow rate = 20 L/min,High pressure limit = maximum
C) V<sub>T </sub>= 500 mL,Flow rate = 20 L/min,High pressure limit = maximum,Inspiratory pause = 2 seconds
D) V<sub>T </sub>= 200 mL,Flow rate = Maximum,High pressure limit = 50 cm H<sub>2</sub>O,Inspiratory pause = 1 second
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Chapter 9: Ventilator Graphics
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Sample Questions
Q1) The most important factor to affect the degree of resistance in the airways is which of the following?
A) Flow rate of the gas
B) Viscosity of the gas
C) Length of the airways
D) Diameter of the airways
Q2) During a patient-ventilator system check the respiratory therapist notices that the pressure-volume loop begins at zero on the x-axis but does not return to zero during expiration.The cause of this is which of the following?
A) Active exhalation
B) Inadequate sensitivity
C) Ventilator circuit leak
D) Decreased compliance
Q3) An inadequate flow setting during volume ventilation will cause which of the following to occur?
A) The volume curve will drop below the zero baseline.
B) The volume curve will not drop to the zero baseline.
C) The exhaled flow will take longer to rise to the zero baseline.
D) The pressure-time curve will appear concave during inspiration.
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Page 11
Chapter 10: Assessment of Respiratory Function
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Sample Questions
Q1) What type of electrode is used by a transcutaneous partial pressure of carbon dioxide (PtcCO<sub>2</sub>)device?
A) Galvanic
B) Polarographic
C) Paramagnetic
D) Stow-Severinghaus
Q2) During calibration of a transcutaneous monitor the respiratory therapist notices a signal drift.The respiratory therapist should do which of the following?
A) Increase the probe temperature.
B) Replace the monitor and call for repair.
C) Add more electrolyte gel to the patient's skin.
D) Change the electrolyte and sensor's membrane.
Q3) Exhaled nitric oxide is used to monitor the effectiveness of which drug used in the treatment of asthma?
A) Anticholinergic bronchodilators
B) Beta adrenergic bronchodilators
C) Corticosteroids
D) Leukotriene inhibitors
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Chapter 11: Hemodynamic Monitoring
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Sample Questions
Q1) The most determining factor for preload is which of the following?
A) Contractility
B) Venous return
C) Ejection fraction
D) Vascular resistance
Q2) The range for the time a pulmonary artery catheter should be inflated is which of the following?
A) 5 to 10 seconds
B) 15 to 30 seconds
C) 30 to 60 seconds
D) 60 to 120 seconds
Q3) An increase in systemic vascular resistance can be elevated by which of the following disorders?
A) Lung collapse
B) Hypervolemia
C) Chronic bronchitis
D) Cardiogenic pulmonary edema
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Chapter 12: Methods to Improve Ventilation in Patient-Ventilator
Management
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Sample Questions
Q1) When using a SVN or pMDI with NPPV,where in the NPPV circuit should the device be placed to obtain the greatest aerosol deposition?
A) Before the leak port
B) Anywhere in the circuit
C) Between the NPPV and the humidifier
D) Between the leak port and the face mask
Q2) A patient with extensive infiltrates throughout the right lung should be placed in which of the following positions to improve oxygenation?
A) Left lung down laterally
B) Right lung down laterally
C) Left lung down with right lung 45 degrees from supine
D) Right lung down with left lung 45 degrees from supine
Q3) In which of the following situations should iatrogenic hyperventilation be considered?
A) Severe traumatic brain injury
B) Initial treatment for increased intracranial pressure
C) Acute head injuries with increased intracranial pressure
D) Acute neurological deterioration with increased intracranial pressure
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Chapter 13: Improving Oxygenation and Management of Ards
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Q1) How long after PEEP is increased should all ventilatory and available hemodynamic parameters be measured and calculated?
A) 5 minutes
B) 15 minutes
C) 25 minutes
D) 40 minutes
Q2) In which ventilator mode should a patient receiving a sustained inflation technique be placed?
A) VC-CMV
B) APRV
C) PC-IMV
D) CPAP/spontaneous
Q3) An absolute contraindication to PEEP is which of the following?
A) Emphysema
B) Bronchopleural fistula
C) Untreated tension pneumothorax
D) Elevated intracranial pressures
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Page 15
Chapter 14: Ventilator-Associated Pneumonia
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Q1) To avoid ventilator-associated pneumonia,how often should ventilator circuits be changed?
A) Every 24 hours
B) Every 48 hours
C) Once weekly
D) Not unless visibly dirty
Q2) Sixty percent of all VAP infections are caused by which of the following?
A) Aerobic gram-negative bacilli
B) Anaerobic gram-negative bacilli
C) Aerobic gram-negative rods
D) Anaerobic gram-positive cocci
Q3) The mortality rate for VAP associated with prolonged hospital stays is which of the following?
A) 5% to 25%
B) 15% to 40%
C) 25% to 50%
D) 45% to 75%
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16
Chapter 15: Sedatives,Analgesics,and Paralytics
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Sample Questions
Q1) The paralytic agent associated with precipitation of malignant hyperthermia is which of the following?
A) Vecuronium
B) Cisatracurium
C) Pancuronium
D) Succinylcholine
Q2) Permissive hypercapnia is needed to protect patients with ARDS from atelectrauma.Which of the following medications is appropriate to facilitate this?
A) Propofol
B) Fentanyl
C) Midazolam
D) Cisatracurium
Q3) The group of drugs that interact with GABA receptor complex on neurons in the brain is which of the following?
A) Opioids
B) Paralytics
C) Benzodiazepines
D) Depolarizing agents
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17
Chapter 16: Extrapulmonary Effects of Mechanical
Ventilation
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Sample Questions
Q1) During spontaneous breathing,the fall in intrapleural pressure that draws air into the lungs during inspiration also draws blood into the major thoracic vessels.This phenomenon increases which of the following?
A) Systemic vascular resistance
B) Right ventricular afterload
C) Right ventricular preload
D) Pulmonary capillary resistance
Q2) Which of the following ventilator parameters would result in the highest mean airway pressure?
A) PIP = 30 cm H<sub>2</sub>O;PEEP = 10 cm H<sub>2</sub>O;T<sub>I</sub> = 0.5 sec;TCT = 5 sec
B) PIP = 50 cm H<sub>2</sub>O;PEEP = 10 cm H<sub>2</sub>O;T<sub>I</sub> = 0.5 sec;TCT = 5 sec
C) PIP = 30 cm H<sub>2</sub>O;PEEP = 15 cm H<sub>2</sub>O;T<sub>I</sub> = 0.5 sec;TCT = 5 sec
D) PIP = 50 cm H<sub>2</sub>O;PEEP = 10 cm H<sub>2</sub>O;T<sub>I</sub> = 0.5 sec;TCT = 5 sec..
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Chapter 17: Effects of Positive Pressure Ventilation on the Pulmonary System
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Q1) The combination of __________________ and ____________________ increases the risk of absorption atelectasis.
A) high tidal volumes,F<sub>I</sub>O<sub>2</sub> >0.4
B) high tidal volumes,F<sub>I</sub>O<sub>2</sub> >=0.7
C) low tidal volumes,F<sub>I</sub>O<sub>s</sub> >0.5
D) low tidal volumes,F<sub>I</sub>O<sub>2 </sub>>0.7
Q2) The RT responds to the high pressure,high respiratory rate,low exhaled volume,and low exhaled minute volume alarms of a mechanically ventilated patient in the ICU.Upon entering the room,the RT notices that the patient,who is still attached to the ventilator,appears diaphoretic,tachypneic,tachycardic,and hypertensive.Breath sounds are absent on the left and distant on the right.The patient's trachea is deviated to the left,and jugular vein distention is present.The endotracheal tube is 24 cm at the teeth.Immediate action should include which of the following?
A) Order a chest radiograph in the upright position.
B) Administer intravenous etomidate and succinylcholine.
C) Pull back the endotracheal tube to 22 cm at the teeth.
D) Insert a 14-gauage needle into the second intercostal space right midclavicular line.
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Page 19
Chapter 18: Troubleshooting and Problem Solving
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Q1) Use of an externally powered,small-volume nebulizer for aerosol delivery during partial ventilatory support with PSV may cause which of the following?
1)High V<sub>T</sub> alarm activation
2)Triggering difficulties
3)Low pressure alarm activation
4)Ventilator inoperative alarm
A) 1 and 2
B) 2 and 3
C) 3 and 4
D) 1 and 4
Q2) When an alarm is activated on a ventilator,the respiratory therapist's first priority is to ______________.
A) assess the patient's level of consciousness.
B) ensure adequate ventilation and oxygenation.
C) assess lung compliance and airway resistance.
D) ensure that bilateral and equal breath sounds are present.
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Chapter 19: Basic Concepts of Noninvasive Positive
Pressure Ventilation
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Q1) A 62-year-old male patient with COPD is being seen in the pulmonary clinic for dyspnea at rest and daytime hypersomnolence.The patient has been hospitalized three times in the past year for COPD exacerbations and once for pneumonia.He currently uses 2 L/min oxygen from a concentrator all the time.The patient reports that he is able to sleep only about 2 hours each night and that he has a headache every morning.Which of the following should be recommended to the physician?
A) Chest cuirass
B) Nocturnal NPPV
C) Nocturnal CPAP
D) Tracheostomy and ventilation
Q2) NPPV is considered the standard of care for the treatment of which of the following?
A) COPD exacerbation
B) Asthma exacerbation
C) Cardiogenic pulmonary edema
D) Community acquired pneumonia
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Chapter 20: Discontinuation and Weaning From Mechanical Ventilation
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Sample Questions
Q1) An SBT should not continue for longer than _____ minutes.
A) 30
B) 60
C) 120
D) 180
Q2) A 46-year-old male patient (IBW = 85 kg)who was injured in a motor vehicle accident has been receiving invasive mechanical ventilation for 24 hours.The patient is awake and alert and looks comfortable on these settings: VC-SIMV with pressure support of 5 cm H<sub>2</sub>O;set rate = 8 breaths/min;set V<sub>T </sub>= 500 mL;F<sub>I</sub>O<sub>2</sub> = 0.4;PEEP = 5 cm H<sub>2</sub>O.A 10-minute spontaneous breathing trial (SBT)yields this information: f = 30 breaths/min,RSBI = 145,P<sub>0.1</sub> = 10 cm H<sub>2</sub>O.What should the respiratory therapist suggest to the physician during patient rounds?
A) Sedate the patient and place him on VC-CMV.
B) Continue with the current ventilator settings.
C) Switch to PC-CMV with a rate of 14 breaths/min.
D) Decrease the mandatory SIMV rate to 4 breaths/min.
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Page 22
Chapter 21: Long Term Ventilation
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Q1) A quadriplegic patient is getting ready for discharge home from an acute care hospital.He has a TT and requires mechanical ventilation around-the-clock,but not supplemental oxygen.What equipment must he have in his home?
1)Transport ventilator
2)Manual resuscitator bag
3)E-cylinder of oxygen
4)Ventilator circuits
A) 1 and 2
B) 3 and 4
C) 1,2,and 4
D) 2 and 4
Q2) In-hospital evaluation of ventilator-assisted infants should be performed how often for the first 2 years of life?
A) Once a month
B) Once every 2 to 3 months
C) Once every 4 to 6 months
D) Once a year
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23
Chapter 22: Neonatal and Pediatric Ventilation
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Q1) Neurally adjusted ventilator assist (NAVA)is particularly useful with newborns because it ___________________.
A) reduces gas trapping.
B) is not affected by leaks.
C) decreases the development of VILA.
D) is sensitive to changes in respiratory drive.
Q2) A newborn with which of the following clinical manifestations should receive nasal CPAP?
A) Substernal retractions,PaCO<sub>2 </sub>= 65 mm Hg,PaO<sub>2</sub> = 48 mm Hg,F<sub>I</sub>O<sub>2</sub> = 0.4.
B) Tachypnea,nasal flaring,PaCO<sub>2</sub> = 50 mm Hg,PaO<sub>2</sub> = 50 mm Hg,F<sub>I</sub>O<sub>2</sub> = 0.6.
C) Grunting,substernal retractions,pH = 7.20,PaCO<sub>2</sub> = 70 mm Hg,PaO<sub>2</sub> = 40 mm Hg,F<sub>I</sub>O<sub>2</sub> = 0.7.
D) Tachypnea,pale skin,pH = 7.32,PaCO<sub>2</sub> = 45 mm Hg,PaO<sub>2</sub> = 75 mm Hg,F<sub>I</sub>O<sub>2</sub> = 0.21.
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Page 24
Chapter 23: Special Techniques in Ventilatory Support
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Q1) Which variable in APRV is responsible for the removal of CO<sub>2</sub> from the body?
A) T<sub>low</sub>
B) T<sub>high</sub>
C) P<sub>low</sub>
D) P<sub>high</sub>
Q2) When T<sub>high </sub>is set at 5.5 seconds,and the T<sub>low</sub> is set at 0.5 seconds;what is the set ventilator rate?
A) 8
B) 10
C) 14
D) 16
Q3) The PaCO<sub>2</sub> can be reduced during HFOV by doing which of the following?
A) Decreasing the amplitude
B) Increasing the frequency
C) Increasing the T<sub>I</sub>%
D) Decreasing the cuff leak
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