Compliance Practice Questions

Question 1

A previously healthy 35-year-old woman is brought into the emergency department after being found unresponsive by her husband. Her husband finds an empty bottle of diazepam tablets in her pocket. She is stuporous. At the hospital, her blood pressure is 90/40 mm Hg, the pulse is 58/min, and the respirations are 6/min. The examination of the pupils shows normal size and reactivity to light. Deep tendon reflexes are 1+ bilaterally. Babinski sign is absent. All 4 extremities are hypotonic. The patient is intubated and taken to the critical care unit for mechanical ventilation and treatment. Regarding the prevention of pneumonia in this patient, which of the following strategies is most likely to achieve this goal?

Accepted Answer

Subglottic drainage of secretions

Answer

Nasogastric tube insertion

Answer

Daily evaluation for ventilator weaning

Answer

Oropharynx and gut antibacterial decontamination

Answer

Prone positioning during mechanical ventilation

Question 2

A 60-year-old woman presents to the clinic with a 3-month history of shortness of breath that worsens on exertion. She also complains of chronic cough that has lasted for 10 years. Her symptoms are worsened even with light activities like climbing up a flight of stairs. She denies any weight loss, lightheadedness, or fever. Her medical history is significant for hypertension, for which she takes amlodipine daily. She has a 70-pack-year history of cigarette smoking and drinks 3–4 alcoholic beverages per week. Her blood pressure today is 128/84 mm Hg. A chest X-ray shows flattening of the diaphragm bilaterally. Physical examination is notable for coarse wheezing bilaterally. Which of the following is likely to be seen with pulmonary function testing?

Accepted Answer

Decreased FEV1: FVC and increased total lung capacity

Answer

Decreased FEV1: FVC and decreased total lung capacity

Answer

Normal FEV1: FVC and decreased total lung capacity

Answer

Increased FEV1: FVC and decreased total lung capacity

Answer

Increased FEV1: FVC and normal total lung capacity

Question 3

A previously healthy 64-year-old woman comes to the physician because of a dry cough and progressively worsening shortness of breath for the past 2 months. She has not had fever, chills, or night sweats. She has smoked one pack of cigarettes daily for the past 45 years. She appears thin. Examination of the lung shows a prolonged expiratory phase and end-expiratory wheezing. Spirometry shows decreased FEV1:FVC ratio (< 70% predicted), decreased FEV1, and a total lung capacity of 125% of predicted. The diffusion capacity of the lung (DLCO) is decreased. Which of the following is the most likely diagnosis?

Accepted Answer

Chronic obstructive pulmonary disease

Answer

Bronchiectasis

Answer

Interstitial lung disease

Answer

Hypersensitivity pneumonitis

Answer

Bronchial asthma

Question 4

A 25-year-old previously healthy woman is admitted to the hospital with progressively worsening shortness of breath. She reports a mild fever. Her vital signs at the admission are as follows: blood pressure 100/70 mm Hg, heart rate 111/min, respiratory rate 20/min, and temperature 38.1℃ (100.6℉); blood saturation on room air is 90%. Examination reveals a bilateral decrease of vesicular breath sounds and rales in the lower lobes. Plain chest radiograph demonstrates bilateral opacification of the lower lobes. Despite appropriate treatment, her respiratory status worsens. The patient is transferred to the intensive care unit and put on mechanical ventilation. Adjustment of which of the following ventilator settings will only affect the patient’s oxygenation?

Accepted Answer

FiO2 and PEEP

Answer

Tidal volume and respiratory rate

Answer

Respiratory rate and PEEP

Answer

Tidal volume and FiO2

Answer

FiO2 and respiratory rate

Question 5

A 57-year-old man comes to the physician because of a 2-year history of fatigue, worsening shortness of breath, and a productive cough for 2 years. He has smoked 1 pack of cigarettes daily for the past 40 years. Examination shows pursed-lip breathing and an increased anteroposterior chest diameter. There is diffuse wheezing bilaterally and breath sounds are distant. Which of the following parameters is most likely to be decreased in this patient?

Accepted Answer

Lung elastic recoil

Answer

Thickness of small airways

Answer

Work of breathing

Answer

Lower airway resistance

Answer

Pulmonary vascular pressure

Question 6

A 14-year-old male presents to the emergency department with altered mental status. His friends who accompanied him said that he complained of abdominal pain while camping. They denied his consumption of anything unusual from the wilderness, or any vomiting or diarrhea. His temperature is 100.5°F (38.1°C), blood pressure is 95/55 mmHg, pulse is 130/min, and respirations are 30/min. His pupils are equal and reactive to light bilaterally. The remainder of the physical exam is unremarkable. His basic metabolic panel is displayed below:

Serum:
Na+: 116 mEq/L
Cl-: 70 mEq/L
K+: 4.0 mEq/L
HCO3-: 2 mEq/L
BUN: 50 mg/dL
Glucose: 1010 mg/dL
Creatinine: 1.2 mg/dL

While the remainder of his labs are pending, the patient becomes bradypneic and is intubated. His ventilator is adjusted to volume control assist-control with a respiratory rate (RR) of 14/min, tidal volume (Vt) of 350 mL, positive end-expiratory pressure (PEEP) of 5 cm H2O, and fractional inspired oxygen (FiO2) of 40%. His height is 5 feet 5 inches. Intravenous fluids and additional medical therapy are administered. An arterial blood gas obtained after 30 minutes on these settings shows the following:

pH: 7.05
pCO2 :40 mmHg
pO2: 150 mmHg
SaO2: 98%

What is the best next step in management?

Accepted Answer

Increase respiratory rate and tidal volume

Answer

Increase respiratory rate

Answer

Increase tidal volume

Answer

Increase tidal volume and positive end-expiratory pressure

Answer

Increase positive end-expiratory pressure

Question 7

A 22-year-old woman presents to the emergency department with a chief concern of shortness of breath. She was hiking when she suddenly felt unable to breathe and had to take slow deep breaths to improve her symptoms. The patient is a Swedish foreign exchange student and does not speak any English. Her past medical history and current medications are unknown. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 90% on room air. Physical exam is notable for poor air movement bilaterally and tachycardia. The patient is started on treatment. Which of the following best describes this patient's underlying pathology?

FEV1 = Forced expiratory volume in 1 second
FVC = Forced vital capacity
DLCO = Diffusing capacity of carbon monoxide

Accepted Answer

Normal DLCO

Answer

Increased FVC

Answer

Increased FEV1

Answer

Increased FEV1/FVC

Answer

Decreased airway tone

Question 8

A 60-year-old man presents with breathlessness for the past 3 months. His symptoms have been getting progressively worse during this time. He denies any history of cough, fever, or chest pain. He works at a local shipyard and is responsible for installing the plumbing aboard the vessels. His past medical history is significant for hypertension for which he takes metoprolol every day. He denies smoking and any illicit drug use. His pulse is 74/min, respiratory rate is 14/min, blood pressure is 130/76 mm Hg, and temperature is 36.8°C (98.2°F). Physical examination is significant for fine bibasilar crackles at the end of inspiration without digital clubbing. Which of the following additional findings would most likely be present in this patient?

Accepted Answer

Decreased diffusing capacity of CO

Answer

Increased pulmonary capillary wedge pressure

Answer

Increased residual lung volume

Answer

Reduced FEV1/FVC ratio

Answer

Decreased pulmonary arterial pressure

Question 9

A 21-year-old man is admitted to the intensive care unit for respiratory failure requiring mechanical ventilation. His minute ventilation is calculated to be 7.0 L/min, and his alveolar ventilation is calculated to be 5.1 L/min. Which of the following is most likely to decrease the difference between minute ventilation and alveolar ventilation?

Accepted Answer

Decreasing the physiologic dead space

Answer

Increasing the partial pressure of inhaled oxygen

Answer

Decreasing the affinity of hemoglobin for oxygen

Answer

Increasing the respiratory depth

Answer

Increasing the respiratory rate

Question 10

A 30-year-old woman presents to the emergency department with breathlessness for the last hour. She is unable to provide any history due to her dyspnea. Her vitals include: respiratory rate 20/min, pulse 100/min, and blood pressure 144/84 mm Hg. On physical examination, she is visibly obese, and her breathing is labored. There are decreased breath sounds and hyperresonance to percussion across all lung fields bilaterally. An arterial blood gas is drawn, and the patient is placed on inhaled oxygen. Laboratory findings reveal:
pH 7.34
pO2 63 mm Hg
pCO2 50 mm Hg
HCO3 22 mEq/L
Her alveolar partial pressure of oxygen is 70 mm Hg. Which of the following is the most likely etiology of this patient’s symptoms?

Accepted Answer

Alveolar hypoventilation

Answer

Right to left shunt

Answer

Ventricular septal defect

Answer

Impaired gas diffusion

Answer

Ventilation/perfusion mismatch

Compliance

Study Resources

Lessons

Questions

Flashcards

Lessons

Definition of lung compliance

Static vs dynamic compliance

Pressure-volume curves

Surfactant function and synthesis

Surface tension effects on compliance

Elastic recoil of lung tissue

Chest wall compliance

Combined respiratory system compliance

Altered compliance in disease states

Restrictive lung disease mechanics

Obstructive lung disease effects

Compliance measurement techniques

Age-related changes in compliance

Practice Questions

Flashcards

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