A 4 – breathmh.net

Question 1:

During a recruitment maneuver, what parameters should be monitored?

A) Saturation and compliance
B) Plateau pressure and compliance
C) Blood pressure (BP)
D) Heart rate (HR)

Correct Answer: B) Plateau pressure and compliance

Explanation (English): During recruitment maneuvers, it is crucial to monitor plateau pressure and lung compliance to ensure effectiveness and to avoid barotrauma/volutrauma. While saturation, BP, and HR are also important, the plateau pressure reflects alveolar pressure, and compliance indicates how well the lungs are responding to the maneuver.

Question 2:

A doctor is preparing to perform a bronchoscopy and requires a local sedative for the procedure. Which local sedative is commonly used for bronchoscopy?

A) Bupivacaine
B) Lidocaine
C) Procaine
D) Mepivacaine

Correct Answer: B) Lidocaine

Explanation (English): Lidocaine is the most commonly used local anesthetic for bronchoscopy. It provides effective local anesthesia, reducing the gag reflex and making the procedure more tolerable.

Question 3:

A 55-year-old patient is intubated and connected to mechanical ventilation. During your routine check, you measure the endotracheal tube (ETT) cuff pressure and find it to be 11 cm H₂O. What is the appropriate action to take?

A) Increase cuff pressure to the recommended range (20-30 cm H₂O).
B) Normal cuff pressure is 20-30 cm H₂O.
C) Maintain the current cuff pressure.
D) Decrease cuff pressure to avoid tracheal injury.

Correct Answer: A) Increase cuff pressure to the recommended range (20-30 cm H₂O).

Explanation (English): The recommended ETT cuff pressure typically ranges between 20–30 cm H₂O. A pressure of 11 cm H₂O is too low, risking leaks and possible aspiration. Increasing it to within 20–30 cm H₂O ensures a proper seal and safeguards the airway.

Question 4:

A patient is in the ICU with severe brain injury, and the clinical team suspects brain death. You are asked to perform a procedure to confirm the diagnosis. Which procedure involves disconnecting the patient from the ventilator and observing for spontaneous breathing while providing oxygen therapy?

A) Apnea test
B) EEG (Electroencephalogram)
C) CT Scan
D) MRI

Correct Answer: A) Apnea test

Explanation (English): The apnea test is a critical component of brain death evaluation. It involves observing whether the patient initiates any spontaneous breaths after being disconnected from the ventilator (while ensuring adequate oxygenation and allowing PaCO₂ to rise above a threshold).

Question 5:

While inspecting a 69-year-old female patient, you note that she has an abnormal anteroposterior curvature of the spine. This best describes which of the following?

A) Kyphosis
B) Scoliosis
C) Kyphoscoliosis
D) Pectus excavatum

Correct Answer: A) Kyphosis

Explanation (English): Kyphosis refers to an excessive outward (forward) curvature of the thoracic spine. Scoliosis is a lateral curvature, kyphoscoliosis involves both kyphosis and scoliosis, and pectus excavatum is a sunken chest deformity.

Question 6:

A patient has just been transported to the ICU and is hemodynamically unstable. Which is the best device to accurately measure the systemic blood pressure (BP)?

A) Non-invasive BP cuff
B) Central venous catheter
C) Pulmonary artery catheter
D) Arterial catheter (A-Line)

Correct Answer: D) Arterial catheter (A-Line)

Explanation (English): An arterial line provides continuous and direct measurement of systemic blood pressure, essential for managing a hemodynamically unstable ICU patient.

Question 7:

A power outage occurred for 30 seconds and then power was restored. You have a patient who is on mechanical ventilation. What is the appropriate action to take now?

A) Reconnect the patient to the ventilator
B) Check the ventilator settings
C) Ask the nurse to manually bag the patient while you check the ventilator
D) Continue monitoring without any changes

Correct Answer: C) Ask the nurse to manually bag the patient while you check the ventilator

Explanation (English): After any power interruption, confirm that the ventilator is functioning correctly and that the settings are accurate before reconnecting the patient. Meanwhile, manually ventilating the patient ensures uninterrupted respiratory support.

Question 8:

Intubation has failed 3 times, but between each attempt, you are able to ventilate the patient with a bag-valve mask. What should you do next?

A) Use a laryngeal mask airway (LMA)
B) Continue ventilating with the bag-valve mask
C) Try intubation with a stylet
D) Call for an anesthesia or airway specialist

Correct Answer: A) Use a laryngeal mask airway (LMA)

Explanation (English): After multiple failed intubation attempts, placing an LMA is recommended to secure the airway temporarily, ensuring adequate ventilation without additional traumatic intubation attempts.

Question 9:

A postoperative patient has developed atelectasis and secretions. After using a flutter device, the secretions have improved, but atelectasis remains. What should be the next step in management?

A) Use incentive spirometry (IS)
B) Increase the frequency of flutter device use
C) Administer bronchodilators
D) Initiate chest physiotherapy

Correct Answer: A) Use incentive spirometry (IS)

Explanation (English): Incentive spirometry encourages sustained deep inhalations, thereby helping to re-expand collapsed alveoli and address atelectasis, especially after surgery.

Question 10:

A patient with congestive heart failure (CHF) presents with edema. After administering diuretics, the patient’s urine output is 1800 mL. All electrolytes are normal except for potassium, which is 3.1 mEq/L. What should be the next step in management?

A) Continue diuretic therapy
B) Administer potassium
C) Reduce diuretic dose
D) Administer sodium bicarbonate

Correct Answer: B) Administer potassium

Explanation (English): A potassium level of 3.1 mEq/L is hypokalemic and can be hazardous (e.g., arrhythmias). Supplementing potassium is necessary to correct the deficiency and prevent complications.

Question 11:

A patient with Acute Respiratory Distress Syndrome (ARDS) has persistently low oxygen levels despite conventional ventilation. What mode of ventilation should be considered next?

A) Extracorporeal Membrane Oxygenation (ECMO)
B) High-Frequency Oscillatory Ventilation (HFOV)
C) Airway Pressure Release Ventilation (APRV)
D) Prone Positioning

Correct Answer: C) Airway Pressure Release Ventilation (APRV)

Explanation (English): APRV maintains a higher mean airway pressure and aids alveolar recruitment in ARDS. While ECMO is a more invasive rescue therapy for severe cases, HFOV may be considered later, and prone positioning can also be used adjunctively. APRV is often the next step after conventional modes.

Question 12:

You need to insert a stylet into an endotracheal tube (ETT) for intubation. What is the correct technique for inserting a stylet?

A) Insert the stylet without lubrication
B) Lubricate the stylet and bend the tip before insertion into the ETT
C) Insert the stylet and bend the tip after it is inside the ETT
D) Insert the stylet directly into the ETT for intubation

Correct Answer: B) Lubricate the stylet and bend the tip before insertion into the ETT

Explanation (English): Lubricating the stylet and gently bending its tip before placing it in the tube reduces friction and allows better shaping of the ETT to facilitate smoother intubation.

Question 13:

A post-heart surgery patient with recurrent pleural effusion and an undiagnosed pneumothorax is scheduled for a chest tube insertion. What should the Respiratory Therapist initiate first?

A) Administer morphine in room air
B) Administer nasal cannula (NC) at 2 L/min
C) Initiate non-invasive ventilation (NIV)
D) Initiate positive pressure ventilation

Correct Answer: A) Administer morphine in room air

Explanation (English): Inserting a chest tube can be painful, so adequate analgesia (e.g., morphine) is vital beforehand. Oxygen therapy can be provided as needed afterward.

Question 14:

A patient is suffering from congestive heart failure (CHF) and has developed pulmonary edema, requiring respiratory support. What is the best respiratory support device to use for this patient?

A) BiPAP (Bilevel Positive Airway Pressure)
B) CPAP (Continuous Positive Airway Pressure)
C) High-Flow Nasal Cannula (HFNC)
D) Mechanical Ventilation

Correct Answer: B) CPAP (Continuous Positive Airway Pressure)

Explanation (English): CPAP helps in cardiogenic pulmonary edema by improving oxygenation and reducing preload, thereby alleviating pulmonary congestion and work of breathing.

Question 15:

A patient presents with muscle weakness. The ECG shows (U waves), (abnormal T waves), and a (widened QRS complex). What is the most likely electrolyte imbalance?

A) Low potassium (Hypokalemia)
B) High potassium (Hyperkalemia)
C) Low calcium (Hypocalcemia)
D) High calcium (Hypercalcemia)

Correct Answer: A) Low potassium (Hypokalemia)

Explanation (English): ECG findings such as U waves, T-wave changes, and widened QRS, along with muscle weakness, are classic for hypokalemia.

Question 16:

Five minutes after drawing an arterial blood gas (ABG) sample, a respiratory therapist notices a bubble in the sample. What should the respiratory therapist do?

A) Remove the bubble and place the sample on ice
B) Discard the sample
C) Run the sample immediately
D) Shake the sample to mix

Correct Answer: B) Discard the sample

Explanation (English): Air bubbles in an ABG sample can cause inaccurate PaO₂ and PaCO₂ readings. The best practice is to discard the sample and obtain a new one.

Question 17:

A 65-year-old patient requires suctioning to clear respiratory secretions. As a respiratory therapist, you need to set the appropriate suction pressure for an adult. What suction pressure should you set?

A) 60-80 mmHg
B) 80-100 mmHg
C) 100-120 mmHg
D) 120-150 mmHg

Correct Answer: D) 120-150 mmHg

Explanation (English): Although many guidelines suggest 100–120 mmHg for adults, some protocols allow up to 150 mmHg for thick secretions, provided mucosal injury is avoided.

Question 18:

What is the standard color of an international oxygen cylinder?

A) Green
B) White
C) Blue
D) Yellow

Correct Answer: B) White

Explanation (English): According to international labeling standards, an oxygen cylinder is white for easy identification worldwide, preventing mix-ups with other gases.

Question 19:

What is the most appropriate oxygen administration equipment for transporting a patient by jet aircraft over long distances?

A) Nasal Cannula
B) Simple Mask
C) Non-rebreather Mask
D) Portable Oxygen Concentrator

Correct Answer: D) Portable Oxygen Concentrator

Explanation (English): A portable oxygen concentrator is ideal for air travel, offering mobility without relying on gas cylinders, ensuring a continuous supply over long distances.

Question 20:

A patient presents with tracheal deviation towards the affected side. Which of the following conditions is most likely the cause?

A) Pneumothorax
B) Atelectasis
C) Pleural Effusion
D) Pulmonary Edema

Correct Answer: B) Atelectasis

Explanation (English): In atelectasis, the collapsed lung pulls the trachea toward the same side due to loss of volume in that lung.

Question 21:

A patient’s arterial blood gas (ABG) analysis shows an unexpectedly high PaO2. What is the most appropriate initial action?

A) Adjust Ventilator Settings
B) Repeat the ABG
C) Administer Supplemental Oxygen
D) Check for Equipment Malfunction

Correct Answer: B) Repeat the ABG

Explanation (English): If an ABG value is unexpectedly high (or abnormal), it is best to confirm by repeating the ABG or checking for sampling/analyzer errors before altering therapy.

Question 22:

What type of sample is used for quality control of an arterial blood gas (ABG) machine?

A) Known ABG for undefined values
B) Known ABG for defined values
C) Unknown ABG for undefined values
D) Unknown ABG for defined values

Correct Answer: B) Known ABG for defined values

Explanation (English): For quality control, reference samples with precisely defined values are used to verify that the ABG machine reads accurately.

Question 23:

Up to what corrected gestational age is an apnea monitor typically used for a baby to ensure they have outgrown the risk of apnea of prematurity?

A) 40 weeks
B) 43 weeks
C) 49 weeks
D) 53 weeks

Correct Answer: B) 43 weeks

Explanation (English): Apnea of prematurity generally resolves by a corrected gestational age of around 43 weeks, at which point the monitor is often discontinued if the infant shows no events.

Question 24:

What type of monitoring involves analyzing biological samples, such as blood, to assess exposure to toxic substances?

A) Biological Monitoring
B) Exposure Monitoring
C) Biological Conditions
D) Environmental Monitoring

Correct Answer: A) Biological Monitoring

Explanation (English): Biological monitoring measures the concentration of chemicals or their metabolites in biological specimens (e.g., blood) to assess actual exposure levels.

Question 25:

Which of the following interventions is most effective in reducing the risk of ventilator-associated pneumonia (VAP)?

A) Continuous suctioning
B) Frequent circuit changes
C) Elevating the head of the bed to 30 to 45 degrees
D) Prophylactic antibiotics

Correct Answer: C) Elevating the head of the bed to 30 to 45 degrees

Explanation (English): Raising the head of the bed decreases the risk of aspiration, a major contributor to VAP, and is a key component of recommended VAP prevention bundles.

Question 26:

Which type of endotracheal tube is generally preferred for mechanical ventilation as it helps prevent aspiration and provides a better seal?

A) Subglottic Tube
B) Cuffed Tube
C) Fenestrated Tube
D) Uncuffed Tube

Correct Answer: A) Subglottic Tube

Explanation (English): A subglottic tube has an additional suction port above the cuff to remove pooled secretions, minimizing the risk of aspiration and improving airway seal.

Question 27:

What does the presence of auto-PEEP on a ventilator waveform typically indicate?

A) Pneumothorax
B) Decreased Lung Compliance
C) Increased Airway Resistance
D) Hypoventilation

Correct Answer: C) Increased Airway Resistance

Explanation (English): Auto-PEEP (intrinsic PEEP) usually reflects incomplete exhalation due to high resistance (e.g., bronchospasm, obstruction) or insufficient expiratory time.

Question 28:

A patient with a vital capacity (VC) of 2600 mL is scheduled for surgery. What is the most likely expectation for the patient’s VC post-operation?

A) VC will remain the same as pre-operation (2600 mL).
B) VC will decrease to approximately 1300 mL.
C) VC will increase to approximately 3000 mL.
D) VC will fluctuate but generally return to pre-operation levels within a few days.

Correct Answer: B) VC will decrease to approximately 1300 mL.

Explanation (English): Postoperative patients, especially with thoracic/abdominal surgery, often experience about a 50% drop in VC due to pain, anesthesia effects, and reduced lung expansion.

Question 29:

A diabetic patient presents with an acetone odor on their breath and an ABG showing metabolic acidosis. What is the most likely diagnosis?

A) Hypoglycemia
B) Diabetic Ketoacidosis
C) Hyperosmolar Hyperglycemic State
D) Lactic Acidosis

Correct Answer: B) Diabetic Ketoacidosis

Explanation (English): Acetone breath (ketone presence) plus a metabolic acidosis indicates diabetic ketoacidosis (DKA) in a diabetic patient.

Question 30:

Which of the following arterial blood gas (ABG) values is indicative of primary metabolic acidosis?

A) pH greater than 7.45
B) PaCO₂ greater than 40 mmHg
C) HCO₃ less than 22 mEq/L
D) PaO₂ less than 80 mmHg

Correct Answer: C) HCO₃ less than 22 mEq/L

Explanation (English): Primary metabolic acidosis is defined by a decreased bicarbonate (<22 mEq/L) leading to a reduced pH.

Question 31:

Bronchial breath sounds heard over a lung field are most consistent with which of the following conditions?

A) Asthma
B) Emphysema
C) Pneumonia
D) Pneumothorax

Correct Answer: C) Pneumonia

Explanation (English): Bronchial (tubular) breath sounds typically occur over consolidated areas, a hallmark of pneumonia.

Question 32:

An elevated dead space to tidal volume (VD/VT) ratio of 55% is suggestive of which of the following conditions?

A) Asthma
B) COPD
C) Pulmonary Embolism
D) Pneumonia

Correct Answer: C) Pulmonary Embolism

Explanation (English): A higher VD/VT ratio implies increased ventilation to poorly perfused alveoli, consistent with pulmonary embolism.

Question 33:

What is the common name for the chemical used to clean blood spills, also known as sodium hypochlorite?

A) Alcohol
B) Bleach
C) Iodine
D) Hydrogen Peroxide

Correct Answer: B) Bleach

Explanation (English): Sodium hypochlorite is chemically known as bleach, widely used to disinfect blood spills and surfaces.

Question 34:

What is the most likely cause of chest retractions observed during inspiration in a neonate?

A) Increased Lung Compliance
B) Decreased Chest Wall Compliance
C) Reduced Airway Resistance
D) Improved Diaphragmatic Function

Correct Answer: B) Decreased Chest Wall Compliance

Explanation (English): Neonates have a very compliant chest wall, so if lung compliance is reduced (e.g., in RDS), more inward retraction is seen during inspiration. High airway resistance can worsen this.

Question 35:

What is a common cause of tachycardia with a bounding pulse?

A) Hypothermia
B) Anxiety and agitation or arterial hypertension
C) Hypovolemia
D) Bradycardia

Correct Answer: B) Anxiety and agitation

Explanation (English): Anxiety or agitation can produce a noticeable increase in heart rate and a bounding pulse.

Question 36:

You are reviewing an arterial blood gas (ABG) result and notice an elevated chloride (Cl⁻) level, a decreased pH, and an elevated bicarbonate (HCO₃⁻) level. What is the most appropriate action?

A) Administer oxygen
B) Repeat the ABG
C) Adjust the ventilator settings
D) This ABG result is not physiologically possible

Correct Answer: D) This ABG result is not physiologically possible

Explanation (English): A higher bicarbonate level would typically correlate with an alkaline pH, not a decreased pH. Such a mismatch indicates an error; the sample or analysis is likely flawed.

Question 37:

A patient with a chest tube in place shows no fluctuation in the water seal chamber during respiration. As a healthcare provider, you need to determine the cause. What is the most likely cause?

A) Air leak
B) Normal function
C) Obstruction
D) Proper placement

Correct Answer: C) Obstruction

Explanation (English): No fluctuation (no “tidaling”) in the water seal often signifies an obstruction in the chest tube or its system, preventing fluid/air movement.

Question 38:

Which of the following medications is a first-line treatment for tuberculosis (TB)?

A) Amoxicillin
B) Azithromycin
C) Rifampin
D) Ciprofloxacin

Correct Answer: C) Rifampin

Explanation (English): Rifampin is a core medication in the standard four-drug regimen for active TB, inhibiting mycobacterial RNA synthesis.

Question 39:

A 28-week premature neonate is intubated and receiving mechanical ventilation. The physician orders surfactant administration. Which medication is most appropriate in this case?

A) Calfactant
B) Albuterol
C) Racemic Epinephrine
D) Ipratropium Bromide

Correct Answer: A) Calfactant

Explanation (English): Calfactant is a surfactant preparation used in premature infants to prevent or treat Respiratory Distress Syndrome (RDS). The other options are not surfactants.

Question 40:

What is the approximate FiO₂ delivered by a nasal cannula at a flow rate of 3 liters per minute (L/min)?

A) 24%
B) 28%
C) 32%
D) 36%

Correct Answer: C) 32%

Explanation (English): Each liter of oxygen flow via nasal cannula increases FiO₂ by ~4% above 21%. At 3 L/min, FiO₂ is about 32–33%.

Question 41:

A 70-year-old male patient is intubated with a size 8 endotracheal tube and is receiving volume-controlled A/C ventilation. Upon assessment, you note that the patient’s cuff pressure is measured at 38 cm H₂O. Which of the following would you recommend?

A) Maintain the current cuff pressure
B) Increase the cuff pressure to > 40 cm H₂O
C) Lower the cuff pressure to < 30 cm H₂O
D) Deflate the cuff completely

Correct Answer: C) Lower the cuff pressure to < 30 cm H₂O

Explanation (English): A cuff pressure of 38 cm H₂O is too high, risking tracheal damage. Reducing it to 20–30 cm H₂O ensures an adequate seal without harming the trachea.

Question 42:

A patient experiences post-extubation stridor. What is the recommended treatment?

A) Heliox (Helium-Oxygen mixture)
B) Normal Saline Nebulization
C) Dexamethasone (Steroid)
D) Racemic Epinephrine (Vasoconstriction)

Correct Answer: D) Racemic Epinephrine (Vasoconstriction)

Explanation (English): Racemic epinephrine causes vasoconstriction and reduces laryngeal swelling, relieving acute stridor after extubation.

Question 43:

During a mass casualty event, which of the following patients should be triaged with the highest priority?

A) A patient with a fractured femur
B) A patient with a large laceration and bleeding
C) A patient with a suspected spinal cord injury
D) A patient with tracheal deviation

Correct Answer: D) A patient with tracheal deviation

Explanation (English): Tracheal deviation suggests a tension pneumothorax, an immediately life-threatening condition requiring urgent decompression.

Question 44:

Which of the following safety features is used to prevent the accidental attachment of incorrect regulators to an E cylinder?

A) Pressure relief valve
B) Pin index system
C) Color-coding
D) Cylinder valve

Correct Answer: B) Pin index system

Explanation (English): The pin index system uses a specific pin-hole arrangement on the cylinder/regulator interface to ensure the correct regulator is attached to the correct gas cylinder.

Question 45:

A patient with a complaint of orthopnea is most likely to experience symptom relief in which of the following positions?

A) Sitting upright
B) Prone
C) Standing
D) Lateral

Correct Answer: A) Sitting upright

Explanation (English): Orthopnea (difficulty breathing lying flat) often improves by sitting upright, reducing venous return and pulmonary congestion.

Question 46:

You are assisting a patient with positive expiratory pressure (PEP) therapy. The patient reports chest pain and exhibits a prolonged expiratory time. What is the most appropriate action?

A) Increase the PEP level
B) Decrease the PEP level
C) Choose a larger PEP device orifice
D) Discontinue PEP therapy and notify the physician

Correct Answer: C) Choose a larger PEP device orifice

Explanation (English): If the resistance is too high, the patient may have pain and prolonged expiration. Selecting a larger orifice reduces resistance and makes exhalation easier.

Question 47:

Which of the following factors is most likely to cause a capillary blood gas (CBG) sample to appear venous?

A) Inadequate warming of the puncture site
B) Excessive squeezing of the puncture site
C) Insufficient sample volume
D) Delay in analyzing the sample

Correct Answer: B) Excessive squeezing of the puncture site

Explanation (English): Over-squeezing can push venous blood or interstitial fluid into the sample, invalidating the intended “arterialized” capillary reading.

Question 48:

A neonate presents with hypertension. To investigate for potential metabolic causes, which of the following blood gas samples is most appropriate to obtain?

A) Venous Blood Gas
B) Arterial Blood Gas
C) Umbilical Blood Gas
D) Capillary Blood Gas

Correct Answer: C) Umbilical Blood Gas

Explanation (English): An umbilical blood gas (from the umbilical cord) provides immediate newborn acid-base status and can help clarify metabolic issues contributing to neonatal hypertension.

Question 49:

Which of the following findings on a pulmonary function test (PFT) is most consistent with restrictive lung disease?

A) Decreased FEV1/FVC ratio
B) Decreased Total Lung Capacity (TLC)
C) Increased Residual Volume (RV)
D) Normal Diffusing Capacity (DLCO)

Correct Answer: B) Decreased Total Lung Capacity (TLC)

Explanation (English): In restrictive diseases, TLC is characteristically reduced, reflecting the lungs’ reduced ability to expand.

Question 50:

A patient receiving mechanical ventilation has a plateau pressure of 30 cm H2O and a peak inspiratory pressure of 40 cm H2O. What is the most likely cause of the elevated peak inspiratory pressure?

A) Decreased lung compliance
B) Atelectasis
C) Mucus plugging
D) Pneumothorax

Correct Answer: C) Mucus plugging

Explanation: An elevated peak inspiratory pressure with a normal plateau pressure is often due to increased airway resistance. Mucus plugging is a common cause of this, as it can partially or completely obstruct the airways, leading to increased resistance during inspiration. This differs from atelectasis, which may affect lung compliance and is less likely with a normal plateau pressure.

Question 51:

What is the primary route of transmission for tuberculosis (TB)?

A) Inhalation of airborne droplets
B) Contact with contaminated surfaces
C) Blood transfusion
D) Ingestion of contaminated food

Correct Answer: A) Inhalation of airborne droplets

Explanation (English): TB commonly spreads via airborne droplet nuclei from coughing/sneezing of an infected individual. Airborne precautions (N95 masks, negative pressure rooms) are necessary.

Question 52:

Which of the following symptoms is most commonly associated with carbon monoxide poisoning?

A) Cyanosis
B) Cherry red skin
C) Headache
D) Rapid breathing

Correct Answer: C) Headache

Explanation (English): Headache is the most frequent early symptom of CO poisoning, often accompanied by dizziness and confusion. Cherry red skin is less consistently seen.

Question 53:

A patient with severe asthma exacerbation is given a short-acting beta-agonist (SABA) but shows minimal improvement. What is the next recommended treatment step?

A) Administer a long-acting beta-agonist (LABA)
B) Administer systemic corticosteroids
C) Switch to anticholinergic therapy
D) Provide high-flow oxygen therapy

Correct Answer: B) Administer systemic corticosteroids

Explanation (English): Systemic steroids reduce airway inflammation and are indicated in severe asthma exacerbations when SABAs alone are insufficient.

Question 54:

A patient has an oxygen saturation (SpO₂) of 88% while on room air. What is the most appropriate oxygen therapy device to use initially?

A) Non-rebreather mask
B) Simple face mask
C) Nasal cannula
D) Venturi mask

Correct Answer: C) Nasal cannula

Explanation (English): For mild-to-moderate hypoxemia (SpO₂ ~88%), starting with a nasal cannula is typically sufficient, escalating if needed.

Question 55:

A 25-year-old male presents with acute shortness of breath. Upon auscultation, you hear diminished breath sounds on the left side. What is the most likely diagnosis?

A) Pneumonia
B) Pulmonary embolism
C) Pneumothorax
D) Asthma exacerbation

Correct Answer: C) Pneumothorax

Explanation (English): Sudden onset dyspnea with absent or diminished breath sounds on one side strongly suggests pneumothorax.

Question 56:

A COPD patient is admitted for an acute exacerbation. Arterial blood gas (ABG) results show pH 7.25, PaCO₂ 68 mmHg, and HCO₃ 30 mEq/L. What is the most likely acid-base disturbance?

A) Respiratory acidosis with partial metabolic compensation
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis

Correct Answer: A) Respiratory acidosis with partial metabolic compensation

Explanation (English): Elevated PaCO₂ with a low pH indicates respiratory acidosis. The increased HCO₃ suggests partial compensation.

Question 57:

A premature infant is receiving CPAP therapy. Which complication is most commonly associated with CPAP in neonates?

A) Bronchopulmonary dysplasia
B) Pneumothorax
C) Pulmonary hypertension
D) Tracheomalacia

Correct Answer: B) Pneumothorax

Explanation (English): In neonates on CPAP, high positive pressures can predispose to alveolar rupture and subsequent pneumothorax.

Question 58:

A patient receiving mechanical ventilation develops a sudden drop in oxygen saturation. Auscultation reveals absent breath sounds on the right side. What is the next best step?

A) Perform a chest X-ray
B) Adjust ventilator settings
C) Increase oxygen flow rate
D) Check endotracheal tube placement

Correct Answer: A) Perform a chest X-ray

Explanation (English): A sudden drop in SpO₂ with absent unilateral breath sounds may indicate a pneumothorax or a malpositioned ETT in the main bronchus. A chest X-ray clarifies the cause.

Question 59:

Which of the following ventilator settings directly controls the amount of CO₂ removed during ventilation?

A) FiO₂
B) PEEP
C) Tidal volume
D) Inspiratory time

Correct Answer: C) Tidal volume

Explanation (English): Tidal volume directly influences minute ventilation and thus CO₂ removal. Higher tidal volume → more CO₂ clearance, if within safe limits.

Question 60:

Which of the following interventions is most effective for clearing thick mucus in a patient with cystic fibrosis?

A) Incentive spirometry
B) Chest physiotherapy
C) Dry powder inhaler
D) Hypertonic saline nebulization

Correct Answer: D) Hypertonic saline nebulization

Explanation (English): Hypertonic saline nebulization helps hydrate and thin thick secretions in CF, aiding mucus clearance.

Question 61:

What is the purpose of the rapid shallow breathing index (RSBI) in ventilator weaning?

A) Measure oxygenation efficiency
B) Evaluate lung compliance
C) Assess readiness to wean
D) Monitor peak airway pressure

Correct Answer: C) Assess readiness to wean

Explanation (English): RSBI = RR / (VT in liters). A value <105 is generally indicative of likely success in weaning from mechanical ventilation.

Question 62:

A patient undergoing weaning from mechanical ventilation has an RSBI of 80 breaths/min/L. What is the next step?

A) Continue mechanical ventilation
B) Proceed with a spontaneous breathing trial (SBT)
C) Increase PEEP
D) Increase FiO₂

Correct Answer: B) Proceed with a spontaneous breathing trial (SBT)

Explanation (English): An RSBI <105 suggests the patient can attempt an SBT, which helps determine if they can maintain adequate ventilation on their own.

Question 63:

What is the hallmark finding of obstructive lung disease on spirometry?

A) Increased FEV₁/FVC ratio
B) Decreased residual volume (RV)
C) Normal total lung capacity (TLC)
D) Decreased FEV₁/FVC ratio

Correct Answer: D) Decreased FEV₁/FVC ratio

Explanation (English): Obstructive diseases reduce airflow disproportionately to lung volume, resulting in a low FEV₁/FVC ratio (<70%).

Question 64:

A patient is receiving high-frequency oscillatory ventilation (HFOV) for severe ARDS. What parameter is adjusted to improve oxygenation?

A) Tidal volume
B) Inspiratory time
C) Mean airway pressure
D) Frequency

Correct Answer: C) Mean airway pressure

Explanation (English): In HFOV, to enhance oxygenation, increasing the mean airway pressure helps recruit alveoli and improve gas exchange.

Question 65:

Which of the following is a key diagnostic feature of emphysema on a chest X-ray?

A) Consolidation
B) Hyperinflation
C) Pleural effusion
D) Ground-glass opacity

Correct Answer: B) Hyperinflation

Explanation (English): Emphysema typically shows hyperinflated lungs with flattened diaphragms and increased retrosternal air space on X-ray.

Question 66:

A patient on CPAP therapy reports nasal dryness and irritation. What is the most appropriate solution?

A) Reduce CPAP pressure
B) Add heated humidification
C) Switch to a full-face mask
D) Discontinue CPAP

Correct Answer: B) Add heated humidification

Explanation (English): Heated humidification relieves nasal dryness/irritation and improves CPAP tolerance.

Question 67:

A patient with acute respiratory distress syndrome (ARDS) is receiving lung-protective ventilation with a tidal volume of 6 mL/kg and a PEEP of 10 cmH₂O. The patient’s oxygen saturation remains below 90% despite an FIO₂ of 1.0. Which intervention would be most appropriate?

A) Increase the PEEP to 15 cmH₂O
B) Increase the tidal volume to 8 mL/kg
C) Initiate prone positioning
D) Increase the respiratory rate

Correct Answer: C) Initiate prone positioning

Explanation (English): Prone positioning significantly improves oxygenation in severe ARDS unresponsive to high FiO₂ and moderate PEEP, aiding alveolar recruitment and matching ventilation-perfusion.

Question 68:

A patient receiving volume-controlled ventilation has a sudden increase in peak airway pressure. What is the first step in management?

A) Check for airway obstruction or kinking
B) Increase tidal volume
C) Reduce respiratory rate
D) Increase FiO₂

Correct Answer: A) Check for airway obstruction or kinking

Explanation (English): A sudden rise in peak pressure often indicates an acute problem like a kinked tube or mucus plug. Always check for mechanical or airway issues first.

Question 69:

After intubating a patient with suspected COVID-19, you need to send the used stylet to the Central Sterile Services Department (CSSD). Which type of bag should you use for disposal?

A) Triple yellow bag
B) Single yellow bag
C) Single red bag
D) Triple red bag

Correct Answer: B) Single yellow bag

Question 70:

A doctor orders 35% oxygen therapy for a post-operative craniotomy patient with an irregular breathing pattern. Which of the following oxygen delivery devices is MOST appropriate in this scenario?

A) Nasal cannula
B) Simple face mask
C) Non-rebreather mask
D) Venturi mask

Correct Answer: D) Venturi mask

Explanation (English): A Venturi mask delivers a precise FiO₂ and is ideal for patients with irregular breathing patterns who require stable oxygen concentrations.

Question 71:

A patient has a Respiratory Quotient (RQ) of 1.16. Based on this value, what does it indicate?

A) The patient is primarily metabolizing carbohydrates.
B) The patient is primarily metabolizing fats.
C) The patient is showing submaximal effort.
D) The patient is in a state of metabolic alkalosis.

Correct Answer: C) The patient is showing submaximal effort.

Explanation (English): An RQ above 1.0 often reflects heavy carbohydrate metabolism, which may occur under moderate-to-intense submaximal effort or partial hyperventilation patterns.

Question 72:

A 55-year-old patient with a history of chronic diuretic use presents to the emergency department complaining of muscle weakness and fatigue. An electrolyte panel reveals hypokalemia. What is the MOST appropriate intervention for this patient’s hypokalemia?

A) Administer intravenous (IV) potassium.
B) Give the patient a banana to eat.
C) Administer a nebulizer treatment with albuterol.
D) No intervention is needed; this potassium level is normal.

Correct Answer: A) Administer intravenous (IV) potassium.

Explanation (English): Symptomatic hypokalemia (e.g., muscle weakness, arrhythmias) warrants prompt correction with IV potassium, especially with chronic diuretic use.

Question 73:

A COPD patient undergoes pulmonary function testing (PFT) and shows a greater than 12% improvement in FEV₁ after bronchodilator administration. The physician asks for your recommendation for a long-acting beta-agonist (LABA). Which of the following medications would you suggest?

A) Arformoterol (Brovana)
B) Albuterol
C) Levalbuterol
D) Indacaterol (Onbrez)

Correct Answer: A) Arformoterol (Brovana)

Explanation (English): Arformoterol (Brovana) is a LABA indicated for COPD maintenance. Albuterol and levalbuterol are short-acting, while Indacaterol is an ultra-LABA but less commonly the first suggestion in this scenario.

Question 74:

Paramedics tell you a patient is coming in from a house fire. They report placing the patient on a nasal cannula (NC) at the scene. Upon arrival, the patient has stable vital signs and good oxygen saturation. What is the MOST appropriate oxygen therapy to provide?

A) Put on a non-rebreather mask with 100% oxygen.
B) Partial-rebreather mask
C) NIV
D) Intubate the patient.

Correct Answer: A) Put on a non-rebreather mask with 100% oxygen.

Explanation (English): Smoke-inhalation/fire victims are at high risk for CO poisoning; a non-rebreather mask at 100% O₂ helps expedite elimination of CO from hemoglobin.

Question 75:

A patient is being monitored for acute respiratory failure. What parameter on the arterial blood gas (ABG) indicates hypoventilation?

A) Decreased PaCO₂
B) Normal pH
C) Elevated PaCO₂
D) Normal PaO₂

Correct Answer: C) Elevated PaCO₂

Explanation (English): Hypoventilation results in insufficient CO₂ removal, causing the PaCO₂ to rise above the normal range (>45 mmHg).

Question 76:

During a code, a patient is receiving chest compressions and manual ventilation via bag-mask. The patient has suspected cervical spine injury. What is the most appropriate maneuver to open the airway?

A) Head tilt-chin lift
B) Jaw-thrust
C) Head extension
D) Neck rotation

Correct Answer: B) Jaw-thrust

Explanation (English): The jaw-thrust maneuver opens the airway with minimal cervical spine movement, recommended for suspected C-spine injuries.

Question 77:

In a patient with suspected pneumonia, which of the following findings would you expect on auscultation?

A) Decreased breath sounds in all lung fields
B) Crackles in the affected area
C) Wheezing throughout both lung fields
D) Stridor

Correct Answer: B) Crackles in the affected area

Explanation (English): Localized crackles (rales) in the affected lung segment are typical in pneumonia, reflecting fluid or consolidation in alveoli.

Question 78:

Which of the following is the primary goal of pulmonary rehabilitation for chronic respiratory patients?

A) To cure the underlying disease
B) To improve exercise tolerance and quality of life
C) To eliminate oxygen therapy
D) To prevent hospitalizations

Correct Answer: B) To improve exercise tolerance and quality of life

Explanation (English): Pulmonary rehabilitation focuses on enhancing exercise capacity and quality of life rather than curing the underlying disease.

Question 79:

A patient with sleep apnea presents with excessive daytime sleepiness and morning headaches. The most likely diagnosis is:

A) Narcolepsy
B) Insomnia
C) Obstructive sleep apnea (OSA)
D) Restless legs syndrome

Correct Answer: C) Obstructive sleep apnea (OSA)

Explanation (English): Excessive daytime sleepiness, morning headaches, and likely snoring episodes are classic of OSA.

Question 80:

What is the primary function of the epiglottis?

A) To warm and humidify air
B) To filter out foreign particles
C) To prevent aspiration of food and liquids
D) To produce sound

Correct Answer: C) To prevent aspiration of food and liquids

Explanation (English): The epiglottis closes off the trachea during swallowing, preventing food/liquid from entering the airway.

Question 81:

What chest X-ray finding is suggestive of adequate exposure?

A) Black lungs
B) White heart
C) Clear visualization of the vertebral bodies
D) Blurred diaphragm

Correct Answer: C) Clear visualization of the vertebral bodies

Explanation (English): Adequate penetration shows faint visualization of vertebrae through the cardiac silhouette, indicating proper exposure.

Question 82:

What is the correct compression-to-ventilation ratio for adult CPR performed by a single rescuer?

A) 15:2
B) 30:2
C) 10:1
D) 5:1

Correct Answer: B) 30:2

Explanation (English): According to current guidelines, 30:2 is the recommended ratio for lone-rescuer adult CPR to ensure optimal circulation and ventilation.