CLINICAL SIMULATION COMPREHENSIVE EXAM SCRIPT COMPLETE QUESTIONS
VERIFIED SOLUTIONS
Clinical Simulation Questions and Answers Verified
Solutions Latest Update 2026/2027
Question:
genetic predisposition
Answer:
Question:
indoor and outdoor pollution Pt Assessment of Emphysema Pt (Primary assessment)
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 -✓✓Thin, underweight Past medical history
for emphysema pts -✓✓Tobacco use Cough (Emphysema) -✓✓Less common, muciod secretions
Appearance of the chest (Emphysema) -✓✓Barrel chest, increased A-P diameter Respiratory pattern
( Emphysema) -✓✓Dyspnea, pursed lip breathing, accessory muscle use, especially during
exacerbations Color (Emphysema) -✓✓Often reddish Clubbing (Emphysema) -✓✓Late stage
Diagnostic Chet Percussion (Emphysema) -✓✓Hyperresonant/tympanic note Breath sounds (
Emphysema) -✓✓Diminished, prolonged expiration Patient Assessment (Primary) Chronic
Bronchitis -✓✓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) -✓✓Stocky,
overweight Past Medical History (Chronic Bronchitis) -✓✓Tobacco use Cough (Chronic Bronchitis
) -✓✓Productive, copious amounts of purulent secretions Chest Appearance (Chronic Bronchitis)
-✓✓Occasionally barrel chest Respiratory Pattern (Chronic Bronchitis ) -✓✓Use of accessory
muscles less common Clubbing ( Chronic Bronchitis ) -✓✓Common Diagnostic Chest Percussion (
Chronic Bronchitis) -✓✓Normal Breath Sounds (Chronic Bronchitis ) -✓✓Rhonchi, crackles,
wheezing Secondary Assessment Emphysema pt -✓✓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 )
-✓✓Translucent (dark) lung fields, depressed or flattened diaphragms, long and narrow heart,
increased retrosternal air space, possibly hypertrophy or right ventricle ABG (emphysema)
-✓✓Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia Severe stage:
Chronic ventilatory failure with hypoxemia Pulmonary Function (Emphysema ) -✓✓Decreased
flowrates, Decreased DLCO CBC (Emphysema) -✓✓Increased RBC/Hct/Hb in late stages Sputum
(Emphysema) -✓✓Normal Secondary Assessment Chronic Bronchitis -✓✓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) -✓✓Translucent lung fields, depressed or flattened diaphragms, possibly
hypertrophy of the right ventricle ABG ( Chronic Bronchitis) -✓✓Mild to moderate stages: Acute
alveolar hyperventilation with hypoxemia Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function ( Chronic Bronchitis ) -✓✓Decreased flowrates, normal DLCO CBC (Chronic
Bronchitis) -✓✓Increased RBC/Hb/Hct in early and late stages Sputum (Chronic Bronchitis )
-✓✓Often shows: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
Treatment for COPD -✓✓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
Question:
Appropriate use of medications 9. Annual flu vaccine Bronchiectasis (definition )
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
, Question:
Can create an obstructive or restrictive pattern or a combination of both Patient Assessment
(Primary) for Bronchiectasis pt
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) -✓✓Recurrent pulmonary infections, Cystic Fibrosis, or Kartageners
Syndrome Shortness of Breath (Bronchiectasis ) -✓✓Present, possibly pursed lip breathing Cough (
Bronchiectasis ) -✓✓Productive with purulent foul smelling sputum, hemoptysis and 3 layer
sputum, may be blood streaked Appearance of chest (Bronchiectasis ) -✓✓Barrel chest, increased
A-P diameter Respiratory Pattern ( Bronchiectasis ) -✓✓Accessory muscle usage Color (
Bronchiectasis ) -✓✓Cyanotic Appearance if the Nail Beds (Bronchiectasis ) -✓✓Clubbing
Diagnostic Chest Percussion ( Bronchiectasis ) -✓✓Hyperresonant/tympanic note Breath Sounds (
Bronchiectasis ) -✓✓Wheezing, diminished breath sounds Patient Assessment ( Secondary)
Bronchiectasis -✓✓Chest X-ray = hyperlucent lung fields, depressed or flattened diaphragm,
enlarged or elongated heart ABG= mild to moderate: Acute alveolar hyperventilation with
hypoxemia Severe: Chronic ventilatory failure with hypoxemia Pulmonary Function = Deceased
flowrates CBC = increased RBC/Hb/Hct Sputum = May indicate infection Special Diagnostic Tests
= CT scan - Increased bronchial wall opacity. Characteristic appearance of end on signet ring
opacity chest X-ray (Bronchiectasis ) -✓✓Hyperlucent lung fields, depressed or flattened
diaphragm, enlarged or elongated heart ABG ( Bronchiectasis ) -✓✓Mild to moderate: acute
alveolar hyperventilation with hypoxemia Severe: Chronic ventilatory failure with hypoxemia
Pulmonary Function ( Bronchiectasis ) -✓✓Decreased flowrates CBC ( Bronchiectasis )
-✓✓Increased RBC/Hb/Hct Sputum (Bronchiectasis ) -✓✓May indicate infection Special
Diagnostic Tests ( Bronchiectasis ) -✓✓CT scan - Increased bronchial wall opacity. Characteristic
appearance of end on signet ring opacity Treatment for Bronchiectasis -✓✓1. Bronchopulmonary
hygiene 2. Lung expansion therapy 3. antibiotics for infection 4. Expectorants 5. Aerosolized
medications Sympathomimetic agents Parasympatholytic agents 6. Surgical resection of involved
segments if necessary 7. Oxygen for hypoxemia 8. Mechanical ventilation for reversible acute
ventilatory failure 9. Childhood vaccines, yearly flu vaccines 10. Avoid triggers: Upper respiratory
infections Smoking
Question:
Polluted environments Chest Trauma definition
VERIFIED SOLUTIONS
Clinical Simulation Questions and Answers Verified
Solutions Latest Update 2026/2027
Question:
genetic predisposition
Answer:
Question:
indoor and outdoor pollution Pt Assessment of Emphysema Pt (Primary assessment)
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 -✓✓Thin, underweight Past medical history
for emphysema pts -✓✓Tobacco use Cough (Emphysema) -✓✓Less common, muciod secretions
Appearance of the chest (Emphysema) -✓✓Barrel chest, increased A-P diameter Respiratory pattern
( Emphysema) -✓✓Dyspnea, pursed lip breathing, accessory muscle use, especially during
exacerbations Color (Emphysema) -✓✓Often reddish Clubbing (Emphysema) -✓✓Late stage
Diagnostic Chet Percussion (Emphysema) -✓✓Hyperresonant/tympanic note Breath sounds (
Emphysema) -✓✓Diminished, prolonged expiration Patient Assessment (Primary) Chronic
Bronchitis -✓✓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) -✓✓Stocky,
overweight Past Medical History (Chronic Bronchitis) -✓✓Tobacco use Cough (Chronic Bronchitis
) -✓✓Productive, copious amounts of purulent secretions Chest Appearance (Chronic Bronchitis)
-✓✓Occasionally barrel chest Respiratory Pattern (Chronic Bronchitis ) -✓✓Use of accessory
muscles less common Clubbing ( Chronic Bronchitis ) -✓✓Common Diagnostic Chest Percussion (
Chronic Bronchitis) -✓✓Normal Breath Sounds (Chronic Bronchitis ) -✓✓Rhonchi, crackles,
wheezing Secondary Assessment Emphysema pt -✓✓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 )
-✓✓Translucent (dark) lung fields, depressed or flattened diaphragms, long and narrow heart,
increased retrosternal air space, possibly hypertrophy or right ventricle ABG (emphysema)
-✓✓Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia Severe stage:
Chronic ventilatory failure with hypoxemia Pulmonary Function (Emphysema ) -✓✓Decreased
flowrates, Decreased DLCO CBC (Emphysema) -✓✓Increased RBC/Hct/Hb in late stages Sputum
(Emphysema) -✓✓Normal Secondary Assessment Chronic Bronchitis -✓✓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) -✓✓Translucent lung fields, depressed or flattened diaphragms, possibly
hypertrophy of the right ventricle ABG ( Chronic Bronchitis) -✓✓Mild to moderate stages: Acute
alveolar hyperventilation with hypoxemia Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function ( Chronic Bronchitis ) -✓✓Decreased flowrates, normal DLCO CBC (Chronic
Bronchitis) -✓✓Increased RBC/Hb/Hct in early and late stages Sputum (Chronic Bronchitis )
-✓✓Often shows: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
Treatment for COPD -✓✓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
Question:
Appropriate use of medications 9. Annual flu vaccine Bronchiectasis (definition )
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
, Question:
Can create an obstructive or restrictive pattern or a combination of both Patient Assessment
(Primary) for Bronchiectasis pt
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) -✓✓Recurrent pulmonary infections, Cystic Fibrosis, or Kartageners
Syndrome Shortness of Breath (Bronchiectasis ) -✓✓Present, possibly pursed lip breathing Cough (
Bronchiectasis ) -✓✓Productive with purulent foul smelling sputum, hemoptysis and 3 layer
sputum, may be blood streaked Appearance of chest (Bronchiectasis ) -✓✓Barrel chest, increased
A-P diameter Respiratory Pattern ( Bronchiectasis ) -✓✓Accessory muscle usage Color (
Bronchiectasis ) -✓✓Cyanotic Appearance if the Nail Beds (Bronchiectasis ) -✓✓Clubbing
Diagnostic Chest Percussion ( Bronchiectasis ) -✓✓Hyperresonant/tympanic note Breath Sounds (
Bronchiectasis ) -✓✓Wheezing, diminished breath sounds Patient Assessment ( Secondary)
Bronchiectasis -✓✓Chest X-ray = hyperlucent lung fields, depressed or flattened diaphragm,
enlarged or elongated heart ABG= mild to moderate: Acute alveolar hyperventilation with
hypoxemia Severe: Chronic ventilatory failure with hypoxemia Pulmonary Function = Deceased
flowrates CBC = increased RBC/Hb/Hct Sputum = May indicate infection Special Diagnostic Tests
= CT scan - Increased bronchial wall opacity. Characteristic appearance of end on signet ring
opacity chest X-ray (Bronchiectasis ) -✓✓Hyperlucent lung fields, depressed or flattened
diaphragm, enlarged or elongated heart ABG ( Bronchiectasis ) -✓✓Mild to moderate: acute
alveolar hyperventilation with hypoxemia Severe: Chronic ventilatory failure with hypoxemia
Pulmonary Function ( Bronchiectasis ) -✓✓Decreased flowrates CBC ( Bronchiectasis )
-✓✓Increased RBC/Hb/Hct Sputum (Bronchiectasis ) -✓✓May indicate infection Special
Diagnostic Tests ( Bronchiectasis ) -✓✓CT scan - Increased bronchial wall opacity. Characteristic
appearance of end on signet ring opacity Treatment for Bronchiectasis -✓✓1. Bronchopulmonary
hygiene 2. Lung expansion therapy 3. antibiotics for infection 4. Expectorants 5. Aerosolized
medications Sympathomimetic agents Parasympatholytic agents 6. Surgical resection of involved
segments if necessary 7. Oxygen for hypoxemia 8. Mechanical ventilation for reversible acute
ventilatory failure 9. Childhood vaccines, yearly flu vaccines 10. Avoid triggers: Upper respiratory
infections Smoking
Question:
Polluted environments Chest Trauma definition
