KETTERING TMC EXAM PRACTICE
(2026) QUESTIONS AND ANSWERS
1. A 65-year-old patient with COPD is receiving oxygen via a 28% air-entrainment mask. The
patient’s PaO2 is 55 mmHg and PaCO2 is 68 mmHg. What is the most appropriate action?
A. Increase the oxygen concentration to 35%
B. Intubate and initiate mechanical ventilation
C. Initiate Non-invasive Positive Pressure Ventilation (NiPPV)
D. Maintain current therapy and monitor
Answer: C
Conceptual Explanation: The patient is exhibiting signs of acute-on-chronic respiratory
failure (high PaCO2 with hypoxemia). NiPPV is the gold standard for COPD exacerbations to
avoid invasive ventilation while correcting gas exchange.
2. While monitoring a patient in the ICU with a Swan-Ganz catheter, the therapist notes a
Pulmonary Capillary Wedge Pressure (PCWP) of 19 mmHg and a Cardiac Index (CI) of 2.0
L/min/m2. These findings are most consistent with:
A. Left ventricular failure
,B. Septic shock
C. Hypovolemic shock
D. Pulmonary embolism
Answer: A
Conceptual Explanation: An elevated PCWP (>18 mmHg) combined with a low Cardiac
Index (<2.5 L/min/m2) indicates cardiogenic issues, specifically left heart failure or fluid
overload.
3. A patient is receiving volume-controlled ventilation. The peak inspiratory pressure (PIP)
has increased from 25 to 35 cmH2O over the last hour, while the plateau pressure remains
constant at 15 cmH2O. This indicates:
A. Decreased lung compliance
B. The patient is biting the tube
C. Development of a pneumothorax
D. Increased airway resistance
Answer: D
Conceptual Explanation: An increase in PIP without an increase in plateau pressure
indicates an increase in transairway pressure, which is caused by increased airway
resistance (e.g., secretions, bronchospasm, or tube obstruction).
, 4. What is the most definitive test to confirm a diagnosis of Myasthenia Gravis?
A. Sweat Chloride Test
B. Methacholine Challenge
C. Tensilon (Edrophonium) Test
D. Acid-fast bacilli stain
Answer: C
Conceptual Explanation: The Tensilon test uses edrophonium to temporarily improve
muscle strength in patients with Myasthenia Gravis, confirming the diagnosis.
5. A 32-week gestation neonate has a Silverman-Anderson score of 8. This indicates:
A. Normal respiratory status
B. Mild respiratory distress
C. Moderate respiratory distress
D. Severe respiratory distress
Answer: D
Conceptual Explanation: The Silverman-Anderson score measures respiratory distress in
neonates from 0 to 10; higher scores (7-10) indicate severe distress.
6. Which of the following drugs should be administered to a patient experiencing status
asthmaticus who has not responded to repeated albuterol treatments?
A. Salmeterol
(2026) QUESTIONS AND ANSWERS
1. A 65-year-old patient with COPD is receiving oxygen via a 28% air-entrainment mask. The
patient’s PaO2 is 55 mmHg and PaCO2 is 68 mmHg. What is the most appropriate action?
A. Increase the oxygen concentration to 35%
B. Intubate and initiate mechanical ventilation
C. Initiate Non-invasive Positive Pressure Ventilation (NiPPV)
D. Maintain current therapy and monitor
Answer: C
Conceptual Explanation: The patient is exhibiting signs of acute-on-chronic respiratory
failure (high PaCO2 with hypoxemia). NiPPV is the gold standard for COPD exacerbations to
avoid invasive ventilation while correcting gas exchange.
2. While monitoring a patient in the ICU with a Swan-Ganz catheter, the therapist notes a
Pulmonary Capillary Wedge Pressure (PCWP) of 19 mmHg and a Cardiac Index (CI) of 2.0
L/min/m2. These findings are most consistent with:
A. Left ventricular failure
,B. Septic shock
C. Hypovolemic shock
D. Pulmonary embolism
Answer: A
Conceptual Explanation: An elevated PCWP (>18 mmHg) combined with a low Cardiac
Index (<2.5 L/min/m2) indicates cardiogenic issues, specifically left heart failure or fluid
overload.
3. A patient is receiving volume-controlled ventilation. The peak inspiratory pressure (PIP)
has increased from 25 to 35 cmH2O over the last hour, while the plateau pressure remains
constant at 15 cmH2O. This indicates:
A. Decreased lung compliance
B. The patient is biting the tube
C. Development of a pneumothorax
D. Increased airway resistance
Answer: D
Conceptual Explanation: An increase in PIP without an increase in plateau pressure
indicates an increase in transairway pressure, which is caused by increased airway
resistance (e.g., secretions, bronchospasm, or tube obstruction).
, 4. What is the most definitive test to confirm a diagnosis of Myasthenia Gravis?
A. Sweat Chloride Test
B. Methacholine Challenge
C. Tensilon (Edrophonium) Test
D. Acid-fast bacilli stain
Answer: C
Conceptual Explanation: The Tensilon test uses edrophonium to temporarily improve
muscle strength in patients with Myasthenia Gravis, confirming the diagnosis.
5. A 32-week gestation neonate has a Silverman-Anderson score of 8. This indicates:
A. Normal respiratory status
B. Mild respiratory distress
C. Moderate respiratory distress
D. Severe respiratory distress
Answer: D
Conceptual Explanation: The Silverman-Anderson score measures respiratory distress in
neonates from 0 to 10; higher scores (7-10) indicate severe distress.
6. Which of the following drugs should be administered to a patient experiencing status
asthmaticus who has not responded to repeated albuterol treatments?
A. Salmeterol
