NEW TMC EXAMINATION QUESTIONS AND ANSWERS WITH SOLUTIONS 2024

NEW TMC EXAMINATION QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
Emphysema/Chronic Bronchitis - ANSWER Patient assessment- (loss of recoil)
O O O O O O O O




barrel chest, increased AP Diameter, clubbing and cyanosis
O O O O O O O




dyspnea, accessory muscle use, pursed lip breathing
O O O O O O




diminished WITH bilateral wheeze
O O O




tympanic/hyperresonant

congested, thick sputum O O




chest x-ray-
O




hyperlucency, hyperinflation, increased AP diameter, flattened diaphragm
O O O O O O




ABG- compensated respiratory acidosis with hypoxemia and hypercapnia
O O O O O O O




PFT's- decreased flows in FEV1, FVC, FEF 25-75%
O O O O O O O




Treatment- low flow oxygen (sats 88-
O O O O O


92%), aerosolized bronchodilators (SABA, LABA, anticholinergic, LAMA), bronchial hygiene, inhaled cortic
O O O O O O O O O O


osteroid, antibiotics (if indicated by sputum culture), referral to smoking cessation program, pulmonary r
O O O O O O O O O O O O O


ehabilitation, consider NPPV for exacerbations, refer patient and family to education programs
O O O O O O O O O O O




Asthma - ANSWER Patient assessment-
O O O O O




pursed lip breathing, chest tightness, increased AP diameter
O O O O O O O




accessory muscle use (during episode)
O O O O




hyperresonant/tympanic

diffuse wheezing, diminished breath sounds, prolonged expiration
O O O O O O




diaphoresis (excessive sweating)
O O




tachycardia, tachypnea, pulsus paradoxus (during severe episode-
O O O O O O


meaning decrease in systolic blood pressure
O O O O O

, Chest x-ray- O




increased AP diameter, dark (translucent) lung fields, depressed/flattened diaphragms
O O O O O O O O




ABG-
Oacute alveolar hyperinflation with hypoxemia, may develop hypercarbia (Co2 retention) in status asthmi
O O O O O O O O O O O O


cus (worst form of asthma, ventilatory failure)
O O O O O O




PFT's-

spirometry shows reduced flowrates (peak flow, FEV1, FVC, FEF 25-75%)
O O O O O O O O O




Post bronchodilator-
O O




considered a significant response if FEV1 increases at least 12% and 200 mL
O O O O O O O O O O O O




Bronchial provocation test- O O




FEV1 decreases significantly when a provocative agent such as methacholine, is inhaled.
O O O O O O O O O O O




Treatment-

Oxygen therapy, aerosol therapy with SABA and anticholinergic agents, consider continuous therapy wit
O O O O O O O O O O O O


h nebulizer, corticosteroids (oral or IV), close monitoring, intubation and mechanical ventilation if ventila
O O O O O O O O O O O O O


tory failure or respiratory arrest occurs, consider heliox therapy or magnesium sulfate or subcutaneous e
O O O O O O O O O O O O O O


pinephrine



Long term control-
O O




Asthma triggers should be eliminated, control medications (LABA, inhaled corticosteroids, mast cell stabi
O O O O O O O O O O O O


lizer, leukotriene inhibitors, asthma action plan based on peak flow monitoring.
O O O O O O O O O O O




Asthma action plan/Peak flow-
O O O




Green

peak flow- (80-100%) stable, continue with medications for treatment plan
O O O O O O O O O




Yellow

peak flow (50-80%)- increase in symptoms, preventative anti-
O O O O O O O


inflammatory inhaler, albuterol, oral steroids, call doctor
O O O O O O