2025 CLINICAL SIMULATION ACTUAL EXAM QUESTIONS
WITH ANSWERS GRADED A+ 2025/2026
appearance of the chest of emphysema patient - barrel chest, increased AP diameter,
hoovers sign
appearance of the chest of chronic bronchitis patient - occasionally barrel chest
respiratory pattern of emphysema patient - dyspnea, pursed lip breathing, accessory
muscle use, especially during exacerbations
respiratory pattern of chronic bronchitis patient - use of accessory muscles less
common
color of emphysema patient - often reddish skin
color of chronic bronchitis patient - cyanotic
clubbing with emphysema patient - late stage
clubbing with chronic bronchitis patient - common
diagnostic chest percussion for emphysema patients - hyperresonant/tympanic note
diagnostic chest percussion for chronic bronchitis patients - normal
breath sounds for emphysema patients - diminished breath sounds, prolonged
expiration
breath sounds for chronic bronchitis patients - rhonichi, crackles, wheezes
chest xray for emphysema patients - translucent (dark) lung fields, depressed or
flattened diaphragms, long and narrow heart, increased retrosternal air space, possibly
hypertrophy of right ventricle
chest xray for chronic bronchitis patients - translucent (dark) lung fields, depressed or
flattened diaphragms, possibly hypertrophy of right ventricle
pulmonary function for emphysema patients - decreased flow rates, decreased DLco
pulmonary function for chronic bronchitis - decreased flow rates, normal DLco normal
CBC for emphysema - increased RBC/HB/Hct in late stages
CBC for chronic bronchitis - increased RBC/HB/Hct in early and late stages
, sputum for emphysema patients - normal
sputum for chronic bronchitis patients - often shows: streptococcus pneumoniae,
haemophilus influenzae, moraxella catarrhalis
treatment for emphysema or chronic bronchitis - 1) low flow oxygen therapy: nasal
cannula at 1-2 l/m or 24-28% air entrainment mask
2) bronchodilators
3) inhaled corticosteroids
4) NPPV for accute exacerbations
Bronchiectasis definition - chronic dilation and distortion of one or more bronchi as a
result of excessive inflammation and destruction of bronchial walls, blood vessels,
elastic tissue and smooth muscle. results in impaired mucociliary clearance causing
accumulation of copious amounts of bronchial secretions
Bronchiectasis involvement - 1) one or both lungs may be involved
2) commonly limited to a lobe or segment
3) frequently found in lower lobes
4) can create an obstructive or restrictive pattern, or a combination of both
Etiology of bronchiectasis - 1) not always clear in >60% of cases
2) acquired
3) congenital (50% of cases from CF and 20% form kartagener's syndrome)
past medical history of bronchiectasis - recurrent pulmonary infections, CF, kartagener's
syndome
cough in bronchiectasis patients - productive with purulent foul smelling sputum,
hemoptysis and three layer sputum, may be blood streaked
appearance of chest in bronchiectasis - barrel chest, increased ap diameter
respiratory pattern of bronchiectasis - accessory muscle usage
color in bronchiectasis patients - cyanotic
diagnostic chest percussion in bronchiectasis - hyperresonant/ tympanic note
breath sounds in bronchiectasis patients - wheezing, diminished breath sounds
chest xray on bronchiectasis patients - hyperlucent lung fields, depressed or flattened
diaphragm, enlarged heart
sputum on bronchiectasis patients - may indicate infection
WITH ANSWERS GRADED A+ 2025/2026
appearance of the chest of emphysema patient - barrel chest, increased AP diameter,
hoovers sign
appearance of the chest of chronic bronchitis patient - occasionally barrel chest
respiratory pattern of emphysema patient - dyspnea, pursed lip breathing, accessory
muscle use, especially during exacerbations
respiratory pattern of chronic bronchitis patient - use of accessory muscles less
common
color of emphysema patient - often reddish skin
color of chronic bronchitis patient - cyanotic
clubbing with emphysema patient - late stage
clubbing with chronic bronchitis patient - common
diagnostic chest percussion for emphysema patients - hyperresonant/tympanic note
diagnostic chest percussion for chronic bronchitis patients - normal
breath sounds for emphysema patients - diminished breath sounds, prolonged
expiration
breath sounds for chronic bronchitis patients - rhonichi, crackles, wheezes
chest xray for emphysema patients - translucent (dark) lung fields, depressed or
flattened diaphragms, long and narrow heart, increased retrosternal air space, possibly
hypertrophy of right ventricle
chest xray for chronic bronchitis patients - translucent (dark) lung fields, depressed or
flattened diaphragms, possibly hypertrophy of right ventricle
pulmonary function for emphysema patients - decreased flow rates, decreased DLco
pulmonary function for chronic bronchitis - decreased flow rates, normal DLco normal
CBC for emphysema - increased RBC/HB/Hct in late stages
CBC for chronic bronchitis - increased RBC/HB/Hct in early and late stages
, sputum for emphysema patients - normal
sputum for chronic bronchitis patients - often shows: streptococcus pneumoniae,
haemophilus influenzae, moraxella catarrhalis
treatment for emphysema or chronic bronchitis - 1) low flow oxygen therapy: nasal
cannula at 1-2 l/m or 24-28% air entrainment mask
2) bronchodilators
3) inhaled corticosteroids
4) NPPV for accute exacerbations
Bronchiectasis definition - chronic dilation and distortion of one or more bronchi as a
result of excessive inflammation and destruction of bronchial walls, blood vessels,
elastic tissue and smooth muscle. results in impaired mucociliary clearance causing
accumulation of copious amounts of bronchial secretions
Bronchiectasis involvement - 1) one or both lungs may be involved
2) commonly limited to a lobe or segment
3) frequently found in lower lobes
4) can create an obstructive or restrictive pattern, or a combination of both
Etiology of bronchiectasis - 1) not always clear in >60% of cases
2) acquired
3) congenital (50% of cases from CF and 20% form kartagener's syndrome)
past medical history of bronchiectasis - recurrent pulmonary infections, CF, kartagener's
syndome
cough in bronchiectasis patients - productive with purulent foul smelling sputum,
hemoptysis and three layer sputum, may be blood streaked
appearance of chest in bronchiectasis - barrel chest, increased ap diameter
respiratory pattern of bronchiectasis - accessory muscle usage
color in bronchiectasis patients - cyanotic
diagnostic chest percussion in bronchiectasis - hyperresonant/ tympanic note
breath sounds in bronchiectasis patients - wheezing, diminished breath sounds
chest xray on bronchiectasis patients - hyperlucent lung fields, depressed or flattened
diaphragm, enlarged heart
sputum on bronchiectasis patients - may indicate infection
