NBRC TMC/CRT/RRT EXAM STUDY GUIDE
QUESTIONS AND ANSWERS VERIFIED 100% CORRECT
Hyperresonant - ANSWER --found where pneumothorax or emphysema is present.
-booming sound
vesicular breath sounds - ANSWER -normal sounds in lungs
bronchial breath sounds - ANSWER --normal sounds over airways.
-breath sounds over lungs indicate LUNG CONSOLIDATION
Egophony - ANSWER --patient instructed to say E and sounds like A.
-lung consolidation
Bronchophony / whisphered pectoriloquy - ANSWER --increased intensity or
transmission of the spoken voice and indicate CONSOLIDATION or
PNEUMONIA
-increase in spoken voice = consolidation
-decrease in spoken voice = obstructon, pneumo, emphysema
Rales - ANSWER --crackles
-secretions/fluid
Coarse rales - ANSWER --rhonchi
-LARGE airway secretions
-needs suctioning
medium rales - ANSWER --middle airway secretions
-needs CPT
Fine rales - ANSWER --fluid in alveoli
-CHF, pulmonary edema
-IPPB, heart drugs, diuretics and O2
Wheeze - ANSWER --due to bronchospasm
-bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
stridor - ANSWER --upper airway obstruction
,-supraglottic swelling (epiglottitis) (thumb sign)
-subglottic swelling (croup, postextubation) (steeple sign)
-foreign body aspiration
-Racemic epinephrine
-intubation if MARKED stridor
-Lateral neck Xray for confirmation
Pleural friction rub - ANSWER --coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
Heart Sound S₁ - ANSWER --closure of the mitral and tricuspid valves at the
beginning of ventricular contraction
Heart Sound S₂ - ANSWER --closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
Heart Sound S₃ - ANSWER --abnormal and may suggest CHF
Heart Sound S₄ - ANSWER --abnormal and indicative of cardiac abnormality such
as myocardial infarction or cardiomegaly
Heart murmurs - ANSWER --sounds caused by turbulent blood flow
-heart valve defects or congenital heart abnormalities
-can occur when blood is pushed through an abnormal opening (ASD, PDA)
Bruits - ANSWER --sounds made in an artery or vein when blood flow becomes
turbulent or flows at an abnormal speed.
-usually heard via stethoscope over the identified vessel (carotid artery)
Blood pressure - ANSWER --systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
-↑BP = cardiac stress = hypoxemia
-↓BP = poor perfusion = hypovolemia, CHF
Costophrenic Angle - ANSWER --angle made by the outer curve of the diaphragm
and the chest wall
-obliterated by pleural effusions and pneumonia
, Diaphragm - ANSWER --dome shaped normally
-flattened with COPD
-hemidiaphragms may shift downward with pneumothorax
-right hemidiaphragm is level of 6th anterior rib and slightly higher than the left
-right lung: 55% and appear larger than left lung
Lateral decubitus CXR - ANSWER --patient lying on affected side
-detecting small pleural effusions
End expiratory film - ANSWER --taken when patient is at end-exhalation
-detecting small pneumothorax/foreign body aspiration (FBA)
Position of ET/Tracheostomy tube - ANSWER --tip should be positioned below
the vocal chords and no closer than 2 cm or 1 inch above the carina.
-approx same level of the aortic knob/arch
-observation and auscultation will quickly determine adequate ventilation before
CXR is taken
-cuff should not extend over the end of the ET or tracheostomy tube
Pacemaker, catheters, Etc. - ANSWER --pacemaker should be positioned in the
right ventricle
-PAC should appear in right lower lung field
-central venous catheters are placed in the right or left subclavian or jugular vein
and should rest in the vena cava or right atrium
-chest tubes should be located in the pleural space surrounding the lung
-NG tubes should be in stomach 2-5 cm below the diaphragm
Croup (laryngotracheobronchitis) - ANSWER --viral disorder
-narrowing subglottic swelling
-steeple/picket fence/pencil sign
-gradual onset
-infants
-Mist tent, O2, Racemic epi, corticosteroids
-barking cough
Epiglottitis - ANSWER --bacterial infection
-supraglottic swelling with an enlraged and flattened epiglottis and swollen
aryepiglottic folds
-Thumb sign
-Rapid onset
, -pediatrics
-provide airway and antibiotics
Computerized Tomography (CT scan) - ANSWER --X-ray through a specific
plane and appear as slices of organs/body parts
-diagnosis of bronchiectasis
-spiral CT scan w/ contrast dye for PE
Magnetic Resonance Imaging (MRI) - ANSWER --2D view without use of
radiation
-used for determining thoracic aneurysms, congenital abnormalities of the aorta
and major thoracic vessels esp. the hilar area
-able to locate precise position of tumors
V/Q scan - ANSWER -Ventilation scan
-Radioisotope (xenon) gas is inhaled
-and obstruction to airflow will allow little gas to enter
Perfusion scan
-albumin, tagged with radioactive iodine is injected into a peripheral vein and
lodges in the pulmonary capillaries
-scanned over chest and shows distribution and volume of perfusion
Ventilation with no perfusion = PE (deadspace disease)
Barium swallow (esophagram) - ANSWER --for diagnosing of abnormalities in
the hypopharynx, esophagus, or stomach
-ingested and traced through the hypopharynx and into the esophagus via
fluoroscope and xray at the end
-suspected esophageal malignancy, dysphagia, congenital defect in hypopharync,
esophagus, gastric reflux, esophageal varices.
Positron Emission Tomography (PET scan) - ANSWER --for determining cancer,
brain disorders and heart disease
-injected with radioactive substance
bronchography (bronchogram) - ANSWER --injection of radio-opaque contrast
into tracheobronchial tree
-study of OBSTRUCTING LESIONS (tumors) and BRONCHIECTASIS
-better administration of postural drainage
QUESTIONS AND ANSWERS VERIFIED 100% CORRECT
Hyperresonant - ANSWER --found where pneumothorax or emphysema is present.
-booming sound
vesicular breath sounds - ANSWER -normal sounds in lungs
bronchial breath sounds - ANSWER --normal sounds over airways.
-breath sounds over lungs indicate LUNG CONSOLIDATION
Egophony - ANSWER --patient instructed to say E and sounds like A.
-lung consolidation
Bronchophony / whisphered pectoriloquy - ANSWER --increased intensity or
transmission of the spoken voice and indicate CONSOLIDATION or
PNEUMONIA
-increase in spoken voice = consolidation
-decrease in spoken voice = obstructon, pneumo, emphysema
Rales - ANSWER --crackles
-secretions/fluid
Coarse rales - ANSWER --rhonchi
-LARGE airway secretions
-needs suctioning
medium rales - ANSWER --middle airway secretions
-needs CPT
Fine rales - ANSWER --fluid in alveoli
-CHF, pulmonary edema
-IPPB, heart drugs, diuretics and O2
Wheeze - ANSWER --due to bronchospasm
-bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
stridor - ANSWER --upper airway obstruction
,-supraglottic swelling (epiglottitis) (thumb sign)
-subglottic swelling (croup, postextubation) (steeple sign)
-foreign body aspiration
-Racemic epinephrine
-intubation if MARKED stridor
-Lateral neck Xray for confirmation
Pleural friction rub - ANSWER --coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
Heart Sound S₁ - ANSWER --closure of the mitral and tricuspid valves at the
beginning of ventricular contraction
Heart Sound S₂ - ANSWER --closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
Heart Sound S₃ - ANSWER --abnormal and may suggest CHF
Heart Sound S₄ - ANSWER --abnormal and indicative of cardiac abnormality such
as myocardial infarction or cardiomegaly
Heart murmurs - ANSWER --sounds caused by turbulent blood flow
-heart valve defects or congenital heart abnormalities
-can occur when blood is pushed through an abnormal opening (ASD, PDA)
Bruits - ANSWER --sounds made in an artery or vein when blood flow becomes
turbulent or flows at an abnormal speed.
-usually heard via stethoscope over the identified vessel (carotid artery)
Blood pressure - ANSWER --systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
-↑BP = cardiac stress = hypoxemia
-↓BP = poor perfusion = hypovolemia, CHF
Costophrenic Angle - ANSWER --angle made by the outer curve of the diaphragm
and the chest wall
-obliterated by pleural effusions and pneumonia
, Diaphragm - ANSWER --dome shaped normally
-flattened with COPD
-hemidiaphragms may shift downward with pneumothorax
-right hemidiaphragm is level of 6th anterior rib and slightly higher than the left
-right lung: 55% and appear larger than left lung
Lateral decubitus CXR - ANSWER --patient lying on affected side
-detecting small pleural effusions
End expiratory film - ANSWER --taken when patient is at end-exhalation
-detecting small pneumothorax/foreign body aspiration (FBA)
Position of ET/Tracheostomy tube - ANSWER --tip should be positioned below
the vocal chords and no closer than 2 cm or 1 inch above the carina.
-approx same level of the aortic knob/arch
-observation and auscultation will quickly determine adequate ventilation before
CXR is taken
-cuff should not extend over the end of the ET or tracheostomy tube
Pacemaker, catheters, Etc. - ANSWER --pacemaker should be positioned in the
right ventricle
-PAC should appear in right lower lung field
-central venous catheters are placed in the right or left subclavian or jugular vein
and should rest in the vena cava or right atrium
-chest tubes should be located in the pleural space surrounding the lung
-NG tubes should be in stomach 2-5 cm below the diaphragm
Croup (laryngotracheobronchitis) - ANSWER --viral disorder
-narrowing subglottic swelling
-steeple/picket fence/pencil sign
-gradual onset
-infants
-Mist tent, O2, Racemic epi, corticosteroids
-barking cough
Epiglottitis - ANSWER --bacterial infection
-supraglottic swelling with an enlraged and flattened epiglottis and swollen
aryepiglottic folds
-Thumb sign
-Rapid onset
, -pediatrics
-provide airway and antibiotics
Computerized Tomography (CT scan) - ANSWER --X-ray through a specific
plane and appear as slices of organs/body parts
-diagnosis of bronchiectasis
-spiral CT scan w/ contrast dye for PE
Magnetic Resonance Imaging (MRI) - ANSWER --2D view without use of
radiation
-used for determining thoracic aneurysms, congenital abnormalities of the aorta
and major thoracic vessels esp. the hilar area
-able to locate precise position of tumors
V/Q scan - ANSWER -Ventilation scan
-Radioisotope (xenon) gas is inhaled
-and obstruction to airflow will allow little gas to enter
Perfusion scan
-albumin, tagged with radioactive iodine is injected into a peripheral vein and
lodges in the pulmonary capillaries
-scanned over chest and shows distribution and volume of perfusion
Ventilation with no perfusion = PE (deadspace disease)
Barium swallow (esophagram) - ANSWER --for diagnosing of abnormalities in
the hypopharynx, esophagus, or stomach
-ingested and traced through the hypopharynx and into the esophagus via
fluoroscope and xray at the end
-suspected esophageal malignancy, dysphagia, congenital defect in hypopharync,
esophagus, gastric reflux, esophageal varices.
Positron Emission Tomography (PET scan) - ANSWER --for determining cancer,
brain disorders and heart disease
-injected with radioactive substance
bronchography (bronchogram) - ANSWER --injection of radio-opaque contrast
into tracheobronchial tree
-study of OBSTRUCTING LESIONS (tumors) and BRONCHIECTASIS
-better administration of postural drainage
