NBRC FINAL PAPER 2026 QUESTIONS WITH
SOLUTIONS GRADED A+
◉ -Increases BP
-Used for septic shock. Answer: -Increases BP
-Used for septic shock
◉ Emphysema. Answer: -Type of COPD
-Abnormal condition of the alveoli resulting destruction and loss of
elasticity.
-Signs & Symptoms: barrel chest, limited physical activity, and
progressive worsening of SOB, productive cough, wheezing, and weight
loss.
-Causes: cigarette smoking, second hand smoking, long term exposure to
toxic chemicals
-CXR: hyperinflated lungs with reduced vascular markings.
-Treatments: ↓ risk factors, medications (bronchodilators, inhaled
steroids), oxygen therapy (low FiO2 1-2lpm) , pulmonary rehab
◉ Chronic Bronchitis. Answer: -Condition where the patient has a
productive cough 25% of the year for at least two consecutive years
-Type of COPD
,-CXR: could be normal, or may show hyperlucency, diminished,
pulmonary marking
-Treatments: anything that promotes good pulmonary hygiene such as
CPT, hydration therapy when sputum is thick, oxygen therapy for
hypoxemia, aerosolized bronchodilator therapy, antibiotic tetracycline
may be preferable
◉ Bronchiectasis. Answer: -Chronic condition where the walls of the
bronchi are thickened from inflammation and infection (yellow/green
mucus)
-Sputum culture—gram negative bacteria
-Bronchogram: Primary test. "tree in winter pattern"
-Treatment: good pulmonary hygiene, CPT, txs etc.
◉ Obstructive Sleep Apnea. Answer: -The cessation of breathing during
sleep; Is usually obstructive in nature but sometimes can be central or a
combination of the two (mixed).
-Signs and Symptoms: snoring, apnea periods that exceed 10 seconds,
obesity, sleepiness during daytime
-Polysomnography (sleep study) - determines if obstructive or central
-If no nasal flow AND no chest movement—then CENTRAL sleep
apnea.
-If no nasal flow WITH chest movement—then OBSTRUCTIVE sleep
apnea
,-Treatment: CPAP or BiPAP (NIPPV) with follow-up weight loss or
upper aw tissue removal through surgery
◉ Difference between Central and Obstructive Sleep Apnea?. Answer:
CENTRAL = If no nasal flow AND no chest movement
OBSTRUCTIVE = If no nasal flow WITH chest movement
◉ Asthma. Answer: -Abnormal constriction of the bronchials resulting
in sputum production and narrowed aw
-Signs and Symptoms: coughing, wheezing, chest tightness, SOB,
accessory muscle use, tachycardia
-In allergic cases, maybe elevate eosinophils which can cause yellow
sputum
-Chest X-ray—hyperinflation, scattered infiltrates, flattened diaphragms.
-Treatment: oxygen, bronchodilators, xanthine med given IV
(aminophylline), inhaled steroids such as oral or IV prednisone
◉ Status Asthmaticus. Answer: -Asthma that will not respond to
bronchodilation therapy, usually persists more than 24 hours.
-Pt. will report the need to take many bronchodilator treatments before
feeling better
-S&S: Accessory muscle use and retractions, dyspnea, Wheezing,
Congested cough, Wet, clammy skin
-pulses paradoxus: an exaggerated fall in a patient's BP during
inspiration by greater than 10 mm Hg.
, -Treatment: May deteriorate quickly, so intubate before failure. Can do
subcutaneous epinephrine (for allergic reaction. Bronchodilators
-Address 3 parts of asthma
1.) inflammation -corticosteroids
2.) Bronchoconstriction - bronchodilators
3.) Sputum- airway clearance, hydration, thinning of sputum if needed.
◉ Myasthenia Gravis (MG). Answer: -NM abnormality where muscles
experience paralysis starting from the head down to the feet including
ventilatory muscles.
-May have a hx of MG if not a new onset, Droopy facial muscles and
eyelids (Ptosis), Dysphagia
-Tensilon Challenge Test—positive for Myasthenic crisis if
improvement is noted upon the administration of Tensilon (never use to
treat, only diagnose)
(a) If Tensilon improves condition then:
Anticholinesterase therapy is indicated including: Neostigmine
(prostigmine), Mestinon (pyridostigmine)
(b) If symptoms improve with Tensilon and then worsen then MUST
reverse with Atropine; This condition is termed a cholinergic crisis;
Always monitor spontaneous ventilatory volumes (Vt and VC) as well
as MIP.
(c) Prepare to intubate prior to Tensilon challenge since it could take out
the respiratory drive
SOLUTIONS GRADED A+
◉ -Increases BP
-Used for septic shock. Answer: -Increases BP
-Used for septic shock
◉ Emphysema. Answer: -Type of COPD
-Abnormal condition of the alveoli resulting destruction and loss of
elasticity.
-Signs & Symptoms: barrel chest, limited physical activity, and
progressive worsening of SOB, productive cough, wheezing, and weight
loss.
-Causes: cigarette smoking, second hand smoking, long term exposure to
toxic chemicals
-CXR: hyperinflated lungs with reduced vascular markings.
-Treatments: ↓ risk factors, medications (bronchodilators, inhaled
steroids), oxygen therapy (low FiO2 1-2lpm) , pulmonary rehab
◉ Chronic Bronchitis. Answer: -Condition where the patient has a
productive cough 25% of the year for at least two consecutive years
-Type of COPD
,-CXR: could be normal, or may show hyperlucency, diminished,
pulmonary marking
-Treatments: anything that promotes good pulmonary hygiene such as
CPT, hydration therapy when sputum is thick, oxygen therapy for
hypoxemia, aerosolized bronchodilator therapy, antibiotic tetracycline
may be preferable
◉ Bronchiectasis. Answer: -Chronic condition where the walls of the
bronchi are thickened from inflammation and infection (yellow/green
mucus)
-Sputum culture—gram negative bacteria
-Bronchogram: Primary test. "tree in winter pattern"
-Treatment: good pulmonary hygiene, CPT, txs etc.
◉ Obstructive Sleep Apnea. Answer: -The cessation of breathing during
sleep; Is usually obstructive in nature but sometimes can be central or a
combination of the two (mixed).
-Signs and Symptoms: snoring, apnea periods that exceed 10 seconds,
obesity, sleepiness during daytime
-Polysomnography (sleep study) - determines if obstructive or central
-If no nasal flow AND no chest movement—then CENTRAL sleep
apnea.
-If no nasal flow WITH chest movement—then OBSTRUCTIVE sleep
apnea
,-Treatment: CPAP or BiPAP (NIPPV) with follow-up weight loss or
upper aw tissue removal through surgery
◉ Difference between Central and Obstructive Sleep Apnea?. Answer:
CENTRAL = If no nasal flow AND no chest movement
OBSTRUCTIVE = If no nasal flow WITH chest movement
◉ Asthma. Answer: -Abnormal constriction of the bronchials resulting
in sputum production and narrowed aw
-Signs and Symptoms: coughing, wheezing, chest tightness, SOB,
accessory muscle use, tachycardia
-In allergic cases, maybe elevate eosinophils which can cause yellow
sputum
-Chest X-ray—hyperinflation, scattered infiltrates, flattened diaphragms.
-Treatment: oxygen, bronchodilators, xanthine med given IV
(aminophylline), inhaled steroids such as oral or IV prednisone
◉ Status Asthmaticus. Answer: -Asthma that will not respond to
bronchodilation therapy, usually persists more than 24 hours.
-Pt. will report the need to take many bronchodilator treatments before
feeling better
-S&S: Accessory muscle use and retractions, dyspnea, Wheezing,
Congested cough, Wet, clammy skin
-pulses paradoxus: an exaggerated fall in a patient's BP during
inspiration by greater than 10 mm Hg.
, -Treatment: May deteriorate quickly, so intubate before failure. Can do
subcutaneous epinephrine (for allergic reaction. Bronchodilators
-Address 3 parts of asthma
1.) inflammation -corticosteroids
2.) Bronchoconstriction - bronchodilators
3.) Sputum- airway clearance, hydration, thinning of sputum if needed.
◉ Myasthenia Gravis (MG). Answer: -NM abnormality where muscles
experience paralysis starting from the head down to the feet including
ventilatory muscles.
-May have a hx of MG if not a new onset, Droopy facial muscles and
eyelids (Ptosis), Dysphagia
-Tensilon Challenge Test—positive for Myasthenic crisis if
improvement is noted upon the administration of Tensilon (never use to
treat, only diagnose)
(a) If Tensilon improves condition then:
Anticholinesterase therapy is indicated including: Neostigmine
(prostigmine), Mestinon (pyridostigmine)
(b) If symptoms improve with Tensilon and then worsen then MUST
reverse with Atropine; This condition is termed a cholinergic crisis;
Always monitor spontaneous ventilatory volumes (Vt and VC) as well
as MIP.
(c) Prepare to intubate prior to Tensilon challenge since it could take out
the respiratory drive
