Clinical Simulation (2026) Actual
Questions and Answers 100% Correct
(verified)
COPD -✓✓Preventable and treatable disease state characterized by air flow limitation
that is not fully reversible.
Emphysema -✓✓Presence of permanent enlargement of the air spaces distal to the
terminal bronchioles, accompanied by destruction of their walls and without obvious
fibroisis
Chronic bronchitis -✓✓Chronic productive cough for three months in each of two
successive years in a pt for whom other causes of the productive cough have been
excluded
Etiology of COPD -✓✓- tobacco smoke
-genetic predisposition
- indoor and outdoor pollution
Pt Assessment of Emphysema Pt (Primary assessment) -✓✓AKA pink puffer or Type A
COPD
Body build = thin, underweight
Past medical history = Tobacco use
Cough = Less common, muciod secretions
Appearance of chest = Barrel chest, increased A-P diameter (Hoover's Sign)
Respiratory Pattern = Dyspnea, pursed-lip breathing, accessory muscle use, especially
during exacerbations
Color= Often reddish
Clubbing = Late stage
Diagnostic Chest Percussion = Hyperresonant/ Tympanic note
Breath Sounds = Diminished, prolonged expiration
Body build of Type A COPD (pink puffer) Emphysema -✓✓Thin, underweight
Past medical history for emphysema pts -✓✓Tobacco use
Cough (Emphysema) -✓✓Less common, muciod secretions
Appearance of the chest (Emphysema) -✓✓Barrel chest, increased A-P diameter
Respiratory pattern ( Emphysema) -✓✓Dyspnea, pursed lip breathing, accessory
muscle use, especially during exacerbations
,Color (Emphysema) -✓✓Often reddish
Clubbing (Emphysema) -✓✓Late stage
Diagnostic Chet Percussion (Emphysema) -✓✓Hyperresonant/tympanic note
Breath sounds ( Emphysema) -✓✓Diminished, prolonged expiration
Patient Assessment (Primary) Chronic Bronchitis -✓✓AKA Blue bloater Type B COPD
Body build = Stocky, overweight
Past Medical History = Tobacco use
Cough = Productive, copious amounts, purulent secretions
Chest Appearance = Ocassionally barrel chest
Color = Cyanotic
Clubbing = Common
Diagnostic Chest Percussion = normal
Breath Sounds = Rhonchi, crackles , wheezing
Body build (Chronic Bronchitis) -✓✓Stocky, overweight
Past Medical History (Chronic Bronchitis) -✓✓Tobacco use
Cough (Chronic Bronchitis ) -✓✓Productive, copious amounts of purulent secretions
Chest Appearance (Chronic Bronchitis) -✓✓Occasionally barrel chest
Respiratory Pattern (Chronic Bronchitis ) -✓✓Use of accessory muscles less common
Clubbing ( Chronic Bronchitis ) -✓✓Common
Diagnostic Chest Percussion ( Chronic Bronchitis) -✓✓Normal
Breath Sounds (Chronic Bronchitis ) -✓✓Rhonchi, crackles, wheezing
Secondary Assessment Emphysema pt -✓✓Chest X-ray = translucent (dark) lung fields,
depressed or flattened diaphragms, long and narrow heart, increased retrosternal air
spaces, possibly hypertrophy or right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia Severe
Stages: Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates (FEV1 , FEF 25-75%, FEF 200-1200,
FEV1/FVC, and PEFR) Decreased DLCO
CBC = Increased RBC/Hb/Hct in late stages
Sputum = Normal
,Chest X-ray (Emphysema ) -✓✓Translucent (dark) lung fields, depressed or flattened
diaphragms, long and narrow heart, increased retrosternal air space, possibly
hypertrophy or right ventricle
ABG (emphysema) -✓✓Mild to moderate stages: Acute alveolar hyperventilation with
hypoxemia Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function (Emphysema ) -✓✓Decreased flowrates, Decreased DLCO
CBC (Emphysema) -✓✓Increased RBC/Hct/Hb in late stages
Sputum (Emphysema) -✓✓Normal
Secondary Assessment Chronic Bronchitis -✓✓AKA Type B Blue Bloater
Chest X-ray = translucent (dark) lung fields, depressed or flattened diaphragms,
possibly hypertrophy of right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia
Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates, DLCO normal
CBC = increased RBC/Hb/Hct in early and late stages
Sputum = Often shows ; Streptococcus pneumoniae, Haemophilus influenza, Moraxella
catarrhalis
Chest X-ray (Chronic Bronchitis) -✓✓Translucent lung fields, depressed or flattened
diaphragms, possibly hypertrophy of the right ventricle
ABG ( Chronic Bronchitis) -✓✓Mild to moderate stages: Acute alveolar hyperventilation
with hypoxemia
Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function ( Chronic Bronchitis ) -✓✓Decreased flowrates, normal DLCO
CBC (Chronic Bronchitis) -✓✓Increased RBC/Hb/Hct in early and late stages
Sputum (Chronic Bronchitis ) -✓✓Often shows: Streptococcus pneumoniae,
Haemophilus influenzae, Moraxella catarrhalis
Treatment for COPD -✓✓1. Low flow o2 therapy
Nasal cannula 1-2 L/min or 24-28% air entrainment mask
Consider o2 conservation devices for home use
2. Bronchodilators (SABA, LABA, and anticholinergic)
3. Inhaled corticosteroids
4. Antibiotics if indicated by sputum culture
5. Bronchial hygiene as indicted
, 6. Referral to smoking cessation program, including nicotine replacement therapy
7. Consider NPPV for acute exacerbations of ventilatory failure
8. Refer pt family to pulmonary rehab ed programs which should include
-Nutritional management
- Avoiding infections
-Exercise program
- Methods to aid in secretion clearance
-Home O2 and aerosol therapy
-Appropriate use of medications
9. Annual flu vaccine
Bronchiectasis (definition ) -✓✓Chronic dilation and distortion one of one or more
bronchi as a result of excessive inflammation and destruction of the bronchial walls,
blood vessels, elastic tissue and smooth muscle. Results in impaired mucocilary
clearance causing accumulation of copious amounts of bronchial secretions
-one or both lungs may be involved
-Commonly limited to lobe or segment
- Frequently found in lower lobes
-Can create an obstructive or restrictive pattern or a combination of both
Patient Assessment (Primary) for Bronchiectasis pt -✓✓Past Medical History =
Recurrent pulmonary infections, Cystic Fibrosis, if Kartageners Syndrome
Shortness of Breath = Present, possibly pursed lip breathing
Cough = Productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum,
may be blood streaked
Appearance of chest = Barrel chest, increased A-P diameter
Respiratory Pattern = Accessory muscle usage
Color = Cyanotic
Appearance of the nail beds = clubbing
Diagnostic Chest Percussion = Hyperresonant/tympanic note
Breath Sounds = Wheezing, diminished breath sounds
Past Medical History ( Bronchiectasis) -✓✓Recurrent pulmonary infections, Cystic
Fibrosis, or Kartageners Syndrome
Shortness of Breath (Bronchiectasis ) -✓✓Present, possibly pursed lip breathing
Cough ( Bronchiectasis ) -✓✓Productive with purulent foul smelling sputum, hemoptysis
and 3 layer sputum, may be blood streaked
Appearance of chest (Bronchiectasis ) -✓✓Barrel chest, increased A-P diameter
Respiratory Pattern ( Bronchiectasis ) -✓✓Accessory muscle usage
Color ( Bronchiectasis ) -✓✓Cyanotic
Questions and Answers 100% Correct
(verified)
COPD -✓✓Preventable and treatable disease state characterized by air flow limitation
that is not fully reversible.
Emphysema -✓✓Presence of permanent enlargement of the air spaces distal to the
terminal bronchioles, accompanied by destruction of their walls and without obvious
fibroisis
Chronic bronchitis -✓✓Chronic productive cough for three months in each of two
successive years in a pt for whom other causes of the productive cough have been
excluded
Etiology of COPD -✓✓- tobacco smoke
-genetic predisposition
- indoor and outdoor pollution
Pt Assessment of Emphysema Pt (Primary assessment) -✓✓AKA pink puffer or Type A
COPD
Body build = thin, underweight
Past medical history = Tobacco use
Cough = Less common, muciod secretions
Appearance of chest = Barrel chest, increased A-P diameter (Hoover's Sign)
Respiratory Pattern = Dyspnea, pursed-lip breathing, accessory muscle use, especially
during exacerbations
Color= Often reddish
Clubbing = Late stage
Diagnostic Chest Percussion = Hyperresonant/ Tympanic note
Breath Sounds = Diminished, prolonged expiration
Body build of Type A COPD (pink puffer) Emphysema -✓✓Thin, underweight
Past medical history for emphysema pts -✓✓Tobacco use
Cough (Emphysema) -✓✓Less common, muciod secretions
Appearance of the chest (Emphysema) -✓✓Barrel chest, increased A-P diameter
Respiratory pattern ( Emphysema) -✓✓Dyspnea, pursed lip breathing, accessory
muscle use, especially during exacerbations
,Color (Emphysema) -✓✓Often reddish
Clubbing (Emphysema) -✓✓Late stage
Diagnostic Chet Percussion (Emphysema) -✓✓Hyperresonant/tympanic note
Breath sounds ( Emphysema) -✓✓Diminished, prolonged expiration
Patient Assessment (Primary) Chronic Bronchitis -✓✓AKA Blue bloater Type B COPD
Body build = Stocky, overweight
Past Medical History = Tobacco use
Cough = Productive, copious amounts, purulent secretions
Chest Appearance = Ocassionally barrel chest
Color = Cyanotic
Clubbing = Common
Diagnostic Chest Percussion = normal
Breath Sounds = Rhonchi, crackles , wheezing
Body build (Chronic Bronchitis) -✓✓Stocky, overweight
Past Medical History (Chronic Bronchitis) -✓✓Tobacco use
Cough (Chronic Bronchitis ) -✓✓Productive, copious amounts of purulent secretions
Chest Appearance (Chronic Bronchitis) -✓✓Occasionally barrel chest
Respiratory Pattern (Chronic Bronchitis ) -✓✓Use of accessory muscles less common
Clubbing ( Chronic Bronchitis ) -✓✓Common
Diagnostic Chest Percussion ( Chronic Bronchitis) -✓✓Normal
Breath Sounds (Chronic Bronchitis ) -✓✓Rhonchi, crackles, wheezing
Secondary Assessment Emphysema pt -✓✓Chest X-ray = translucent (dark) lung fields,
depressed or flattened diaphragms, long and narrow heart, increased retrosternal air
spaces, possibly hypertrophy or right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia Severe
Stages: Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates (FEV1 , FEF 25-75%, FEF 200-1200,
FEV1/FVC, and PEFR) Decreased DLCO
CBC = Increased RBC/Hb/Hct in late stages
Sputum = Normal
,Chest X-ray (Emphysema ) -✓✓Translucent (dark) lung fields, depressed or flattened
diaphragms, long and narrow heart, increased retrosternal air space, possibly
hypertrophy or right ventricle
ABG (emphysema) -✓✓Mild to moderate stages: Acute alveolar hyperventilation with
hypoxemia Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function (Emphysema ) -✓✓Decreased flowrates, Decreased DLCO
CBC (Emphysema) -✓✓Increased RBC/Hct/Hb in late stages
Sputum (Emphysema) -✓✓Normal
Secondary Assessment Chronic Bronchitis -✓✓AKA Type B Blue Bloater
Chest X-ray = translucent (dark) lung fields, depressed or flattened diaphragms,
possibly hypertrophy of right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia
Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates, DLCO normal
CBC = increased RBC/Hb/Hct in early and late stages
Sputum = Often shows ; Streptococcus pneumoniae, Haemophilus influenza, Moraxella
catarrhalis
Chest X-ray (Chronic Bronchitis) -✓✓Translucent lung fields, depressed or flattened
diaphragms, possibly hypertrophy of the right ventricle
ABG ( Chronic Bronchitis) -✓✓Mild to moderate stages: Acute alveolar hyperventilation
with hypoxemia
Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function ( Chronic Bronchitis ) -✓✓Decreased flowrates, normal DLCO
CBC (Chronic Bronchitis) -✓✓Increased RBC/Hb/Hct in early and late stages
Sputum (Chronic Bronchitis ) -✓✓Often shows: Streptococcus pneumoniae,
Haemophilus influenzae, Moraxella catarrhalis
Treatment for COPD -✓✓1. Low flow o2 therapy
Nasal cannula 1-2 L/min or 24-28% air entrainment mask
Consider o2 conservation devices for home use
2. Bronchodilators (SABA, LABA, and anticholinergic)
3. Inhaled corticosteroids
4. Antibiotics if indicated by sputum culture
5. Bronchial hygiene as indicted
, 6. Referral to smoking cessation program, including nicotine replacement therapy
7. Consider NPPV for acute exacerbations of ventilatory failure
8. Refer pt family to pulmonary rehab ed programs which should include
-Nutritional management
- Avoiding infections
-Exercise program
- Methods to aid in secretion clearance
-Home O2 and aerosol therapy
-Appropriate use of medications
9. Annual flu vaccine
Bronchiectasis (definition ) -✓✓Chronic dilation and distortion one of one or more
bronchi as a result of excessive inflammation and destruction of the bronchial walls,
blood vessels, elastic tissue and smooth muscle. Results in impaired mucocilary
clearance causing accumulation of copious amounts of bronchial secretions
-one or both lungs may be involved
-Commonly limited to lobe or segment
- Frequently found in lower lobes
-Can create an obstructive or restrictive pattern or a combination of both
Patient Assessment (Primary) for Bronchiectasis pt -✓✓Past Medical History =
Recurrent pulmonary infections, Cystic Fibrosis, if Kartageners Syndrome
Shortness of Breath = Present, possibly pursed lip breathing
Cough = Productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum,
may be blood streaked
Appearance of chest = Barrel chest, increased A-P diameter
Respiratory Pattern = Accessory muscle usage
Color = Cyanotic
Appearance of the nail beds = clubbing
Diagnostic Chest Percussion = Hyperresonant/tympanic note
Breath Sounds = Wheezing, diminished breath sounds
Past Medical History ( Bronchiectasis) -✓✓Recurrent pulmonary infections, Cystic
Fibrosis, or Kartageners Syndrome
Shortness of Breath (Bronchiectasis ) -✓✓Present, possibly pursed lip breathing
Cough ( Bronchiectasis ) -✓✓Productive with purulent foul smelling sputum, hemoptysis
and 3 layer sputum, may be blood streaked
Appearance of chest (Bronchiectasis ) -✓✓Barrel chest, increased A-P diameter
Respiratory Pattern ( Bronchiectasis ) -✓✓Accessory muscle usage
Color ( Bronchiectasis ) -✓✓Cyanotic
