CRT RRT NBRC STUDY EXAMS GUIDE QUESTIONS
AND ANSWERS SURE A+
✔✔stridor - ✔✔-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 - ✔✔-coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
✔✔Heart Sound S₁ - ✔✔-closure of the mitral and tricuspid valves at the beginning of
ventricular contraction
✔✔Heart Sound S₂ - ✔✔-closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
✔✔Heart Sound S₃ - ✔✔-abnormal and may suggest CHF
✔✔Heart Sound S₄ - ✔✔-abnormal and indicative of cardiac abnormality such as
myocardial infarction or cardiomegaly
✔✔Heart murmurs - ✔✔-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 - ✔✔-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 - ✔✔-systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
-↑BP = cardiac stress = hypoxemia
-↓BP = poor perfusion = hypovolemia, CHF
✔✔Costophrenic Angle - ✔✔-angle made by the outer curve of the diaphragm and the
chest wall
-obliterated by pleural effusions and pneumonia
✔✔Diaphragm - ✔✔-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 - ✔✔-patient lying on affected side
-detecting small pleural effusions
✔✔End expiratory film - ✔✔-taken when patient is at end-exhalation
-detecting small pneumothorax/foreign body aspiration (FBA)
✔✔Position of ET/Tracheostomy tube - ✔✔-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. - ✔✔-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) - ✔✔-viral disorder
-narrowing subglottic swelling
-steeple/picket fence/pencil sign
-gradual onset
-infants
-Mist tent, O2, Racemic epi, corticosteroids
-barking cough
,✔✔Epiglottitis - ✔✔-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) - ✔✔-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) - ✔✔-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 - ✔✔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) - ✔✔-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) - ✔✔-for determining cancer, brain
disorders and heart disease
-injected with radioactive substance
✔✔bronchography (bronchogram) - ✔✔-injection of radio-opaque contrast into
tracheobronchial tree
-study of OBSTRUCTING LESIONS (tumors) and BRONCHIECTASIS
-better administration of postural drainage
, ✔✔Electroencephalography (EEG) - ✔✔-measures electrical activity in the brain
-brain tumors, traumatic brain injuries, retardation, loss of brain function,
epilepsy/seizures,
-EVALUATION OF SLEEP DISORDERS
✔✔Pulmonary Angiography - ✔✔-most definitive for DX of pulmonary embolism
-pressures in cardiac chambers can be measured
-inserted into the femoral vein and advanced through the right heart and into the
pulmonary artery which could identify filling defects
✔✔ultrasonography of the heart (Echocardiogram) - ✔✔-noninvasive for monitoring
cardiac performance
-doppler color flow mapping with 2D and M-Mode achocardiography to assess overall
ventricular function including LEFT VENTRICULAR VOLUME and EJECTION
FRACTION
-Valvular disease or dysfunction
-myocardial disease
-abnormalities of cardiac blood flow
-cardiac anomalies in the infant
-abnormal heart sounds
✔✔ICP monitoring - ✔✔-track the dynamics inside the skull such as volume-pressure
relationships, pressure waves, and cerebral perfusion pressures
-ICP > 20 mm Hg = hyperventilated until PaCO2 is 25-30 mmHg
CAUSES
-Intracranial tumors
-Abscesses
-Meningitis
-Cerebral Edema
-Subdural Hematoma
✔✔3 types of ICP monitoring - ✔✔-Ventricular Catheter: inserted through a burr hole
(surgical opening into the skull
-Subarachnoid bolt: metal screw with sensor chip that is inserted through a hole drilled
into the subdural or subarachnoid space
-Epidural Sensor: consists of placement of a fiberoptic sensor, radio transmitter, or tiny
balloon in the epidural space through a burr hole in the skull
✔✔Cerebral Perfusion Pressure (CPP) - ✔✔-Pressure gradient that determines cerebral
perfusion
-CPP = MAP - ICP
-Normal Value 70 - 90 mmHg
AND ANSWERS SURE A+
✔✔stridor - ✔✔-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 - ✔✔-coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
✔✔Heart Sound S₁ - ✔✔-closure of the mitral and tricuspid valves at the beginning of
ventricular contraction
✔✔Heart Sound S₂ - ✔✔-closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
✔✔Heart Sound S₃ - ✔✔-abnormal and may suggest CHF
✔✔Heart Sound S₄ - ✔✔-abnormal and indicative of cardiac abnormality such as
myocardial infarction or cardiomegaly
✔✔Heart murmurs - ✔✔-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 - ✔✔-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 - ✔✔-systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
-↑BP = cardiac stress = hypoxemia
-↓BP = poor perfusion = hypovolemia, CHF
✔✔Costophrenic Angle - ✔✔-angle made by the outer curve of the diaphragm and the
chest wall
-obliterated by pleural effusions and pneumonia
✔✔Diaphragm - ✔✔-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 - ✔✔-patient lying on affected side
-detecting small pleural effusions
✔✔End expiratory film - ✔✔-taken when patient is at end-exhalation
-detecting small pneumothorax/foreign body aspiration (FBA)
✔✔Position of ET/Tracheostomy tube - ✔✔-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. - ✔✔-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) - ✔✔-viral disorder
-narrowing subglottic swelling
-steeple/picket fence/pencil sign
-gradual onset
-infants
-Mist tent, O2, Racemic epi, corticosteroids
-barking cough
,✔✔Epiglottitis - ✔✔-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) - ✔✔-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) - ✔✔-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 - ✔✔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) - ✔✔-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) - ✔✔-for determining cancer, brain
disorders and heart disease
-injected with radioactive substance
✔✔bronchography (bronchogram) - ✔✔-injection of radio-opaque contrast into
tracheobronchial tree
-study of OBSTRUCTING LESIONS (tumors) and BRONCHIECTASIS
-better administration of postural drainage
, ✔✔Electroencephalography (EEG) - ✔✔-measures electrical activity in the brain
-brain tumors, traumatic brain injuries, retardation, loss of brain function,
epilepsy/seizures,
-EVALUATION OF SLEEP DISORDERS
✔✔Pulmonary Angiography - ✔✔-most definitive for DX of pulmonary embolism
-pressures in cardiac chambers can be measured
-inserted into the femoral vein and advanced through the right heart and into the
pulmonary artery which could identify filling defects
✔✔ultrasonography of the heart (Echocardiogram) - ✔✔-noninvasive for monitoring
cardiac performance
-doppler color flow mapping with 2D and M-Mode achocardiography to assess overall
ventricular function including LEFT VENTRICULAR VOLUME and EJECTION
FRACTION
-Valvular disease or dysfunction
-myocardial disease
-abnormalities of cardiac blood flow
-cardiac anomalies in the infant
-abnormal heart sounds
✔✔ICP monitoring - ✔✔-track the dynamics inside the skull such as volume-pressure
relationships, pressure waves, and cerebral perfusion pressures
-ICP > 20 mm Hg = hyperventilated until PaCO2 is 25-30 mmHg
CAUSES
-Intracranial tumors
-Abscesses
-Meningitis
-Cerebral Edema
-Subdural Hematoma
✔✔3 types of ICP monitoring - ✔✔-Ventricular Catheter: inserted through a burr hole
(surgical opening into the skull
-Subarachnoid bolt: metal screw with sensor chip that is inserted through a hole drilled
into the subdural or subarachnoid space
-Epidural Sensor: consists of placement of a fiberoptic sensor, radio transmitter, or tiny
balloon in the epidural space through a burr hole in the skull
✔✔Cerebral Perfusion Pressure (CPP) - ✔✔-Pressure gradient that determines cerebral
perfusion
-CPP = MAP - ICP
-Normal Value 70 - 90 mmHg
