TUTORIAL SYSTEMS RRT DECISION
MAKING (CLIN SIMS) EXAM QUESTIONS
WITH COMPLETE ANSWERS
CHF key points - ANSWER-cardiomegaly, diffuse infiltrates, pedal edema
suspected MI? - ANSWER-anticoagulant therapy
recent MI - ANSWER-use ultrasound to identify cause of CHF
immediate emergency care - ANSWER-placement of airway and 100% o2
severe metabolic acidosis - ANSWER-administer sodium bicarbonate
high pressure alarm - ANSWER-suction patient
increasing chest pain? - ANSWER-obtain a CXR
pleural effusion - ANSWER-perform thoracentesis
Epiglottitis - ANSWER-priority is intubation
DM epiglotitis - ANSWER-sedation and wrist restraints if thrashing, ABX, monitor pulse
ox, ventilatory support
Diagnosing Epiglottitis - ANSWER-thumb sign on lateral neck xray
croup KI - ANSWER-loud, barking cough, steeple sign
cystic fibrosis diagnosis - ANSWER-Sweat chloride test, CXR
CF drugs - ANSWER-CTFR (ivacaftor), nebulized Tobraymycin, pulmozyne
Ventilation/Oxygenation - ANSWER-draw ABG on room air if able, follow with 2L nasal
cannula
status asthmaticus - ANSWER-administration of corticosteroids (Solu-Medrol) and
aggressive bronchodilators (Albuterol)
treatment of newborn hypoxemia - ANSWER-nasal CPAP, use lowest FiO2 to achieve
SpO2 > 90%
treatment of RDS in newborn - ANSWER-surfactant replacement therapy
, newborn initial vent settings - ANSWER-PC/IMV
-PIP : 20-25 cmH2O (lower with RDS : 18-25)
-RR: 30-40 bpm
-PEEP: 4-7 cmH2O (3-6 for RDS)
-IT: .4
-Flowrate: 8-12
general decision making - ANSWER-"next" = FIRST
pneumonia - ANSWER-administer antibiotics (Ciprofloxacin)
pleural effusion - ANSWER-chest pain on one side, absent breath sounds on one side,
blunting of costophrenic angle on one side
-treat with thoracentesis
Pleural fluid analysis - ANSWER-exudative: local disease (malignancy, infection,
abcess, hemothorax)
-transudative: systemic illness (liver cirrhosis, CCF, PTE)
pediatric asthma exacerbation - ANSWER-priority is bronchodilation
bronchiectasis treatment - ANSWER-O2 to reverse hypoxemia, dyspnea, and
tachypnea, antibiotics
diagnosis of bronchiectasis - ANSWER-CT scan (increased air way diameters), sputum
gram stain, CXR
AIDS decision making - ANSWER-monitoring with continuous pulse oximetry, ECG,
ABGs
-bronchodilator treatments, supplemental oxygen, TMP-SFX for pneumonia, ARV for
HIV
COPD monitoring - ANSWER-spirometry (FEV1) after bronchodilator
GOLD standard for COPD - ANSWER-Mild: FEV1 > 80% predicted
Moderate: FEV1 >50<80% pred.
Severe: FEV1 >30% <50% pred.
Very Severe: FEV1 < 30% or < 50% with chronic resp. failure
at home COPD treatment - ANSWER-supplemental oxygen is most effective treatment
via nasal cannula
large volume replacement therapy with trauma - ANSWER-IV Ringers Lactate
SpO2 and PaO2 - ANSWER-4,5,6 - 7,8,9
MAKING (CLIN SIMS) EXAM QUESTIONS
WITH COMPLETE ANSWERS
CHF key points - ANSWER-cardiomegaly, diffuse infiltrates, pedal edema
suspected MI? - ANSWER-anticoagulant therapy
recent MI - ANSWER-use ultrasound to identify cause of CHF
immediate emergency care - ANSWER-placement of airway and 100% o2
severe metabolic acidosis - ANSWER-administer sodium bicarbonate
high pressure alarm - ANSWER-suction patient
increasing chest pain? - ANSWER-obtain a CXR
pleural effusion - ANSWER-perform thoracentesis
Epiglottitis - ANSWER-priority is intubation
DM epiglotitis - ANSWER-sedation and wrist restraints if thrashing, ABX, monitor pulse
ox, ventilatory support
Diagnosing Epiglottitis - ANSWER-thumb sign on lateral neck xray
croup KI - ANSWER-loud, barking cough, steeple sign
cystic fibrosis diagnosis - ANSWER-Sweat chloride test, CXR
CF drugs - ANSWER-CTFR (ivacaftor), nebulized Tobraymycin, pulmozyne
Ventilation/Oxygenation - ANSWER-draw ABG on room air if able, follow with 2L nasal
cannula
status asthmaticus - ANSWER-administration of corticosteroids (Solu-Medrol) and
aggressive bronchodilators (Albuterol)
treatment of newborn hypoxemia - ANSWER-nasal CPAP, use lowest FiO2 to achieve
SpO2 > 90%
treatment of RDS in newborn - ANSWER-surfactant replacement therapy
, newborn initial vent settings - ANSWER-PC/IMV
-PIP : 20-25 cmH2O (lower with RDS : 18-25)
-RR: 30-40 bpm
-PEEP: 4-7 cmH2O (3-6 for RDS)
-IT: .4
-Flowrate: 8-12
general decision making - ANSWER-"next" = FIRST
pneumonia - ANSWER-administer antibiotics (Ciprofloxacin)
pleural effusion - ANSWER-chest pain on one side, absent breath sounds on one side,
blunting of costophrenic angle on one side
-treat with thoracentesis
Pleural fluid analysis - ANSWER-exudative: local disease (malignancy, infection,
abcess, hemothorax)
-transudative: systemic illness (liver cirrhosis, CCF, PTE)
pediatric asthma exacerbation - ANSWER-priority is bronchodilation
bronchiectasis treatment - ANSWER-O2 to reverse hypoxemia, dyspnea, and
tachypnea, antibiotics
diagnosis of bronchiectasis - ANSWER-CT scan (increased air way diameters), sputum
gram stain, CXR
AIDS decision making - ANSWER-monitoring with continuous pulse oximetry, ECG,
ABGs
-bronchodilator treatments, supplemental oxygen, TMP-SFX for pneumonia, ARV for
HIV
COPD monitoring - ANSWER-spirometry (FEV1) after bronchodilator
GOLD standard for COPD - ANSWER-Mild: FEV1 > 80% predicted
Moderate: FEV1 >50<80% pred.
Severe: FEV1 >30% <50% pred.
Very Severe: FEV1 < 30% or < 50% with chronic resp. failure
at home COPD treatment - ANSWER-supplemental oxygen is most effective treatment
via nasal cannula
large volume replacement therapy with trauma - ANSWER-IV Ringers Lactate
SpO2 and PaO2 - ANSWER-4,5,6 - 7,8,9
