Egan Fundamentals of Respiratory Care 10th Edition by Robert M. Kacmarek Test Bank

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Egan Fundamentals of Respiratory Care 10th Edition by Robert M. Kacmarek Test Bank

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WITH ANSWERS

Egans Fundamentals of Respiratory Care 10th Edition by Robert M. Kacmarek Test Bank

Chapter 04: Principles of Infection Prevention and Control

Test Bank

 

MULTIPLE CHOICE

 

  1. About how many people die each year in the United States from hospital-acquired infections (HAIs)?
a. 5,000
b. 25,000
c. 99,000
d. 250,000

 

 

ANS:  C

HAIs account for an estimated 1.7 million infections; $4.5 billion in costs, and 99,000 excess deaths annually.

 

DIF:    Recall             REF:   p. 62              OBJ:   1

 

  1. Approximately what percent of patients receiving mechanical ventilation develop pneumonia as a complication?
a. 1%
b. 10%
c. 15%
d. 25%

 

 

ANS:  D

Approximately 25% of patients undergoing mechanical ventilation develop pneumonia.

 

DIF:    Recall             REF:   p. 62              OBJ:   1

 

  1. Which of the following is considered the primary source of infection in the health care setting?
a. medical equipment
b. humans
c. food and water
d. carpet

 

 

ANS:  B

Humans (patients, personnel, or visitors) are the primary source for infectious agents in the health care setting

 

DIF:    Recall             REF:   p. 62              OBJ:   1

 

  1. How do endotracheal tubes increase the risk of infection?
a. impeding local host defenses
b. providing surfaces for biofilms to develop
c. by reducing neutrophil effectiveness
d. both A and B

 

 

ANS:  D

Endotracheal tubes allow pathogens to increase the risk of infection by impeding local host defenses and providing biofilms that may facilitate adherence of pathogens.

 

DIF:    Application    REF:   p. 62              OBJ:   5

 

  1. All of the following factors increase the risk of surgical patients for developing postoperative pneumonia except:
a. obesity
b. prolonged intubation
c. history of smoking
d. strong cough

 

 

ANS:  D

Patients at highest risk include elderly persons, the severely obese, those with chronic obstructive pulmonary disease (COPD) or a history of smoking, and those having an artificial airway in place for long periods. Strong cough mechanism actually helps to prevent atelectasis and pneumonia

 

DIF:    Recall             REF:   p. 63              OBJ:   4

 

  1. What is the most common route of pathogen transmission in the hospital setting?
a. indirect contact
b. droplet transmission
c. airborne transmission
d. surgical transmission

 

 

ANS:  A

Indirect contact transmission is the most frequent mode of transmission in the health care environment

 

DIF:    Recall             REF:   p. 63              OBJ:   3

 

  1. Which of the following is an example of indirect contact transmission involving fomites?
a. use of a sterile needle on a pneumonia patient
b. use of a dirty nebulizer on another patient
c. drinking tap water
d. inhaling tuberculosis pathogens in the emergency department

 

 

ANS:  B

Instruments that have been inadequately cleaned between patients before disinfection or sterilization are an example of indirect contact transmission involving fomites.

 

DIF:    Application    REF:   p. 63              OBJ:   3

 

  1. If you are caring for a patient who is suspected of having SARS, at what distance from the patient is it recommended to wear an effective filtration mask?
a. 6 feet
b. 10 feet
c. 12 feet
d. 15 feet

 

 

ANS:  A

Current HICPAC guidelines state it may be prudent to don a mask when within 6 feet of the patient or upon entry into the room of a patient who is on droplet isolation.

 

DIF:    Application    REF:   p. 63              OBJ:   9

 

  1. Which of the following diseases is transmitted primarily by airborne transmission?
a. tuberculosis
b. measles
c. smallpox
d. all the above

 

 

ANS:  D

The pathogens transmitted by the airborne route include Mycobacterium tuberculosis, varicella-zoster virus (chickenpox), and rubeola virus (measles). Airborne transmission of variola (smallpox) has been documented and airborne transmission of SARS, monkeypox, and the viral hemorrhagic fever virus has been reported, although not proved conclusively.

 

DIF:    Recall             REF:   p. 64              OBJ:   3

 

  1. What techniques are used by most hospitals to reduce host susceptibility to infection?
a. immunization
b. chemoprophylaxis
c. surveillance
d. both A and B

 

 

ANS:  D

Hospital efforts to decrease host susceptibility focus mainly on employee immunization and chemoprophylaxis.

OBJ 6

DIFF: Recall

 

DIF:    Recall             REF:   p. 64              OBJ:   6

 

  1. What vaccination does OSHA require hospital employers to provide?
a. tuberculosis
b. smallpox
c. hepatitis B
d. Streptococcus pneumoniae

 

 

ANS:  C

OSHA mandates that employers offer hepatitis B vaccination.

 

DIF:    Recall             REF:   p. 64              OBJ:   6

 

  1. Exposure to which of the following organisms calls for postexposure chemoprophylaxis?
a. N. meningitides
b. B. pertussis
c. B. anthracis
d. All of the above

 

 

ANS:  D

Post exposure chemoprophylaxis is recommended under defined circumstances for B. pertussis (whooping cough), N. meningitides (meningococcal meningitis), B. anthracis (anthrax), influenza virus, human immunodeficiency virus, and group A streptococci.

 

DIF:    Recall             REF:   p. 64-65         OBJ:   9

 

  1. What is the first step in equipment processing for reuse on another patient?
a. drying the equipment
b. cleaning the equipment
c. disinfecting the equipment
d. sterilizing the equipment

 

 

ANS:  B

Cleaning is the first step in all equipment processing.

 

DIF:    Recall             REF:   p. 72              OBJ:   8

 

  1. Which of the following statements is NOT true regarding the use of soaps to clean equipment?
a. Soaps act by lowering the surface tension.
b. Soaps work poorly in hard water.
c. Soaps have good bactericidal activity.
d. Soaps can help remove organic material.

 

 

ANS:  C

Soaps act by lowering surface tension and forming an emulsion with organic matter. Unfortunately, soaps have little bactericidal activity and work poorly in hard water. A detergent refers to a substance (usually a chemical agent but sometimes a physical one) applied to inanimate objects that destroys disease-causing pathogens but not spores.

 

DIF:    Application    REF:   p. 72-73         OBJ:   7

 

  1. What should be used to wipe down the surface of devices that cannot be immersed in water?
a. 70% ethyl alcohol
b. warm soapy water
c. strong detergent
d. bleach

 

 

ANS:  A

The surface of the device should be disinfected using a 70% ethyl alcohol solution or the equivalent.

 

DIF:    Recall             REF:   p. 79              OBJ:   7

 

  1. Which of the following organisms is NOT destroyed by a disinfection agent?
a. gram-negative cocci
b. bacterial spores
c. gram-positive rods
d. viruses

 

 

ANS:  B

Disinfection describes a process that destroys the vegetative form of all pathogenic organisms on an inanimate object except bacterial spores.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. What solution should be used to disinfect the surfaces of the room of a patient who was infected with C. difficile?
a. 70% ethyl alcohol
b. 5.25% sodium hypochlorite
c. 1% sodium benzoate
d. 5% iodine solution

 

 

ANS:  B

Because C. difficile may form spores that are resistant to commonly used surface disinfectants, the CDC recommends the use of 1:10 dilution of 5.25% sodium hypochlorite (household bleach) and water for routine environmental disinfection in the rooms of patients with C. difficile.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. Which of the following statements is NOT true regarding the use of alcohol disinfectants?
a. Their activity drops when diluted below 50% concentration.
b. Alcohols are good for surface cleaning of stethoscope bells and diaphragms.
c. They can damage rubber tubing.
d. They are considered sporicidal.

 

 

ANS:  D

Alcohol disinfectants in the health care setting refer to either ethyl alcohol or isopropyl alcohol. Neither is considered a high-level disinfectant as a single agent, they are not sporicidal, and they do not penetrate protein-rich materials. Their activity drops when diluted below 50% concentration. Alcohols are inactivated by protein and can damage rubber, plastics, and the shellac mounting of lensed instruments. Alcohol wipes are a good choice for disinfecting small surfaces, such as medication vial tops. Alcohols are also useful as surface disinfectants for stethoscopes, ventilators, and manual ventilation bags.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. Which of the following statements is NOT true regarding the use of phenolics as a disinfectant?
a. They are bactericidal.
b. They are fungicidal.
c. They are ineffective on surfaces shortly after application.
d. They cause tissue irritation.

 

 

ANS:  C

Phenolics are not sporicidal but are bactericidal, fungicidal, and tuberculocidal at their recommended use dilution (see Table 4-3). Phenolics retain their activity in the presence of organic matter and can remain effective on surfaces long after application.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. Which of the following characteristics is true for iodophors as disinfectants?
a. water soluble
b. nonstaining
c. less irritating to tissue
d. all of the above

 

 

ANS:  D

Unlike iodine tinctures, iodophors are water soluble, nonstaining, and less irritating to tissue. Iodophors are bactericidal, virucidal, and tuberculocidal.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. Which of the following statements is NOT true regarding the use of glutaraldehyde?
a. It is a true sterilizing agent when used properly.
b. It can retain activity up to 90 days once activated.
c. It is not used for disinfection on surfaces due to cost.
d. It can cause significant tissue inflammation in workers who use it.

 

 

ANS:  B

Glutaraldehyde (saturated dialdehyde) is a commonly used high-level disinfectant/sterilant. When aqueous solutions of 2% glutaraldehyde are alkalized (activated) to a pH between 7.5 and 8.5, glutaraldehyde can kill vegetative bacteria, M. tuberculosis, fungi, viruses, and spores in less than 10 minutes (see Table 4-3). This sporicidal activity qualifies glutaraldehyde as a true sterilizing agent.

 

DIF:    Recall             REF:   p. 74              OBJ:   7

 

  1. What is the recommended dilution level of bleach according to the CDC for cleaning up blood spills?
a. 1:1
b. 1:5
c. 1:10
d. 1:20

 

 

ANS:  C

The CDC recommends a 1:10 dilution of bleach (or an Environmental Protection Agency [EPA]-registered disinfectant) to disinfect blood spills.

 

DIF:    Recall             REF:   p. 77-78         OBJ:   7

 

  1. What is the most common, efficient, and easiest sterilization method?
a. ETO
b. flash sterilization
c. steam sterilization
d. use of hydrochlorofluorcarbon

 

 

ANS:  C

Moist heat in the form of steam under pressure is the most common, efficient, and easiest sterilization method.

 

DIF:    Recall             REF:   p. 74              OBJ:   7

 

  1. Which of the following statements is NOT true regarding the use of ETO for sterilization?
a. It is harmless to rubber and plastics.
b. It will penetrate prewrapping.
c. Acute exposure is of little consequence.
d. It is useful for equipment that cannot be autoclaved.

 

 

ANS:  C

Unfortunately, acute exposure to ETO gas can cause airway inflammation, nausea, diarrhea, headache, dizziness, and even convulsions.

 

DIF:    Recall             REF:   p. 75              OBJ:   7

 

  1. Which of the following is the most common source of patient infections?
a. large-volume nebulizers
b. small-volume nebulizers
c. internal circuits of a ventilator
d. oxygen therapy devices

 

 

ANS:  A

Large-volume nebulizers are the worst offenders.

 

DIF:    Recall             REF:   p. 76              OBJ:   4

 

  1. Which of the following steps for disinfection of a bronchoscope is NOT true?
a. The first step is cleaning the scope.
b. Disinfection is done by immersion in a liquid disinfectant.
c. The device is stored lying flat to promote drying.
d. Drying techniques can include forced air.

 

 

ANS:  C

Store in a manner so that the bronchoscope is vertical to prevent recontamination and facilitate drying.

 

DIF:    Recall             REF:   p. 72              OBJ:   7

 

  1. Which of the following organisms has been associated with health careassociated infections in patients using a poorly disinfected bronchoscope?
a. M. tuberculosis
b. Pseudomonas aeruginosa
c. Klebsiella
d. both A and B

 

 

ANS:  D

Health careassociated infections associated with bronchoscopes have been most commonly reported with M. tuberculosis, nontuberculosis mycobacterium, and P. aeruginosa.

 

DIF:    Recall             REF:   p. 79              OBJ:   4| 5

 

  1. Which of the following statements is/are true regarding the use of disposable respiratory care equipment?
a. Recent research supports their use as a cost-effective measure.
b. Many quality issues exist.
c. Reusing the equipment is often done.
d. All of the above are true.

 

 

ANS:  D

Three major issues are involved in using disposables: cost, quality, and reuse.

 

DIF:    Recall             REF:   p. 80              OBJ:   8

 

  1. Which of the following is NOT a category under Expanded Precautions?
a. Contact Precautions
b. Droplet Precautions
c. Standard Precautions
d. Airborne Infection Isolation

 

 

ANS:  C

There are four categories of Expanded Precautions: Contact Precautions, Droplet Precautions, Airborne Infection Isolation, and Protective Environment.

 

DIF:    Recall             REF:   p. 69              OBJ:   8

 

  1. What is the minimum recommended time for handwashing in the health care environment?
a. 5 seconds
b. 15 seconds
c. 30 seconds
d. 60 seconds

 

 

ANS:  B

Hand hygiene includes handwashing with both plain or antiseptic-containing soap and water for at least 15 seconds.

 

DIF:    Recall             REF:   p. 65              OBJ:   6

 

  1. Which of the following statements is NOT true regarding the use of sterile gloves in the hospital setting?
a. They should be worn for all invasive procedures.
b. They should not be used as a substitute for handwashing.
c. The same pair can be used on numerous patients if noninvasive procedures are done.
d. They may have small invisible defects that cause contamination of the users hands.

 

 

ANS:  C

Gloves should be changed, regardless of use, between each patient contact.

 

DIF:    Recall             REF:   p. 66              OBJ:   6

 

  1. Which of the following is NOT one of the five key recommended components of an infection control program in the hospital setting?
a. development
b. surveillance
c. investigation
d. reporting

 

 

ANS:  A

The five key recommended components of an infection control program are surveillance, investigation, prevention, control, and reporting.

 

DIF:    Recall             REF:   p. 81              OBJ:   6

 

  1. Which of the following diseases is transmitted through direct contact?
a. HIV
b. pertussis
c. hepatitis B
d. hepatitis C

 

 

ANS:  A

The only one of those diseases that is transmitted through direct contact is HIV. Hepatitis B and C and both indirect contact, and pertussis is through droplet transmission.

 

DIF:    Recall             REF:   p. 63              OBJ:   4

 

  1. Which of the following diseases travels through droplet mode?
a. influenza
b. small pox
c. pertussis
d. both A and C

 

 

ANS:  D

Influenza and Pertussis BOTH travel through droplet mode. Small pox travels airborne thorugh droplet nuclei.

 

DIF:    Recall             REF:   p. 63              OBJ:   4

 

  1. What is a Prevention Bundle?
a. The use of multiple evidence based best practices to prevent device related infection
b. Recent research supports the use of cost-effective measurements.
c. An ongoing process of monitoring patients and personnel for the acquisition of infection in the healthcare setting
d. All of the above

 

 

ANS:  A

Prevention Bundle is the use of multiple evidence-based best practices to prevent device related infection.

 

DIF:    Recall             REF:   p. 69              OBJ:   6

 

  1. Besides humans, what is another source of infectious agents in a health care setting?
a. ventilator-associated pneumonia (VAP)
b. catheter-related bloodstream infections
c. catheter-associated urinary tract infections (UTI)
d. all of the above

 

 

ANS:  D

All of the above can be infectious agents in a health care setting. This is why it is important to use medical devices for the least amount of time necessary.

 

DIF:    Application    REF:   p. 81              OBJ:   5

 

  1. Small volume nebulizers produce bacterial aerosols that have been commonly associated with which of the following diseases?
a. Pseudomonas aeruginosa
b. measles
c. small pox
d. nosocomial pneumonia

 

 

ANS:  D

Small volume nebulizers produce bacterial aerosols that have been associated with nosocomial pneumonia.

 

DIF:    Application    REF:   p. 70              OBJ:   5

 

  1. What is the purpose of an inspiratory HEPA filter in a ventilator circuit?
a. The purpose is to serve as a heated thermistor that prevents condensation from forming in the circuits.
b. It prevents pathogens from being expelled into the surroundings.
c. When placed between the ventilator and the circuit, it can eliminate bacteria
d. None of the above

 

 

ANS:  C

The purpose of an inspiratory HEPA filter, when it is placed between the ventilator and the external circuit, is to eliminate bacteria from the driving gas and prevent retrograde contamination back into the ventilator.

 

DIF:    Application    REF:   p. 70              OBJ:   8

 

  1. The unit residence asked you to reduce the risk of contamination caused by condensation in the circuit of a mechanically ventilated patient. Which of the following would help to reduce or eliminate condensation in this patients circuit?
a. using a heat and moisture exchange (HME)
b. by draining the circuit on a daily basis
c. by not using any form of heater at all
d. by lowering the temperature in the heater

 

 

ANS:  A

By replacing an active humidification system by a passive humidification one (HME), there will be less condensation in the circuit because no water is being used to heat and moisten the air, but instead the patients own body heat is used. Draining the circuit daily, not using heat, or lowering the heater temperature are not acceptable and may place the patient at risk of infection caused by inspisated secretions among other consequences.

 

DIF:    Analysis         REF:   p. 76              OBJ:   6

 

Chapter 20: Review of Thoracic Imaging

Test Bank

 

MULTIPLE CHOICE

 

  1. What lung problem is ventilation/perfusion () scanning used to detect?
a. asthma
b. pulmonary embolism
c. pneumonia
d. lung cancer

 

 

ANS:  B

Ventilation/perfusion scanning (also known as  scanning) is often used in evaluating for pulmonary embolism.

 

DIF:    Recall             REF:   p. 452            OBJ:   7

 

  1. Which of the following structures will result in the most radiopaque shadow on the chest radiograph?
a. aorta
b. heart
c. lungs
d. ribs

 

 

ANS:  D

Bone absorbs a large amount of the x-ray beam and is seen as a nearly white (radiopaque) shadow.

 

DIF:    Recall             REF:   p. 453            OBJ:   2

 

  1. The right heart shadow is NOT visible on the chest radiograph. Which of the following pathologies may explain this?
a. right middle lobe pneumonia
b. right lung pneumothorax
c. bilateral emphysema
d. bleb in the right lower lobe

 

 

ANS:  A

The structures visible on a chest radiograph are seen only when tissue of one density is next to tissue of another density. For example, the heart is visible as a soft tissue density in the middle of the chest because the lungs, which are primarily air density, normally surround it. If the chest on either side of the heart were filled with water (pulmonary consolidation or pleural effusion) the normal heart shadow would not be visible on the radiograph.

 

DIF:    Recall             REF:   p. 453            OBJ:   5

 

  1. In which of the following situations is obtaining a chest radiograph least useful?
a. following intubation
b. following placement of a central venous pressure line
c. when the static pressure drops by 2 cm H2O during CMV
d. when the patients oxygenation status deteriorates for no known reason

 

 

ANS:  C

The respiratory therapist needs to be familiar with the common clinical indications for obtaining a chest radiograph (Table 20-1).

 

DIF:    Recall             REF:   p. 466            OBJ:   1

 

  1. In what pulmonary condition does the chest radiograph often lag behind the clinical status of the patient?
a. pulmonary embolism
b. emphysema
c. pneumonia
d. congestive heart failure

 

 

ANS:  C

The chest radiograph often lags behind the clinical condition of the patient. This is common in pneumonia where the patient may come in with high fever and cough typical for pneumonia but an infiltrate on the chest film may not appear for 12 to 24 hours.

 

DIF:    Recall             REF:   p. 454            OBJ:   3

 

  1. Which radiographic view of the chest allows the physician to read the best quality film?
a. anteroposterior
b. posteroanterior
c. lateral
d. lordotic

 

 

ANS:  B

The posteroanterior view is usually performed in the radiology department with equipment that standardizes the distance from the x-ray source to the film and where the x-ray technician can maximize the quality of each film. In addition, taking the film with the anterior chest closest to the film minimizes magnification of the heart.

 

DIF:    Recall             REF:   p. 454            OBJ:   4

 

  1. Your patient just had an anteroposterior chest film taken. When you view the film, what may be a consideration?
a. The lungs may appear smaller than they really are.
b. The heart may appear less dense then it really is.
c. The ribs may appear more horizontal than normal.
d. The heart may appear larger than it really is.

 

 

ANS:  D

The closer x-ray source and the position of the patient both lead to a slight magnification of the heart shadow.

 

DIF:    Recall             REF:   p. 454            OBJ:   4

 

  1. What abnormality may appear to be present on the chest x-ray but is simply due to abnormal rotation of the patient during production of the film?
a. enlarged lungs
b. enlarged heart
c. widened mediastinum
d. thickened pleura

 

 

ANS:  C

Patient rotation will make the mediastinum appear unusually wide.

 

DIF:    Recall             REF:   p. 455            OBJ:   3

 

  1. What problem exists when interpreting an overexposed chest film?
a. There is difficulty in seeing the peripheral blood vessels.
b. The ribs appear wider than normal.
c. The heart shadow is blurred.
d. The lymph nodes in the mediastinum cannot be seen.

 

 

ANS:  A

An overpenetrated x-ray overexposes the film, leaving the lung parenchyma black and no ability to visualize the peripheral blood vessels. This overpenetration will make evaluation of the lung parenchyma far more difficult.

 

DIF:    Recall             REF:   p. 455            OBJ:   2

 

  1. In the standard posteroanterior chest film, what proportion of the chest width should the heart shadow not exceed?
a. 33%
b. 40%
c. 50%
d. 65%

 

 

ANS:  C

In the posteroanterior projection, the diameter of the heart shadow should not exceed one-half the diameter of the chest.

 

DIF:    Recall             REF:   p. 457            OBJ:   4

 

  1. Computed tomography (CT) scanning of the chest would be LEAST useful for which of the following?
a. to evaluate the large vessels of the mediastinum
b. to evaluate the pleura
c. to evaluate lung masses
d. to evaluate patients with asthma

 

 

ANS:  D

Conventional CT scanning of the chest is commonly used to evaluate lung nodules and masses, the great vessels of the chest, mediastinum, and pleural disease.

 

DIF:    Recall             REF:   p. 457            OBJ:   7

 

  1. Which of the following diseases is NOT typically evaluated using high-resolution CT?
a. emphysema
b. asthma
c. bronchiectasis
d. interstitial lung disease

 

 

ANS:  B

HRCT is ideally suited to evaluating diffuse parenchymal lung disease like interstitial lung disease, emphysema, and bronchiectasis.

 

DIF:    Recall             REF:   p. 457            OBJ:   7

 

  1. CT angiography is most often used to evaluate the patient for which of the following conditions?
a. pulmonary emboli
b. chronic obstructive pulmonary disease
c. congestive heart failure
d. bilateral pneumonia

 

 

ANS:  A

In the chest, CT angiography has been used for years to identify pulmonary thromboemboli.

 

DIF:    Recall             REF:   p. 457            OBJ:   7

 

  1. Which of the following is a major limitation of magnetic resonance imaging (MRI) of the chest?
a. cannot visualize large vessels
b. cannot be used in patients with pacemakers
c. cannot be used to examine hilar structures
d. interpretation difficult

 

 

ANS:  B

It is critically important to avoid taking conventional metal objects near the MRI machine, because the powerful magnet will pull the metallic object into the magnet with great force, exposing patients and health care providers in its path to life-threatening risk.

 

DIF:    Recall             REF:   p. 458            OBJ:   7

 

  1. Which of the following structures in the chest is NOT typically examined using MRI?
a. lung parenchyma
b. hilar structures
c. large vessels in the lung
d. structures in the mediastinum

 

 

ANS:  A

The most common uses for MRI in the chest are for imaging the mediastinum, large vessels in the lung, and hilar regions of the lungs.

 

DIF:    Recall             REF:   p. 458            OBJ:   7

 

  1. Which of the following statements is NOT true regarding the use of ultrasound to image the chest?
a. It is useful to image the heart.
b. It is useful to image pleural abnormalities.
c. It is useful to image lung tissue.
d. It uses sound waves that echo back to the sensor.

 

 

ANS:  C

Ultrasound of the chest is excellent for evaluating the heart or pleural fluid. Ultrasonic evaluation of the lung itself is rarely useful because of the poor ability of ultrasound to transmit through the air-filled lungs.

 

DIF:    Recall             REF:   p. 459            OBJ:   7

 

  1. What is indicated by rounding of the costophrenic angles seen on the posteroanterior or lateral chest film?
a. emphysema
b. excess pleural fluid
c. obesity
d. rib fractures

 

 

ANS:  B

If the point of the costophrenic angle is rounded rather than sharp, it usually indicates a hydrothorax is present.

 

DIF:    Recall             REF:   p. 459            OBJ:   5

 

  1. What chest x-ray view is best used to identify excess pleural fluid?
a. posteroanterior
b. anteroposterior
c. lateral decubitus
d. apical lordotic

 

 

ANS:  C

The best film for detecting small amounts of pleural fluid is the lateral decubitus view, which is a frontal view taken as the patient is lying on the side of the suspected effusion.

 

DIF:    Recall             REF:   p. 460            OBJ:   5

 

  1. What is the earliest sign of a left-sided pleural effusion on an upright chest radiograph?
a. an increased distance between the inferior margin of the left lung and the stomach gas bubble
b. inability to see small pulmonary blood vessels over the left lower lung
c. a widened mediastinum
d. elevation of the right hemidiaphragm

 

 

ANS:  A

The earliest sign of a left-sided pleural effusion on an upright chest radiograph is an increased distance between the inferior margin of the left lung and the stomach gas bubble.

 

DIF:    Recall             REF:   p. 460            OBJ:   5

 

  1. What is indicated by an air-fluid level in the pleural space?
a. tension pneumothorax
b. hydropneumothorax
c. pleural effusion
d. an aerobic infection

 

 

ANS:  B

An air-fluid level in the pleural space indicates a hydropneumothorax.

 

DIF:    Recall             REF:   p. 460            OBJ:   8

 

  1. In which of the following would loculation of pleural fluid NOT be as likely to occur?
a. empyema
b. exudative fluid
c. hemothorax
d. congestive heart failure

 

 

ANS:  D

Loculation of pleural fluid (or trapping so the fluid does not move freely with changing positions) is more commonly seen in exudative effusions, hemothorax (blood in the pleural space), and empyema (infection of the pleural fluid).

 

DIF:    Application    REF:   p. 460            OBJ:   8

 

  1. What is indicated by the presence of gas bubbles within the pleural fluid without prior surgery or needle insertion?
a. hemothorax
b. pneumothorax
c. empyema
d. CHF

 

 

ANS:  C

The presence of gas bubbles within the fluid without prior surgery or needle insertion (which can introduce air) establishes the diagnosis of empyema.

 

DIF:    Recall             REF:   p. 461            OBJ:   8

 

  1. Which of the following statements is NOT true regarding the use of the chest x-ray to detect a pneumothorax?
a. An expiratory film may be best for a small pneumothorax.
b. The standard chest film is of limited use in detecting a pneumothorax.
c. The film will show a lack of vascular markings in the affected region.
d. The lung margin is often visible with a pneumothorax.

 

 

ANS:  B

The clinician can easily detect a pneumothorax on the standard chest film in most cases by seeing the lung margin and noting absence of bronchovascular markings between the lung margin and the inner aspect of the chest wall. Visualizing a small pneumothorax may be assisted by taking the chest radiograph when the patient exhales.

 

DIF:    Recall             REF:   p. 462            OBJ:   6

 

  1. Which of the following statements is NOT true regarding the recognition and treatment of a tension pneumothorax as seen on the chest radiograph?
a. The hemidiaphragm on the affected side will be pushed downward.
b. The mediastinum will be pushed towards the unaffected side.
c. It requires immediate insertion of a chest tube.
d. The patient should be intubated.

 

 

ANS:  D

A tension pneumothorax is suggested on chest films when the hemidiaphragm is pushed down inferiorly or when the mediastinum is shifted toward the opposite lung. A tension pneumothorax requires immediate decompression with a chest tube or Heimlich valve.

 

DIF:    Recall             REF:   p. 462-463     OBJ:   8

 

  1. What term is used to describe the shadows seen on the chest film when the alveoli fill with pus, fluid, or blood?
a. consolidates
b. infiltrates
c. alveolar lesions
d. densities

 

 

ANS:  B

Both pneumonia and a bleeding lung can cause identical-appearing patchy increased density shadows of that tend to coalesce over time on the chest radiograph. These shadows are often referred to as infiltrates.

 

DIF:    Recall             REF:   p. 463            OBJ:   8

 

  1. Which of the following is NOT true regarding the visualization of air bronchograms on the chest film?
a. They indicate fluid in the pleura.
b. They are caused by air-filled airways surrounded by consolidation.
c. They are the hallmark of alveolar consolidation.
d. They signify air space disease.

 

 

ANS:  B

These shadows or opacities often have lucent tubular visible structures running through them that represent air bronchograms. Normally, patent airways are not visible in the outer two thirds of the lung on the chest radiograph. There is no contrast between air in the airway and air in the lung. However, the increased contrast produced by filling of the surrounding alveoli with fluid makes the airways more visible and causes the air bronchogram sign. Air bronchograms are the hallmark of infiltrates that fill alveoli (so-called air space disease).

 

DIF:    Recall             REF:   p. 463            OBJ:   8

 

  1. Which of the following is NOT a typical cause of pulmonary edema as seen on the chest radiograph?
a. left heart failure
b. renal failure
c. cor pulmonale
d. fluid overload

 

 

ANS:  C

Edema from vascular congestion can be caused by failure of the left heart (cardiogenic pulmonary edema), renal failure, or fluid overload.

 

DIF:    Recall             REF:   p. 463            OBJ:   8

 

  1. What is the most common cause of cephalization as seen on the upright chest film?
a. renal failure
b. left heart failure
c. hypoxemia
d. empyema

 

 

ANS:  B

Cephalization of the pulmonary blood flow is often caused by left heart failure.

 

DIF:    Recall       &n

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