Question 1

Treatment of an empyema typically includes:

Accepted Answer

A)  pleurodesis. 
B)  thoracostomy tube insertion. 
C)  lobectomy. 
D)  pneumonectomy. 
A)  pleurodesis. 
B)  thoracostomy tube insertion. 
C)  lobectomy. 
D)  pneumonectomy. B

Question 2

Pulmonary function testing on a patient with atelectasis associated with pleural effusion would likely reveal:
1) increased VC.
2) decreased ERV.
3) decreased FRC.
4) normal RV/TLC ratio.

Accepted Answer

A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 3, 4 
A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 3, 4 C

Question 3

What percentage of patients with bacterial pneumonia are likely to develop pleural effusion?

Accepted Answer

A)  Up to 10% 
B)  Up to 20% 
C)  Up to 30% 
D)  Up to 40% 
A)  Up to 10% 
B)  Up to 20% 
C)  Up to 30% 
D)  Up to 40% D

Question 4

During a chest assessment on a patient with a large pleural effusion, which of the following would be expected?
1) Increased tactile and vocal fremitus
2) Hyperresonant percussion note
3) Diminished breath sounds
4) Tracheal shift

Accepted Answer

A) 1, 4 
B) 1, 2 
C) 3, 4 
D) 1, 3, 4 
A) 1, 4 
B) 1, 2 
C) 3, 4 
D) 1, 3, 4

Question 5

What is the most common cause of a chylothorax?

Accepted Answer

A)  Thoracic duct trauma 
B)  Abdominal tumor 
C)  GERD 
D)  Pyloric stenosis 
A)  Thoracic duct trauma 
B)  Abdominal tumor 
C)  GERD 
D)  Pyloric stenosis

Question 6

While reviewing an upright chest radiograph of a patient with a pleural effusion, the respiratory therapist observes a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this characteristic sign called?

Accepted Answer

A)  Meniscus sign 
B)  Scarf sign 
C)  Transudate sign 
D)  Kerley B lines 
A)  Meniscus sign 
B)  Scarf sign 
C)  Transudate sign 
D)  Kerley B lines

Question 7

The major pathologic and structural changes associated with a significant pleural effusion include which of the following?
1) Diaphragm elevation
2) Atelectasis
3) Compression of the great vessels
4) Lung compression

Accepted Answer

A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 3, 4 
A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 3, 4

Question 8

The anatomic alteration caused by a pleural effusion is:

Accepted Answer

A)  pulmonary fibrosis. 
B)  separation of the visceral and parietal pleura. 
C)  adhesion of the visceral and parietal pleura. 
D)  pulmonary edema. 
A)  pulmonary fibrosis. 
B)  separation of the visceral and parietal pleura. 
C)  adhesion of the visceral and parietal pleura. 
D)  pulmonary edema.

Question 9

A respiratory therapist is assisting a physician who is performing a thoracentesis. It is suspected that the patient has a chylothorax. How would the pleural effusion be described?

Accepted Answer

A)  Milky white 
B)  Straw colored 
C)  Red 
D)  Green 
A)  Milky white 
B)  Straw colored 
C)  Red 
D)  Green

Question 10

Which of the following are chest radiograph findings associated with a large pleural effusion?
1) Blunting of the costophrenic angle
2) Fluid level on the affected side
3) Mediastinal shift toward the unaffected side
4) Elevated hemidiaphragm on the affected side

Accepted Answer

A) 1, 3 
B) 2, 4 
C) 1, 2, 4 
D) 1, 2, 3 
A) 1, 3 
B) 2, 4 
C) 1, 2, 4 
D) 1, 2, 3

Question 11

A patient has a pleural effusion from an unknown cause. A fluid sample has been taken for analysis. To help identify the cause of the effusion, which of the following tests should be performed?
1) Specific gravity
2) Biochemical makeup
3) Cytologic examination
4) Bacterial culture

Accepted Answer

A) 1, 3 
B) 1, 2, 4 
C) 2, 3, 4 
D) 1, 2, 3 
A) 1, 3 
B) 1, 2, 4 
C) 2, 3, 4 
D) 1, 2, 3

Question 12

In the absence of surgery or trauma, what does the presence of blood in the pleural fluid most likely signify?

Accepted Answer

A)  Malignant disease 
B)  Fungal disease 
C)  Chylothorax 
D)  Tuberculosis 
A)  Malignant disease 
B)  Fungal disease 
C)  Chylothorax 
D)  Tuberculosis

Question 13

A patient has malignant mesothelioma related to chronic asbestos exposure. What would his pleural effusion fluid likely show on laboratory analysis?
1) Erythrocytes
2) Lymphocytes
3) Normal mesothelial cells
4) Malignant mesothelial cells

Accepted Answer

A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 2, 4 
A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 2, 4

Question 14

An adult patient with a large pleural effusion requires placement of a thoracostomy tube. Which of the following statements are true regarding thoracostomy tube placement?
1) The tube is placed in the second to third intercostal space.
2) The tube is placed in the fourth to fifth intercostal space.
3) The tube is placed in the midclavicular line.
4) The tube is placed in the midaxillary line.

Accepted Answer

A) 1, 4 
B) 2, 3 
C) 1, 3 
D) 2, 4 
A) 1, 4 
B) 2, 3 
C) 1, 3 
D) 2, 4

Question 15

Which of the following are associated with a transudative pleural effusion?
1) Thin and watery fluid
2) Fluid has a lot of cellular debris
3) Fluid has high protein count
4) Few blood cells

Accepted Answer

A) 2, 3 
B) 1, 4 
C) 1, 2, 3 
D) 1, 3, 4 
A) 2, 3 
B) 1, 4 
C) 1, 2, 3 
D) 1, 3, 4

Exam 24: Pleural Effusion and Empyema

Treatment of an empyema typically includes:

Pulmonary function testing on a patient with atelectasis associated with pleural effusion would likely reveal: 1) increased VC. 2) decreased ERV. 3) decreased FRC. 4) normal RV/TLC ratio.

What percentage of patients with bacterial pneumonia are likely to develop pleural effusion?

During a chest assessment on a patient with a large pleural effusion, which of the following would be expected? 1) Increased tactile and vocal fremitus 2) Hyperresonant percussion note 3) Diminished breath sounds 4) Tracheal shift

What is the most common cause of a chylothorax?

While reviewing an upright chest radiograph of a patient with a pleural effusion, the respiratory therapist observes a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this characteristic sign called?

The major pathologic and structural changes associated with a significant pleural effusion include which of the following? 1) Diaphragm elevation 2) Atelectasis 3) Compression of the great vessels 4) Lung compression

The anatomic alteration caused by a pleural effusion is:

A respiratory therapist is assisting a physician who is performing a thoracentesis. It is suspected that the patient has a chylothorax. How would the pleural effusion be described?

Which of the following are chest radiograph findings associated with a large pleural effusion? 1) Blunting of the costophrenic angle 2) Fluid level on the affected side 3) Mediastinal shift toward the unaffected side 4) Elevated hemidiaphragm on the affected side

A patient has a pleural effusion from an unknown cause. A fluid sample has been taken for analysis. To help identify the cause of the effusion, which of the following tests should be performed? 1) Specific gravity 2) Biochemical makeup 3) Cytologic examination 4) Bacterial culture

In the absence of surgery or trauma, what does the presence of blood in the pleural fluid most likely signify?

A patient has malignant mesothelioma related to chronic asbestos exposure. What would his pleural effusion fluid likely show on laboratory analysis? 1) Erythrocytes 2) Lymphocytes 3) Normal mesothelial cells 4) Malignant mesothelial cells

Which of the following are associated with a transudative pleural effusion? 1) Thin and watery fluid 2) Fluid has a lot of cellular debris 3) Fluid has high protein count 4) Few blood cells

The Patient Interview

The Physical Examination

The Pathophysiologic Basis for Common Clinical Manifestations

Pulmonary Function Testing

Blood Gas Assessment

Assessment of Oxygenation

Assessment of the Cardiovascular System

Radiologic Examination of the Chest

Other Important Tests and Procedures

The Therapist-Driven Protocol Program

Respiratory Insufficiency, Respiratory Failure and Ventilatory Management Protocols

Recording Skills and Intra-Professional Communication

Chronic Obstructive Pulmonary Disease, Chronic Bronchitis and Emphysema

Asthma

Cystic Fibrosis

Bronchiectasis

Atelectasis

Pneumonia, Lung Abscess Formation, and Important Fungal Diseases

Tuberculosis

Pulmonary Edema

Pulmonary Vascular Disease: Pulmonary Embolism and Pulmonary Hypertension

Flail Chest

Pneumothorax

Kyphoscoliosis

Cancer of the Lung, Prevention and Palliation

Interstitial Lung Diseases

Acute Respiratory Distress Syndrome

Guillain-Barré Syndrome

Myasthenia Gravis

Cardiopulmonary Assessment and Care of Patients With Neuromuscular Disease

Sleep Apnea

Newborn Assessment and Management

Pediatric Assessment, Protocols, and Pals Management

Meconium Aspiration Syndrome

Transient Tachypnea of the Newborn

Respiratory Distress Syndrome

Pulmonary Air Leak Syndrome

Respiratory Syncytial Virus Infection Bronchiolitis

Chronic Lung Disease of Infancy

Congenital Diaphragmatic Hernia

Congenital Heart Disease

Croup and Croup-Like Syndromes: Laryngotracheobronchitis, Bacterial Tracheitis, and Acute Epiglottitis

Near Drowningwet Drowning

Smoke Inhalation, Thermal Injuries, and Carbon Monoxide Intoxication

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