Respiratory physiotherapy

50 Gulf Prometric Physiotherapist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Respiratory physiotherapy, part of Cardiopulmonary Physiotherapy. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   A man with diabetic ketoacidosis breathes deeply and fast. His ABG shows pH 7.20, PaCO2 22 mmHg and HCO3 9 mmol/L. How is it best interpreted?

   1. ARespiratory alkalosis with metabolic compensation
   2. BRespiratory acidosis with metabolic compensation
   3. CNormal blood gas for a diabetic patient
   4. DMetabolic acidosis with respiratory compensation

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   Answer: D · Metabolic acidosis with respiratory compensation

   The pH is acidotic and the bicarbonate is very low, so the primary disorder is metabolic. The low PaCO2 shows deep, rapid (Kussmaul) breathing blowing off CO2 to compensate. Respiratory physiotherapy should not try to slow this breathing, because it is protective.

   • A: The pH is acidotic, so the process is not alkalosis.
   • B: CO2 is low, not high, so the primary change is not respiratory.
   • C: Bicarbonate of 9 mmol/L is markedly abnormal.

   Remember this

   In metabolic acidosis, low PaCO2 from fast deep breathing is a protective compensation.

2. Question 2 · Medium

   A patient with ARDS is on a ventilator with PEEP 14 cmH2O. Why does the physiotherapist ask for a closed suction system?

   1. AIt removes the need to pre-oxygenate before suction
   2. BIt gives a higher suction pressure and clears secretions faster
   3. CIt keeps the circuit sealed so that PEEP is maintained and alveolar derecruitment is avoided
   4. DIt allows suction without any risk of infection

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   Answer: C · It keeps the circuit sealed so that PEEP is maintained and alveolar derecruitment is avoided

   Disconnecting the circuit for open suction drops the PEEP at once, and the recruited alveoli collapse again. This produces hypoxia that can last several minutes. A closed in-line catheter keeps the airway pressure stable and also protects staff from aerosols.

   • A: Pre-oxygenation is still needed with closed suction.
   • B: Suction pressure is set separately and is not higher.
   • D: Infection risk is reduced, not removed.

   Remember this

   Closed suction keeps PEEP stable and prevents alveolar derecruitment in ARDS.

3. Question 3 · Medium

   On day 2 after a coronary bypass, a patient has diminished breath sounds at both bases, a low-grade fever and a saturation of 93% on room air. Which treatment is most appropriate?

   1. ABed rest with the head flat to reduce sternal stress
   2. BAvoid all breathing exercises until the sternum has united
   3. CPercussion and vibration over the sternum twice a day
   4. DDeep breaths with a hold, supported huffs and early out-of-bed mobilisation

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   Answer: D · Deep breaths with a hold, supported huffs and early out-of-bed mobilisation

   These findings suggest basal atelectasis from shallow breathing and pain. Deep breathing with a hold, supported cough and upright mobilisation increase lung volume and reduce complications. Sternal precautions are respected by hugging a pillow, not by stopping treatment.

   • A: Lying flat reduces lung volume and promotes atelectasis.
   • B: Avoiding exercise raises the risk of pneumonia.
   • C: Percussion over a fresh sternotomy is inappropriate.

   Remember this

   After surgery, deep breathing with a hold, supported cough and early mobilisation prevent atelectasis.

4. Question 4 · Medium

   A patient with COPD needs a precise oxygen concentration of 28%. Which device delivers this most reliably?

   1. ANasal cannulae at 4 L/min
   2. BA Venturi mask
   3. CA non-rebreathing reservoir mask
   4. DA simple face mask

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   Answer: B · A Venturi mask

   A Venturi mask entrains a fixed proportion of room air, so it delivers a set oxygen concentration, such as 24% or 28%, whatever the patient's breathing pattern. This suits patients at risk of CO2 retention. Variable-performance devices give a concentration that changes with breathing.

   • A: Nasal cannulae give a variable concentration, and 4 L/min is about 36%.
   • C: A reservoir mask gives high, uncontrolled concentrations.
   • D: A simple mask gives a variable concentration of about 35-55%.

   Remember this

   A Venturi mask gives a fixed, controlled oxygen concentration.

5. Question 5 · Medium

   Which patient with COPD is the best candidate for referral to pulmonary rehabilitation?

   1. AA stable patient with MRC dyspnoea grade 3 who is limited in daily activities
   2. BA patient in the first hours of an exacerbation on NIV
   3. CA patient with unstable angina at rest
   4. DA patient with no breathlessness and normal activity

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   Answer: A · A stable patient with MRC dyspnoea grade 3 who is limited in daily activities

   Pulmonary rehabilitation is offered to people with chronic respiratory disease who are functionally limited by breathlessness, usually MRC grade 3 or more. It improves exercise capacity and quality of life. It can also start within weeks of an exacerbation, but not during acute instability.

   • B: Acute instability on NIV must settle before rehabilitation.
   • C: Unstable angina is a contraindication to exercise training.
   • D: A patient with no limitation gains little from a programme.

   Remember this

   Refer functionally limited, stable COPD patients (MRC grade 3 or more) to pulmonary rehabilitation.

6. Question 6 · Hard

   A drowsy patient with COPD is on a 15 L/min non-rebreathing mask with SpO2 100% and a PaCO2 of 80 mmHg. What is the best next step?

   1. AStop oxygen entirely and give vigorous chest percussion
   2. BEncourage deep breathing and review the patient again in 6 hours
   3. CReduce oxygen to target 88-92% and arrange non-invasive ventilation
   4. DIncrease the oxygen further to protect the brain from damage due to hypoxia

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   Post-bronchodilator spirometry shows FEV1/FVC 0.55, FEV1 50% of predicted and FVC 90% of predicted. How is this best described?

   1. AA restrictive pattern, as the FVC is reduced
   2. BA normal result for an older adult
   3. CA mixed pattern that cannot be classified
   4. DAn obstructive pattern, as FEV1/FVC is below 0.7

   Answer and explanation in LearnFree account

8. Question 8 · Medium

   In a ventilated ICU patient, which finding should delay early mobilisation?

   1. AAn awake, calm and cooperative patient
   2. BAn FiO2 of 0.4 and a PEEP of 6 cmH2O in use
   3. CStable heart rate of 90 beats per minute
   4. DRapidly increasing vasopressor requirements

   Answer and explanation in LearnFree account

9. Question 9 · Easy

   In a patient with severe acute asthma who is tiring after hours of wheeze, which blood gas change is an ominous sign?

   1. AA rising HCO3 with a falling PaCO2
   2. BA low HCO3 with a normal PaCO2 and normal pH
   3. CA normal or rising PaCO2 with a falling pH
   4. DA falling PaCO2 with a rising pH after treatment

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10. Question 10 · Medium

    Why does prone positioning improve oxygenation in severe ARDS?

    1. AIt rests the heart by reducing the cardiac workload to almost zero
    2. BIt lowers the haemoglobin level and reduces oxygen demand
    3. CIt removes the need for PEEP
    4. DIt recruits dorsal lung and improves ventilation-perfusion matching

    Answer and explanation in LearnFree account

11. Question 11 · Medium

    A patient with an exacerbation of COPD has pH 7.28 and PaCO2 68 mmHg despite medical therapy. What is indicated?

    1. ADischarge with observation
    2. BChest percussion alone
    3. CHigher-flow oxygen by mask
    4. DNon-invasive ventilation

    Answer and explanation in LearnFree account

12. Question 12 · Easy

    Which position is used to drain the anterior segments of both upper lobes?

    1. ALying prone with the foot of the bed raised
    2. BSitting upright, leaning forward over a pillow
    3. CLying supine, with the head flat and a pillow under the knees
    4. DSide-lying with the head down 20 degrees

    Answer and explanation in LearnFree account

13. Question 13 · Hard

    After ventilation a patient is trialled on a T-piece, with a respiratory rate of 26 per minute and tidal volume of 280 mL. Calculate the rapid shallow breathing index and say how it is interpreted.

    1. AAbout 11, favouring weaning success
    2. BAbout 93, favouring weaning failure
    3. CAbout 11, favouring weaning failure
    4. DAbout 93, favouring weaning success

    Answer and explanation in LearnFree account

14. Question 14 · Hard

    A ventilated patient has right lower lobe collapse from retained secretions on the chest radiograph, with stable blood pressure. Which positioning is best?

    1. ARight side-lying, with the collapsed lung lowermost in the dependent position
    2. BLeft side-lying with the right lung uppermost, plus suction and hyperinflation
    3. CFlat supine with no tilt and the head of the bed lowered
    4. DProne with the head down and the arms above the head

    Answer and explanation in LearnFree account

15. Question 15 · Medium

    Blood gas results for a sedated patient: pH 7.28, PaCO2 62 mmHg, HCO3 25 mmol/L. Which disturbance is present?

    1. AAcute (uncompensated) respiratory acidosis
    2. BCompensated respiratory acidosis
    3. CMetabolic acidosis with respiratory compensation
    4. DRespiratory alkalosis

    Answer and explanation in LearnFree account

16. Question 16 · Easy

    On auscultation of a patient with acute asthma, which added sound is a high-pitched, musical noise heard mainly on expiration?

    1. AStridor
    2. BCoarse crackles
    3. CPleural rub
    4. DWheeze

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17. Question 17 · Hard

    At sea level on room air, a patient has PaO2 60 mmHg and PaCO2 40 mmHg. Using alveolar PO2 = 0.21 x (760 - 47) - PaCO2 / 0.8, what is the alveolar-arterial oxygen gradient?

    1. AAbout 90 mmHg, from subtracting PaO2 from the inspired PO2
    2. BAbout 40 mmHg, normal for an adult on room air
    3. CAbout 40 mmHg, raised, so a gas-exchange problem is present
    4. DAbout 10 mmHg, normal, so hypoventilation explains it

    Answer and explanation in LearnFree account

18. Question 18 · Medium

    Which finding is a contraindication to manual hyperinflation in a ventilated patient?

    1. ARetained secretions with basal crackles
    2. BAn undrained pneumothorax
    3. CLeft lower lobe atelectasis
    4. DPEEP of 5 cmH2O with a stable blood pressure

    Answer and explanation in LearnFree account

19. Question 19 · Medium

    Which is the most common pulmonary complication after upper abdominal surgery?

    1. AAtelectasis
    2. BPneumothorax
    3. CPulmonary embolism
    4. DARDS

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20. Question 20 · Medium

    An anxious patient has pH 7.49, PaCO2 29 mmHg and HCO3 22 mmol/L. Which interpretation fits?

    1. AMetabolic acidosis with respiratory compensation
    2. BRespiratory acidosis from retained carbon dioxide
    3. CMetabolic alkalosis with respiratory compensation
    4. DAcute respiratory alkalosis from hyperventilation

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21. Question 21 · Easy

    After climbing stairs, a man with emphysema exhales slowly through puckered lips. What does this manoeuvre chiefly achieve?

    1. AStrengthening the diaphragm muscle
    2. BIncreasing the respiratory rate
    3. CKeeping the airways open longer during expiration
    4. DRaising PaCO2 to drive the breathing

    Answer and explanation in LearnFree account

22. Question 22 · Easy

    Before an exercise session, a physiotherapist counts the breathing of a calm, well adult client for one minute. Which count falls within the expected range?

    1. A40 to 60 breaths per minute
    2. B4 to 8 breaths per minute
    3. C25 to 35 breaths per minute
    4. D12 to 20 breaths per minute

    Answer and explanation in LearnFree account

23. Question 23 · Medium

    A one-way speaking valve is to be fitted to a patient's cuffed tracheostomy tube. What must be done first?

    1. ADeflate the cuff completely
    2. BInflate the cuff fully
    3. CFit a closed inner cannula
    4. DConnect the valve to the ventilator circuit

    Answer and explanation in LearnFree account

24. Question 24 · Hard

    A ventilated patient has a tidal volume of 500 mL, a plateau pressure of 30 cmH2O and a PEEP of 10 cmH2O. What is the static compliance?

    1. A50 mL/cmH2O
    2. B16.7 mL/cmH2O
    3. C25 mL/cmH2O
    4. D12.5 mL/cmH2O

    Answer and explanation in LearnFree account

25. Question 25 · Medium

    A patient breathing room air has pH 7.44, PaO2 52 mmHg and PaCO2 33 mmHg. How is this classified?

    1. AType I (hypoxaemic) respiratory failure
    2. BNormal gas exchange
    3. CType II (hypercapnic) respiratory failure
    4. DMetabolic acidosis

    Answer and explanation in LearnFree account