Kacmarek: Egan's Fundamentals of Respiratory Care, 10th
Edition Chapter 26: Pulmonary Vascular Disease
Test Bank
MULTIPLE CHOICE
1. Venous thromboembolism is a major national health issue in the United States.
a. True
b. False
2. Approximately what percentage of patients who die from pulmonary embolism are NOT
suspected before death?
a. 5%
b. 20%
c. 40%
d. 70%
3. Which of the following risk factors is NOT associated with an increase in the incidence of
pulmonary embolism?
a. advanced age
b. immobilization
c. multiple injuries from trauma
d. positive smoking history
4. Where do most pulmonary emboli originate?
a. deep veins of the arms
b. deep veins of the legs
c. thrombi from the right side of the heart
d. veins of the thorax
5. Which of the following conditions predispose a patient to venous thromboembolic disease?
1. carcinoma
2. COPD
3. trauma
4. thrombocytosis
a. 1, 2, and 3
b. 1 and 4
c. 2
d. 1, 3, and 4
6. What percentage of patients with pulmonary embolism have pulmonary infarction as a
complication?
a. less than 10%
b. about 25%
c. about 40%
d. about 65%
7. Most pulmonary infarctions occur in the lung apexes.
a. True
b. False
8. Death from massive pulmonary embolism is the result of cardiovascular collapse rather than
respiratory failure.
a. True
b. False
9. Which of the following pathophysiologic changes in the lung is not typically associated with
pulmonary embolism?
a. bronchoconstriction
b. decreased ciliary mobility
c. increased dead space ventilation
d. reduced surfactant production
10. Which of the following conditions contribute to the development of hypoxemia in a patient
with pulmonary emboli?
1. cardiogenic shock
2. destruction of lung parenchyma
3. intrapulmonary shunt
4. mismatch
a. 1, 2, and 3
b. 1 and 4
c. 2 only
d. 1, 3, and 4
11. What is the main hemodynamic consequence of pulmonary emboli?
a. increased pulmonary vascular resistance
b. increased systemic vascular resistance
c. pulmonary instability
d. pulmonary vasodilation
12. What percentage of the pulmonary vascular bed must be occluded by emboli before
pulmonary hypertension occurs?
a. 25%
b. 33%
c. 50%
d. 75%
13. What is the critical value for mean pulmonary arterial pressure, above which the right
ventricle fails and death may ensue?
a. 30 mm Hg
b. 40 mm Hg
c. 50 mm Hg
d. 60 mm Hg
14. What treatment is initiated in patients suspected of pulmonary emboli, and continued until
pulmonary emboli is ruled out?
a. antiarrhythmia
b. anticoagulation
c. corticosteroids
d. diuretics
15. What is the most frequent symptom found in patients with confirmed pulmonary emboli?
a. cough
b. dyspnea
c. leg swelling
d. pleuritic pain
16. Which of the following are the main components of Virchow’s triad?
1. hypercoagulable states
2. vessel wall abnormalities
3. fibrinogen abnormalities
4. venous stasis
a. 2.
b. 1, 2, and 3.
c. 1, 2, and 4.
d. 1, 2, 3, and 4.
17. Which of the following physical examination findings are consistent with the diagnosis of
pulmonary embolism?
1. congestive heart failure
2. inspiratory crackles on auscultation
3. loud P2
4. tachypnea
a. 2, 3, and 4
b. 1 and 4
c. 3
d. 1, 2, 3, and 4
18. Which of the following findings on a chest radiograph is NOT consistent with pulmonary
embolism?
a. diffuse hyperinflation
b. elevation of the diaphragm
c. enlargement of the heart shadow
d. pleural effusion
19. Approximately what percentage of patients with pulmonary embolism have a normal ECG?
a. 10% to 15%
b. 25% to 30%
c. 40% to 60%
d. 70% to 75%
20. What are the two most common findings on the electrocardiogram (ECG) in the patient with
pulmonary embolism?
a. bradycardia and elevated ST segment
b. inverted T waves and depressed ST segment
c. large P waves and inverted T waves
d. tachycardia and depressed ST segment
21. Which of the following arterial blood gas findings is seen in most patients with pulmonary
embolism?
a. hypercapnia
b. hypoxemia
c. low pH
d. normal SaO2
22. A D-dimer test is performed in a patient in whom a pulmonary embolism is suspected. The
value comes back at 379 mg/L. What does this suggest?
a. almost completely establishes the presence of pulmonary embolism
b. almost completely rules out pulmonary embolism
c. establishes roughly a 50/50 chance of pulmonary embolism
d. is indeterminate but highly suggestive of pulmonary embolism
23. Why is the D-dimer test not routinely performed on hospital inpatients suspected of having
pulmonary emboli?
a. A high D-dimer only suggests the presence of comorbidities.
b. A low D-dimer is associated with immunodepression.
c. It loses sensitivity if numerous blood tests have been performed.
d. The cost is prohibitive.
24. How does impedance plethysmography determine the presence or absence of deep vein
thrombosis?
a. notes resistance to electrical current associated with blood flow
b. radioactive isotopes target clots and show “hot” on gamma cameras
c. uses ultrasonic waves to delineate the presence of clot or clots
d. uses radiographic technique to spot the clots
25. The presence of previous chronic obstructive pulmonary disease (COPD)
reduces the diagnostic usefulness of scans in acute pulmonary embolism.
a. True
b. False
26. In patients suspected of having pulmonary emboli in whom noninvasive studies do not give a
definite diagnosis, what diagnostic procedure is the test of choice?
a. CT
b. MRI
c. pulmonary angiography
d.
27. Which of the following is true regarding the use of CT with contrast for diagnosing
pulmonary embolism (PE)?
a. limited due to availability of CT equipment
b. most sensitive of the diagnostic techniques
c. can only identify the medium to large PE
d. high risk of mortality limits its use
28. Which of the diagnostic tests for pulmonary embolism is probably the safest and the most
consistently accurate?
a. impedance plethysmography
b. MRI
c. pulmonary angiogram
d. helical CTA
29. Prophylactic deep venous thrombosis (DVT) therapy would be most important in which of the
following patient groups?
a. general surgery patients
b. general ward patients
c. ICU patients
d. patients with hip replacements
30. Which of the following medications should be used in the hospital for prophylactic deep
venous thrombosis therapy?
a. acetylcholine esterase
b. albuterol
c. aspirin
d. heparin
31. Most hospitalized patients who are immobile need prophylaxis for venous thromboembolism.
a. True
b. False
32. Which of the following medications would be standard therapy to treat acute deep venous
thrombi?
a. acetylcholine esterase
b. heparin
c. streptokinase
d. warfarin
33. What is the fastest way to achieve therapeutic levels of heparin in the treatment of acute deep
venous thrombi?
a. continuous drip system
b. follow established nomogram
c. large bolus at 10 µg/kg
d. IV injections while tracking blood levels
34. What is the most commonly used oral anticoagulant?
a. acetylcholine esterase
b. heparin
c. streptokinase
d. warfarin
35. What drug would be the treatment of choice for pulmonary emboli?
a. heparin
b. streptokinase
c. urokinase
d. warfarin
36. A patient with pulmonary emboli has severe hypoxemia, acute right-sided heart failure, and
shock. What treatment should be given at this time?
a. acetylcholine esterase
b. heparin
c. streptokinase
d. warfarin
37. At rest, what level does the mean pulmonary artery pressure need to reach before it is
considered pulmonary hypertension?
a. >10 mm Hg
b. >15 mm Hg
c. >20 mm Hg
d. >25 mm Hg
38. Pulmonary artery hypertension (PAH) is NOT associated with which of the following
conditions?
a. amyotrophic lateral sclerosis
b. cirrhosis of the liver
c. congenital heart disease
d. human immunodeficiency virus infection
39. What is the initial event in the pathogenesis of idiopathic pulmonary artery hypertension
(IPAH)?
a. insult to the pulmonary endothelium
b. elevated level of serotonin
c. monoclonal proliferation of endothelial cells
d. vascular remodeling
40. Primary pulmonary hypertension is more common in males than in females.
a. True
b. False
41. On average, how long does the diagnosis of idiopathic pulmonary artery hypertension (IPAH)
follow the onset of the disease?
a. 6 months
b. 1 year
c. 18 months
d. 2 years
42. What are the two most common symptoms associated with primary pulmonary hypertension?
a. dry cough and dyspnea
b. dyspnea and angina
c. hemoptysis and dyspnea
d. syncope and chest pain
43. Which of the following physical examination findings is NOT found in patients with primary
pulmonary hypertension?
a. cyanosis
b. diastolic heart murmur
c. digital clubbing
d. loud second heart sound (P2)
44. Which of the following radiographic findings is NOT typical for patients with primary
pulmonary hypertension?
a. enlargement of the pulmonary artery
b. enlargement of the right ventricle
c. narrowing of the peripheral arteries
d. pleural effusion
45. What ECG findings are typically seen in patients with idiopathic pulmonary artery
hypertension?
1. frequent premature ventricular complexes
2. right-axis deviation
3. right ventricular hypertrophy
4. left bundle-branch block
a. 1, 2, and 4
b. 2 and 3
c. 4
d. 1, 2, 3, and 4
46. What ECG finding is most often associated with right-sided heart failure and pulmonary
hypertension?
a. elevated ST segment
b. inverted P wave in lead I
c. prolonged PR interval
d. right-axis deviation
47. What is the most important noninvasive diagnostic test for evaluation of a patient with
idiopathic pulmonary artery hypertension (IPAH)?
a. posteroanterior chest radiograph
b. physical examination
c. pulmonary function testing
d. scan
48. What is the most common pulmonary function abnormality found in patients with idiopathic
pulmonary artery hypertension (IPAH)?
a. reduced diffusing capacity of the lungs (DLCO)
b. reduced forced vital capacity (FVC)
c. reduced forced expiratory flow (FEF25%-75%)
d. reduced lung compliance (CL)
49. What is the 5-year survival rate for patients with untreated idiopathic pulmonary artery
hypertension (IPAH)?
a. 33%
b. 44%
c. 55%
d. 66%
50. Idiopathic pulmonary artery hypertension (IPAH) is often a fatal disease.
a. True
b. False
51. Unless there are contraindications, what treatment is given universally to all patients with
idiopathic pulmonary artery hypertension (IPAH)?
a. oral anticoagulation
b. oxygen
c. steroids
d. vasodilators
52. Why is the use of oxygen to maintain oxygen saturations greater than 90% particularly
important in the management of idiopathic pulmonary artery hypertension? a. These
patients have a low cardiopulmonary reserve.
b. Low alveolar oxygen causes vasoconstriction.
c. Many patients have central cyanosis.
d. These patients are especially susceptible to tissue hypoxia.
53. Why are calcium channel blockers NOT used in all patients with idiopathic pulmonary artery
hypertension?
a. It causes severe side effects.
b. Many of these patients have systemic hypotension.
c. Only a small percentage of IPAH patients respond.
d. There is a high incidence of anaphylaxis.
54. What IV infusion has been found to improve exercise capacity, hemodynamic variables, and
survival in patients with severe IPAH?
a. bosentan
b. epoprostenol
c. methylprednisolone
d. sildenafil
55. What type of drug is Bosentan?
a. corticosteroid
b. endothelin antagonists
c. phosphodiesterase inhibitors
d. prostanoids
56. Lung transplantation is an option in the management of idiopathic pulmonary artery
hypertension.
a. True
b. False
57. In what type of IPAH patient is lung transplantation indicated?
a. all pulmonary artery hypertension patients with clinically significant disease
b. patients not responding to vasodilators with significant cardiac dysfunction c.
patients with class II, class III, or class IV disease
d. patients with refractory hypoxemia
58. What is the most important factor contributing to the onset of pulmonary hypertension in the
patient with COPD?
a. alveolar hypoxia
b. compression of pulmonary vasculature
c. left ventricular failure
d. loss of vascular surface
59. What therapy has been proven to improve survival in patients with COPD and pulmonary
hypertension?
a. bronchodilators
b. oral vasodilators
c. oxygen
d. prostanoids
60. What drug is NOT classified as a prostanoid?
a. epoprostenol
b. iloprost
c. treprostinil
d. sildenafil
