Kacmarek: Egan's Fundamentals of Respiratory Care, 10th 

Edition ​Chapter 29: Neuromuscular and Other Diseases of the Chest Wall  

Test Bank  

MULTIPLE CHOICE  

1. Which of the following would not be considered a common pulmonary consequence of 
neuromuscular disease?  
a. sleep apnea  
b. aspiration  
c. cor pulmonale  
d. pneumothorax  

2. Hypoventilation that occurs with progressive neuromuscular disease may be a protective 

3. Respiratory muscle weakness is associated with all of the following abnormalities except: 
a. pulmonary embolism  
b. ventilatory insufficiency  
c. hypoxemia  
d. atelectasis  
 
4. Patients with respiratory muscle weakness due to neuromuscular disease may initially report 
with the following symptoms except:  
a. exertional dyspnea  
b. fatigue  
c. oliguria  
d. orthopnea  

5. All of the following are examples of clinical conditions that can precipitate respiratory failure 
rapidly in patients with significant neuromuscular weakness except:  
a. pulmonary edema  
b. pneumonia  
c. mucous plugging  
d. increased sigh breath  

6. Patients with poor inspiratory muscle function might show significant orthopnea and prefer to 
sleep in a prone position.  
a. True  
b. False  

 
7. Expiratory muscle weakness is accompanied by a poor cough and secretion clearance. 
a. True  
b. False 

8. Pulmonary function testing in patients with neuromuscular weakness would show normal 
values for which of the following?  
a. diffusing capacity of the lungs (DLCO)  
b. vital capacity  
c. forced expiratory volume in 1 second  
d. total lung capacity  
9. A decrease in forced expiratory volume in 1 second (FEV​1​) and vital capacity (VC) of greater 
than 20% when a patient moves from the seated to the supine position is suggestive of which 
of the following?  
a. diaphragmatic muscle weakness  
b. scalene muscle weakness  
c. brainstem injury  
d. internal intercostal weakness  

10. All of the following clinical conditions precipitate respiratory failure rapidly in patients with 
significant neuromuscular weakness except:  
a. pulmonary edema  
b. pneumonia  
c. mucus plugging  
d. pulmonary fibrosis  

11. What finding is associated with Duchenne’s muscular dystrophy?  

12. By what age do most patients with Duchenne’s muscular dystrophy die? 
a. 10 years  
b. 20 years  
c. 35 years  
d. 50 years  

13. What respiratory dysfunction is commonly seen in myotonic dystrophy? 

14. Disorders of the neuromuscular junction include all of the following ​except​: 
a. Lambert-Eaton syndrome  
b. myasthenia gravis  
c. dermatomyositis  
d. tetanus, botulism  
15. In what group of patients is myasthenia gravis most common?  
a. older males 
b. younger males  
c. younger females  
d. older females  

16. In myasthenia gravis, which two pulmonary function values are the most sensitive in detecting 
respiratory muscle weakness?  
1. TLC and VC  
2. PI​max and
​ PE​max  
3. VC and expired volume per unit time (V​E​)  
4. VC and tidal volume (V​T​)  
a. 1 ONLY  
b. 1 and 2  
c. 3 and 4  
d. 2 and 3  
17. Lambert-Eaton syndrome is characterized by which of the following?  
a. It affects mainly the limbs and eyes.  
b. Patients have a mean age of 40 years.  
c. Large-cell carcinoma is most common.  
d. It is commonly associated with small-cell lung cancer.  

18. Nerve conduction studies are most helpful in the clinical diagnosis of which of the following? 
a. myasthenia gravis  
b. Lambert-Eaton syndrome  
c. myotonic dystrophy  
d. amyotrophic lateral sclerosis  

19. Peripheral nerve disorders that cause respiratory muscle dysfunction can be caused by all of 
the following ​except​:  
a. inflammatory processes  
b. vascular disorders  
c. metabolic imbalances  
d. fluid imbalances  

20. What is the most common peripheral neuropathy causing respiratory insufficiency? 
a. Lambert-Eaton syndrome  
b. amyotrophic lateral sclerosis  
c. Guillain-Barré syndrome  
d. myasthenia gravis  

21. What is the mortality rate for Guillain-Barré syndrome?  

 
22. Which of the following is often preceded by a history of upper respiratory or flu-like 
symptoms?  
a. myotonic dystrophy  
b. polymyositis  
c. Guillain-Barré syndrome  
d. amyotrophic lateral sclerosis 

23. What treatment strategies have improved the outcome in Guillain-Barré syndrome? 
a. plasmapheresis  
b. corticosteroids  
c. radiation therapy  
d. antibiotics  

24. What percentage of patients with Guillain-Barré syndrome has respiratory muscle 
compromise?  
a. 10%  
b. 33%  
c. 60%  
d. 100%  

25. All of the following criteria for weaning a patient with Guillain-Barré syndrome from 
mechanical ventilation have shown to be predictive of weaning success except: a. VC 
greater than 18 ml/kg  
b. transdiaphragmatic pressures greater than 31 cm H​2​O  
c. PI​max greater
​ than 30 cm H​2​O  
d. cardiac output above 2.0 L/min  

26. How is diaphragmatic paralysis most often diagnosed?  

27. What percentage of amyotrophic lateral sclerosis patients die within 5 years of diagnosis? 
a. 10%  
b. 25%  
c. 50%  
d. 80%  
28. At what level do the nerves that innervate the diaphragm exit the spine? 
a. C1-3  
b. C3-5  
c. C6-7  
d. T1-3  
29. What is the hallmark finding of diaphragm paralysis?  
a. rapid and shallow breathing  
b. weak cough  
c. abdominal paradox  
d. retractions  
30. What alteration in respiration is typically associated with stroke involving the cerebral cortex? 
a. severe hypoxemia 
b. respiratory acidosis  
c. mild hyperventilation  
d. sleep apnea  

31. Cobb angles are used to measure the severity in which disorder of the thoracic cage? 
a. ankylosing spondylitis  
b. flail chest  
c. scoliosis  
d. pectus excavatum  

32. Which of the following is NOT a pulmonary complication frequently associated with flail 
chest?  
a. pneumothorax  
b. hemothorax  
c. pulmonary contusion  
d. aspiration pneumonia  

33. To effectively document and assess the need for endotracheal intubation in a patient with 
neuromuscular disease, which of the following would be most appropriate? a. spirometry 
every 4 to 6 hours  
b. chest x-ray every shift  
c. polysomnograpy testing  
d. monitoring SpO2 with pulse oximeter