Lecture on Equipment Issues, Exams, Cut Scores, and Clinical Simulations

Jul 6, 2024

Lecture on Equipment Issues, Exams, Cut Scores, and Clinical Simulations

Equipment Issues

  • Increasing Flow
    • Common fix for many equipment problems.
    • Good strategy if unsure what the exact issue is.

Exam Cut Scores

  • Scoring Example
    • Test scored 85/140: just shy of the lower cut score.
    • Minimum required: 86 to 91 for CRT credential.
    • Minimum score 92 to avoid retake for RRT eligibility.
    • Scores around 66-67% considered comparable to 70-75% academic standards.

Types of Questions on the TMC

  • Recall Questions
    • Example: Normal potassium range (3.5-5).
    • 33 recall questions on the TMC.
  • Application Questions
    • Example: Blood gas interpretation related to potassium levels.
    • 66 application questions on the TMC.
  • Analysis Questions
    • Example: Combine symptoms and test results to determine underlying causes, like potassium levels.

Clinical Simulation Exam

  • Structure

    • 22 exam simulations, some with multiple patient scenarios.
    • Mimics real patient cases.
    • "Choose Your Own Adventure" format with branching logic.

  • Scoring System

    • Tracks score, minimal passing, and maximum score.
    • Excess points from easier simulations act as a buffer.
    • Failing multiple simulations still possible to pass overall.
    • Minimum passing score of 270 out of a theoretical 500, but only need 271 to pass.

Test Prep Strategies

  • Study Routine
    • Study consistently; avoid cramming night before.
    • Take practice exams to find weak areas to focus on.
  • Test Day Preparation
    • Know test center location and account for traffic.
    • Test when you are mentally at best.
    • Eat before the test; minimize new caffeine or stimulants.
    • Relax the night before and get a good night's sleep.

Disease Processes and Locations

  • Obstructive Diseases (C-BABE)

    • Cystic fibrosis, Bronchiectasis, Asthma, Bronchitis (chronic), and Emphysema.
    • Mainly affect the airway.
    • Emphysema affects distal airways and alveoli.

  • Restrictive Diseases

    • Examples: Atelectasis, Pneumonia, Pulmonary Edema, Pneumothorax, Pleural Effusion, ARDS.
    • Mainly affect the alveoli.

  • Pulmonary Capillary Bed Disorders

    • Pulmonary embolism, Hypertension.

Mechanical Ventilation

  • Peak and Plateau Pressures

    • Peak Inspiratory Pressure (PIP): Airway and alveoli combined.
    • Plateau Pressure (Plat): Alveoli only.
    • Rising PIP and Plat together indicate an alveolar problem.
    • Rising PIP independently of Plat indicates an airway problem.

  • Compliance and Resistance Formulas

    • Dynamic Compliance: TV / (PIP - PEEP) -> Normal: 30-40 mL/cm H2O.
    • Static Compliance: TV / (Plat - PEEP) -> Normal: 60-100 mL/cm H2O.
    • Airway Resistance: ((PIP - Plat) / Flow(L/s)) -> Normal: 0.6-2.4 cm H2O/L/s.

PFT (Pulmonary Function Tests)

  • Distinguishing Obstructive and Restrictive Disorders
    • Obstructive: Decreased expiratory flows (FEV1/FVC <70%), Increased volumes (RV, FRC, TLC).
    • Restrictive: Normal flows (FEV1/FVC >70%), Decreased volumes (RV, FRC, TLC).
  • Reversibility of Obstruction
    • Calculated with increase in FEV1 post-bronchodilator (>12% considered reversible).

Additional Test-Taking Tips

  • Prepare for both TMC and Clinical Simulations
    • Do not memorize; understand principles and how things work together.
  • During the test
    • Answer all questions; don’t leave anything blank.
    • Manage your time effectively and track your progress.

Overall, focus on understanding concepts, knowing how to apply them, and how to handle different types of questions on the exams. Practice real simulation scenarios and maintain a good test-taking routine to optimize your performance.