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ANS: D
The definition of transpulmonary pressure (PL) is the pressure required to maintain alveolar inflation. Transairway pressure (P TA) is
the pressure gradient required to produce airflow in the conducting tubes. Transrespiratory pressure (P TR) is the pressure to inflate
the lungs and airways during positive-pressure ventilation. Transthoracic pressure (P TT) represents the pressure required to expand
or contract the lungs and the chest wall at the same time.
REF: pg. 4
6. Calculate the pressure needed to overcome airway resistance during positive-pressure ventilation when the proximal airway
pressure (PAw) is 35 cm H2O and the alveolar pressure (PA) is 5 cm H2O.
a. 7 cm H2O
b. 30 cm H2O
c. 40 cm H2O
d. 175 cm H2O
ANS: B
The transairway pressure (PTA) is used to calculate the pressure required to overcome airway resistance during mechanical
ventilation. This formula is PTA = Paw - PA.
REF: pg. 4
7. The term used to describe the tendency of a structure to return to its original form after being stretched or acted on by an outside
force is which of the following?
a. Elastance
b. Compliance
c. Viscous resistance
d. Distending pressure
ANS: A
The elastance of a structure is the tendency of that structure to return to its original shape after being stretched. Th e more elastance
a structure has, the more difficult it is to stretch. The compliance of a structure is the ease with which the structure distends or
stretches. Compliance is the opposite of elastance. Viscous resistance is the opposition to movement offered by adjacent structures
such as the lungs and their adjacent organs. Distending pressure is pressure required to maintain inflation, for example, alveolar
distending pressure.
REF: pg. 5
8. Calculate the pressure required to achieve a tidal volume of 400 mL for an intubated patient with a respiratory system compliance
of 15 mL/cm H2O.
a. 6 cm H2O
b. 26.7 cm H2O
c. 37.5 cm H2O
d. 41.5 cm H2O
ANS: B
ΔC = ΔV/ΔP then ΔP = ΔV/ΔC
REF: pg. 5
10. Calculate the effective static compliance (C s) given the following information about a patient receiving mechanical ventilation:
peak inspiratory pressure (PIP) is 56 cm H2O, plateau pressure (Pplateau) is 40 cm H2O, exhaled tidal volume (VT) is 650 mL, and
positive end expiratory pressure (PEEP) is 10 cm H2O.
a. 14.1 mL/cm H2O
b. 16.3 mL/cm H2O
c. 21.7 mL/cm H2O
d. 40.6 mL/cm H2O
ANS: C
The formula for calculating effective static compliance is Cs = VT/(Pplateau − EEP).
ANS: C
The formula for calculating effective static compliance is Cs = VT/(Pplateau − EEP).
12. A patient receiving mechanical ventilation has an exhaled tidal volume (V T) of 500 mL and a positive end expiratory pressure
setting (PEEP) of 5 cm H2O. Patient-ventilator system checks reveal the following data:
The respiratory therapist should recommend which of the following for this patient?
1. Tracheobronchial suctioning
2. Increase in the set tidal volume
3. Beta adrenergic bronchodilator therapy
4. Increase positive end expiratory pressure
a. 1 and 3 only
b. 2 and 4 only
c. 1, 2, and 3 only
d. 2, 3, and 4 only
ANS: A
Calculate the transairway pressure (P TA) by subtracting the plateau pressure from the peak inspiratory pressure. Analyzing the P TA
will show any changes in the pressure needed to overcome airway resistance. Analyzing the P plateau will demonstrate any changes in
compliance. The Pplateau remained the same for the first two checks and then actually dropped at the 1000-hour check. Analyzing the
PTA, however, shows a slight increase between 0600 and 0800 (from 12 to 14 cm H2O) and then a sharp increase to 23 cm H2O at
1000. Increases in PTA signify increases in airway resistance. Airway resistance may be caused by secretion buildup,
bronchospasm, mucosal edema, and mucosal inflammation. Tracheobronchial suctioning will remove any secretion buildup, and a
beta adrenergic bronchodilator will reverse bronchospasm. Increasing the tidal volume will add to the airway resistance according
to Poiseuille’s law. Increasing the PEEP will not address the root of this patient’s problem; the patient’s compliance is normal.
REF: pg. 7
13. The values below pertain to a patient who is being mechanically ventilated with a measured exhaled tidal volume (V T) of 700 mL.
Time Peak Inspiratory Pressure (cm H2O) Plateau Pressure (cm H2O)
0800 35 30
1000 39 34
1100 45 39
1130 50 44
REF: pg. 7
14. The respiratory therapist should expect which of the following findings while ventilating a patient with acute respiratory distress
syndrome (ARDS)?
a. An elevated plateau pressure (Pplateau)
b. A decreased elastic resistance
c. A low peak inspiratory pressure (PIP)
d. A large transairway pressure (P TA) gradient
ANS: A
ARDS is a pathological condition that is associated with a reduction in lung compliance. The formula for static compliance (CS)
utilizes the measured plateau pressure (P plateau) in its denominator (CS = VT /(Pplateau − EEP). Therefore, with a consistent exhaled
tidal volume (VT), an elevated Pplateau will decrease CS.
ANS: C
CS = VT/(Pplateau − EEP)
REF: pg. 7
16. Plateau pressure (Pplateau) is measured during which phase of the ventilatory cycle?
a. Inspiration
b. End-inspiration
c. Expiration
d. End-expiration
ANS: B
The calculation of compliance requires the measurement of the plateau pressure. This pressure measurement is made during
no-flow conditions. The airway pressure (Paw) is measured at end-inspiration. The inspiratory pressure is taken when the pressure
reaches its maximum during a delivered mechanical breath. The pressure that occurs during expiration is a dynamic measurement
and drops during expiration. The pressure reading at end-expiration is the baseline pressure; this reading is either at zero
(atmospheric pressure) or at above atmospheric pressure (PEEP).
REF: pg. 7
17. The condition that is associated with an increase in airway resistance is which of the following?
a. Pulmonary edema
b. Bronchospasm
c. Fibrosis
d. Ascites
ANS: B
Airway resistance is determined by the gas viscosity, gas density, tubing length, airway diameter, and the flow rate of the gas
through the tubing. The two factors that are most often subject to change are the airway diameter and the flow rate of the gas. The
flow rate of the gas during mechanical ventilation is controlled. Pulmonary edema is fluid accumulating in the alveoli and will
cause a drop in the patient’s lung compliance. Bronchospasm causes a narrowing of the airways and will, therefore, increase the
airway resistance. Fibrosis causes an inability of the lungs to stretch, decreasing the patient’s lung compliance. Ascites causes fluid
buildup in the peritoneal cavity and increases tissue resistance, not airway resistance.
REF: pg. 7
18. An increase in peak inspiratory pressure (PIP) without an increase in plateau pressure (P plateau) is associated with which of the
following?
a. Increase in static compliance (CS)
b. Decrease in static compliance (CS)
c. Increase in airway resistance
d. Decrease in airway resistance
ANS: C
The PIP represents the amount of pressure needed to overcome both elastance and airway resistance. The P plateau is the amount of
pressure required to overcome elastance alone. Since the P plateau has remained constant in this situation, the static compliance is
unchanged. The difference between the PIP and the Pplateau is the transairway pressure (P TA) and represents the pressure required to
overcome the airway resistance. If PTA increases, the airway resistance is also increasing, when the gas flow rate remains the same.
19. The patient-ventilator data over the past few hours demonstrates an increased peak inspiratory pressure (PIP) with a constant
transairway pressure (PTA). The respiratory therapist should conclude which of the following?
a. Static compliance (CS) has increased.
b. Static compliance (CS) has decreased. c.
Airway resistance (Raw) has increased. d.
Airway resistance (Raw) has decreased.
ANS: B
The PIP represents the amount of pressure needed to overcome both elastance and airway resistance. The P plateau is the amount of
pressure required to overcome elastance alone, and is the pressure used to calculate the static compliance. Since P TA has stayed the
same, it can be concluded that Raw has remained the same. Therefore, the reason the PIP has increased is because of an increase in
the Pplateau. This correlates to a decrease in C S.
REF: pg. 6
(1) We shoot with our eyes—we shoot the Namuki with our eyes,
The Wambunga, we shoot them with our eyes—the Namuki, we shoot them
with our eyes;
Bang! we shoot with our eyes—the Wamwera, we shoot them with our
eyes;
Bang! we shoot with our eyes—the Wakumbwa—we shoot them with our
eyes.
The singers, who are principally Nubians, state that this song is in
their mother tongue, the Darfur dialect. I have not yet succeeded in
obtaining a literal translation. The general meaning of the words,
which are sung with enviable lung-power and indefatigable energy, is
somewhat as follows:
“We are always strong. The Jumbe (headman) has been hanged by
the command of Allah. Hongo (one of the insurgent leaders) has
been hanged by the command of Allah.”
Thus much as to the results of my musical inquiries so far as they
concern the foreign elements (foreign, that is to say, here at Lindi) of
the Wanyamwezi and Nubians. I have obtained some records of
ngoma songs from Yaos and other members of inland tribes, but I
cannot tell for the present whether they are a success, as I find to my
consternation that my cylinders are softening under the influence of
the damp heat, so that I can take records, but cannot risk
reproducing them for fear of endangering the whole surface. A
cheerful prospect for the future!
Very interesting from a psychological point of view is the
behaviour of the natives in presence of my various apparatus. The
camera is, at any rate on the coast, no longer a novelty, so that its use
presents comparatively few difficulties, and the natives are not
particularly surprised at the results of the process. The only
drawback is that the women—as we found even at Dar es Salam—
usually escape being photographed by running away as fast as their
legs will carry them. The cinematograph is a thing utterly outside
their comprehension. It is an enchini, a machine, like any other
which the mzungu, the white man, has brought into the country—
and when the said white turns a handle on the little black box,
counting at the same time, in a monotonous rhythm, “Twenty-one,
twenty-two, twenty-one, twenty-two,” the native may be pleasantly
reminded of the droning measures which he is accustomed to chant
at his work; but what is to be the result of the whole process he
neither knows nor cares.
GIRLS FROM LINDI
Few people, I fancy, will know where Masasi is, yet those interested
in the Colonies might well be acquainted with its situation, for in its
own small way it is quite a civilizing centre. The English Mission[6]
has been at work here for nearly the third of a century, and, since the
suppression of the rebellion, a native corporal with a dozen black
German soldiers has been gallantly maintaining his ground, in a
boma specially built for the purpose, in case of any renewed warlike
impulses on the part of the interior tribes.
I preferred to take up my quarters with the soldiers, not from any
hostility to religion, but because the two clergymen at the mission
station, about an hour’s walk from us, are both advanced in years,
and it would be unfair to trouble them with visitors. Besides their
station was burnt down during the rebellion, so that they are leading
for the moment a more idyllic than agreeable life in their former
cattle-shed. In spite of this, the two old gentlemen, as I had every
opportunity of convincing myself in the course of two long visits,
enjoy extraordinarily good health. Archdeacon Carnon, the younger
of the two, in particular, took as lively an interest in the German
Emperor and his family as if he lived in a London suburb, instead of
in a negro village at the ends of the earth. Canon Porter seems to be
failing a little, but this is only to be expected as he is getting on for
eighty and has been in the country nearly thirty years.[7] In former
days I understand that he studied the ethnology of his district
(inhabited by Wanyasa, Wayao, and Wamakonde) very thoroughly,
so that up to yesterday I had great hopes of profitable results from
my intercourse with him and his more active colleague. But in this I
was disappointed. At the ceremonious, and, I must say, sumptuous
breakfast which the two clerical gentlemen set before us two
worldlings, Ewerbeck and me, whenever I began to speak about the
inhabitants of the neighbourhood and their tribal affinities, the
conversation was invariably diverted towards the Emperor and his
family! He must have made a truly extraordinary impression on
other nations.
However, our business is with the native African, not with the
white intruder, even though he should come in the peaceful guise of
the missionary.
My landing at Lindi of itself implied the main course of my
journey. A glance at the map of East Africa shows that the extreme
south-eastern corner of our colony, considered with regard to
population, stands out like an island from the almost uninhabited
country surrounding it. The region north of the Middle, and partly
also of the Upper Rovuma is (as Lieder, the geologist, whose early
death is such a loss to science, described it) a silent pori for hundreds
of miles, extending far beyond the Umbekuru and into the hinterland
of Kilwa—an uninhabited wilderness, where not a single native
village speaks of the large and peaceable population found here by
Roscher, Livingstone and Von Der Decken nearly half-a-century ago.
Only a narrow strip running parallel to the coast some distance
inland connects this island of population with the north, while
another, much more scantily peopled, runs up the Rovuma to the
Nyasa country.
Being thus cut off from surrounding tribes, the south-east—i.e., the
Makonde Plateau, the Lukuledi Valley north of it, and the wide plain
to the west of these highlands—forms a compact, well-defined whole,
an ideal sphere of work for one who, like
myself, has only a limited time at his disposal,
but wishes the work done in this time to be as
far as possible complete. The Wamwera,
whom I had in view in the first instance, have
had, to my great regret, to be postponed for
the present. I left Lindi on July 11th, with the
Imperial District Commissioner, Mr.
Ewerbeck. Ngurumahamba, the first
noticeable place on the Lukuledi road, still
bears the impress of the Coast—there is even a
stone house among the huts of the Waswahili;
but on the second day we reach the Yao tribe
at Mtua. Here we first come in touch with the
far interior, for these are the advance guard of
the great migration which brought this
vigorous and energetic race about the middle
of the last century from its old home south-
A MAN OF THE
MWERA TRIBE AND A east of Lake Nyasa towards the shores of the
YAO Indian Ocean, and which is still going on. As
to the way in which these migrations are
accomplished, we are apt to be misled by the
picture—no doubt a very incorrect one—which has remained in our
minds from our school-days, in connection with the migration par
excellence—the great westward movement of our own forefathers.
We think of men, horses, and waggons, a dense, compact wave of
people, rolling on slowly but irresistibly across the countries lying in
its track. Here we find nothing of the sort. It is true that these Mtua
Yaos are not typical of their tribe in this respect, as they were rescued
from the Wangoni, further north, on the eastern shore of Nyasa,
about ten years ago by Captain Engelhardt, and transferred to this
settlement. But otherwise the immigration of foreign (though still
African) elements takes place, here in the south, quietly and almost
imperceptibly—a band, a horde, a group of families, sometimes, but
not always, under the command of a chief, appears one fine day, hoes
a piece of land at a suitable place in the pori, builds a few airy huts,
and the immigration is complete. Conflicts, more or less sanguinary,
between the aborigines and the intruders may have occurred—may
even have been the rule—in former times; nothing of the kind seems
to happen to-day. Whether the native has become more tolerant, or
the firm hand of the German Government, to whom every accession
of population must be welcome, has produced a change in his views,
I am compelled to leave undecided.
In outward appearance these Yaos can scarcely be distinguished
from the Swahilis of the coast. The women are dressed in precisely
the same kind of kanga (calico printed in brightly-coloured patterns,
and manufactured in Holland), as the Coast women, though not so
neatly and fashionably as the girls at Dar es Salam, where the
patterns in vogue change faster than even at Paris. They also wear
the same coquettish little pin in the left nostril as the Coast ladies. Of
Indian origin, this kipini, called chipini in Yao, has conquered the
whole east coast of Africa, and is spreading, as a symbol of higher
culture and refinement, among the more progressive tribes of the
interior. In its simplest form a mere cylinder of pith, the better
specimens are made—according to the means of the wearer—of
ebony, tin, or silver. The ebony pins are almost always very tastefully
inlaid with tin. To our notions, the chipini hardly beautifies the
human countenance; but once the beholder is accustomed to its
effect, it becomes quite pretty and attractive, lending a coquettish
touch to the brown face it adorns.