NEW RPSGT EXAM- 2018 Study Guide and Practice Test

The purpose of an intentional mask leak is to...

Wash out CO2 and prevent rebreathing

Recommended guidelines state that HSV can be considered when....

Cheyne Stokes and central Apneas have not been eliminated.

What is aerophagia?

The swallowing of air

What is maxillomandibular advancement?

Treatment that involves cutting and advancing the upper and lower jaw bones; enlarging and stabilizing the posterior airway.

What is the PRIMARY function of the EPAP setting?

To eliminate desaturations and arousals.

According to guidelines, how many Hypopneas need to occur in peds pts prior to increasing pressure?

1

What are the AASM guidelines for supplemental O2 during PAP studies?

1lmp during PAP titration when SPO2 is less than or equal to 88% for 5 or more minutes and in the absence of obstructive events.

If a pts Apneas are fixed at 10cm, but Hypopneas and snoring still occur at 16cm, what levels of BiLevel should be used?

IPAP: 14
EPAP: 10

Which of the following can reduce the effectiveness of CPAP and why: Nasal spray, Alcohol, Anti depressants.

Alcohol: impairs arousal response which can lead to longer than normal events and severe desats. Inhibits upper airway activity

What syndrome would a pt with COPD and OSA have?

Overlap syndrome

What are hypoxemia and hypercapnia?

Hypoxemia: very low 02 in the blood
Hypercapnia: very high CO2 in the blood.

What would a patient with both hypoxemia and hypercapnia most likely be diagnosed with?

Hypoventilation

What is an MWT's MOST important use?

Measure patients ability to resist the urge to fall asleep

Tricyclic antidepressants, large amounts of caffeine and large amounts of chocolate have been known to trigger what?

REM sleep behavior disorder

Recommended impedance for eeg and eog

5k ohms

The amount of space needed to archive digitized data is MOST impacted by?

Sampling rate

Cortical activity is best described as

Spontaneous arousal

Calculate the AHI based on the following data
25 obstructive apneas
5 central apneas
23 mixed apneas
15 hypopneas
48 RERAS
65 arousals
360 min of sleep

11

According to RECOMMENDED guidelines, the minimum duration of a significant leg movement is

.5

According to RECOMMENDED guidelines, an optional parameter to include in the report for an adult polysomnogram is

Occurrence of hypoventilation during the diagnostic study in adult

The respiratory event that requires oxygen desaturation and/ or an arousal as part of the scoring criteria is

Obstructive hypopnea

An ECG arrhythmia commonly seen when recording PSG's, particularly in patients that have obstructive sleep apnea and cardiac disease. It can be identified by the morphology of an irregularly irregular ventricular rhythm associated with replacement of consistent P waves by rapid oscillations that vary in size, shape, and timing

Atrial fibrillation

The stage that is the greatest portion of the epoch

The stage that is the greatest portion of the epoch

What is the best response when a patient asks the technologist if they have sleep apnea and will need to wear a CPAP mask?

Provide the patient with educational material about sleep apnea

Which of the following is the MOST LIKELY cause of a 35 minute REM latency

Untreated depression

A breathing pattern characterized by at least three cycles of crescendo breathing with duration of at least 10 minutes is

Cheyne Stokes respiration

An important responsibility of the scoring tech is to

Confirm accuracy of report components

Which type of calibration is based on a series of patient instructions intended to verify the signal response and quality

Physiological

The most important reason for performing a MWT is to

Measure the patient's ability to resist the urge to fall asleep

The importance of selecting sampling rates according to RECOMMENDED guidelines is to

Minimize aliasing effect

The syndrome characterized by prolonged episodes of severe hypoxemia and associated PaCO2 elevation that worsens during sleep is

Obesity hypoventilation

The patient's medical history indicates the patient has been taking tricyclic antidepressants for the past 5 years. The technologist should anticipate that the patient may have an increased likelihood of

REM Sleep Behavior Disorder

According to RECOMMENDED guidelines, the sampling rate to provide the optimal resolution for recording EEG in a patient with suspected nocturnal seizure is

500Hz

The electrode located 30% above the left pre-a crease is

C3

According to RECOMMENDED guidelines, four nap opportunities on a MSLT would be acceptable when the patient

Had REM on at least two nap opportunities

A patient's history indicates a diagnosis of overlap syndrome. The tech can anticipate that the patient has

COPD AND OSA

ACCORDING TO RECOMMENDED GUIDELINES, WHICH OF THE FOLLOWING SHOULD BE INCLUDED WHEN RECORDING PEDIATRIC PATIENTS

END-TIDAL CO2

THE ABILITY TO REMONTAGE WHILE RECORDING ON DIGITAL EQUIPMENT IS THE RESULT OF

SYSTEM REFERENCING

WHEN REVIEWING A PATIENT'S HISTORY IN PREPARATION FOR A POLYSOMNOGRAM, PHYSIOLOGIC FINDINGS SUGGESTIVE OF HYPOVENTILATION INCLUDE

HYPOXEMIA AND HYPERCAPNIA

WHEN THE AMPLITUDE OF A SIGNAL EXCEEDS THE PHYSICAL LIMITATIONS OF A CHANNEL THE MOST IMPORTANT ADJUSTMENT THE TECH CAN MAKE TO OPTIMIZE WAVEFORM DISPLAY IS TO

DECREASE SENSITIVITY

WHEN INTERMITTENT 60 HZ ACTIVITY OCCURS IN THE F4-M1 ELECTRODES DURING REM SLEEP THE BEST IMMEDIATE ACTION WOULD BE TO

RELY ON F3-M2

A PATIENT WITH MILD DEMENTIA BECOMES MORE CONFUSED AND/OR AGITATED IN THE EARLY EVENING. THE PATIENT IS MOST LIKELY EXPERIENCING

SUNDOWNING

THE MOST COMMON METHOD TO MONITOR BLOOD OXYGEN SATURATION DURING POLYSOMNOGRAPHY IS

PULSE OXIMETRY

THE MOST APPROPRIATE ACTION A TECHNOLOGIST WOULD TAKE WHEN THERE IS CONFIRMED VENTRICULAR TACHYCARDIA GREATER THAN 30 SECONDS IS

INITIATE EMERGENCY RESPONSE SYSTEM

A PATIENT'S CHART INDICATES THAT THEY USE 30 L/MIN OF OXYGEN AT HOME. THE TECH NOTES THAT THE PHYSICIAN'S ORDERS FOR THE PSG SPECIFIES THE STUDY WITHOUT SUPPLEMENTAL OXYGEN AND TO ADD 1.0 L/MIN OXYGEN IF THE SATURATION IS LESS THAN 89%. THE BEST ACTION FOR THE TECH IS TO

CALL THE PHYSICIAN FOR CONFIRMATION

WHICH OF THE FOLLOWING IS THE MOST LIKELY EFFECT OF ZOLPIDEM AND ZALEPLON ON SLEEP ARCHITECTURE

INCREASED SLEEP LATENCY

WHICH OF THE FOLLOWING BEST DESCRIBES A REFERENTIAL MONTAGE

THERE IS POTENTIAL FOR ELECTRODE CONTAMINATION

ACCORDING TO RECOMMENDED GUIDELINES, THE DEVICE THAT SHOULD BE USED TO MONITOR AIRFLOW AND DETECT APNEA DURING A DIAGNOSTIC STUDY IS

ORONASAL THERMAL SENSOR

WHICH PROCESS WOULD BE AN ADEQUATE ROUTINE FOR DISINFECTING CUP ELECTRODES AFTER REMOVING ADHESIVE RESIDUE, GEL AND ORGANIC MATERIAL, AND WASHING IN WARM WATER AND MILD DETERGENT

SOAKING IN 1: 10 BLEACH AND WATER FOR 10 MIN.

WHICH OF THE FOLLOWING WOULD BE MOST IMPORTANT TO DOCUMENT DURING A POLYSOMNOGRAM

POSITION CHANGES

THE ELECTRODE ARRAY USED FOR RECORDING PHYSIOLOGIC ACTIVITY IS REFERRED TO AS

MONTAGE

ACCORDING TO RECOMMENDED GUIDELINES, THE MAXIMUM ELECTRODE IMPEDANCE FOR EEG AND EOG RECORDING IS

5000 OHMS

ACCORDING TO RECOMMENDED GUIDELINES, UNATTENDED PORTABLE MONITORING CAN BE USED AS AN ALTERNATIVE TO IN LAB TESTING WHEN

THERE IS A HIGH PROBABILITY OF MODERATE TO SEVERE OSA WITHOUT COMORBID CONDITIONS

A SELF REPORTING TOOL USED TO EVALUATE SUBJECTIVE SLEEP QUALITY AND DISTURBANCE OVER THE PREVIOUS MONTH IS

PITTSBURGH SLEEP QUALITY INDEX

THE MOST APPROPRIATE SETTING A TECHNOLOGIST WOULD USE TO CONTROL THE FREQUENCY BAND OF WAVEFORMS ON A RECORDING IS THE

(LOW FILTER (HIGH PASS FILTER)

WHICH OF THE FOLLOWING CAN NEGATIVELY IMPACT ALL BIOELECTRIC CHANNELS

CONTAMINATED M1

WHICH OF THE FOLLOWING SUBSTANCES CAN REDUCE THE EFFECTIVENESS OF PAP THERAPY

ALCOHOLIC BEVERAGES

A PATIENT THAT INTENTIONALLY ENGAGES IN BEHAVIORAL PATTERNS THAT ARE INCONSISTENT WITH SLEEPING WELL IS DEMONSTRATING

INADEQUATE SLEEP HYGIENE

WHAT IS THE BEST TOOL THAT A PHYSICIAN COULD USE TO MORE CLEARLY EXPLAIN THE RESULTS OF THE SLEEP STUDY AND THE IMPORTANCE OF THERAPY TO A PATIENT

HISTOGRAM

REAL TIME ACCESS TO PAP COMPLIANCE DATA IS AN EXAMPLE OF

EFFICACY MONITORING

A PROCESS TO DECREASE FEAR OF ARTIFICIAL CIRCUMSTANCES BY REPEATED AND CONTROLLED EXPOSURE TO A FEARED SITUATION IS

DESENSITIZATION

WHAT HAS THE LARGEST IMPACT ON ADHERENCE TO PAP THERAPY

PATIENT EDUCATION

WHICH STATEMENT IS TRUE REGARDING CPAP

THERE IS ONE LEVEL OF PRESSURE FOR INSPIRATION AND EXPIRATION

SLEEP DEBT CAN BEST BE DESCRIBED AS THE

CUMULATIVE EFFECT OF INSUFFICIENT SLEEP

ACCORDING TO RECOMMENDED GUIDELINES FOR PEDIATRIC CPAP TITRATION, HOW MANY HYPOPNEAS MUST OCCUR PRIOR TO INCREASING PRESSURE

ONE

EXCESSIVE WARMING AND HUMIDIFICATION WILL CAUSE

WATER TO POOL IN THE CPAP TUBING

MAXILLOMANDIBULAR ADVANCEMENT TREATS OSA BY

ENLARGING AND STABILIZING THE UPPER AIRWAY

IN PATIENTS WITH SEVERE SLEEP-DISORDERED BREATHING THE MOST COMMONLY SEEN RESPONSE RESULTING FROM SUCCESSFUL PAP TITRATION IS

REM AND SLOW WAVE REBOUND

WHICH OF THE FOLLOWING IS MOST LIKELY TO OCCUR DUE TO AN IMPROPERLY FITTING PAP INTERFACE?

CONJUNCTIVITIS

WHEN A PATIENT COMPLAINS OF CLAUSTROPHOBIA, IS UNABLE TO TOLERATE PAP AND REQUESTS TO END THE PSG, THE NEXT BEST STEP IS TO

SCHEDULE DESENSITIZATION

A PATIENT REPORTS A COMPLETE NASAL OBSTRUCTION PRIOR TO PAP TITRATION. THE TECH SHOULD

USE A ORO-NASAL INTERFACE

THE BEST CANDIDATE FOR ORAL APPLIANCE WOULD HAVE

MILD OSA

DURING STAGE N2 SLEEP, THE PATIENT CHANGES POSITION AND THE TECH NOTES INCREASED SNORING AND AN INCREASING LEAK. THE TECH SHOULD

REPOSITION AND ADJUST PAP INTERFACE

ACCORDING TO RECOMMENDED GUIDELINES, CPAP SHOULD BE INCREASED AT AN INTERVAL NO LESS THAN

5 MINUTES

THE PRIMARY FUNCTION OF EPAP IS TO

MAINTAIN UPPER AIRWAY PATENCY THROUGH INSPIRATION

BASED ON THE PSG RESULTS BELOW, WHAT WOULD BE THE BEST RECOMMENDATION FOR A PATIENT THAT IS NON-COMPLIANT AND REFUSES TO CONTINUE WITH CPAP THERAPY
OVERALL AHI 8
OVERALL REM AHI 38
SUPINE REM AHI 28
SUPINE NREM AHI 21
LATERAL NREM AHI 1
LATERAL REM 3

POSITION THERAPY

THE BEST METHOD FOR DETECTING APNEAS AND HYPOPNEAS DURING PAP TITRATION IS TO USE A/AN

AIRFLOW SIGNAL GENERATED BY THE PAP DELIVERY DEVICE

THE PRIMARY BENEFIT OF HEATED HUMIDIFICATION IS TO

HELP REDUCE NASAL CONGESTION

A SIDE EFFECT OF CPAP IS

AEROPHAGIA

THE MOST COMMON REASON FOR CHANGING THE PAP INTERFACE DURING A TITRATION IS

UNACCEPTABLE LEAK VALUE

WHAT IS THE RECOMMENDED STARTING PRESSURE FOR PEDIATRIC AND ADULT CPAP TITRATION

4 CMH2O

THE PURPOSE OF INTENTIONAL LEAK IS TO

WASH OUT CO2 AND PREVENT REBREATHING

DURING CPAP TITRATION AT 10 CM H2O, SPO2, VALUES RANGE BETWEEN 80 AND 85% FOR 10 MIN DESPITE ABSENCE OF RESPIRATORY EVENTS. WHAT IS THE BEST ACTION FOR THE TECH TO TAKE

FOLLOW PROTOCOL FOR SUPPLEMENTAL OXYGEN

ACCORDING TO RECOMMENDED GUIDELINES, ADAPTIVE SERVO VENTILATION CAN BE CONSIDERED DURING A TITRATION STUDY WHEN A DOWN TITRATION

HAS NOT ELIMINATED CHEYNE STOKES RESPIRATION OR CENTRAL EMERGENT APNEAS

DURING A TITRATION STUDY THE PATIENTS APNEAS ARE ELIMINATED AT 10 CM H2O BUT HYPOPNEAS AND SNORING CONTINUE AT 16 CM H20. ACCORDING TO RECOMMENDED GUIDELINES, THE APPROPRIATE PRESSURES TO BEGIN A BILEVEL TITRATION ARE

IPAP 10
EPAP 14

DURING A CPAP TITRATION AT 15 CM H20, THE PATIENT IS RESTLESS AND CONTINUES TO HAVE FREQUENT OBSTRUCTIVE RESPIRATORY EVENTS. THE BEST ACTION IS TO

CHANGE TO BI LEVEL

DC Channel

PSG channel derived from an external piece of equipment such as a PAP device or oximeter.

Stray Capacitance

When electrical signals from external sources interfere w/ signals derived from the pt.

Amperes are measured in what units?

Coulombs/second

Time Axis

Horizontal positioning of the pen.

Common Mode Rejection

The process by which a differential amplifier rejects identical inputs (unwanted signals).

Mechanical Baseline

Pen's vertical position when the power to the PSG is turned off.

Electrical Baseline

The vertical positioning of the pen w/ power of PSG turned ON.

Capnometer

A device used to measure the level of CO2 in a sample of air.

Frequency

Measured in hertz(Hz) or cycles/second.

Paper Speed for PSG

10 mm/sec

When a pt. looks towards an EOG electrode it causes what?

A positive charge, or downward deflection.

Rise Time

Amount of time it takes for a wave to reach 63% of its peak.

Sensitivity Setting for EEG Channel

7uV/mm or 70uV/cm
*In pt.'s w/ low amplitude EEGs, the sensitivity can be adjusted to 5uV/mm or 50uV/cm

Filter Settings for Respiratory Effort & Airflow

LFF= 0.1Hz HFF= 15Hz