Pulmonary Function Testing Final Exam
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Section 1: Spirometry Basics (Questions 1-10)
Question 1
Which of the following volumes is directly measured during a forced vital capacity
(FVC) maneuver, rather than calculated?
A) Residual volume (RV)
B) Forced expiratory volume in 1 second (FEV₁)
FEV₁ is directly measured as the volume exhaled in the first second of a forced
maneuver. RV, functional residual capacity (FRC), and total lung capacity (TLC)
require gas dilution or plethysmography.
C) Total lung capacity (TLC)
D) Functional residual capacity (FRC)
Question 2
A patient performs a spirometry test. The FVC is 4.0 L, and the FEV₁ is 2.4 L. What
is the FEV₁/FVC ratio?
A) 40%
B) 60%
*FEV₁/FVC = 2.4 ÷ 4.0 = 0.60 or 60%. A ratio <70% (or < lower limit of normal)
suggests obstructive lung disease.*
C) 70%
D) 80%
,Question 3
Which of the following indicates acceptable spirometry test quality according to
ATS/ERS standards?
A) Only 2 attempts performed
B) Back-extrapolated volume <5% of FVC or 150 mL, whichever is greater
*Back-extrapolation detects delayed start of test (excessive hesitation).
Acceptable criteria: back-extrapolated volume <5% of FVC OR <150 mL (whichever
is larger). Also need 3 acceptable maneuvers with 2 reproducible within 150 mL.*
C) Exhalation time of 3 seconds
D) Cough during first second of exhalation
Question 4
What is the most common cause of a falsely low FEV₁ and FVC during spirometry?
A) Poor patient effort (submaximal exhalation)
Submaximal effort (not blasting out as hard or fast as possible) reduces both FEV₁
and FVC. Other common errors include slow start, early termination, and leak.
B) Calibration error causing falsely high volumes
C) Using a pediatric mouthpiece
D) Testing at high altitude
Question 5
A patient exhales forcefully for 6 seconds but has not reached a plateau (volume
continues to rise slowly). This maneuver is:
A) Acceptable if FVC is reproducible
B) Not acceptable; exhalation should continue until plateau (<0.025 L change
over 1 second)
*ATS/ERS criteria require a plateau on the volume-time curve (no further volume
increase) or exhalation ≥15 seconds in patients with severe obstruction. A rising
volume at 6 seconds indicates incomplete exhalation, underestimating FVC.*
C) Always acceptable in elderly patients
D) Diagnostic of restrictive disease
Question 6
Which predicted value set should be used to interpret spirometry in a 45-year-old
, Asian American male?
A) Caucasian reference equations
B) Race-specific or universal equations with ethnicity adjustment
*Lung volumes differ by race (Asians have ~10-15% lower FVC than Caucasians).
Using Caucasian equations may falsely label restrictive disease. Current ATS
recommends race-specific equations or universal equations with adjustment.*
C) Pediatric equations
D) No adjustment needed
Question 7
The peak expiratory flow rate (PEFR) is measured during which phase of
spirometry?
A) Maximal forced exhalation immediately after full inspiration
*PEFR is the maximum flow achieved during a forced exhalation from total lung
capacity (TLC), typically occurring within the first 50-100 ms.*
B) During slow vital capacity exhalation
C) During maximal inspiration
D) After 50% of FVC has been exhaled
Question 8
A patient with known COPD has FVC 3.0 L (60% predicted), FEV₁ 1.2 L (40%
predicted), FEV₁/FVC 40%. According to GOLD criteria, this patient has:
A) Severe obstruction
*GOLD grades obstruction by FEV₁ % predicted: Mild ≥80%, Moderate 50-79%,
Severe 30-49%, Very severe <30%. FEV₁ 40% predicted is severe.*
B) Moderate obstruction
C) Very severe obstruction
D) No obstruction
Question 9
What is the minimum exhalation time recommended for a patient with suspected
severe COPD during spirometry?
A) 3 seconds
B) 6 seconds
2026/2027 | Complete Exam Style– Questions
| 100% Verified – Detailed Rationales Pass
Guaranteed – A+ Graded
Section 1: Spirometry Basics (Questions 1-10)
Question 1
Which of the following volumes is directly measured during a forced vital capacity
(FVC) maneuver, rather than calculated?
A) Residual volume (RV)
B) Forced expiratory volume in 1 second (FEV₁)
FEV₁ is directly measured as the volume exhaled in the first second of a forced
maneuver. RV, functional residual capacity (FRC), and total lung capacity (TLC)
require gas dilution or plethysmography.
C) Total lung capacity (TLC)
D) Functional residual capacity (FRC)
Question 2
A patient performs a spirometry test. The FVC is 4.0 L, and the FEV₁ is 2.4 L. What
is the FEV₁/FVC ratio?
A) 40%
B) 60%
*FEV₁/FVC = 2.4 ÷ 4.0 = 0.60 or 60%. A ratio <70% (or < lower limit of normal)
suggests obstructive lung disease.*
C) 70%
D) 80%
,Question 3
Which of the following indicates acceptable spirometry test quality according to
ATS/ERS standards?
A) Only 2 attempts performed
B) Back-extrapolated volume <5% of FVC or 150 mL, whichever is greater
*Back-extrapolation detects delayed start of test (excessive hesitation).
Acceptable criteria: back-extrapolated volume <5% of FVC OR <150 mL (whichever
is larger). Also need 3 acceptable maneuvers with 2 reproducible within 150 mL.*
C) Exhalation time of 3 seconds
D) Cough during first second of exhalation
Question 4
What is the most common cause of a falsely low FEV₁ and FVC during spirometry?
A) Poor patient effort (submaximal exhalation)
Submaximal effort (not blasting out as hard or fast as possible) reduces both FEV₁
and FVC. Other common errors include slow start, early termination, and leak.
B) Calibration error causing falsely high volumes
C) Using a pediatric mouthpiece
D) Testing at high altitude
Question 5
A patient exhales forcefully for 6 seconds but has not reached a plateau (volume
continues to rise slowly). This maneuver is:
A) Acceptable if FVC is reproducible
B) Not acceptable; exhalation should continue until plateau (<0.025 L change
over 1 second)
*ATS/ERS criteria require a plateau on the volume-time curve (no further volume
increase) or exhalation ≥15 seconds in patients with severe obstruction. A rising
volume at 6 seconds indicates incomplete exhalation, underestimating FVC.*
C) Always acceptable in elderly patients
D) Diagnostic of restrictive disease
Question 6
Which predicted value set should be used to interpret spirometry in a 45-year-old
, Asian American male?
A) Caucasian reference equations
B) Race-specific or universal equations with ethnicity adjustment
*Lung volumes differ by race (Asians have ~10-15% lower FVC than Caucasians).
Using Caucasian equations may falsely label restrictive disease. Current ATS
recommends race-specific equations or universal equations with adjustment.*
C) Pediatric equations
D) No adjustment needed
Question 7
The peak expiratory flow rate (PEFR) is measured during which phase of
spirometry?
A) Maximal forced exhalation immediately after full inspiration
*PEFR is the maximum flow achieved during a forced exhalation from total lung
capacity (TLC), typically occurring within the first 50-100 ms.*
B) During slow vital capacity exhalation
C) During maximal inspiration
D) After 50% of FVC has been exhaled
Question 8
A patient with known COPD has FVC 3.0 L (60% predicted), FEV₁ 1.2 L (40%
predicted), FEV₁/FVC 40%. According to GOLD criteria, this patient has:
A) Severe obstruction
*GOLD grades obstruction by FEV₁ % predicted: Mild ≥80%, Moderate 50-79%,
Severe 30-49%, Very severe <30%. FEV₁ 40% predicted is severe.*
B) Moderate obstruction
C) Very severe obstruction
D) No obstruction
Question 9
What is the minimum exhalation time recommended for a patient with suspected
severe COPD during spirometry?
A) 3 seconds
B) 6 seconds
