TEST BANK FOR RUPPEL’S MANUAL OF PULMONARY FUNCTION TESTING 12th EDITION BY MOTTRAM.COMPLETE 2024/2025 UPDATE

TEST BANK FOR RUPPEL’S MANUAL OF PULMONARY FUNCTION TESTING 12th EDITION BY MOTTRAM COMPLETE 2024/2025 UPDATE Table of Contents. Chapter 1: Indications for Pulmonary Function Testing Test Bank 4 MULTIPLE CHOICE 4 Chapter 2: Spirometry 12 Chapter 3: Diffusing Capacity Tests Test Bank 27 MULTIPLE CHOICE 27 Chapter 4: Lung Volumes, Airway Resistance, and Gas Distribution Tests Test Bank 36 MULTIPLE CHOICE 37 Chapter 5: Ventilation and Ventilatory Control Tests Test Bank 45 MULTIPLE CHOICE 45 Chapter 6: Blood Gases and Related Tests Test Bank 54 MULTIPLE CHOICE 54 Chapter 7: Cardiopulmonary Exercise Testing Test Bank 64 MULTIPLE CHOICE 64 Chapter 8: Pediatric Pulmonary Function Tests Test Bank 76 MULTIPLE CHOICE 76 Chapter 9: Bronchoprovocation Testing Test Bank 85 MULTIPLE CHOICE 85 Chapter 10: Specialized Test Regimens Test Bank 90 MULTIPLE CHOICE 90 Chapter 11: Pulmonary Function Test Equipment Test Bank 97 MULTIPLE CHOICE 97 Chapter 12: Quality Systems in the Pulmonary Function Laboratory Test Bank 108 MULTIPLE CHOICE 108 Chapter 13: Reference Values and Interpretation Strategies Test Bank 126 MULTIPLE CHOICE 126 Chapter 1: Indications for Pulmonary Function Testing Test Bank MULTIPLE CHOICE 1. Who first popularized spirometry for the evaluation of pulmonary function? a. August and Marie Krogh b. Alvan Barach c. John Severinghaus d. John Hutchinson ANSWER: D Hutchinson popularized the concept of using VC to assess lung function, and the names he gave to several other lung compartments are still used today. 2. Which of the following are indications for performing spirometry? 1. Assess the risk of lung resection. 2. Determine the response to bronchodilator therapy. 3. Assess the severity of restrictive lung disease. 4. Quantify the extent of COPD. a. 1 and 4 b. 2 and 3 c. 1 , 2, and 4 d. 2 , 3, and 4 ANSWER: C Spirometry cannot assess severity of restriction; for that you need to measure lung volumes 3. The main indication for the measurement of lung volumes is to do which of the following? a. Diagnose or assess the severity of restriction. b. Evaluate the severity of pulmonary hypertension. c. Determine the level of cardiopulmonary fitness. d. Assess the risk of abdominal surgical procedures. ANSWER: A The most common reason for measuring lung volumes is to identify restrictive lung disease. 4. DLCO measurements may be indicated to evaluate pulmonary involvement in which of the following systemic diseases? a. Asthma b. Sarcoidosis c. Exertional hypoxemia d. Guillain-Barre syndrome ANSWER: B Sarcoidosis is the only systemic disease listed that affects gas exchange. 5. Blood gas analysis is used with patients with COPD to do which of the following? a. Monitor airway responsiveness. b. Determine level of cardiopulmonary fitness. c. Detect pulmonary hypertension. d. Assess need for supplementary O2. ANSWER: D Blood gas analysis is most commonly used to determine the need for supplemental oxygen and to manage patients who require ventilatory support. 6. Which of the following cause emphysema? 1. 1- Antitrypsin deficiency 2. Exposure to environmental pollutants 3. Radiation therapy 4. Cigarette smoking a. 1 and 2 b. 3 and 4 c. 1 , 2, and 4 d. 2 , 3, and 4 ANSWER: C Emphysema is caused primarily by cigarette smoking. Some emphysema is caused by the absence of a protective enzyme. Chronic exposure to environmental pollutants can also contribute to the development of emphysema. 7. An adult patient complains of chest tightness and cough whenever he jogs in cold weather. These symptoms are consistent with which of the following? a. Cystic fibrosis b. Asthma c. Pulmonary hypertension d. Idiopathic pulmonary fibrosis ANSWER: B Agents or events that cause an asthmatic episode are called triggers (see Box 1-7, Chapter 1). Antigens such as animal dander, pollens, and dusts are the most common triggers. Other common triggers include exposure to air pollutants and exercise in cold or dry air. 8. Which of the following statements concerning tumors in the upper airway is true? a. There may be variable or fixed obstruction. b. Fixed obstruction will be present. c. Variable obstruction will be present. d. Small airway obstruction will result. ANSWER: A Tumors involving the upper airway may cause variable or fixed obstruction. 9. Sarcoidosis is a systemic disorder that usually causes which of the following? a. A restrictive ventilatory defect b. An obstructive ventilatory defect c. Hyper reactive airways d. Primary pulmonary hypertension ANSWER: A Restriction is often associated with the following: interstitial lung diseases, including idiopathic fibrosis, pneumoconioses, and sarcoidosis . 10. For which of the following conditions might pulmonary function testing be contraindicated? a. Vocal cord dysfunction b. Untreated pneumothorax c. Congestive heart failure (CHF) d. Bronchiolitis obliterans ANSWER: B Pulmonary function tests are usually contraindicated in the presence of pneumothorax. However, undiagnosed pneumothorax may present a risk if pulmonary function studies are performed. 11. Which of the following correctly describe(s) appropriate physical measurements before pulmonary function testing? 1. Actual body weight should be used to calculate predicted values. 2. Standing height should be measured when the patient is barefoot. 3. Arm span should be used instead of height for a patient with kyphosis. 4. Age should be recorded to the nearest decade (10 years ). a. 1 only b. 2 and 3 c. 1 , 2, and 4 d. 1 , 2, 3, and 4 ANSWER: B Various physical measurements are required for estimating each patient’s expected level of pulmonary function. Age to the nearest month, height to the nearest 0.1 cm, and weight are usually recorded in addition to the patient’s gender. Race or ethnic origin should also be recorded. (Although body weight is recorded, it is not used to calculate predicted values.) 12. In addition to explaining the procedure for each pulmonary function test to the patient, the pulmonary function technologist should do which of the following? a. Briefly explain the physiologic basis of the test. b. Demonstrate the correct performance of the test maneuver. c. Limit feedback to the patient to reduce the placebo effect. d. Explain the exact number of efforts that will be required for each test. ANSWER: B In addition to a description of the test, the maneuver should always be demonstrated. 13. The single-breath diffusing capacity test was first described by: a. John Severinghaus b. August and Marie Krogh c. Robert Hyatt d. Leland Clark ANSWER: B The basis for the modern single-breath diffusing capacity (DLCO) test was described by August and Marie Krogh in 1911. 14. DLCO measurements may be indicated to evaluate gas exchange abnormality in which of the following? a. Ketoacidosis b. Myasthenia gravis c. Interstitial lung disease d. Bronchitis ANSWER: C The other options do not affect the alveolar capillary membrane interface. 15. Vocal cord dysfunction will typically affect the flow-volume loop in what way? a. Blunt the expiratory portion of the curve b. Blunt both the inspiratory and expiratory portions of the curve c. Blunt the inspiratory portion of the curve Have no effect on the curve but cause inspiratory stridor ANSWER: C The vocal cords are normally held open or abducted during inspiration. When damaged, the vocal cords move toward the midline, narrowing the airway opening. This type of obstruction limits flow primarily during inspiration. 16. All of the following disease processes are potential causes of a restrictive pattern except: a. Interstitial lung disease (e.g., fibrosis, sarcoidosis) b. Kyphoscoliosis c. Asthma d. Neuromuscular disorders ANSWER: C Asthma causes airway obstruction. 17. The following data are obtained from a subject complaining of shortness of breath: Predicted Found % Pred TLCpl 5.76 3.18 55 RVpl 2.38 1.18 50 FVC 3.38 2.10 62 FEV1 2.63 1.88 71 FEV1/FVC 78 89 DLCO 23.1 6.0 26 These data are most consistent with which disease entity? a. Pulmonary fibrosis b. Kyphoscoliosis c. Obesity d. Emphysema ANSWER: A Excerpt from the restrictive disease discussion: These reductions in VC and TLC occur as fibrosis causes the lungs to become stiff. Pulmonary fibrosis is the only disease entity listed that causes a reduction in lung volumes and affects the alveolar capillary interface (e.g., reduced DLCO). 18. Lou Gehrig, a famous New York Yankee baseball player, is often associated with which neuromuscular disease? a. Amyotrophic lateral sclerosis b. Guillain-Barré syndrome c. Diaphragm paralysis syndrome Myasthenia gravis A Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) affects the anterior horn cells of the spinal cord (motor neurons). 19. The following data are obtained from a subject complaining of shortness of breath: Predicted Found % Pred TLCpl 6.59 4.12 63 RVpl 2.43 3.01 124 FVC 4.16 1.14 28 FEV1 3.16 1.16 37 FEV1/FVC 76 99 MEP +190 63 33 MIP -101 -56 55 These data are most consistent with which disease entity? a. Obesity b. Pectus excavatum c. Pulmonary fibrosis d. Myasthenia gravis ANSWER: D Progression of a myasthenic crisis can be assessed using VC and respiratory pressures. Results would yield a reduction in lung volumes and respiratory muscle pressures, as seen in this case. 20. All of the following pulmonary function tests may be used to follow the effect of treatment for congestive heart failure except: a. Lung volumes d. ANSWER: b. Arterial blood gases c. Diffusing capacity d. Maximal respiratory pressures ANSWER: D Pulmonary function tests, particularly lung volumes and DLCO, may be used to monitor the effects of treatment. Arterial blood gases may also assist in assessing gas exchange, but the respiratory muscles are not affected. 21. All of the following anthropometric measurements are essential for pulmonary function testing except: a. Height b. Percent body fat c. Gender Age B Age, height, and weight are usually recorded in addition to the patient’s sex. Race or ethnic origin should also be recorded. 22. There are three essential components to an FVC maneuver. Which of the following is the first phase of the maneuver? a. A deep breath to TLC b. Continued exhalation to RV c. The initial blast of inspiratory breath after emptying the lungs fully ANSWER: A According to the American Thoracic Society-European Respiratory Society (ATS-ERS) guidelines, the first important portion of the maneuver is the deep breath to TLC before the initial blast. 23. According to the ATS-ERS general considerations guidelines, all of the following should be avoided before lung function testing except: a. Smoking within 1 hour of testing b. Wearing restrictive clothing c. Eating a large meal within 2 hours of testing d. Consuming alcohol within 4 hours of testing ANSWER: B According to the ATS-ERS general guidelines, all should be avoided before testing except wearing restrictive clothing. 24. According to the ATS-ERS general considerations guidelines, all of the following laboratory variables must be recorded except: a. Ambient temperature b. Date and time of test c. When the equipment was last cleaned d. Barometric pressure ANSWER: C According to the ATS-ERS general guidelines, all variables listed must be recorded except equipment cleaning. 25. Who is credited with first describing the flow-volume curve? a. Hyatt b. Hutchinson c. Tiffeneau d. Fowler ANSWER: A Hyatt is recognized for first describing the flow-volume curve in the 1950s. 26. Which of the following is an indication for a cardiopulmonary exercise test? a. Vocal cord dysfunction b. Pulmonary rehabilitation prescription c. Exercise-induced asthma d. Undefined cough ANSWER: B Understanding the physiologic basis for the patient’s exercise limitation is an important aspect in prescribing effective therapy such as pulmonary rehabilitation. 27. A patient with cystic fibrosis may present with an increased: a. FRCpl and RV/TLC ratio b. FVC and FEV1 c. VA and DLCO d. MIP and MEP ANSWER: A Cystic fibrosis results in gas trapping as the disease progresses, which is revealed in lung volume measurements. 28. Technologist-driven protocols allow a selection of tests related to the: a. Diagnosis b. Clinical question asked c. Physician interpretation d. Work of breathing ANSWER: B The initial tests performed should be based on the clinical question to be answered by the pulmonary function testing. Additional tests are determined based on the results of the selected tests associated with the clinical question. 29. According to the ATS-ERS recommendations, which of the following activities should be avoided before testing lung function? 1 . Smoking within 1 hour of testing 2. Vigorous exercise 30 minutes before testing 3. Eating a large meal 2 hours before testing 4. Consuming alcohol within 24 hours of testing a. 1 , 3, and 4 b. 1 and 4 c. 2 , 3, and 4 d. 1 , 2, and 3 ANSWER: D Consuming alcohol should be avoided 4 hours before the test; otherwise, all other recommendations are correct. Chapter 2: Spirometry Test Bank MULTIPLE CHOICE 1. A subject who complains of shortness of breath has an FVC of 2.57 L, but her VC is 2.99 L. These findings suggest which of the following? a. Pulmonary fibrosis b. Chest wall abnormality c. Emphysema d. Fixed upper airway obstruction ANSWER: C FVC is often lower than VC in patients with obstructive diseases if forced expiration causes airway collapse. This pattern is often seen in emphysema because of loss of tethering support of the airways. 2. A 47-year-old man with a history of cough has the following spirometry results: Measured Predicted FVC (L BTPS) 3.85 4.01 FEV1 (L BTPS) 2.14 3.33 These findings show the presence of which of the following? a. Reversible airway obstruction b. Moderate obstructive disease c. Normal lung function d. Incorrectly selected predicted values ANSWER: B While the ratio of FEV1/VC defines obstruction, the severity of obstruction is defined by the degree to which the FEV1 is reduced. Moderate FEV1= 60% to 69% of predicted; 2.14 □ 3.33 = 64%. 3. A 22-year-old patient with dyspnea performs three spirometry trials. Trial 1 Trial 2 Trial 3 FVC (L BTPS) 4.21 4.49 4.65 FEV1 (L BTPS) 3.88 3.91 3.93 The pulmonary function technologist should do which of the following? a. Report the values from Trial 3. b. Report the largest sum of FVC and FEV1. c. Average the data from Trials 2 and 3. d. Perform at least one more maneuver. ANSWER: D The two largest values for both FVC and FEV1 should be within 150 ml (or within 100 ml if the FVC is 1 L or less). The second largest value is simply subtracted from the largest value for both FVC and FEV1 to determine repeatability. If repeatability is not met, additional acceptable trials should be performed. 4. Why should all values from a series of peak flow measurements be reported? a. PEF may decrease with repeated efforts. b. A minimum of three values must be averaged. c. Peak flowmeters do not need to be precise. d. Forced exhalation produces a bronchodilator effect. ANSWER: A At least three maneuvers should be performed and recorded, along with the order in which the values were obtained. All readings are recorded to detect effort-induced bronchospasm. 5. Which of the following determines the shape of the “effort-independent” portion of the expiratory F-V curve? 1. Abdominal pressure during forced expiration 2. Elastic recoil of the lung 3. Flow resistance in the small airways 4. Cross-sectional area of the trachea a. 1 and 2 b. 2 and 3 c. 1, 3, and 4 d. 4 only ANSWER: B Elastic recoil determines the pressure applied to gas in the lung during a forced expiration. This pressure is determined by the recoil of the lung and chest wall. Resistance to flow in the airways is the second factor affecting the shape of the flow- volume curve. 6. A patient being evaluated for disability has the following spirometry results: Measured Predicted FVC (L) 4.00 4.10 FEV1 (L) 2.00 3.30 MVV (L/min) 105 110 What do these findings indicate? a. The patient has moderate obstructive disease. b. The patient has restriction. c. The patient‟s FEV1 is larger than measured. d. The patient did not make a good effort on the MVV. ANSWER: A While the ratio of FEV1/FVC defines obstruction, the severity of obstruction is defined by the degree to which the FEV1 is reduced. Moderate FEV1= 60% to 69% of predicted; 2.00  3.30 = 61%. DIF: 2 REF: p. 51 OBJ: AL-2 MSC: NBRC: CPFT 3C-3 7. Before bronchodilator studies, inhaled -adrenergic agents should be withheld for how long? a. 0.5 to 1.5 hours unless corticosteroids are being used b. 4 to 12 hours for regular or long-acting preparations c. 24 hours for most inhalers d. 24 to 48 hours ANSWER: B See Table 2-2, Chapter 2. 8. Which answer is consistent with the following flow-volume curve? a. Normal forced expiratory flow pattern b. Variable intrathoracic obstruction c. Airways obstruction d. Fixed large airway obstruction ANSWER: C 9. A subject has spirometry repeated before and after inhaled bronchodilators. The following data are obtained: Predicted Before Drug After Drug FVC 5.20 4.90 5.30 FEV1 4.10 3.10 3.30 PEF 9.20 7.77 8.92 Which of the following statements best describes these findings? a. There is mild obstruction with significant response to bronchodilators. b. There is mild obstruction without significant change after bronchodilators. c. There is a paradoxical response to bronchodilators. d. Spirometry is within normal limits. ANSWER: B While the ratio of FEV1/VC defines obstruction, the severity of obstruction is defined by the degree to which the FEV1 is reduced. Mild FEV1 is greater than 70% predicted (3.10  4.10 = 75%). Bronchodilator response is significant if the percent change is 12% or there is an absolute increase greater than 200 ml. 10. A 50-year-old woman with dyspnea has the following spirometry results: Measured Predicted FVC (L BTPS) 3.99 4.10 FEV1 (L BTPS) 3.44 3.33 These findings are consistent with which of the following? a. Reversible airway obstruction b. Mild obstructive disease c. Normal lung function d. Invalid predicted values ANSWER: C Data are within normal limits. (FEV1/FVC 86%; FEV1 97% of predicted.) 11. A 17-year-old patient with asthma performs three spirometry trials: Trial 1 Trial 2 Trial 3 FVC (L BTPS) 3.21 3.44 3.49 FEV1 (L BTPS) 2.88 2.91 2.93 The pulmonary function technologist should do which of the following? a. Report the values from Trial 3. b. Average the data from Trials 2 and 3. c. Calibrate the spirometer and repeat all three trials. d. Perform at least one more maneuver. ANSWER: A Spirometry acceptability and repeatability criteria were achieved. Report the largest FVC and FEV1. 12. A subject being tested for possible environmental exposure to asbestos produces the following spirometry results: Measured Predicted FVC (L) 4.00 4.07 FEV1 (L) 3.44 3.37 MVV (L/min) 52 135 The pulmonary function technologist may conclude that: a. The patient has restriction. b. The patient has moderate obstructive disease. c. The patient‟s FEV1 is not valid. d. The patient did not make a good effort on the MVV. ANSWER: D If the measured MVV is less than 80% of (FEV1  40), poor patient effort or neuromuscular weakness may be suspected. 13. Which of the following diagnoses is consistent with the following flow-volume curve? a. Variable intrathoracic obstruction b. Fixed extrathoracic obstruction c. Small airway obstruction d. Normal expiratory and inspiratory flows ANSWER: D See Interpretive Strategies 2-3, Chapter 2. 14. Which answer is consistent with the following three superimposed flow-volume loops? a. Normal airway function b. Small airway obstruction c. Variable intrathoracic restriction d. Fixed extrathoracic obstruction ANSWER: D 15. A subject has an FVC of 1.8L(39% of predicted) The same individual has a slow VC of 2.7 L. Which of the following might explain these findings? 1. Normal findings in severe restrictive disease 2. Airway compression in obstructive lung disease 3. Poor effort or early termination of the FVC 4. Representative findings in early small airway disease a. 1, 3, and 4 b. 2 and 3 c. 1 and 4 d. 2 only ANSWER: B FVC is often lower than VC in patients with obstructive diseases, if forced expiration causes airway collapse. This pattern is often seen in emphysema because of loss of tethering support of the airways. Poor effort during the FVC maneuver can also affect the results. 16. A subject produces the following simple spirometry results: Measured Predicted FVC (L, BTPS) 4.5 4.0 FEV1 (L, BTPS) 3.6 3.2 These findings are consistent with: a. Combined obstruction and restriction b. Moderate obstructive disease c. Normal lung function d. Incorrectly selected predicted values ANSWER: C Data are within normal limits. (FEV1/FVC 80%; FEV1 113% of predicted.) 17. A subject referred for pulmonary function tests because of shortness of breath has an FEV1 of 98%. This finding is suggestive of: a. Restrictive lung disease b. Obstructive lung disease c. Normal lung function d. Upper airway abnormality ANSWER: C Data are within normal limits. 18. The FEF25%-75% depends on which of the following? a. FVC b. PEF c. FEV1 d. FEV1% ANSWER: A FEF25%-75% is measured from a segment of the FVC. 19. In diseases that cause obstruction of the small airways, the MEFV curve may assume a concave appearance because of: 1. Loss of elastic recoil 2. Turbulent gas flow patterns 3. Increased specific conductance 4. Increased airway resistance a. 1, 2, and 3 b. 2, 3, and 4 c. 2 and 3 d. 1 and 4 ANSWER: D The degree of concavity increases because of reduced flows resulting from loss of elastic recoil. Increased airway resistance would also cause flow limitation. 20. A patient produces the following spirometry results: Actual Predicted FVC (L) 4.0 4.1 FEV1 ( L) 2.0 3.3 MVV (L/min) 45 110 These findings indicate that: 1. Obstruction is present. 2. Restriction is present. 3. The FEV1 is overestimated. 4. The MVV is underestimated. a. 1, 2, and 3 b. 2, 3, and 4 c. 1 and 4 d. 2 and 3 ANSWER: C While the ratio of FEV1/VC defines obstruction (50%), the severity of obstruction is defined by the degree to which the FEV1 is reduced. Moderate FEV1= 60% to 69% of predicted; 2.00  3.30 = 61%. If the measured MVV is less than 80% of (FEV1  40), poor patient effort or neuromuscular weakness may be suspected. 21. In addition to the FEV1 and FVC, which of the following is useful in gauging subject effort during spirometry? a. PEF b. FEF50% c. FEF25%-75% d. max25 ANSWER: A Other methods of selecting the best test have been suggested and are sometimes used. PEF may be used to assess patient effort for an FVC maneuver. 22. Which answer is consistent with the flow-volume curve shown? a. Normal forced expiratory flow pattern b. Variable intrathoracic obstruction c. Airway obstruction d. Fixed extrathoracic obstruction ANSWER: C See Interpretive Strategies 2-3, Chapter 2. 23. According to the 2005 ATS-ERS repeatability standards, of the three acceptable tracings, the two largest FVC values and the two largest FEV1 values in a subject with a vital capacity greater or equal to 1.0 L should be within how many milliliters? a. 50 b. 100 c. 150 d. 200 ANSWER: C The two largest acceptable values for both FVC and FEV1 should be within 150 ml (or within 100 ml if the FVC is 1 L or less). The second largest value is simply subtracted from the largest value for both FVC and FEV1 to determine repeatability. 24. Back extrapolation is the method used to determine “time zero” when measuring which of the following parameters? a. FVC b. FEV1 c. FEF25%-75% d. MVV ANSWER: B To accurately determine FEV1, the back-extrapolated volume should be less than 5% of the FVC or less than 150 ml, whichever is greater. 25. A subject performed four acceptable FVC maneuvers. Predicted Maneuver 1 Maneuver 2 Maneuver 3 Maneuver 4 FEV1 4.80 4.83 4.60 4.23 4.03 What do the results most likely represent? a. Variable effort b. Malingering c. Inability to understand the test d. Maneuver-induced bronchospasm ANSWER: D Positioning loops side by side or superimposing can also help detect decreasing flows with repeated efforts. This pattern may be seen because FVC maneuvers can induce bronchospasm. 26. A 62-year-old female complaining of shortness of breath has the following spirometry results. Ambient temperature is 26 C (conversion factor = 1.068). FEV1 FVC Trial 1 2.10 2.65 Trial 2 1.96 N 3.11 Trial 3 1.99 2.99 What is the subject‟s reportable FEV1 in BTPS conditions? a. 2.10 L b. 2.17 L d. 2.24 L d. 2.65 L ANSWER: C The data appear acceptable and repeatable. The largest FEV1 should be reported, which is 2.10. Multiply this value by the BTPS correction factor (2.10  1.068 = 2.24 L). 27. What are the recommended dosages for assessing bronchodilator response, according to the ATSERS spirometry guidelines? a. Four doses of albuterol (100 µg) or ipratropium bromide (40 µg) b. Two doses of albuterol (100 µg) or ipratropium bromide (80 µg) c. Four doses of albuterol (80 µg) or ipratropium bromide (80 µg) d. Two doses of albuterol (80 µg) or ipratropium bromide (40 µg) ANSWER: A The ATS-ERS guidelines‟ recommended dose of albuterol is 400 µg, delivered as four inhalations of 100 µg each by MDI, separated by 30-second intervals. For ipratropium bromide, the recommended dose is 160 µg, delivered as four inhalations of 40 µg each by MDI. 28. What is the calculated bronchodilator response in this subject? Pre-Drug Post-Dilator FVC 4.5 4.8 FEV 2.8 3.9 a. 39% b. 6% c. 1.1 L d. 71% ANSWER: A Percent change in FEV1 is calculated. Post-FEV1–pre-FEV1/pre-FEV1 ([(3.9 – 2.8)  2.8] □ 100 = 39%). 29. According to the ATS-ERS recommendations, what are the criteria for measuring an accurate height in a subject before testing? 1. Shoes off 2. Feet apart 3. Heels flat against wall 4. Standing upright a. 1 and 4 b. 1, 2, and 4 c. 1, 3, and 4 d. All of the above ANSWER: C The height should be measured without shoes, with the feet together, standing upright ,with shoulders, buttocks, and heels flat against the wall or stadiometer, and the head tilted so that the lower orbital level and the external auditory meatus (Frankfurt plane) are level; measurements should be recorded to the nearest 0.1 cm. 30. Which of the following would be considered key components of the FVC maneuver? a. Maximal inspiration, blast of expiration, and complete exhalation b. Maximal inspiration and exhalation for at least 6 seconds c. Forceful exhalation, exhalation for at least 6 seconds in adults and 3 seconds in children younger than the age of 10 d. No cough in the first second and a fast start (back extrapolation 150 ml) ANSWER: A There are three distinct phases to the FVC maneuver, as follows: (1) maximal inspiration, (2) a „„blast‟‟ of exhalation, and (3) continued complete exhalation to the end of the test. 31. A 48-year-old female complaining of cough has the following spirometry results: Pre-Drug % Predicted Post-Dilator FVC 3.32 94 3.58 FEV1 2.34 79 2.75 FEV1/FVC 70.4 76.7 How would you interpret her spirometry results? a. Normal spirometry with no significant response to bronchodilator b. Mild obstruction with a positive response to bronchodilator c. Mild obstruction with no significant response to bronchodilator d. Normal spirometry with a positive response to bronchodilator ANSWER: B While the ratio of FEV1/FVC defines obstruction, the severity of obstruction is defined by the degree to which the FEV1 is reduced. Mild FEV1 is greater than 70% of predicted. Bronchodilator response is significant if FEV1 increases greater or equal to 12% or an absolute increase is greater or equal to 200 ml. 32. A 63-year-old male complaining of shortness of breath and muscle weakness has the following pulmonary function results: Measured % Predicted FVC 4.27 96 FEV1 3.29 93 FEV1/FVC 77.1 These findings are consistent with: a. Normal study b. Borderline obstruction c. Neuromuscular weakness (e.g., ALS) d. Mild obstruction ANSWER: A Data are within normal limits. 33. A 69-year-old female complaining of cough and shortness of breath has the following pulmonary function results: Measured % Predicted FVC 1.54 58 FEV1 1.22 57 FEV1/FVC 79.2 These findings are consistent with: a. Severe obstruction b. Moderate restriction with no evidence of obstruction c. Severe restriction with concomitant obstruction d. Variable extrathoracic obstruction ANSWER: B If both FVC and FEV1 reduced proportionately, restriction is present. 34. A subject has the following spirometry results: Trial 1 Trial 2 Trial 3 Trial 4 FVC 1.48 1.67 1.42 1.38 FEV1 1.18 1.38 1.22 1.18 What do the results most likely represent? a. Variable effort b. Maneuver induced bronchospasm c. Unacceptable maneuvers d. Repeatable maneuvers ANSWER: A The two largest values for both FVC and FEV should be within 150 ml (or within 100 ml if the FVC is 1 L or less). The second largest value is simply subtracted from the largest value for both FVC and FEV1 to determine repeatability. Because the repeatability criteria were not achieved, the efforts are too variable. 35. The following data were obtained while performing a spirometry test on a 43-year-old patient. Trial 1 Trial 2 Trial 3 FVC 3.90 L 4.15 L 4.30 L FEV1 3.25 L 3.60 L 3.50 L What should the technologist do next? a. Perform another trial. b. Report the FVC and FEV1 from Trial 3. c. Report the FVC and FEV1 from Trial 2. d. Report the FVC from Trial 3 and the FEV1 from Trial 2. ANSWER: D Spirometry acceptability and repeatability criteria were achieved. Report the largest FVC and FEV1. 36. Which of the following parameters does not have to be corrected to BTPS? a. FEV1/FVC ratio b. FEF25%-75% c. FVC d. FEV1 ANSWER: A The FVC and FEVt are both reported in liters corrected to BTPS. FEVt% is the ratio of FEVt to FVC, expressed as a percentage. 37. A 52-year-old female has a 30-pack-year history of cigarette smoking and has shortness of breath. Room temperature is 26 C (conversion factor = 1.068). FEV1 FVC Trial 1 2.00 2.50 Trial 2 1.98 3.01 Trial 3 1.95 2.96 What is the subject‟s reportable FEV1 in BTPS conditions? a. 2.00 L b. 2.11 L c. 2.14 L d. 2.67 L ANSWER: C The data appear acceptable and repeatable. The largest FEV1, which is 2.00, should be reported. Multiply this value by the BTPS correction factor (2.00  1.068 = 2.14 L). Chapter 3: Diffusing Capacity Tests Test Bank MULTIPLE CHOICE 1. Why is CO an ideal gas for measuring diffusing capacity of the lungs? a. It is taken up by Hb in a manner similar to O2. b. It is always present in capillary blood at 0.3%. c. It is quickly converted to CO2 in the lungs. d. It does not react with He or other tracer gases. ANSWER: A A small amount of CO in inspired gas produces measurable changes in the concentration of inspired versus expired gas. Because little or no CO is normally present in pulmonary capillary blood, the pressure gradient causing diffusion is basically the alveolar pressure. 2. Which of the following determines the fractional concentration of CO after 10 seconds of breath holding (FACOT) ? a. (FAHe/FIHe)  FICO b. Volume inspired divided by FAHe/FIHe c. Estimation of the ratio FICO/FAHe d. Measurement of CO from an alveolar sample ANSWER: D The sample is analyzed to obtain the fractional CO and tracer gas concentrations in alveolar gas, FACOT (where T is the time of the breath hold), and FA tracer, respectively. The concentration of CO in the alveoli at the beginning of the breath hold (FACO0) must be determined as well. 3. The Jones method of timing the breath hold for DLCOsb measures the interval from of alveolar sampling. a. Beginning of inspiration to beginning b. 0.3 units of inspiratory time to the middle c. 0.5 units of inspiratory time to the middle d. Beginning of breath hold to the end ANSWER: B The Jones method measures breath-hold time from 0.3 of the inspiratory time to the midpoint of the alveolar sample collection. 4. A Valsalva maneuver during the DLCOsb: a. Is required to properly perform the breath hold b. May cause the DL/VA to appear artificially elevated c. May cause the DLCOsb to appear artificially reduced d. Helps keep breath-hold time between 8 and 12 seconds ANSWER: C A Valsalva maneuver reduces pulmonary capillary blood volume and may produce a falsely