Deck 19: Pulmonary Function Testing

Question 1

To ensure validity of the forced vital capacity (FVC) measurement, how many attempts should the patient perform?

A)just one good one
B)two that are nearly the same
C)three that are acceptable
D)at least four

Answer 1

C

Question 2

What is the most common measurement of pulmonary mechanics during pulmonary function testing?

A)tidal volume
B)forced vital capacity
C)residual volume
D)inspiratory reserve volume

Answer 2

B

Question 3

What is the ability of a measuring device to consistently provide the same measure of the same quantity?

A)capacity
B)accuracy
C)linearity
D)precision

Answer 3

D

Question 4

What is the primary problem in obstructive lung disease?

A)increased airway resistance
B)low lung volumes
C)increased pulmonary capillary pressure
D)reduced lung diffusion

Question 5

What do relative contraindications for lung volume determinations include?
I)recent cataract removal surgery
II)unstable cardiovascular status
III)untreated pneumothorax
IV)hemoptysis of unknown origin

A)I, II, and III
B)II and IV
C)I, III, and IV
D)I, II, III, and IV

Question 6

All of the following pulmonary function devices directly collect and measure gas volumes except:

A)water-sealed spirometer
B)dry rolling-seal spirometer
C)bellows spirometer
D)pneumotachometer

Question 7

To what does the range or limit of a device's measuring ability refer?

A)capacity
B)accuracy
C)error
D)precision

Question 8

What is the American Thoracic Society standard for volumetric accuracy of spirometers?

A)±1% error, or within 10 ml of the reference value
B)±3% error, or within 50 ml of the reference value
C)±5% error, or within 100 ml of the reference value
D)±10% error, or within 500 ml of the reference value

Question 9

Which of the following are indications for assessing pulmonary function?
I)screen for pulmonary disease
II)evaluate patients for surgical risk
III)assess the progression of disease
IV)assist in determining pulmonary disability
V)modify the therapeutic approach to patient care

A)I, III, and IV
B)III, IV, and V
C)I, II, III, IV, and V
D)II, IV, and V

Question 10

What is the American Thoracic Society standard for accuracy when measuring flows during pulmonary function testing?

A)90% accuracy or within 0.30 L/sec, whichever is greater
B)95% accuracy or within 0.20 L/sec, whichever is greater
C)97% accuracy or within 0.10 L/sec, whichever is greater
D)99% accuracy or within 0.05 L/sec, whichever is greater

Question 11

You perform a series of pulmonary function tests on a patient with a potentially infectious disease carried via the airborne route. Which of the following infection-control procedures should you implement?
I. Wear a respirator or close-fitting surgical mask.
II. Dispose of, sterilize, or disinfect the tubing circuit after testing.
III. Clean the interior surface of the spirometer before the next test.

A)I
B)I and II
C)II and III
D)I, II, and III

Question 12

What would you use to determine the accuracy of a water-sealed spirometer in measuring lung volumes?

A)calibrated high-flow flowmeter
B)computer-generated flow patterns
C)calibrated 3-L syringe
D)standard subject with known volumes

Question 13

How often should a spirometer in continual use undergo volumetric calibration?

A)every 4 hours
B)every shift
C)at least daily
D)weekly

Question 14

Which of the following is typically elevated in restrictive lung disease?

A)lung compliance
B)lung volumes
C)pressure needed to expand the lung
D)airway's resistance

Question 15

Which of the following adverse reactions is NOT seen with pulmonary function testing?

A)syncope
B)cough
C)hemoptysis
D)chest pain

Question 16

Tests of pulmonary mechanics include all of the following except:

A)maximum voluntary ventilation (MVV)
B)functional residual capacity
C)forced expiratory flows (FEFs)
D)forced expiratory volumes (FEVs)

Question 17

While checking the accuracy of a portable spirometer for volumetric measures with a calibrated super syringe, you obtain a mean measured value of 2.7 L. What is the percent error of this instrument?

A)1%
B)10%
C)30%
D)90%

Question 18

What do we measure to determine the precision of an instrument?

A)mean measured reference value
B)difference between the mean measured and actual reference value
C)range of the mean measured reference value
D)standard deviation (SD) of the mean measured reference value

Question 19

How closely a device measures a certain reference value refers to what quality?

A)capacity
B)accuracy
C)linearity
D)precision

Question 20

Which of the following statements is FALSE regarding measurement of the patient's forced vital capacity (FVC)?

A)The patient can be sitting or standing.
B)Nose clips are not required.
C)It is an effort-dependent test.
D)Accurate results can be obtained without patient cooperation.

Question 21

What is the predicted normal forced vital capacity (FVC) for the average 20-year-old man?

A)4.5 L
B)5.6 L
C)6.2 L
D)7.0 L

Question 22

What is the predicted normal FEV₁ for the average 20-year-old man?

A)3.3 L
B)4.0 L
C)4.7 L
D)5.2 L

Question 23

How can you ensure reliability when measuring the expiratory reserve volume (ERV)?

A)Have the patient perform the maneuver twice, ensure consistency, then take the best value.
B)Have the patient perform the maneuver three times, and then take the last value.
C)Have the patient perform the maneuver twice, ensure consistency, then take the mean value.
D)Have the patient perform the maneuver until he or she becomes fatigued, and then take the last value.

Question 24

You have just given your patient a 0.03 mg/ml dose of methacholine to assess for asthma. The subsequent forced vital capacity (FVC) shows no change. What should you do next?

A)Report to the physician that the patient does not have asthma.
B)Wait 1 hour and repeat the test at the same dose.
C)Have the patient return tomorrow to repeat the test.
D)Double the dose and repeat the FVC maneuver.

Question 25

What is the amount of gas that can be inhaled over and above that which is normally inhaled during quiet breathing?

A)functional residual capacity (FRC)
B)expiratory reserve volume (ERV)
C)inspiratory reserve volume (IRV)
D)vital capacity (VC)

Question 26

What pulmonary function test presents the highest risk for fainting?

A)slow vital capacity
B)tidal volume per minute
C)maximum voluntary ventilation
D)total lung capacity

Question 27

What is the minimum percent of the forced vital capacity that healthy people can exhale in the first 1 second?

A)50%
B)60%
C)70%
D)80%

Question 28

You are examining the expiratory flow tracing during the patient's forced vital capacity (FVC) maneuver. At what point during the exhalation can you generally begin to see flow from the bronchioles?

A)beyond 30%
B)beyond 50%
C)beyond 70%
D)beyond 90%

Question 29

What is the most common lung volume measured during spirometry?

A)tidal volume
B)vital capacity
C)total lung capacity
D)expiratory reserve volume

Question 30

Which of the following techniques are used to measure residual volume?
I)helium dilution
II)body plethysmography
III)nitrogen washout
IV)flow-volume loops

A)II and IV
B)I, II, and III
C)I, II, III, and IV
D)I, III, and IV

Question 31

What is the predicted normal for the peak expiratory flow (PEF) in the average man?

A)5.5 L/sec
B)6.5 L/sec
C)8.0 L/sec
D)9.5 L/sec

Question 32

What is the minimum objective standard for the volume exhaled during the final 1 second of an acceptable forced vital capacity effort?

A)0.10 L
B)0.05 L
C)0.025 L
D)0.001 L

Question 33

Which of the following volumes or capacities cannot be measured by simple spirometry?
I. functional residual capacity (FRC)
II. expiratory reserve volume (ERV)
III. residual volume (RV)
IV. inspiratory reserve volume (IRV)

A)I, III, and IV
B)I, II, III, and IV
C)I and III
D)I and IV

Question 34

When evaluating a forced vital capacity maneuver post bronchodilator use to determine the reversibility of any airway obstruction, what percent increase in FEV₁ is needed to be able to say the treatment was effective?

A)5%
B)10%
C)15%
D)20%

Question 35

After a resting expiration, air still remains in the lungs. What is this volume called?

A)functional residual capacity (FRC)
B)vital capacity (VC)
C)residual volume (RV)
D)expiratory reserve volume (ERV)

Question 36

A patient has an expired minute ventilation of 14.2 L and a ventilatory rate of 25/min. What is the average V_T?

A)568 ml
B)635 ml
C)725 ml
D)410 ml

Question 37

What shape of the flow-volume loop is typical for the patient with a fixed upper airway obstruction?

A)circular
B)box
C)elliptical
D)ramp

Question 38

Which of the following is equal to total lung capacity (TLC)?

A)V_T + ERV + IRV + RV
B)IC + V_T + ERV
C)VC + ERV
D)FRC + IRV

Question 39

Which of the following is a TRUE statement?

A)VC = FRC + V_T
B)VC = IRV + V_T + ERV
C)VC = V_T + IRV + RV
D)FRC = V_T + ERV

Question 40

Which of the following statements is NOT true about the FEV₁ measurement?

A)It is a volume measurement.
B)The recorded FEV₁ must come from the same forced vital capacity (FVC) effort.
C)It is often compared to the size of the FVC.
D)It is a popular test.

Question 41

To what should all spirometric values obtained under ambient conditions be converted?

A)ambient temperature and pressure, saturated (ATPS)
B)standard temperature and pressure, dry (STPD)
C)body temperature, ambient pressure, saturated (BTPS)
D)ambient temperature and pressure, dry (ATPD)

Question 42

In which of the following conditions is total lung capacity (TLC) always reduced?

A)restrictive lung disease
B)obstructive lung disease
C)combined restrictive and obstructive disease
D)acute airways obstruction

Question 43

Under which of the following conditions would you postpone a diffusing capacity test?
I. Just before the test, the patient smoked two cigarettes.
II. Just before the test, the patient had an episode of severe coughing.
III. Just before the test, the patient had a long wait at a busy bus stop.

A)I
B)I and III
C)II and III
D)I, II, and III

Question 44

What percent of the total lung capacity (TLC) does the residual volume (RV) normally represent?

A)10%
B)20%
C)30%
D)40%

Question 45

During a helium (He) dilution functional residual capacity (FRC) measurement, the technologist first bleeds in 500 ml of He (He Vol) and obtains an initial reading of 4.0% (FiHe). After equilibration, the second He reading is 3.2% (FfHe). What is the patient's FRC?

A)4450 ml
B)3125 ml
C)2680 ml
D)3670 ml

Question 46

When used to determine functional residual capacity, the body plethysmograph operates on which of the following physical principles?

A)Dalton's law
B)Charles' law
C)Boyle's law
D)Gay-Lussac's law

Question 47

What is the gas normally used to measure the diffusing capacity of the lung?

A)O₂
B)CO
C)CO₂
D)He

Question 48

Which of the following statements is TRUE when comparing the pulmonary function test results of men versus women?

A)Males and females have the same predicted values when corrected for height.
B)Males and females have the same predicted values when corrected for weight.
C)Males and females have the same predicted values when corrected for age.
D)Males have larger predicted volumes when corrected for height.

Question 49

What is the predicted normal tidal volume in the adult patient?

A)300 to 450 ml
B)400 to 500 ml
C)500 to 700 ml
D)450 to 750 ml

Question 50

How reliable is the tidal volume measurement in predicting the type of lung disease present?

A)very reliable
B)somewhat reliable
C)not reliable
D)reliable but only in certain age groups

Question 51

Toward the end of a nitrogen washout test for functional residual capacity, the expired concentration of N₂ begins rising. What does this probably indicate?

A)The patient is trying too hard.
B)There is a leak in the system.
C)The test is nearing completion.
D)N₂ is being trapped in the lungs.

Question 52

Which of the following statements is TRUE about inspiratory capacity (IC)?
I. It is reduced in restrictive lung diseases.
II. It may be reduced in obstructive lung diseases.
III. It may help determine the type of lung expansion therapy to apply.

A)I only
B)II only
C)III only
D)I, II, and III

Question 53

Which of the following are true statements related to the volume of tissue nitrogen excreted during the N₂ washout test for measuring functional residual capacity (FRC)?
I. It is not a factor.
II. It varies with the length of the test.
III. It varies with the weight of the patient.
IV. It cannot be correct for.

A)I only
B)II and III only
C)II, III, and IV
D)IV only

Question 54

In both the helium dilution test and nitrogen washout functional residual capacity (FRC) determinations, at what point should the patient normally be connected to the system to begin the test?

A)resting expiration
B)full forced inspiration
C)resting inspiration
D)full forced expiration

Question 55

What is the normal average inspiratory capacity (IC)?

A)1200 ml
B)2400 ml
C)3600 ml
D)4800 ml

Question 56

A patient has a vital capacity of 4200 ml, a functional residual capacity (FRC) of 3300 ml, and an expiratory reserve volume (ERV) of 1500 ml. What is the residual volume (RV)?

A)5700 ml
B)2700 ml
C)1800 ml
D)7500 ml

Question 57

During a helium dilution test for functional residual capacity, you notice that it takes 19 minutes for equilibration between the gas concentrations in the spirometer and the patient's lungs. Based on this information, what can you conclude?

A)The patient has restrictive lung disease.
B)The spirometer is leaking helium.
C)The patient has obstructive lung disease.
D)Insufficient oxygen was added to the system.

Question 58

What is the normal predicted vital capacity (VC) measurement in the adult patient?

A)3600 ml
B)4800 ml
C)5400 ml
D)6000 ml

Question 59

What causes the residual volume (RV) and functional residual capacity (FRC) to increase?

A)atelectasis
B)chronic obstructive lung disease
C)pneumonia
D)pneumothorax

Question 60

What is the normal predicted total lung capacity (TLC) for adults?

A)about 6 L
B)about 7 L
C)about 8 L
D)about 9 L

Question 61

What conclusions can you draw from the following data, obtained on a 67-year-old, 76-kg man admitted for pulmonary complications arising from silicosis? $\begin{array}{|l|l|l|l|l|l|l|l|}\hline& \text { ACTUAL } & \text { PRED } & \% \text { PRED } && \text { ACTUAL } & \text { PRED } & \% \text { PRED } \\\hline \text { TLC } & 4.34 & 7.73 & 56 \% & \text { FVC } & 2.86 & 4.74 & 60 \% \\\hline \text { FRC } & 1.73 & 4.36 & 40 \% & \% \text { FEV }_{1} & 96 \% & 83 \% & \\\hline \text { RV } & 1.45 & 2.63 & 55 \% & \text { FEF }_{200-1200} & 6.89 & 6.71 & 103 \% \\\hline \text { VC } & 2.89 & 4.74 & 61 \% & \text { FEF }_{25 \%-75 \%} \% & 2.78 & 2.88 & 96 \% \\\hline\end{array}$

A)Results indicate generalized airway obstruction.
B)Results indicate normal pulmonary function.
C)Results indicate a combined disease process.
D)Results indicate a restrictive lung disorder.

Question 62

What is a normal single-breath diffusing capacity for carbon monoxide for a young, healthy man of average size?

A)10 ml/min/mm Hg
B)20 ml/min/mm Hg
C)30 ml/min/mm Hg
D)40 ml/min/mm Hg

Question 63

What conclusions can you draw from the following data, obtained from a 41-year-old man who admits to "occasional smoking" but otherwise reveals no past history of pulmonary problems? $\begin{array}{|l|l|l|l|l|l|l|l|}\hline& \text { ACTUAL } & \text { PRED } & \% \text { PRED } && \text { ACTUAL } & \text { PRED } & \% \text { PRED } \\\hline \text { TLC } & 4.75 & 4.90 & 97 \% & \text { FVC } & 2.96 & 3.63 & 82 \% \\\hline \text { FRC } & 2.31 & 2.21 & 105 \% & \% \text { FEV }_{1} & 82 \% & 78 \% & \\\hline \text { RV } & 1.28 & 1.20 & 106 \% & \text { FEF }_{200-1200} & 4.33 & 5.45 & 79 \% \\\hline \text { VC } & 3.48 & 3.63 & 96 \% & \text { FEF }_{25} \%-75 \% & 1.95 & 3.37 & 58 \% \\\hline\end{array}$

A)Results indicate small airway obstruction.
B)Results indicate generalized airway obstruction.
C)Results indicate a restrictive lung disorder.
D)Results indicate a combined disease process.

Question 64

The DLCO would be decreased in all of the following except:

A)pulmonary emphysema
B)secondary polycythemia
C)severe anemia
D)pulmonary fibrosis

Question 65

A patient has a decreased DLCO but a normal DLCO/V_A ratio. The patient most likely has

A)emphysema
B)pulmonary fibrosis
C)a small lung (low total lung capacity)
D)secondary polycythemia

Question 66

What conclusions can you draw from the following data, obtained on a 32-year-old 53-kg woman admitted for elective surgery? $\begin{array}{|l|l|l|l|l|l|l|l|}\hline& \text { ACTUAL } & \text { PRED } & \% \text { PRED } && \text { ACTUAL } & \text { PRED } & \% \text { PRED } \\\hline \text { TLC } & 4.93 & 5.27 & 94 \% & \text { FVC } & 3.67 & 3.86 & 95 \% \\\hline \text { FRC } & 2.41 & 2.43 & 99 \% & \% \text { FEV }_{1} & 84 \% & 78 \% & \\\hline \text { RV } & 1.29 & 1.35 & 96 \% & \text { FEF }_{200-1200} & 5.66 & 5.74 & 99 \% \\\hline \text { VC } & 3.64 & 3.86 & 94 \% & \text { FEF }_{25 \%-75 \%} & 3.53 & 3.49 & 101 \% \\\hline\end{array}$

A)Results indicate a mild restrictive lung disorder.
B)Results indicate normal pulmonary function.
C)Results indicate a combined disease process.
D)Results indicate generalized airway obstruction.

Question 67

Which of the following are necessary to ensure a valid single-breath diffusing capacity of the lungs (DLCO) test result?
I. Two or more acceptable tests should be averaged.
II. Breath-hold time should be between 3 and 5 seconds.
III. Corrections for hemoglobin (Hb) and COHb should be included.
IV. The maneuvers should be reproducible to within 10%.

A)I, II, and III
B)II and IV
C)I, III, and IV
D)I, II, III, and IV