(Test Bank) Ruppel's Manual of Pulmonary Function Testing

Mottram, 11

Medicine

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11th Edition

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Test Bank for Ruppel's Manual of Pulmonary Function Testing, The downloadable file consists of 155 pages, and the total size of the file is 1.58 MB. Purchase now only for highly discounted price.

Author(s): Mottram

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TEST BANKFOR RUPPEL’S MANUAL OF PULMONARY FUNCTION TESTING 11TH EDITION BY MOTTRAM 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 ANS: 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. DIF: 1 REF: p. 2 OBJ: None MSC: NBRC: None 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 ANS: C Spirometry cannot assess severity of restriction; for that you need to measure lung volumes (see Box 1-2, Chapter 1). DIF: 1 REF: p. 7 OBJ: EL-2 MSC: NBRC: None 3. The main indication for the measurement of lung volumes is to do which of the following? a. Diag nose 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. ANS: A The most common reason for measuring lung volumes is to identify restrictive lung disease. DIF: 1 REF: p. 35 OBJ: EL-2 MSC: NBRC: None 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 -Barré syndrome ANS: B Sarcoidosis is the only systemic disease listed that affects gas exchange. DIF: 1 REF: p. 9 | p. 19 | p. 21 | p. 35 OBJ: EL-2 MSC: NBRC: None 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. ANS: D Blood gas analysis is most commonly used to determine the need for supplemental oxygen and to manage patients who require ventilatory support. DIF: 2 REF: p. 15 OBJ: EL-1 MSC: NBRC: CPFT 2A -2 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 ANS: 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. DIF: 1 REF: p. 11 OBJ: EL-3 | AL-2 MSC: NBRC: None 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 ANS: 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. DIF: 2 REF: p. 16 OBJ: EL-3 MSC: NBRC: None 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. ANS: A Tumors involving the upper airway may cause variable or fixed obstruction. DIF: 2 REF: p. 19 OBJ: EL-2 MSC: NBRC: CPFT 3C -3 9. Sarcoidosis is a systemic disorder that usually causes which of the following? a. A restrictive ventilatory defect b. An obstructive ventilatory defect c. Hyperreactive airways d. Primary pulmonary hypertension ANS: A Restriction is often associated with the following: interstitial lung diseases, including idiopathic fibrosis, pneumoconioses, and sarcoidosis. DIF: 1 REF: p. 19 | p. 21 OBJ: EL-3 MSC: NBRC: None 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 ANS: 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. DIF: 1 REF: p. 23 OBJ: EL-4 MSC: NBRC: CPFT 2B -6 11. Which of the followin g 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 ANS: 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 origi n should also be recorded. (Although body weight is recorded, it is not used to calculate predicted values.) DIF: 1 REF: p. 29 OBJ: None MSC: NBRC: CPFT 3A -20 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. ANS: B In addition to a description of the test, the maneuver should always be demonstrated. DIF: 1 REF: p. 32 OBJ: None MSC: NBRC: CPFT 2B -6 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 ANS: B The basis for the modern single -breath diffusing capacity (D LCO) test was described by August and Marie Krogh in 1911. DIF: 1 REF: p. 5 OBJ: None MSC: NBRC: None 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 ANS: C The other options do not affect the alveolar capillary membrane interface. DIF: 1 REF: p. 9 OBJ: EL-2 MSC: NBRC: None 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 d. Have no effect on the curve but cause inspiratory stridor ANS: 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. DIF: 2 REF: p. 18 OBJ: EL-4 MSC: NBRC: CPFT 3C -3 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 ANS: C Asthma causes airway obstruction. DIF: 1 REF: p. 21 | p. 22 | p. 23 OBJ: EL-3 MSC: NBRC: None 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 FEV 1 2.63 1.88 71 FEV 1/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 ANS: 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 capill ary interface (e.g., reduced DLCO). DIF: 3 REF: p. 20 OBJ: EL-3 MSC: NBRC: RPFT 3C -4b 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 d. Myasthenia gravis ANS: A Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) affects the anterior horn cells of the spinal cord (motor neurons). DIF: 1 REF: p. 24 OBJ: EL-3 MSC: NBRC: None 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 FEV 1 3.16 1.16 37 FEV 1/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 ANS: D Progression of a myasthenic crisis can be assessed using VC and respiratory pressures. Results would yield a reduction in lung volumes and respi ratory muscle pressures, as seen in this case. DIF: 3 REF: p. 24 OBJ: EL-3 MSC: NBRC: RPFT 3C -4b 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 b. Arterial blood gases c. Diffusing capacity d. Maximal respiratory pressures ANS: D Pulmonary function tests, particularl y lung volumes and D LCO, 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. DIF: 2 REF: p. 25 OBJ: EL-4 MSC: NBRC: None 21. All of the following anthropometric measurements are essential for pulmonary function testing except: a. Height b. Percent body fat c. Gender d. Age ANS: B Age, height, and weight are usually recorded in addition to the patient’s sex. Race or ethnic origin should also be recorded. DIF: 1 REF: p. 29 OBJ: None MSC: NBRC: CPFT 3A -20 22. There are three essential components to an FVC maneuver. Which of the followin g 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 ANS: 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. DIF: 1 REF: p. 31 OBJ: None MSC: NBRC: CPFT 2A -6 23. According to th e 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 ANS: B According to the ATS -ERS general guidelines, all should be avoided before testing except wearing restrictive clothing. DIF: 1 REF: p. 28 OBJ: None MSC: NBRC: CPFT 2B -6 24. According to the ATS -ERS general considerations guide lines, 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 ANS: C According to the ATS -ERS general guidelines, all variables listed must be recorded except equipment cleaning. DIF: 1 REF: p. 31 | p. 32 OBJ: None MSC: NBRC: None 25. Who is credited with first describing the flow-volume curve? a. Hyatt b. Hutchinson c. Tiffeneau d. Fowler ANS: A Hyatt is recognized for first describing the flow-volume curve in the 1950s. DIF: 1 REF: p. 3 OBJ: None MSC: NBRC: None 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 ANS: B Understanding the physiologic basis for the patient’s exercise limitation is an important aspect in prescribing effective therapy such as pulmonary rehabilitation. DIF: 1 REF: p. 10 OBJ: AL-1 MSC: NBRC: None 27. A patient with cystic fibrosis may present with an increased: a. FRCpl and RV/TLC ratio b. FVC and FEV 1 c. VA and DLCO d. MIP and MEP ANS: A Cystic fibrosis results in gas trapping as the disease progresses, which is revealed in lung volume measurements. DIF: 2 REF: p. 10 | p. 11 OBJ: AL-2 MSC: NBRC: CPFT 3C -3 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 ANS: 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. DIF: 1 REF: p. 30 | p. 31 OBJ: AL-3 MSC: NBRC: None 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 ANS: D Consuming alcohol should be avoided 4 hours before the test; otherwise, all other recommendations are correct. DIF: 1 REF: p. 28 OBJ: EL-1 MSC: NBRC: CPFT 2B -6 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 ANS: 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. DIF: 2 REF: p. 48 OBJ: EL -1 MSC: NBRC: CPFT 3B-3 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 FEV 1 (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 ANS: B While the ratio of FEV 1/VC defines obstruction, the severity of obstruction is defined by the degree to which the FEV 1 is reduced. Moderate FEV 1= 60% to 69% of predicted; 2.14 □ 3.33 = 64%. DIF: 2 REF: p. 51 OBJ: EL -2 MSC: NBRC: CPFT 3C-3 TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM 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 FEV 1 (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 FEV 1. c. Average the data from Trials 2 and 3. d. Perform at least one more maneuver. ANS: D The two largest values for both FVC and FEV 1 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 FEV 1 to determine repeatability. If repeatability is not met, additional acceptable trials should be performed. DIF: 3 REF: p. 53 OBJ: EL -1 MSC: NBRC: CPFT 2C-6 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. ANS: 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. DIF: 2 REF: p. 62 OBJ: None MSC: NBRC: CPFT 2B-9 5. Which of the following determines the shape of the “effort -independent” portion of the expiratory F-V curve? TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM 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 ANS: 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 -volum e curve. DIF: 1 REF: p. 55 OBJ: AL-3 MSC: NBRC: None 6. A patient being evaluated for disability has the following spirometry results: Measured Predicted FVC (L) 4.00 4.10 FEV 1 (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 FEV 1 is larger than measured. d. The patient did not make a good effort on the MVV. TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM ANS: A □ 3.30 = 61%. While the ratio of FEV 1/FVC defines obstruction, the severity of obstruction is defined by the degree to which the FEV 1 is reduced. Moderate FEV 1= 60% to 69% of predicted; 2.00 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 ANS: B See Table 2-2, Chapter 2. DIF: 1 REF: p. 66 OBJ: EL -4 MSC: NBRC: CPFT 2A-6 8. Which answer is consistent with the following flow -volume curve? TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM a. Normal forced expiratory flow pattern b. Variable intrathoracic obstruction c. Airways obstruction d. Fixed large airway obstruction ANS: C See Interpretive Strategies 2-3, Chapter 2. DIF: 2 REF: p. 58 OBJ: AL -3 MSC: NBRC: CPFT 3C-3 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 FEV 1 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. ANS: B While the ratio of FEV 1/VC defines obstruction, the severity of obstruction is defined by the degree to which the FEV 1 is reduced. Mild FEV 1 is greater than 70% predicted (3.10 4.10 = 75%). Bronchodilator response is significant if the percent change is 12% or there is an absolu te increase greater than 200 ml. DIF: 3 REF: p. 51 | p. 68 OBJ: EL -4 MSC: NBRC: RPFT 3C-3 10. A 50-year -old woman with dyspnea has the following spirometry results: Measured Predicted TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM FVC (L BTPS) 3.99 4.10 FEV 1 (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 ANS: C Data are within normal limits. (FEV 1/FVC 86%; FEV 1 97% of predicted.) DIF: 2 REF: p. 51 OBJ: EL-2 MSC: NBRC: CPFT 3C-3 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 FEV 1 (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. ANS: A Spirometry acceptability and repeatability criteria were achieved. Report the largest FVC and FEV 1. DIF: 3 REF: p. 62 OBJ: EL-1 TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM MSC: NBRC: CPFT 2C-6 12. A subject being tested for possible environmental exposure to asbestos produces the following spirometry results: Measured Predicted FVC (L) 4.00 4.07 FEV 1 (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 FEV 1 is not valid. d. The patient did not make a good effort on the MVV. ANS: D If the measured MVV is less than 80% of (FEV 1 40), poor patient effort or neuromuscular weakness may be suspected . DIF: 3 REF: p. 66 OBJ: EL -1 MSC: NBRC: CPFT 2C-6 13. Which of the following diagnoses is consistent with the following flow -volume curve? TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM a. Variable intrathoracic obstruction b. Fixed extrathoracic obstruction c. Small airway obstruction d. Normal expiratory and inspiratory flows ANS: D See Interpretive Strategies 2-3, Chapter 2. DIF: 2 REF: p. 58 OBJ: AL -3 MSC: NBRC: CPFT 3C-3 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 ANS: D See Interpretive Strategies 2-3 and Figure 2-14, Chapter 2. DIF: 2 REF: p. 58 | p. 61 OBJ: AL -3 MSC: NBRC: CPFT 3C-3 TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM 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 ANS: 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 maneu ver can also affect the results. DIF: 3 REF: p. 48 OBJ: EL -3 MSC: NBRC: RPFT 3C-3 16. A subject produces the following simple spirometry results: Measured Predicted FVC (L, BTPS) 4.5 4.0 FEV 1 (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 ANS: C Data are within normal limits. (FEV 1/FVC 80%; FEV 1 113% of predicted.) TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM DIF: 3 REF: p. 51 OBJ: EL -2 MSC: NBRC: RPFT 3C-3 17. A subject referred for pulmonary function tests because of shortness of breath has an FEV 1 of 98%. This finding is suggestive of: a. Restrictive lung disease b. Obstructive lung disease c. Normal lung function d. Upper airway abnormality ANS: C Data are within normal limits. DIF: 3 REF: p. 51 OBJ: AL -2 MSC: NBRC: RPFT 3C-3 18. The FEF 25% -75% depends on which of the following? a. FVC b. PEF c. FEV 1 d. FEV 1% ANS: A FEF 25% -75% is measured from a segment of the FVC. DIF: 1 REF: p. 52 OBJ: None MSC: NBRC: None 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 TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM b. 2, 3, and 4 c. 2 and 3 d. 1 and 4 ANS: D The degree of concavity increases because of reduced flows resulting from loss of elastic recoil. Increased airway resistance would also cause flow limitation. DIF: 2 REF: p. 58 OBJ: AL-4 MSC: NBRC: None 20. A patient produces the following spirometry resul ts: Actual Predicted FVC (L) 4.0 4.1 FEV 1 ( L) 2.0 3.3 MVV (L/min) 45 110 These findings indicate that: 1. Obstruction is present. 2. Restriction is present. 3. The FEV 1 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 ANS: C While the ratio of FEV 1/VC defines obstruction (50%), the severity of obstruction is defined by the degree to which the FEV 1 is reduced. Moderate FEV 1= 60% to 69% of predicted; 2.00 3.30 = 61%. If the measured MVV is less than 80% of (FEV 1 40), poor patient effort or neuromuscular weakness may be suspected. DIF: 3 REF: p. 51 | p. 58 OBJ: AL -2 MSC: NBRC: CPFT 2C-6 TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM 21. In addition to the FEV 1 and FVC, which of the following is useful in gauging subject effort during spirometry? a. PEF b. FEF 50% c. FEF 25% -75% d. max 25 ANS: 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. DIF: 1 REF: p. 55 OBJ: EL -1 MSC: NBRC: CPFT 2C-6 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 ANS: C See Interpretive Strategies 2 -3, Chapter 2. DIF: 2 REF: p. 58 OBJ: AL-3 TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM MSC: NBRC: CPFT 3C-3 23. According to the 2005 ATS -ERS repeatability standards, of the three acceptable tracings, the two largest FVC values and the two largest FEV 1 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 ANS: C The two largest acceptable values for both FVC and FEV 1 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 FEV 1 to determine repeatability. DIF: 1 REF: p. 47 OBJ: EL -1 MSC: NBRC: CPFT 2C-6 24. Back extrapolation is the method used to determine “time zero” when measuring which of the following parameters? a. FVC b. FEV 1 c. FEF 25% -75% d. MVV ANS: B To accurately determine FEV 1, the back -extrapolated volume should be less than 5% of the FVC or less than 150 ml, whichever is greater. DIF: 1 REF: p. 47 OBJ: EL -1 MSC: NBRC: CPFT 2C-6 25. A subject performed four acceptable FVC maneuvers. Predicted Maneuver 1 Maneuver 2 Maneuver 3 Maneuver 4 FEV 1 4.80 4.83 4.60 4.23 4.03 What do the results most likely represent? a. Variable effort TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM b. Malingering c. Inability to understand the test d. Maneuver -induced bronchospasm ANS: 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. DIF: 2 REF: p. 55 OBJ: EL -1 MSC: NBRC: CPFT 2C-6 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). FEV 1 FVC Trial 1 2.10 2.65 Trial 2 1.96 3.11N Trial 3 1.99 2.99 What is the subject‟s reportable FEV 1 in BTPS conditions? a. 2.10 L b. 2.17 L c. 2.24 L d. 2.65 L ANS: C The data appear acceptable and repeatable. The largest FEV 1 should be reported, which is 2.10. Multiply this value by the BTPS correction factor (2.10 1.068 = 2.24 L). DIF: 3 REF: p. 64 OBJ: AL -1 MSC: NBRC: CPFT 3A-4 27. What are the recommended dosages for assessing bronchodilator response, according to the ATS - ERS 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) TEST BANK FOR RUPPEL'S MANUAL OF PULMONARY FUNCTION TESTI Stuvia.com - The Marketplace to Buy and Sell your Study MateriNalG 11TH EDITION BY MOTTRAM c. Four doses of albuterol (80 µg) or ipratropium bromide (80 µg) d. Two doses of albuterol (80 µg) or ipratropium bromide (40 µg) ANS: 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. DIF: 1 REF: p. 66 OBJ: AL -1 MSC: NBRC: CPFT 2A-1 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% ANS: A Percent change in FEV 1 is calculated. Post -FEV 1–pre-FEV 1/pre -FEV 1 ([(3.9 – 2.8) 2.8] □ 100 = 39%). DIF: 2 REF: p. 67 OBJ: EL -4 MSC: NBRC: CPFT 3C-11a 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