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Which of the following values is most commonly used to evaluate an individual's response to bronchodilator? a. FVC b. FEV c. FEF25-75% d. Diffusing capacity - Precise Answer โโb. FEV Among the common parameters of the spirometric measurements, FEV is considered to be the determinant o obstructive pathologies supported by the decreased FEV1%. Also, it is the first parameter taken into considerati bronchodilator challenge is done. A 15% change from FEV baseline value after bronchodilator response indicates positive result Following an FCV maneuver, the flow rate is considered the least effort dependent is the: a. FEV b. FEF 200- c. FEF 25- d. MVV - Precise Answer โโc. FEF 25- Among the following flow rate, the least effort dependent is the FEF 25- 75%. FEF 25% -75% is measured from a segment of the FVC that includes flow from medium and small airways Lung volumes and capacities are indicated:
a. Assess response to exercise training b. Whenever simple spirometry is performed c. Diagnosing restrictive lung diseases d. When hypoxemia is suspected - Precise Answer โโc. Diagnosing restrictive lung diseases Measurements of flow rates are used in diagnosing obstructive diseases for the reason that flow is the first affected aspect in obstructive pathologies while on the other hand lung volumes and capacities are primarily indicated for restrictive pathologies. IRV: 1200 mL, VT: 500 mL, ERV: 1000 mL. Based on the values given, what is the TLC? a. 1700 mL b. 1700 mL plus RV c. 2700 mL plus RV d. 2700 mL minus RV - Precise Answer โโc. 2700 mL plus RV TLC = IRV + VT + ERV + RV TLC = 6000 mL Volume of air in the lungs after a maximum inspiration Maximal Inspiratory Pressure is a measurement used to assess a patient's: a. Ventilator status
c. 10% d. 25% - Precise Answer โโa. 15% Bronchodilation Challenge is done to determine the patient's response to bronchodilator. First, baseline values will be taken specifically the FEV1. Secondly, the RT will administer a beta-2 adrenergic bronchodilator. Lastly, the RT will perform FVC maneuver and a 15% change from the baseline value of FEV1 is considered a positive result. A correctly performed nitrogen washout test requires that the test last for: a. 7 minutes and/or a final N2 concentration of 10% is measured b. 10 minutes and/or until a final N2 concentration of 5% is measured c. A final concentration of 10% is measured for 3 successive breaths d. A final N2 concentration of 1.5% is measured for 3 successive breaths
- Precise Answer โโd. A final N2 concentration of 1.5% is measured for 3 successive breaths When the peak exhaled concentration of N2 is less than 1.5%, the patient exhales completely and the Fractional concentration of alveolar nitrogen is noted.
ยท The time it takes to washout the nitrogen is approximately 2 - 5 minutes in healthy patients and longer in those with obstructive lung defect
- You instruct your patient to take a maximum inspiration followed by a maximum expiration. You have just instructed your patient to perform a: a. Inspiratory Reserve Volume b. Tidal Volume Breath c. Vital Capacity d. Inspiratory Capacity - Precise Answer โโc. Vital Capacity ยท Volume of air that can be exhaled after a maximum inspiration ยท FVC: when VC exhaled forcefully ยท VC = IRV + TV + ERV ยท Normal value: 4800 mL To evaluate and follow the course of a patient with interstitial lung diseases, which of the following pulmonary function testing procedures would you recommend? a. DLCO b. He Dilution c. Forced expiratory flow/s volume d. Metacholine test - Precise Answer โโa. DLCO
Pneumotachometer collects and measures has volumes INDIRECTLY by measuring the flow of the gas within the system. To what does the range or limit of a device's measuring ability refer: a. Accuracy b. Precision c. Capacity d. Error - Precise Answer โโc. Capacity
- Range or limit of how much it can measure.
- Most instruments have the capacity to measure volumes and flow rates of all adults How closely a device measures a certain reference value refers to what quality? a. Accuracy b. Precision c. Capacity d. Error - Precise Answer โโa. Accuracy
- How well it measures a known reference value
- A standard reference value is provided by a 3 liters calibration syringe
What is the ability of a measuring device to consistently provide the same measure of the same quantity? a. Accuracy b. Precision c. Capacity d. Error - Precise Answer โโb. Precision Refers to how reproducible measurements are when testing is repeated, even if the results are not correct What is the American Thoracic Society standards for volumetric accuracy of spirometers? a. ๅ 1% error, or within 10 mL of the reference value b. ๅ 10% error, or within 500 mL of the reference value c. ๅ 5% error, or within 100 mL of the reference value d. ๅ 3% error, or within 50 mL of the reference value - Precise Answer โโd. ๅ 3% error, or within 50 mL of the reference value ATS standards for spirometers: +/- 3% or +/- 0.5 L, whichever is greater Tests for pulmonary mechanics include all of the following, except: a. Maximum voluntary ventilation (MVV) b. Functional residual capacity
Normal time for helium dilution is 2 to 5 minutes. Longer than that indicates that an obstructive pathology is suspected. What is the normal average inspiratory capacity (IC)? a. 1200 ml b. 2400 ml c. 3600 ml d. 4800 ml - Precise Answer โโc. 3600 ml ยท Maximum amount of air that can be inhaled after a normal inhalation ยท IC = IRV + VT ยท 3600 mL ยท 75 - 85% of VC Airway resistance is usually defined as: a. The pressure difference between the ends of the airway divided by the flow rate of gas moving through the airway b. The sum of the pressures between the ends of the airway divided by the flow rate of gas moving through the airway c. The pressure difference between the ends of the airway multiplied by the flow rate of gas moving through the airway d. The sum of the pressure between the ends of the airway multiplied the flow rate of gas moving through the airway - Precise Answer โโa. The pressure difference between the ends of the airway divided by the flow rate of gas moving through the airway
Airway resistance is PIP - Pplat divided by the inspiratory flow rate on mechanical ventilation. Same concept goes with PFT. All of the following statements for quality assurance for measuring diffusing capacity are correct, except: a. Measuring the diffusing capacity of a well-known subject will provide a quality control standard b. Measuring the diffusing capacity of the 5.0 L syringe will provide a quality control standard c. Accuracy and linearity of the gas analyzer d. Accuracy and precision of the volume or flow measuring device - Precise Answer โโb. Measuring the diffusing capacity of the 5.0 L syringe will provide a quality control standard Accuracy of volumetric spirometers are done as well as with the calibration of it using a 3-L syringe Which of the following best represents the normal range for adult patients' minute volume? a. 10 to 15 lpm b. 12 to 20 lpm c. 8 to 12 lpm d. 5 to 10 lpm - Precise Answer โโd. 5 to 10 lpm
FVC Maneuver has its peak expiratory flow after maximum inhalation. After achieving the peak, it will abruptly exhale and will decrease up to residual volume Which of the following tests would you recommend to measure the extent of gas trapping in a patient with emphysema? a. He Dilution b. DLCO-SB Technique c. Body Plethysmography d. N2 washout - Precise Answer โโc. Body Plethysmography Helium dilution and Nitrogen washout can also be used in determining the extent of gas trapping but Body plethysmography is more accurate in measuring the TGV. Comparative study that helps in the diagnosis of patients with questionable history of wheezing and possible asthma a. Broncoprovocation studies b. Bronchodilator studies c. Metacholine challenge test d. A and C - Precise Answer โโd. A and C In cases of undiagnosed asthma but presents with questionable wheezing, Bronchoprovocation or Metacholine Challenge Tests can be performed in order to rule out or confirm the presence of asthma.
The FEF 25-75 is measured using which of the following pulmonary function tests? a. FRC b. FVC c. TLC d. MVV - Precise Answer โโb. FVC Flow rates can be measured by the FVC Maneuver through spirometry. Which of the following pulmonary function values are increased in patients with emphysema? a. FVC b. FEF 200- c. FRC d. MVV - Precise Answer โโc. FRC Emphysema is characterized by destroyed alveolar walls leading to air trapping and dynamic hyperinflation. volume and capacity is measured indirectly (RV, TLC and FRC) are all increased. To best determine an asthmatic's response to a bronchodilator, which of the following tests should be performed before and after the use of a bronchodilator? a. Maximal Inspiratory Pressure
a. I only b. I and III only c. II and III only d. I, II and III - Precise Answer โโb. I and III only Direct spirometry cannot measure the RV, FRC, and TLC. Those three can only be measured by Helium Dilution, Nitrogen Washout and the most accurate of them, Body Plethysmography. Establishes the response of a patient with airway obstruction in a bronchodilator and to the degree of reversibility of the obstruction a. Broncoprovocation studies b. Bronchodilator studies c. Metacholine challenge test d. Both A and B d. None of the above - Precise Answer โโb. Bronchodilator studies Bronchodilation benefit studies establishes the diagnosis that the patient has airway obstruction and assesses if the airway obstruction is responsive to the given bronchodilator. To evaluate and follow the course of a patient with interstitial lung diseases, which of the following pulmonary function testing procedures would you recommend? a. Diffusing capacity (DLCO)
b. Forced expiratory volumes/flows c. He dilution FCR and TLC d. Methacholine challenge test - Precise Answer โโa. Diffusing capacity (DLCO) DLCO is decreased in patients with decreased AC membrane and deranged interstitium. A doctor suspects that a patient's asthma-like symptoms are due to airway hyperreactivity. She asks your advice on the best way to confirm this diagnosis. You would recommend: a. Peak expiratory flow rate monitoring b. Bronchial provocation testing c. Carbon monoxide diffusing capacity d. Pre/post bronchodilator spirometry - Precise Answer โโb. Bronchial provocation testing Asthma-like symptoms which is undiagnosed can be subjected to bronchial provocation testing or methacholine challenge test to confirm the hyperreactivity of the airways. Which of the following tests of lung mechanics would you recommend to detect the suspected overinflation on a patient receiving ventilatory support? a. Pressure-volume curve b. Flow-volume curve
The maneuver for MV is panting and may be at risk of Respiratory alkalosis and fainting. Watch out for the patient's response during the test. 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% - Precise Answer โโb. Beyond 50% Expiratory flow rates have its own area in the airways reflected by the percentage of the flows. 25%, 50%, and 75% represents the large to smaller airways, respectively. You have just given your patient is 0.03 mg/ml dose of metacholine to assess for asthma. The subsequent forced vital capacity shows no change. What should you do next? a. Have the patient return tomorrow to repeat the test b. Wait 1 hour and repeat the test at the same dose c. Report to the physician that the patient does not have asthma d. Double the dose and repeat the FVC maneuver - Precise Answer โโd. Double the dose and repeat the FVC maneuver
The starting dose for the methacholine is 0.01 mg/ml. If the patient presents no change in FVC and especially the FEV1 increases the dose until the patient will no longer present the desired results documented by the FEV1. 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. Insufficient oxygen was added to the system b. The patient has obstructive lung disease c. The spirometer is leaking helium d. The patient has restrictive lung disease - Precise Answer โโb. The patient has obstructive lung disease Longer time for equilibration indicates obstructive pathologies. What is a normal single-breath diffusing capacity for carbon monoxide for a young, healthy man of average size? a. 10 ml/min/mmHg b. 20 ml/min/mmHg c. 30 ml/min/mmHg d. 40 ml/min/mmHg - Precise Answer โโd. 40 ml/min/mmHg
