Ruppel: Manual of Pulmonary Function Testing, 9th Edition

Chapter 1: Indications for Pulmonary Function Testing

Test Bank 

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: Cognitive Level: Recall
REF: Page 2

2) Which of the following are indications for performing spirometry?

I. Assess the risk of lung resection
II. Determine the response to bronchodilator therapy
III. Assess the severity of restrictive lung disease
IV. Quantify the extent of COPD

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

ANS: C
Spirometry cannot assess severity of restriction; for that you need to measure lung volumes (Box 1-2). 

DIF: Cognitive Level: Recall
REF: Page 8, Box 1-2 

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

ANS: A
The most common reason for measuring lung volumes is to identify restrictive lung disease.

DIF: Cognitive Level: Recall
REF: Page 8 and Box 1-3

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: Cognitive Level: Recall
REF: Page 9, Box 1-4

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: Cognitive Level: Recall
REF: Page 9

6) Which of the following cause emphysema?

I. 1-Antitrypsin deficiency
II. Exposure to environmental pollutants
III. Radiation therapy
IV. Cigarette smoking

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

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: Cognitive Level: Recall
REF: Page 11

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 (Box 1-7). 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: Cognitive Level: Recall
REF: Page 15

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: Cognitive Level: Recall
REF: Page 18

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: Cognitive Level: Recall
REF: Page 19

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: Cognitive Level: Recall
REF: Page 23

11) Which of the following correctly describes appropriate physical measurements before pulmonary function testing?

I. Actual body weight should be used to calculate predicted values
II. Standing height should be measured when the patient is barefoot
III. Arm span should be used instead of height for a patient with kyphosis
IV. Age should be recorded to the nearest decade (10 years)

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

ANS: B
Various physical measurements are required for estimating each patient’s expected level of pulmonary function. Age, height, and weight are usually recorded in addition to the patient’s sex. Race or ethnic origin should also be recorded. (Although body weight is recorded, it is not used to calculate predicted values.)

DIF: Cognitive Level: Recall
REF: Page 26

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 be demonstrated. 

DIF: Cognitive Level: Recall
REF: Page 30

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 (Dlco) test was described by August and Marie Krogh in 1911. 

DIF: Cognitive Level: Recall 
REF: Page 6

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: Cognitive Level: Recall
REF: Page 9, Box 4, Line E

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: Cognitive Level: Recall
REF: Page 18

16) All 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. List diseases or causes of restriction. 

DIF: Cognitive Level: Recall
REF: Page 19

17) The following data are obtained from a subject complaining of shortness of breath: 
	Predicted	Found	%pred	
TLC	5.76	3.18	55	
RV	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

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 capillary interface (e.g., reduced Dlco). 

DIF: Cognitive Level: Application
REF: Page 19

18) Lou Gehrig, a famous New York Yankee baseball player, is often associated with this 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: Cognitive Level: Recall
REF: Page 23

19) The following data are obtained from a subject complaining of shortness of breath: 
	Predicted	Found	%pred	
TLC	6.59	4.12	63	
RV	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

ANS: 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. 

DIF: Cognitive Level: Application
REF: Page 24

20) All 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, 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. 

DIF: Cognitive Level: Recall
REF: Page 24

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: Cognitive Level: Recall
REF: Page 27

22) There are three essential components to an FVC maneuver. Which two are considered the most important?

A. A deep breath and the initial blast
B. A deep breath and continued exhalation for at least 6 seconds or until empty
C. The initial blast and then continued exhalation for at least 6 seconds or until empty
D. Demonstration of the maneuver prior to the subject performing the maneuver
ANS: A
According to the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines, a maneuver can be considered usable even if the subject does not meet the end-of-test criteria. 

DIF: Cognitive Level: Recall
REF: ATS/ERS Spirometry Guideline page 325 

23) According to the ATS/ERS general considerations guidelines, all 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: Cognitive Level: Recall
REF: ATS/ERS General Guidelines, Table 2, page 155

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

ANS: C
According to the ATS/ERS general guidelines, all variables listed must be recoded except equipment cleaning. 

DIF: Cognitive Level: Recall
REF: ATS/ERS General Guidelines, page 155

25) Who is credited for 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: Cognitive Level: Recall
REF: Page 4