Egan’s Chapter 19 Practice Questions:

 

1. The ability of the lungs to perform gas exchange depends on what four general physiologic functions: 1. The diaphragm and thoracic muscles must be capable of expanding the thorax and lungs to produce a sub-atmospheric pressure, 2. The airways must be unobstructed to allow gas to flow into the lungs and reach the alveoli, 3. The cardiovascular system must circulate blood through the lungs and ventilated alveoli, 4. O₂ and CO₂ must be able to diffuse through the alveolar capillary membrane

2. Accuracy: A measuring instrument is how well it measures a known reference value

3. Accuracy: How well it measures a known reference value

4. Airway resistance: Measure of the impedance to ventilation caused by the movement of gas through the airways. Airway resistance is computed as the change in pressure along a tube divided by the flow

5. Ambient conditions are converts into what: BTPS

6. Because of the potential for acute hyperventilation and fainting or coughing, the patient should be in what position: The seated position

7. Best curve: The trial that meets the acceptability criteria and gives the largest sum of FVC plus FEV₁

8. The best curve is defined as: The trail that meets the acceptability criteria and gives the largest sum of FVC plus FEV₁

9. Capacity: The range or limits of how must it can measure

10. Capacity: The range or limits of how much it can measure

11. A complete evaluation of the respiratory system includes what: Patient history, Physical examination, Chest x ray examination, Arterial blood gas analysis, Tests of pulmonary function

12. Compliance: The volume of gas inspired per the amount of inspiratory effort; effort is measured as the amount of pressure created in the lung of in the pleural space when the inspiratory muscles contract

13. A __________ correlation exists between measurements of pulmonary mechanics and age: Negative

14. A _________ correlation exists between measurements of pulmonary mechanics and height: Positive

15. These devices measure: Flow

16. Diffusing capacity of the lung (DL): Number of milliliters of gas that transfer from the lungs to the pulmonary blood per minute for each 1 mm Hg partial pressure difference between the alveoli and pulmonary capillary blood

17. Diffusing capacity of the lung for carbon monoxide (DLCO): The difference between the volume of carbon monoxide inhaled and the volume of carbon monoxide exhaled, considering the partial pressure of carbon monoxide in the lung at the time of measurement

18. Diffusing capacity of the lung to effective total lung capacity ratio (DLCO/Va): Differentiates between diffusion abnormalities caused by having a small lung volume compared with diffusion abnormalities caused by alveolar-capillary membrane pathologies



19. Effective total lung capacity (Va): Single breath technique distributes a gas mixture through unobstructed airways to an alveolar volume

20. Error: An arithmetic difference between reference values and measured values

21.Every measuring instrument has: Capacity, Accuracy, Error, Resolution, Precision, Linearity, Output

22. A ____________ exhalation is acceptable for children younger than 10 years: 3 second

23. Expiratory reserve volume (ERV): Total amount of gas that can be exhaled from the lung after a quiet exhalation

24. Extrapolated Volume: The volume exhaled before the zero time point

25. FEF 25% to 75% is a measure of: The flow during the middle portion of FVC, or the time necessary to exhale the middle 50%.

26. FEF 200 to 1200 and FEF 25% to 75%: Represent the average flow rates that occur during specific intervals of forced vital capacity

27. The Fleisch pneumotachometer measures: The changes in pressure as gas flows through a minimal, constant resistance according to the formula: V=∆P/R

28. Flow measuring devices are commonly called: Pneumotachometers

29. Flow volume loop: The forced expiratory VC sometimes is followed by a forced inspiratory VC to produce a complete image of forced breathing

30. For baseline testing, patients should temporarily abstain from: Bronchodilator medications, Short-acting bronchodilators, Long-acting β agonist bronchodilators, Oral therapy with aminophylline should be stopped for 12 hours

31. Forced expiratory flow between 25% and 75% of FVC (FEF 25%-75%): Measure of average expiratory flow during the middle of forced vital capacity

32. Forced expiratory flow between 75% and 85% of FVC (FEF 75%-85%): Measure of average expiratory flow during the end of forced vital capacity

33. Forced expiratory flow between 200 mL and 1200 mL of FVC (FEF 200-1200): Measure of average expiratory flow during the early phase of exhalation; specifically, it is a measure of the flow rate for the 1000 mL of expired gas immediately following the first 200 ml of expired gas

34. Forced Expiratory Volume in 1 second (FEV₁): A measurement of the volume exhaled in the first second of FVC

35. Forced expiratory volume in 1 second (FEV₁): Maximum volume of gas that a patient can exhale during the first second of the forced vital capacity maneuver

36. Forced expiratory volume in 1 second to vital capacity ratio (FEV₁/FVC): Percent of the measured forced vital capacity that can be exhaled in 1 second

37. Forced expiratory volume in 1 second to vital capacity ratio (FEV₁/FVC) is calculated by: Dividing the patients largest FEV₁ by the patients largest VC and converting it to a percentage by multiplying by 100

38. Forced expiratory volume in half of a second (FEV 0.5): Maximum volume of gas that the patient can exhale during the first one half of a second of a forced vital capacity maneuver

39. Forced Vital Capacity (FVC): Maximum volume of gas that the subject can exhale as forcefully and as quickly as possible

40. For tests of pulmonary function, what four important general principles should be considered: Test specificity, Sensitivity, Validity, Reliability

41. For volume measurements, standard reference values are provided by a: Graduated 3.0 L calibration syringe

42. Functional residual capacity (FRC): Total amount of gas left in the lungs after a resting expiration

43. FVC is an _____________ maneuver that requires careful patient instruction, understanding, coordination, and cooperation: Effort dependent

44. FVC maneuver must be completely exhaled or an exhalation time of at least: 6 seconds for adults and children over the age of 10

45. How can airway radius be reduced: Excessive contraction of the bronchial and bronchiolar muscles (Bronchospasm), Excessive secretions in the airways, Swelling of the airway mucosa, Airway tumors, Collapse of the bronchioles

46. How do you know if there is a leak in the system when using Nitrogen washout: The test must occur in a leak proof circuit because the presence of any air increase the measured nitrogen percentage and results in grossly elevated measurements of lung volumes

47. How long does a patient with obstructive lung disease require to equilibrate: 20 minutes because of slow gas mixing in the lung. In normal patients, equilibration occurs in about 2 to 5 minutes

48. How many attempts must be done when similar readings to indicate that the FVC is valid: 3

49. How often should the machine be calibrated: At least daily, although best practice in many labs is to verify accuracy before each test subject

50. How to calculate minute volume/ventilation: Respiration Rate x tidal volume = ventilation



51. How to calculate the % of error: % error= mean measured value – reference value÷ reference value x 100

52. How to calibrate the machine: Use a 3.0 L calibration syringe

53. How to measure residual volume: When the FRC is known, RV can be calculates as the difference between FRC and ERV.

FRC-ERV

54. How to measure TLC: RV + VC

55. If a person can not exhale at least 70% of their VC in 1 second what is the problem: There must be an obstruction

56. Inspiratory capacity (IC): Maximum amount of air that can be inhaled from the resting end expiratory level or FRC; sum of the tidal volume and inspiratory reserve volume

57. Inspiratory reserve volume (IRV): Maximum volume of air that can be inhaled after normal quiet inspiration

58. In what patients may the validity of measuring the forced vital capacity be hindered: Acutely ill patients or who have recently smoked a cigarette

59. Is there an inverse or direct relationship between Airway resistance and flow: Inverse, If the pressure difference is constant, a reduced flow rate indicates an increase in airway resistance

60. Is there an inverse or direct relationship between compliance and volume: Direct

61. Is tidal volume alone a valid indicator of the type of lung disease: NO

62. Is TLC increased or decreased in obstructive lung disease: Increased

63. Is TLC increased or decreased in restrictive lung disease: Decreased

64. Linearity: The accuracy of the instrument over its entire range of measurement

65. Linearity: Refers to the accuracy of the instrument over its entire range of measurement, or its capacity

66. The magnitude of the expansion in the _________: Volume measured

67. Male values are smaller or larger than female values when height and age are equal: Larger

68. Maximal Voluntary Ventilation: An effort dependent test for which the patient is asked to breathe as deeply and as rapidly as possible for at least 12 seconds. MVV is a test that reflects patient cooperation and effort, the ability of the diaphragm and thoracic muscles to expand the thorax and lungs, and airway patency

69. Maximal voluntary ventilation (MVV): Variation of the intermittent mandatory ventilation mode of ventilatory support in which the ventilator keeps the total minute volume constant

70. Measuring pulmonary mechanics is assessing what: The ability of the lungs to move large volumes of air quickly through the airways to identify airway obstruction

71. Measuring what can identify the destruction of alveolar tissue or the loss of functioning alveolar surface area: The diffusing capacity of the lung for carbon monoxide (DLCO)

72. Minute Ventilation (VE): Total lung ventilation per minute, the product of tidal volume and respiration rate. it is measured by expired gas collection for a period of 1 to 3 minutes; normal rate is 5 to 10 L/min

73. Normal values for the DLCO using the single breath technique are based primarily on: Age

Height

Gender

74. Obstructive pulmonary disease: Any respiratory disease characterized by decreased airway size and increased airway secretions

75. Output: Includes the specific measurements made or computed by the instrument.

76. Output: The specific measurements made or computed by the instrument

77. Peak expiratory flow rate (PEF): Maximum expiratory flow rate in L/sec

78. The peak flow: The slope of the tangent to the steepest portion of the FVC curve

79. Plethysmography techniques apply what law: Boyles Law

80. Pneumotachometers: Flow measuring devices

81. A positive response to saline is defined as: Decreased in FEV₁ of 10% or greater

82. Precision: Synonymous with reliability of measurement and the opposite of variability

83. Precision: Is synonymous with reliability or measurements and the opposite or variability

84. Provoking a hyper-reactive airway response by inhaling ______ is the most popular technique with the most predictable results: Methacholine

Inhaling histamine, cold air, exercising can also be used

85. Pulmonary mechanics: The measurements of FVC, FEV₁, several FEF values, forced inspiratory flow rates, and MVV

86. Reduced lung compliance is a result of lung: Alveolar inflammation, Pulmonary fibrosis, Neoplasms in the alveoli, A reduced thoracic compliance may be the result of thoracic wall abnormalities such as kyphoscoliosis, Neuromuscular diseases by affecting the function of inspiratory muscles

87. Residual volume represents how much of TLC: 20%

88. Residual volume (RV): Volume of gas remaining in the lungs after a complete exhalation

89. Resolution: The smallest detectable measurement; instruments with high resolution can measure the smallest volumes, flows, and times

90. Resolution: The smallest detectable measurement

91. Restrictive pulmonary disease: Broad category of disorders with widely variable etiologies but all resulting in a reduction in lung volumes, particularly the inspiratory and vital capacities; categorized according to origin skeletal/thoracic, neuromuscular, pleural, interstitial and alveolar

92. Reversibility is defined as: A 15% or greater improvement in FEV₁ and at least a 200 mL increase in FEV₁

93. Reversibility of the airway obstruction indicates what: That the therapy was effective

94. The severity of pulmonary impairment is based on what: A comparison of each patients measurement with the predicted normal value for the patient

95. The speed of expansion represents the ______: Flow rate

96. Spirometer: Sometimes used as a generic term for all volume measuring and flow measuring devices

97. Spirometers: Volume measuring devices, Includes: water sealed, bellows, and dry rolling seal types

98. Spirometry includes the tests of: Pulmonary mechanics, The measurements of FVC, FEV₁, several FEF values, Forced inspiratory flow rates, MVV

99. Test Reliability: The consistency of the test results

100. Thermistors or mass flowmeters: Another type of flow measuring device measures the temperature chance created by gas flowing through it.

101. Thoracic gas volume (TGV): Technique that measure lung volume

102. Tidal Volume (VT): Volume of air that is inhaled or exhaled from the lungs during effortless breathing

103. To ensure reliability of FEV₁ the largest FEV₁ and second largest FEV₁ from the acceptable trials should not very by more than: .150 L

104. To ensure reliability, the largest FVC and the second largest FVC from the acceptable trails should not vary by more than _______: .150 L

105. To ensure validity, each patient must perform a minimum of how many acceptable FVC maneuvers: 3

106. Total lung capacity (TLC): Total amount of gas in the lungs after a maximum inspiration

107. Tubinometers: Use rotation of a fan or blades similar to a windmill. The number of rotations indicates

volume, and the speed of the rotations indicates flow

108. The two largest repeated measurements should agree within: 5%

109. A typical normal value for a 20 year old healthy man is: 40 ml/min/mm Hg

110. The validity of MVV depends on what: The duration of the maneuver, which should be at least 12 seconds; the breathing frequency, which should be at least 90/min; and the average volume, which should be at least 50% of FVC

111. The validity of PEF rate is based on: A preceding inspiration to total lung capacity and a maximal effort.

112. Vital Capacity (VC): Total amount of air that can be exhaled after a maximum inspiration; the sum of the inspiratory reserve volume, the tidal volume and the expiratory reserve volume

113. Volume measuring devices are SPECIFICALLY called: Spirometers, and include water sealed, bellows, and dry rolling seal types. These devices expand as they collect gas volumes

114. What about 50% of FEV₁: Should be able to exhale in .5 seconds

115. What are some adverse affects that have occurred: Pneumothorax, Syncope, Chest pain, Paroxysmal coughing, Bronchospasm

116.What are the contraindications of pulmonary function testing: Hemoptysis, Pneumothorax, Myocardial Infarction, Pulmonary embolism, Acute chest or abdominal pain, Nausea, Vomiting, Recent cataract removal surgery, Patients with dementia or confusion may not achieve optimal or repeatable results.

117. What are the indications of pulmonary function testing: To identify and quantify changes in pulmonary function, To evaluate need and quantify therapeutic effectiveness, To perform epidemiologic surveillance for pulmonary disease, To assess patient for risk of postoperative pulmonary complications, To determine pulmonary disability

118. What are the three categories of pulmonary function tests measuring: Dynamic flow rates of gases though the airways, Lung volumes and capacities, The ability of the lungs to diffuse gases

119. What are the three components to pulmonary function testing: 1. Performing spirometry for measuring airway mechanics, 2. Measuring lung volumes and capacities, 3. Measuring the diffusing capacity of the lung (DL)

120. What are the two general types of measuring instruments: Instruments that measure gas volume, Instruments that measure gas flow

121. What are the two major categories of pulmonary disease: Obstructive pulmonary disease, Restrictive pulmonary disease

122. What can disqualify a Forced vital capacity trial: Cough, An inspiration, A Valsalva maneuver, A leak, An obstructed mouth piece

123. What does a decrease in flow rate signify: An increase in airways resistance and the presence of airway obstruction when patient effort creating the difference between mouth pressure and lung pressure is constant

124. What does an FEV₁/FVC of less than 70% indicate: An obstructive impairment

125. What is Airway resistance (Raw): The difference in pressure between the ends of the airways divided by the flow rate of gas moving through the airway

126. What is the accuracy of flow: 95%

127. What is the accuracy of volume: ± 3% or within 50 mL or reference value

128. What is the minimum objective standard for FEV₁: .025 L

129. What is the most commonly measured lung volume: Vital Capacity (VC)

130. What is the most commonly performed test of pulmonary mechanics: Forced Vital Capacity (FVC)

131. What is the normal tidal volume amount for an adult: 500 to 700 mL

132. What is the normal value for ERV: 1200 ml

133. What is the normal value for IRV: 3100 ml

134. What is the normal value for peak expiratory flow: 9.5 L

135. What is the normal value for RV: 1200 ml

136. What is the normal value for TLC: 6000 ml

137. What is the normal value for VC: 4800 ml

138. What is the normal value of FRC: 2400 ml

139. What is the normal value of Inspiratory Capacity: 360 ml

140. What is the predicted normal FEV₁ for a 20 year old man: 4.7 L

141. What is the predicted normal FVC for a 20 year old man: 5.60 L

142. What is the primary problem in obstructive pulmonary disease: An increase in airway resistance Raw

143. What is the primary problem in restrictive lung disease: Reduced lung compliance, thoracic compliance, or both.

144. What is the primary problem with Obstructive Pulmonary disease: An increase in airway resistance, An increase in total lung capacity, An increase in functional residual capacity, A decrease in flow

145. What is the primary problem with Restrictive Pulmonary disease: Reduced compliance, thoracic compliance or both. An inability for the lungs to expand, a reduction in volumes

146. What is the primary purpose of pulmonary function testing: To identify pulmonary impairment and to quantify the severity of pulmonary impairment if present

147. What is the typical VC: 4.80 L

The predicted normal FVC for a 20 year old 180 cm male approaches 5.60 L

148. What makes up the Functional Residual Capacity: Expiratory Reserve volume (ERV) and the Residual Volume (RV)

149. What pulmonary test poses the greatest risk for fainting: MVV

150. What test is used to measure FRC: A diffusion test

151. What type of gas is used in a diffusion test: carbon monoxide (CO)

152. When a patient performs a FVC how much volume in % must be exhaled in 1 second: 70%

153. When are flow rate measured: Because the radius of the airways normally lessens slightly during expiration, flow rates are usually measured during expiration

154. When id a dilution test used: In obstructive lung disease

155. When performing pulmonary function testing what establishes test validity: Strictly following testing procedures

Ensuring patient effort and performance

Ensuring equipment accuracy and calibration

156. When will performing a bronchial provocation be indicated: When the patient’s history suggests episodic symptoms of hyperactive airways and airway obstruction, such as seasonal or exercise induced wheezing

157. Why is Vial Capacity reduced in restrictive lung disease: Because the patients inhaled volume is reduced