Test bank for respiratory care anatomy and physiology 3nd edition by will beachey

Pulmonary fibrosis ANS: A An abnormally increased FRC represents hyperinflation, which may be caused by a loss of elastic recoil or partial airway obstruction.. Body plethysmography mea

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by Will Beachey

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Chapter 5: Pulmonary Function Measurements

Test Bank

MULTIPLE CHOICE

1 Which of the following characteristics influence pulmonary function?

I Age

II Gender

III Height

IV Diet

a I, III

b II, III, IV

c I, II, III

d II, IV

ANS: C

Physical characteristics that influence pulmonary function the most are age, gender, height, ethnic origin, and body size or surface area

2 Lung function is considered normal when values are within what range of predicted?

a 80% to 120%

b 100% to 120%

c 60% to 80%

d 80% to 90%

ANS: A

Function is generally classified as normal if values are within 20% of the predicted values (i.e., 80% to 120% of the predicted values)

3 Which of the following values cannot be directly measured?

ANS: A

Because residual volume (RV) cannot be exhaled, it cannot be measured via direct spirometry Therefore, no capacity containing RV can be directly measured

4 Which of the following methods allow indirect measurement of RV and capacities containing it?

I Helium dilution

II End-tidal CO2

III Nitrogen washout

IV Body plethysmography

a I, III, IV

b III, IV

c I, II, III, IV

d II, IV

ANS: A

RV and capacities containing it are measured indirectly via one of the following methods: helium dilution, nitrogen washout, or body plethysmography

5 Which of the following methods allows measurement of gas in the lung of a patient with obstructed airways?

I Helium dilution

II End-tidal CO2

III Nitrogen washout

IV Body plethysmography

a I, III

d I, IV

ANS: B

Neither the helium dilution nor the nitrogen washout techniques measure gas trapped behind occluded airways

6 Which of the following methods to measure gas in the lungs is based on Boyle’s law?

a Helium dilution

b End-tidal CO2

c Nitrogen washout

d Body plethysmography

ANS: D

The plethysmographic method is based on Boyle’s law

7 Which of the following are features of plethysmography?

I It is quite rapid

II Successive FRC measurements can be made

III It measures ventilated air space

IV It measures nonventilated air space

a I, II, III

b I, II, III, IV

c II, III

d I, IV

ANS: B

The plethysmographic method is quite rapid; successive functional residual capacity (FRC) measurements can be made as the patient pants against the occluded mouthpiece This

technique measures the ventilated and nonventilated air spaces

8 An abnormally increased FRC is typically associated with which of the following conditions?

a Hyperinflation

b Increased elastic recoil

c Increased compliance

d Pulmonary fibrosis

ANS: A

An abnormally increased FRC represents hyperinflation, which may be caused by a loss of elastic recoil or partial airway obstruction

9 Which of the following explains the lack of response to bronchodilators by some patients with severe emphysema?

a Airway obstruction is caused by severe bronchospasm

b Airway obstruction is caused by passive airway compression and collapse during

expiration

c Airway obstruction is associated with air trapping

d Airway obstruction with hyperinflation is not sensitive to bronchodilators

ANS: B

Partial airway obstruction caused by bronchospasm is generally reversed by bronchodilator drugs; thus the associated increase in FRC is reversible Increased FRC caused by a

permanent loss of elastic recoil is not reversible In severe emphysema, this loss of lung elasticity is associated with passive airway compression and collapse during expiration, causing air trapping Bronchodilator drugs are not useful in these circumstances

emphysema The physician requests that the study be performed to measure FRC

Upon completion of both the helium dilution and body plethysmography it is found that the FRC obtained via body plethysmography is higher than that obtained via helium dilution What is the probable explanation for the difference in obtained FRC values?

a Body plethysmography overestimates FRC

b Helium dilution measures only the true FRC

c Body plethysmography measures only gas that is in communication with

unobstructed airways while helium dilution measures all gas in the chest

d Body plethysmography measures all gas in the chest while helium dilution

measures only gas that is in communication with unobstructed airways

ANS: D

The helium dilution test can measure only gas that is in communication with unobstructed airways Body plethysmography measures all gas in the chest, including gas trapped behind obstructed airways Thus, if body plethysmography yields higher FRC values than helium dilution measurements, air trapping must be present This is consistent with diseases such as emphysema, in which a loss of elastic lung recoil results in a loss of tethering forces that hold airways open during forceful exhalations As a result, small noncartilaginous airways collapse prematurely, trapping air In this patient, test results are consistent with the presence of

emphysema

a Obstructive

b Restrictive

c Mixed

d Idiopathic

ANS: A

Diseases increasing FRC and RV are generally classified as obstructive

I Fibrotic lung disease

II ARDS

III Skeletal deformities

IV Asthma

a I, II, III

b II, III

c I, II, III, IV

d II, III, IV

ANS: A

Fibrotic lung diseases increase lung elastic recoil, shrinking all volumes and capacities Increased alveolar-capillary membrane permeability, characteristic of acute respiratory

distress syndrome (ARDS), disrupts surfactant synthesis and increases alveolar surface

tension This decreases FRC and RV by causing widespread alveolar collapse

Extrapulmonary restriction of lung expansion by skeletal deformities also reduces all lung volumes and capacities Regardless of the mechanisms involved, reduced FRC and high lung recoil increase the work of breathing Diseases decreasing FRC and RV are generally

classified as restrictive

a Increased RV

b Reduced maximum expiratory flow rate

c Decreased VC

d Increased TLC

ANS: B

The major feature of obstructive disease is a reduced maximum expiratory flow rate

diseases?

a Loss of elastance

b Increased airway resistance

c Loss of compliance

d Increased airflow

ANS: B

Obstructive diseases increase the work of breathing primarily by increasing airway resistance

a Increased RV

b Reduced maximum expiratory flow rate

c Decreased lung volumes and capacities

d Increased TLC

ANS: C

The major feature of restrictive disease is a reduction of lung volumes and capacities

diseases?

a Loss of elastance

b Increased airway resistance

c Loss of compliance

d Increased airflow

ANS: C

Restrictive diseases generally increase the WOB by decreasing lung compliance, making expansion difficult

compliance?

b Pulmonary fibrosis

c Neuromuscular disease

d Pneumonia

ANS: C

Neuromuscular diseases are unique in that they are classified as restrictive, although lung and thoracic compliance may be normal However, they present a restrictive pulmonary function pattern because muscle weakness limits inspiratory and expiratory volumes

DIF: Recall REF: 101

a 5% to 10%

b 10% to 15%

c 20% to 25%

d 30% to 35%

ANS: C

The normal RV/TLC ratio is 20% to 25% in healthy adults up to age 49 In people older than

50 years of age, the RV/TLC ratio may range as high as 35%, reflecting normal loss of elastic recoil with aging

I Muscle strength

II Airway patency

III Neurological function

IV Diaphragmatic function

a I, II, III

b II, III, IV

c I, II, III, IV

d II, III, IV

ANS: A

The ability to generate high flow rates depends on muscular strength, airway patency, and neurological function

I It is the most frequently performed pulmonary function test

II It provides much information about large and small airway function

III It is an effort-dependent test

IV A test is assumed valid if the person can repeat three FVC maneuvers with a variation no greater than 10%

a III, IV

b I, II, III

c I, II, IV

d I, II, III, IV

ANS: B

The forced vital capacity (FVC) measurement requires the person to exhale the vital capacity (VC) as forcefully and rapidly as possible The FVC is the most frequently performed

pulmonary function test because it provides much information about large and small airway function It is an effort-dependent test, requiring thorough patient instruction, understanding, and maximal effort A test is assumed valid if the person can repeat three FVC maneuvers with a variation no greater than 5%

DIF: Recall REF: 102

a 2 to 4 seconds

b 4 to 6 seconds

c 1 to 2 seconds

d 6 to 8 seconds

ANS: B

Normal people can exhale 100% of the FVC in 4 to 6 seconds People who have severe airway obstruction may require more than 10 seconds.

a A low FEV1 and a low FEV1/FVC ratio

b A high FEV1 and a low FEV1/FVC ratio

c A low FEV1 and a high FEV1/FVC ratio

d A normal FEV1 and a low FEV1/FVC ratio

ANS: A

A low 1-second forced expiratory volume (FEV1) and a low FEV1/FVC ratio define an obstructive impairment

a A low FEV1 and a low FEV1/FVC ratio

b A high FEV1 and a low FEV1/FVC ratio

c A low FEV1 and a normal FEV1/FVC ratio

d A normal FEV1 and a low FEV1/FVC ratio

ANS: C

Restrictive impairments also have a low FEV1 but a normal or even high FEV1/FVC ratio

ANS: B

The FEV1 is an index of severity in chronic obstructive pulmonary disease (COPD) The ability to work and the likelihood of dying from respiratory disease are statistically correlated with the FEV1

Normal healthy adults exhale approximately 83% of the FVC in 1 second (FEV1), 94% in 2 seconds (FEV2), and 97% in 3 seconds (FEV3)

25 Which of the following values indicates significant airway obstruction?

a FEV1/FVC < 85%

b FEV1/FVC < 80%

c FEV1/FVC < 75%

d FEV1/FVC < 65%

ANS: D

Age causes the FEV1/FVC ratio to decrease because of reduced elastic recoil An FEV1/FVC ratio lower than 70% indicates that significant airway obstruction is present

I It reflects large airway function

II PEF in normal adults may exceed 10 L/sec

III It is an effort-dependent test

IV PEF is useful in assessing gross changes in airway function and evaluating the response to bronchodilator drugs

a III, IV

b I, II, III

c I, II, IV

d I, II, III, IV

ANS: D

The peak expiratory flow (PEF) reflects initial expiratory flow coming from the large airways

at the beginning of the FVC Thus, PEF reflects large airway function It is an

effort-dependent test: the greater the effort, the higher the test value PEF in normal adults may exceed 10 L/sec Reproducibility of the PEF is a good indication of maximal patient effort The PEF is useful in assessing gross changes in airway function and evaluating the response to bronchodilator drugs This test is very useful in managing asthma in outpatient and home settings

smokes two packs of cigarettes a day is brought to the emergency department She complains

of having the flu 2 weeks earlier and that her breathing has become more difficult since then Her pulmonary function test reveals the following results:

Predicted Actual Percent of Predicted

FEV1/FVC More than 75% 31% —

(A value equal to or greater than 80% of the predicted value is considered normal.)

What condition do these pulmonary function results suggest?

a Obstructive

b Restrictive

c Mixed

d Neuromuscular disease

ANS: A

Diagnoses of obstructive and restrictive patterns are traditionally based on three main

variables: FVC, FEV1, and FEV1/FVC This woman’s test shows that the FVC is normal (above 80% of predicted), but the FEV1 and FEV1/FVC are decreased The normal FVC rules out restrictive disease These findings are consistent with an obstructive impairment because they point to expiratory airflow limitation A normal person is expected to exhale about 80%

of the FVC in the first second This woman’s reduced flows are probably caused by loss of elastic support in the airways, producing premature bronchiolar collapse during forced

expiration As the obstructive disease becomes more severe, the FVC also may decrease because air trapping limits her ability to exhale as much air as a normal person

I It is more sensitive to flow coming from medium to small airways

II Normal FEF25-75% for a healthy young adult is approximately 4 to 5 L/sec

III It does not have more variance than other measures of flow

IV Because the FEF25-75% is so variable, its validity is questionable

a III, IV

b I, II, III

c I, II, IV

d I, II, III, IV

ANS: C

The average forced expiratory flow rate over the middle 50% of the FVC (FEF25-75%) is more sensitive to flow coming from medium to small airways The primary resistance to expiratory flow during the middle half of the FVC comes from rapid narrowing of small airways as the lung deflates Normal FEF25-75% for a healthy young adult is approximately 4 to 5 L/sec Unfortunately, this test has more variance than other measures of flow, even in normal people

An FEF25-75% equal to 65% of the predicted value may still be within statistically normal limits.Because the FEF25-75% is so variable, its validity is questionable; the FEV1 is more useful and reliable in assessing the response to bronchodilators

following parameters?

I Ventilatory apparatus

II Muscle strength

III Endurance

IV Airway diameter, lung compliance, and neural control mechanisms

a III, IV

b I, II, III

c I, II, IV

d I, II, III, IV

ANS: D

The maximum voluntary ventilation (MVV) reflects the overall integrated function of the ventilatory apparatus, including muscle strength, endurance, airway diameter, lung

compliance, and neural control mechanisms As such, MVV is a nonspecific test MVV varies considerably in healthy people, as much as 30% from the mean Therefore, only large

reductions in MVV are significant

a Obstructive

b Restrictive

c Mixed

d Idiopathic

ANS: B

The MVV is relatively unaffected by purely restrictive disease Faster breathing rates

compensate for smaller tidal volumes, producing near normal MVV values

the presence of which of the following spirometric values?

a FEV1 30% to 50% and FEV1/FVC < 70%

b FEV1 < 50% and FEV1/FVC < 70%

c FEV1 50% to 80% and FEV1/FVC < 70%

d FEV1 < 80% and FEV1/FVC < 60%

ANS: A

GOLD Classification of COPD by Severity

Stage Characteristics

I: Mild COPD FEV1/FVC less than 70%

FEV1 80% or more of predicted II: Moderate COPD FEV1/FVC less than 70%

FEV1 50% or more but less than 80% of predicted III: Severe COPD FEV1/FVC less than 70%

FEV1 less than 50% but greater than 30% of predicted

IV Very severe COPD FEV1/FVC less than 70%

FEV1 less than 30% of predicted; life threatening exacerbations; severe

ANS: B

Small airways less than 2 mm in diameter account for less than 20% of total airway resistance This means a significant amount of small airway obstruction may remain undetected by

conventional spirometry

small airways resistance?

a FEF25-75%

b Frequency dependence of compliance

c Closing volume

d Low-density gas spirometry

ANS: B

Frequency dependence of compliance is an extremely sensitive test for early detection of abnormal small airways resistance and is the standard against which other tests are compared

obstruction than FEF25-75% or FEV1?

b The volume of isoflow (VisoV.)

d Dynamic compliance

ANS: B

The VisoV· test is more sensitive to small airway obstruction than the FEF25-75% or FEV1