Ruppel’s Manual of Pulmonary Function Testing 10th Edition by Carl Mottram – Test Bank

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Chapter 5: Ventilation and Ventilatory Control Tests

Test Bank

 

MULTIPLE CHOICE

 

  1. A circuit is set up to perform a CO2 rebreathing response test. The reservoir bag in the circuit should contain which of the following?
a. Room air
b. 3% CO2 in air
c. 7% CO2 in O2
d. 100% O2

 

 

ANS:   C

The patient rebreathes from a reservoir (usually an anesthesia bag) of 7% CO2 in O2.

 

DIF:    1                      REF:    p. 140              OBJ:    None               MSC:   NBRC: None

 

  1. A subject has the following results after 4.0 minutes of a CO2 rebreathing test:
  Time (min) 0 4
PETCO2 37 57
(L/min) 5.0 12.5

These findings are consistent with which of the following?

a. Normal lung function
b. Obesity-hypoventilation syndrome
c. Chronic asthma
d. Interstitial pulmonary fibrosis

 

 

ANS:   B

The response to an increase in PaCO2 in a healthy individual is a linear increase in E of approximately 3 L/min/mm Hg (PCO2).

 

DIF:    3                      REF:    p. 143              OBJ:    EL-2

 

  1. Exhaled gas is collected for 5 minutes; the mixed expired PCO2 is measured. Blood gases are drawn during the last minute of gas collection, and the following data are recorded:
PECO2 24 mm Hg
pH 7.38
PaCO2 32
PaO2 71

 

What is this subject’s VD/VT ratio?

a. 0.75
b. 0.33
c. 0.25
d. 0.11

 

 

ANS:   C

VD/VT = (PaCO2 – PECO2) ¸ PaCO2; (32 – 24) ¸ 32 = 0.25.

 

DIF:    2                      REF:    p. 139              OBJ:    EL-3                MSC:   NBRC: None

 

  1. The measurement of a patient’s respiratory dead space is 0.3 L (BTPS). If she is breathing at a rate of 22 breaths/min with a VT of 0.7 L (BTPS), what is her A?
a. 22.0 L (BTPS)
b. 15.4 L (BTPS)
c. 8.8 L (BTPS)
d. 6.6 L (BTPS)

 

 

ANS:   C

A = fB(VT – VD); 22(0.7 – 0.3) = 8.8 L.

 

DIF:    2                      REF:    p. 139              OBJ:    None

 

  1. A patient with COPD has the following data recorded:
E 7.6 L/min (BTPS)
Respiratory rate 18/min

What is this subject’s VT?

a. 0.42 L (BTPS)
b. 0.33 L (BTPS)
c. 0.23 L (BTPS)
d. 0.14 L (BTPS)

 

 

ANS:   A

VT = E/frequency; 7.6 ¸ 18 = 0.42.

 

DIF:    2                      REF:    p. 136              OBJ:    EL-1

 

  1. The VD/VT ratio may be estimated noninvasively by measuring which of the following?
a. VT and mixed expired PCO2
b. Mixed expired PCO2 and end-tidal PCO2
c. End-tidal PCO2 and VT
d. Arterial PCO2 and mixed expired PCO2

 

 

ANS:   B

The VD/VT ratio can be calculated if arterial and mixed-expired PCO2 values are known. It can also be estimated noninvasively.

 

DIF:    1                      REF:    p. 139              OBJ:    AL-1               MSC:   NBRC: None

 

  1. Which of the following measurements confirm the diagnosis of hypoventilation?
  2. Respiratory rate of 7/min
  3. Ventilation of 4.0 L/min (BTPS)
  4. PaCO2 of 49 mm Hg
  5. pH of 7.29
a. 2 only
b. 3 only
c. 1 and 2
d. 3 and 4

 

 

ANS:   D

Low VA associated with acute respiratory acidosis (PaCO2 greater than 45 and pH less than 7.35 in healthy patients) defines hypoventilation.

 

DIF:    1                      REF:    p. 137              OBJ:    EL-2                MSC:   NBRC: None

 

  1. P100 is the:
a. Ventilation in liters per minute when the patient is breathing 100% O2
b. PETCO2 when the subject is breathing 100 L/min
c. Pressure developed during the first 100 msec of an occluded breath
d. Mean alveolar pressure extrapolated to a respiratory rate of 100/min

 

 

ANS:   C

Occlusion pressure (P100 or P0.1) is the pressure generated at the mouth during the first 100 msec of an inspiratory effort against an occluded airway.

 

DIF:    1                      REF:    p. 141              OBJ:    None               MSC:   NBRC: None

 

  1. A rebreathing CO2 response test should be terminated in which of the following situations?
  2. When the PETCO2 exceeds 9% in the circuit
  3. If the FIO2 drops below 0.21
  4. When the subject has rebreathed for 4 minutes
  5. As soon as the P100 has been measured
a. 1 only
b. 2 and 3
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:   C

The patient rebreathes until the concentration of PETCO2 exceeds 9% or until 4 minutes have elapsed. If for some reason the FIO2 were to fall below 0.21, the test would be terminated too.

 

DIF:    2                      REF:    p. 136              OBJ:    None               MSC:   NBRC: None

 

  1. A subject has the following data recorded during a rebreathing O2 (hypoxic) response test:
  Time (min) 0 1 2 3 4
PETCO2 (mm Hg) 38 39 39 38 37
SpO2 (%) 95 94 92 88 85
E (L/min) 4.1 5.2 9.5 20.4 44.5

These findings are consistent with which of the following?

a. A normal ventilatory response to hypoxemia
b. A blunted ventilatory response to hypoxemia
c. An improperly calibrated pneumotachometer
d. A malfunctioning end-tidal CO2 analyzer

 

 

ANS:   A

See Interpretive Strategies 5-3, Chapter 5.

 

DIF:    2                      REF:    p. 143              OBJ:    None               MSC:   NBRC: None

 

  1. A subject performing a closed-circuit hypoxic response test abruptly stops the test and complains of dizziness. This is most likely because of:
a. Inadequate scrubbing of CO2
b. Failure to maintain eucapnia
c. Incomplete gas mixing in the circuit
d. Excessive resistance in the circuit

 

 

ANS:   A

The closed circuit technique uses a CO2 scrubber to remove CO2. Increasing CO2 levels in a circuit with a dysfunctional scrubber would cause symptoms of dizziness. Figure 5-1 (see Chapter 5) describes the system.

 

DIF:    2                      REF:    p. 142              OBJ:    AL-3               MSC:   NBRC: None

 

  1. A subject has the following results after 4 minutes of a CO2 rebreathing test:
  Time (min) 0 4
PETCO2 (mm Hg) 40 56
E (L/min) 6 48

These findings are consistent with a ventilatory response that is:

a. Markedly reduced
b. Slightly reduced
c. Normal
d. Extremely high

 

 

ANS:   C

The response to an increase in PaCO2 in a healthy individual is a linear increase in E of approximately 3 L/min/mm Hg (PCO2).

 

DIF:    3                      REF:    p. 143              OBJ:    None               MSC:   NBRC: None

 

  1. A subject’s exhaled gas is collected in a meteorologic balloon for 5 minutes, then analyzed for PO2, PCO2, and volume expired. Blood gases are drawn simultaneously and the following data are recorded:

Temperature: 25° C

BTPS correction factor: 1.011

PB: 750 mm Hg

Volume expired: 27.5 L (ATPS)

FECO2: 0.046 (4.6%)

Respiratory rate: 12/min (average)

pH: 7.38

PCO2: 44

PO2: 71

What is this subject’s E?

a. 1.27 L (BTPS)
b. 2.29 L (BTPS)
c. 5.91 L (BTPS)
d. 7.73 L (BTPS)

 

 

ANS:   C

E = Collected expired volume/5 minutes times BTPS correction factor.

 

DIF:    3                      REF:    p. 138              OBJ:    EL-1                MSC:   NBRC: None

 

  1. What is the subject’s tidal volume (VT)?
a. 493 ml (BTPS)
b. 577 ml (BTPS)
c. 1011 ml (BTPS)
d. 2292 ml (BTPS)

 

 

ANS:   A

VT = E/frequency

 

DIF:    3                      REF:    p. 136              OBJ:    EL-1                MSC:   NBRC: None

 

  1. What is the subject’s VD/VT%?
a. 15%
b. 25%
c. 33%
d. 40%

 

 

ANS:   B

VD/VT = (PaCO2 – PECO2) ¸ PaCO2.

 

DIF:    3                      REF:    p. 139              OBJ:    AL-1               MSC:   NBRC: None

 

  1. What is the subject’s E?
a. 3.37 L/min (BTPS)
b. 4.61 L/min (BTPS)
c. 7.73 L/min (BTPS)
d. 8.19 L/min (BTPS)

 

 

ANS:   B

E = fB(VT – VD)

 

DIF:    3                      REF:    pp. 139-140    OBJ:    None               MSC:   NBRC: None

 

  1. To calculate respiratory dead space (VD), which of the following are required?
  2. VT
  3. E
  4. PaCO2
  5. PECO2
a. 1 and 3
b. 2 and 4
c. 1, 3, and 4
d. 3 and 4

 

 

ANS:   C

VD/VT = (PaCO2 – PECO2) ¸ PaCO2.

 

DIF:    2                      REF:    p. 139              OBJ:    AL-1               MSC:   NBRC: None

 

  1. Hyperventilation can be defined by:
  2. A respiratory rate greater than 25/min
  3. Ventilation greater than 25 L/min (BTPS)
  4. PaCO2 less than 35 mm Hg
  5. pH greater than 7.45
a. 1 and 2
b. 3 and 4
c. 2 and 4
d. 1, 2, and 3

 

 

ANS:   B

Excessive VA (PaCO2 less than 35 and pH greater than 7.45 in healthy patients) defines hyperventilation.

 

DIF:    1                      REF:    p. 141              OBJ:    None               MSC:   NBRC: None

 

  1. Which of the following parameters should be measured to assess the adequacy of the output of the respiratory centers?
a. PaCO2
b. PaO2
c. VD/VT
d. P100

 

 

ANS:   D

The output of the central respiratory centers is sometimes also measured as the pressure developed during the first tenth of a second when the airway is blocked (P100 or P0.1).

 

DIF:    1                      REF:    p. 136              OBJ:    None               MSC:   NBRC: None

 

  1. Which of the following tests requires a variable CO2 scrubbing device in the breathing circuit?
a. Dead space determination
b. Closed-circuit O2 response test
c. Closed-circuit CO2 response test
d. Open-circuit CO2 response test

 

 

ANS:   B

Closed-circuit technique (progressive hypoxemia). The patient rebreathes from a system similar to that used for the closed-circuit CO2 response, but the system contains a CO2 scrubber.

 

DIF:    1                      REF:    p. 142              OBJ:    AL-3               MSC:   NBRC: None

 

  1. A subject has the following data recorded during a rebreathing CO2 response test:
  Time (min) 0 1 2 3 4
PETCO2 (mm Hg) 38 41 48 54 61
E (L/min) 5.1 5.2 5.5 5.4 5.5

These findings are consistent with:

a. A decreased ventilatory response
b. A normal ventilatory response
c. An improperly calibrated pneumotachometer
d. A malfunctioning end-tidal CO2 analyzer

 

 

ANS:   A

The response to an increase in PaCO2 in a healthy individual is a linear increase in E of approximately 3 L/min/mm Hg (PCO2).

 

DIF:    3                      REF:    p. 143              OBJ:    None               MSC:   NBRC: None

 

  1. Sodium hydroxide crystals (Sodasorb) are used to scrub CO2 from a rebreathing circuit. What is the color these crystals change to when they are fully depleted?
a. Violet
b. Blue
c. Red
d. White

 

 

ANS:   A

Sodasorb changes from off-white to violet when it is exhausted.

 

DIF:    1                      REF:    p. 137              OBJ:    AL-3

MSC:   NBRC: CPFT 1B-11

 

  1. A subject’s tidal breathing is measured at 720 ml, with a respiratory rate of 12. Assuming a dead space of 150 ml, what is the subject’s alveolar volume?

Temperature 19° C BTPS conversion factor 1.111

a. 7.60 L
b. 6.84 L
c. 8.64 L
d. 9.60 L

 

 

ANS:   A

VA = fB(VT – VD).

 

DIF:    2                      REF:    p. 139              OBJ:    None               MSC:   NBRC: None

 

  1. What is the calculated VD/VT ratio, given the following variables?
PCO2 38 mm Hg
Respiratory rate 15
PaCO2 42 mm Hg
E 7.8 L
Temp 19° C BTPS conversion factor 1.111

 

a. 10.7%
b. 9.6%
c. 12%
d. 15%

 

 

ANS:   B

VD/VT = (PaCO2 – PECO2) ¸ PaCO2.

 

DIF:    2                      REF:    p. 139              OBJ:    AL-1               MSC:   NBRC: None

 

  1. Which of the following statements best describes the measurement P100 or P0.1?
a. Pressure measure at 100 mm Hg during CO2 response test
b. Occlusion pressure measured at 10 msec during a hypoxic challenge test
c. Pressure measured at 100 msec during a CO2 response test
d. The oxygen saturation level at which the partial pressure of oxygen is 100 mm Hg

 

 

ANS:   C

Occlusion pressure (P100 or P0.1) is the pressure generated at the mouth during the first 100 msec of an inspiratory effort against an occluded airway during a response test.

 

DIF:    1                      REF:    p. 136              OBJ:    None               MSC:   NBRC: None

 

  1. When preparing for a CO2 response test, the technologist should fill the rebreathing bag with which of the following concentrations?
a. Oxygen 21%, CO2 7%, Balance N2
b. Oxygen 90%, CO2 10%
c. Oxygen 93%, CO2 7%
d. Oxygen 21%, CO2 10%, Balance N2

 

 

ANS:   C

The patient rebreathes from a reservoir (usually an anesthesia bag) of 7% CO2, 93% O2.

 

DIF:    1                      REF:    p. 141              OBJ:    None               MSC:   NBRC: None

 

  1. All of the following are end-of-test criteria for a CO2 response except:
a. Test duration of 4 minutes
b. PETCO2 ³9%
c. Patient intolerance
d. End-tidal CO2 ³75 mm Hg

 

 

ANS:   D

The patient rebreathes until the concentration of PETCO2 exceeds 9% or until 4 minutes have elapsed.

 

DIF:    1                      REF:    p. 141              OBJ:    None               MSC:   NBRC: None

 

  1. What formula can you use to estimate dead space?
a. 1 ml per pound of ideal body weight
b. 2 ml per pound of ideal body weight
c. 1 ml per kg of ideal body weight
d. 5 ml per kg of ideal body weight

 

 

ANS:   A

Dead space consists of anatomic and alveolar components. Anatomic dead space is usually estimated from body weight (1 ml/lb of ideal body weight).

 

DIF:    1                      REF:    p. 139              OBJ:    None               MSC:   NBRC: None

 

  1. The diagram shows the graphic data from a CO2 response test. On the basis of the gross change, what physiologic response do these data represent?
a. Blunted CO2 response
b. 3.5 L/min/mm Hg
c. Normal response
d. 0.5 L/min/mm Hg

 

 

ANS:   C

The response to an increase in PaCO2 in a healthy individual is a linear increase in E of approximately 3 L/min/mm Hg (PCO2).

 

DIF:    3                      REF:    p. 143              OBJ:    None               MSC:   NBRC: None

 

  1. All of the following would cause an increased VD/VT ratio except:
a. Exercise
b. COPD
c. Pulmonary hypertension
d. Pulmonary embolism

 

 

ANS:   A

Exercise causes a decreased VD/VT ratio. In healthy individuals, the VT increases more than the VD, so the ratio decreases.

 

DIF:    1                      REF:    p. 141              OBJ:    AL-2               MSC:   NBRC: None

 

  1. The high altitude simulation test is used to predict hypoxemia in individuals:
a. Climbing mountains to 2000 ft
b. Climbing mountains to 4000 ft
c. Flying at 6000 ft
d. Flying at 8000 ft

 

 

ANS:   D

The high altitude simulation test exercise is used to emulate high altitude in subjects susceptible to hypoxia during air travel. The test is designed to predict hypoxemia at the maximum allowable aircraft cabin pressure altitude of 8000 ft.

 

DIF:    1                      REF:    p. 145              OBJ:    AL-4               MSC:   NBRC: None

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