Review 3

  1. Lung compliance is usually measured in patient's with __________?
    stiff lungs, e.g. pulmonary fibrosis
  2. Airway resistance is usually measured in patient's with ___________?
    asthma or chronic bronchitis
  3. Bedside spirometry is indicated for:
    Patients showing signs of respiratory difficulty & for whom the need for mechanical ventilation is being considered
  4. Tidal volume is usually measured by?
    Vt and RR are accumulated for one minutes and an average Vt is calculated.
  5. Small tidal volumes may be found in patients:
    have a low metabolic rate, are sleeping, in a coma, have neuromuscular disease or are alkalotic.
  6. Large tidal volumes may be found in patients:
    high metabolic rates, have a fever, have a dead-space producing disease (such as pulmonary embolism), increased ICP or are acidotic.
  7. Normal I:E Ratio
    1.2 to 1.4
  8. A prolonged inspiratory time is seen?
    in patients with upper airway obstruction
  9. A prolonged expiratory time is seen?
    in patients with asthma or COPD
  10. Calculate the patients Ti and Te when the I:E Ratio is 1:2 and the f = 12
    (60 sec/min)/12 bpm = 5 secs per respiration; 5 sec per resp/3 parts I&E = 1.66 sec per part; Ti = 1 part = 1.66sec; Te = 2 parts = 3.32 sec.
  11. Calculate a neonate's I:E ratio when the Ti = 0.3 sec and the Te = 0.9 sec.
    I:E = 0.3/0.9; I:E = 1/3 = 1:3
  12. Normal Minute Volume Is ___?
    5-10 lpm
  13. Estimated normal anatomic dead space is ___?
    1 ml/lbs
  14. Calculate the alveolar ventilation of a 154 lb patient with a measured Vt of 500ml.
    Vt - (1 ml/lb) = 500 - 154 = 346 ml calculated alveolar ventilation
  15. Formula for calculating Minute Alveolar Ventilation
    VA = RR x (Vt-Vds)
  16. MIP is most commonly used to _____?
    determine the weanability of mechanically ventilated pateints
  17. Normal MIP
    at least -60 cm H2O
  18. Normal MEP
    at least 80 cm H2O
  19. Significance of VC
    in general, a decreasing VC is a sign the patient is tiring or ventilatory effort is inadequate
  20. Normal adult peak flow
    used to access effectiveness of bronchodilators
  21. "Green Zone" Peak Flow
    80%-100% of predicted: adequate control
  22. "Yellow Zone" Peak Flow
    50-79% of predicted: not adequately controlled
  23. "Red Zone" Peak Flow
    less than 50% of predicted: not controlled
  24. Exhaled Nitric Oxide (eNO)
    measures eosinophilic airway inflammation
  25. Indications for screening spirometry
    R/O airway obstruction; access presence of airway obstruction in an at-risk patient; access the severity of airway obstruction in a symptomatic patient
  26. Critical FEV1/FVC value
    • 70%
    • If patient's ratio is < 70%, there is an airway obstruction problem
  27. Spirometry findings in patients with restrictive disease?
    all volumes and capacities are smaller than predicted
  28. A small FEF25%-75% with a normal FVC may indicate:
    early small airway disease
  29. The FEV1 is most commonly used to ____?
    judge patient's response to inhaled bd
  30. FVC in restrictive lung disease
    exhale the FVC more quickly than expected
  31. FVC in obstructive lung disease
    take longer than expected to exhale the FVC
  32. Which is the most important forced expiratory volume test?
  33. Examples of small airway disease:
    asthma, chronic bronchitis, bronchiectasis, CF, emphysema
  34. In a flow-volume loop, what sign is characteristic of small airway disease?
    A "scooped-out" appearance
  35. Examples of restrictive disease:
    fibrosis, pleural effusion, pneumothorax, hemothorax, kyphoscoliosis, obesity, pregnancy, ascites
  36. Ina flow-volume loop, what sign is characteristic of restrictive disease?
    small volumes with right shift.
  37. In a flow volume loop, what does a near normal FVC volume and a greatly decreased peak expiratory flow rate suggest?
    variable obstruction from tumor or FB
  38. In a flow-volume loop, what does a near normal FVC volume and a greatly reduced inspiratory flow rate suggest?
    variable extrathoracic obstruction such as vocal cord paralysis, laryngeal tumor or FB
  39. In a flow volume loop, what does a near normal FVC volume with reduced inspiratory and expiratory flows suggest?
    a fixed obstruction such as a tumor in the trachea or mainstem bronchus
  40. What does the Nitrogen Washout Distribution Test (also called the Single-Breath Nitrogen Washout Test) measure?
    evenness of the distribution of ventilation into the lungs during inspiration and the emptying rate of lungs during exhalation.
  41. What does the Helium Dilution Test measure?
  42. General Rule: TLC > 120% predicted indicates?
    obstructive disease
  43. General Rule: TLC <80% of predicted indicates?
    restrictive disease
  44. Indications for a lung compliance test?
    Distinguish between overly compliant lungs (emphysema) and noncompliant lungs (fibrosis).
  45. DLCO measures:
    diffusing capacity of carbon monoxide to diffuse through the lungs into the blood. Indicated in emphysema and fibrosis.
  46. RV, FEC & TLC > 120% predicted indicates?
    Obstructive disease with air-trapping
  47. EV, FRC & TLC <80% predicted indicates?
    restrictive lung disease
  48. Which of the following statements is true of the MEP test?

    A) a pressure of +40 cm H2O usually is adequate and it is a good indicator of the patient's ability to cough & the patient should hold the effort for 1 to 3 seconds
  49. The predicted FVC value for African-Americans is:

    A) 10% to 15% less than for Caucasians
  50. Which of the following test results are needed to calculate TLC?

    A) RV & VC only
  51. A normal MEFV loop would show:

    D) FEF50% less than FIF50%
  52. A person with neuromuscular disease has been having serial bedside spirometry performed. Over the past 4 hours, her VC and MIP values have been decreasing. How should this be interpreted?

    C) her condition is worsening
  53. An order is received to perform the following bedside spirometry tests on a patient: Vt, FVC and peak flow. Which device would you take with you to perform the tests?

    D) differential pressure pneumotachometer
  54. Before a patient does an FVC test, the pneumotachometer should have the following done:

    D) a 3L volume should be pumped into and out of the circuit
  55. For help in the diagnosis of a patient with a questionable hx of wheezing and possible asthma, which of the following would be the best test?

    C) bronchoprovocation test
  56. A patient has just been tested for CL in a body plethysmograph. The patient's compliance was determined to be 0.2 L (200 ml)/cm H2O. Based on this data, the patient most likely has:

    B) emphysema
  57. Calculate a patient's inspiratory and expiratory times when he has an I:E Ratio of 2:1 and a RR of 15 bpm.

    A) 2.7 seconds for inspiration and 1.3 seconds for expiration
  58. When a patient performs an MEP test, it is important that he or she:

    A) inhales to TLC and blows out hard
  59. A patient weights 45 kg (100 lbs). The patient's predicted Vt would be:

    C) 350 ml
  60. An order is received to calculate a patient's alveolar ventilation. The patient's RR is 16 and average Vt is 580 ml. The patient weighs 170 lbs. The patient's alveolar ventilation is:

    C) 410 ml
  61. A patient has an FEV1 that is calculated to be 80% of her/her FVC. On the basis of this finding, the patient probably:

    D) is clinically normal
  62. The VC is made up of the:

    D) ERV, Vt and IRV
  63. Which of the following are true of PF measurement?

    A) it increases with height and decreases with age and is usually seen at the beginning of the patient's FVC effort
  64. An RT is having a patient perform the MIP test. His three attempts produce these results: =15 cm H2O, -45 cm H2O and -20 cm H2O. The best explanation for these values is that:

    A) the patient is not trying his best every time
  65. The physician wants to know whether a new bronchodilator would be helpful to the patient with asthma. The physician orders a new before and after BD study. The patient has the following peak flow values: 7.5 lpm before the medication and 9.4 lpm after the medication. Calculate the percentage change.

    B) 25%
  66. Complete spirometry is performed on a 50 YO patient, revealing the following data: TLC 137% predicted; RV 164% predicted; FVC 52% predicted; FEF25-75 36% predicted; and FEV1/FVC 27% predicted. How should this data be interpreted?

    A) severe obstructive disease
  67. A nitrogen washout test for RV has been performed on a patient for 7 minutes and has not reached the desired nitrogen percentage. What could explain this situation?

    B) the patient has severe air trapping
  68. A new patient has been scheduled for a battery of PFT's. He tells you that he is so nervous about the testing that he has smoked 4 cigarettes in the past two hours. Which of the following tests is most likely to be affected by this?

    B) lung diffusion
  69. After spirometry is performed, it is important that the patient flow rates be reported at:

    A) BTPS
  70. A patient is performing a residual volume test on a water seal spirometer in the PF Lab. After breathing on the system for 1 minute, the patient takes out the mouthpiece and c/o being SOB. What is the most likely problem with the PF system?

    D) the CO2 absorber has been left out of the system
  71. Which of the following studies produces the most accurate determination of the TLC in a patient with severe emphysema?

    D) body plethysmograph test
  72. The PF Lab has recently acquired an exhaled nitric oxide analyzer. Which patient population should it be used with?

    A) asthmatics
  73. Before a patient performs a FVC test, all of the following should be done to the water sealed spirometer EXCEPT:

    A) place CO2 absorbing material in line with the circuit
  74. A properly performed FVC test will not have:

    C) any coughing or leaks or weak patient effort or an unsatisfactory start or exhibit excessive variability among the test results
  75. A patient has the suspected diagnosis of asthma. Which of the following tests would be the LEAST helpful in assessing the patient for this condition?

    D) diffusion study
  76. A patient with COPD has been admitted. To help clarify the patient's diagnosis as emphysema or asthma, which of the following should be recommended?

    A) spirometry before and after an inhaled beta agonist
  77. As teh therapist in the PF Lab, you have received an order to perform exhaled NO analysis, spirometry and RV testing on a 10 YO girl with a hx of wheezing and chronic cough. First, you perform eNO analysis and find the girl's eNO value to be 35 ppb. How should this information be interpreted?

    B) the patient's value is increased from normal
  78. A wright respirometer can be used for all of the following bedside spirometry tests EXCEPT:

    A) FVC
Card Set
Review 3
Review 3