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Brian's Practice Course > NBRC Practice Exam - Notable Questions > Flashcards

NBRC Practice Exam - Notable Questions Flashcards

1
Q
  1. Instrumentation/Equipment
    Set Up, Maintain, Calibrate

An elevation in which of the following may distort COHb and SaO2 (meas) values obtained from a hemoximeter (CO-oximeter)?

A. fetal hemoglobin
B. methemoglobin
C. deoxyhemoglobin
D. total hemoglobin

A

A. fetal hemoglobin

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2
Q
  1. Instrumentation/Equipment
    Set Up, Maintain, Calibrate

An autocalibration system indicates 8 cm H2O while an external manometer indicates 10 cm H2O during a manual calibration of a mouth pressure transducer in a body plethysmograph. Which of the following should a pulmonary function technologist do to correct the problem?

A. check for a leak in the u-tube manometer.

B. add water to the u-tube manometer.

C. service the autocalibration device

D. check for a leak in the mouth shutter.

A

C. service the autocalibration device.

2 devices are measuring different values upon calibration. One device is erroneous.

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3
Q
  1. Instrumentation/Equipment
    Set Up, Maintain, Calibrate

Which of the following is required to verify speed accuracy of a new treadmill?

A. stop watch
B. rotameter
C. odometer
D. biologic control

A

A. stop watch

You need belt lenth x rpm.

to find rpm (revolutions per minute) you need a way to keep time.

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4
Q
  1. Instrumentation/Equipment
    Set Up, Maintain, Calibrate

According to the ATS/ERS 2005 recommendations on diffusing capacity, a carbon monoxide analyzer should be within what percentage of linearity?

A. 0.5
B. 1.0
C. 5.0
D. 10.0

A

A. 0.5

Carbon monoxide linearity should be within 0.5%

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5
Q
  1. Instrumentation/Equipment
    Troubleshooting

An automated blood gas analyzer indicates that it is unable to calibrate the pH electrode. Which of the following would cause this problem?

A. the wrong calibration gas is installed.
B. the internal barometer is malfunctioning
C. the system is unable to maintain electrode temperature.
D. the hemolyzer failed.

A

C. the system is unable to maintain electrode temperature

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6
Q
  1. Instrumentation/Equipment
    Troubleshooting

A consistently slow response by a blood gas O2 electrode is most likely an indication of

A. moisture contamination
B. electrode not at thermal equilibration
C. membrane contamination with protein.
D. air bubbles in the electrolyte solution.

A

C. membrane contamination with protein

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7
Q
  1. Instrumentation/Equipment
    Troubleshooting

A hemoximeter (CO-oximeter has produced the following results on a series of patient samples during a 1-hour period

MetHb: COHb:

  1. 9_______-0.10
  2. 2_______0.01
  3. 8_______0.02
  4. 4_______-0.04

Which of the following corrective actions should a pulmonary function technologist recommend?

A. Clean the cuvette
B. Change the flush solutions
C. Run a hemoglobin calibration
D. Change the calibration gases

A

A. Clean the cuvette

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8
Q
  1. Instrumentation/Equipment
    Troubleshooting

The measured FVC of a biologic control has decreased by 0.50L for the past 2 days. Which of the following should a pulmonary function technologist do FIRST?

A. replace the flow sensor and recalibrate
B. replace the batteries in the portable spirometer.
C. place a bacterial filter inline and recheck the biologic quality control.
D. check the FVC of the biologic quality control on a different spirometer.

A

A. replace the flow sensor and recalibrate

FVC decreased by half a liter for 2 days in a row (on a known biologic control.) First thing to do is replace the sensor and recalibrate.

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9
Q
  1. Procedures
    Select Test Protocols and Equipment

Which of the following tests should be used to evaluate a 5 year old child with asthma like symptoms?

A. maximal voluntary ventilation
B. methacholine challenge
C. mannitol challenge
D. lung volumes by gas dilution

A

B. methacholine challenge

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10
Q
  1. Procedures
    Select Test Protocols and Equipment

Pulse oximetry is requested during a maximum exercise stress test performed on a patient with severe COPD who smokes. Which of the following should a pulmonary function technologist recommend?

A. measure exhaled CO2
B. obtain an arterial blood gas sample.
C. perform baseline spirometry
D. proceed with the study as requested

A

B. obtain an arterial blood gas sample

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11
Q
  1. Procedures
    Select Test Protocols and Equipment

A high school athlete is referred for an exercise induced bronchospasm evaluation. During a history evaluation, she states it is hard to breathe when running. A pulmonary function technologist should

A. initiate 25% supplemental O2 for the exercise test.
B. modify the workload for the exercise test.
C. obtain tidal breathing loops during the exercise test.
D. administer 2 puffs of albuterol via MDI/spacer prior to testing.

A

C. obtain tidal breathing loops during the exercise test.

“hard to breathe when running.”

Flow volume loops should be obtained during exercise.

We are looking for an obstruction (fixed or variable) that would cause difficulty during exercise. We will need flow volume loops to assess the problem.

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12
Q
  1. Procedures
    Perform the Procedure

According to ATS/ERS recommendations for children less than 10 years of age, what is the minimal exhalation time (sec) for acceptable spirometry?

A. 3
B. 4
C. 5
D. 6

A

A. 3 seconds

Minimum exhalation time for kids under 10 years of age is 3 seconds.

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13
Q
  1. Procedures
    Perform the Procedure

When measuring the FRC by N2 washout, which of the following decreases washout time most effectively?

A. initiating the test at FRC level
B. performing an IC maneuver periodically
C. initiating a 10 second breath hold every 30 seconds
D. performing an FVC maneuver at the end of the test

A

B. performing an IC maneuver periodically

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14
Q
  1. Procedures
    Perform the Procedure

A pulmonary function technologist notices that FRC is 200% of predicted at the conclusion of a helium dilution test. Which of the following should the technologist do next?

A. report the results
B. check the supplemental O2 supply
C. check for a leak in the system
D. reduce the BTPS correction factor.

A

C. check for a leak in the system

Too much helium has been diluted, which has caused the FRC to appear higher than it is.

If too much helium has been diluted, it will result in an unusually high FRC. The helium was diluted by leaking out of the system.

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15
Q
  1. Procedures
    Evaluate Validity of Result

A patient without lung disease has an elevated RV with a normal FRC measured by N2 washout. Which of the following should a pulmonary function technologist do?

A. repeat the FRC measurement
B. repeat the vital capacity maneuver
C. check for a leak in the system
D. perform an inspiratory capacity maneuver

A

B. repeat the vital capacity maneuver.

There is no leak (FRC is normal).
No need for an IC.
No indication that the N2 system is malfunctioning, so no need for an additional FRC.

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16
Q
  1. Procedures
    Evaluate Validity of Result

A healthy 16 year old male comes to the laboratory to perform a treadmill exercise for evaluation of dyspnea on exertion. The following data are obtained whil perfroming an 8 min exercise induced protocol:

Baseline………….Max Exercise……..5-min post Exercise

HR….72……………………….135………………………..86
BP…..120/80………………..140/90………………130/85
Ve…..7.2………………………24…………………………..
FEV1..4.0……………………………………………………..3.9

Which of the following should a pulmonary function technologist do?

A. explain to the patient that he has exercise induced bronchospasm
B. tell the patient that the result of the test was normal
C. document that the patient had a hypertensive response to exercise
D. repeat the study with a higher workload

A

D. repeat the study with a higher workload.

You were given an FEV1 and a Ve at maximum exercise. FEV1 x 35 is a good indicator of maximum voluntary ventilation (MVV). The patients MVV should be around 140 but his Ve at “max exercise” was 24. He can work much harder, and doing so will provide better results.

17
Q
  1. Data Management
    Calcualte Results, Select Reference Ranges and Data

The following baseline biologic control data was collected over 2 weeks for spirometry:

FVC_____________FEV1

  1. 10______________2.10
  2. 60_____________2.50
  3. 50_____________2.45
  4. 45_____________2.50
  5. 60_____________2.60

What FVC value should be used to establish the biologic control mean?

A. 3.45
B. 3.50
C. 3.54
D. 3.60

A

C. 3.54

*page F-15

Remember, good FVC’s will be within 5% or 150ml of each other. Of the 5 tests, one of them is not within 150ml of the others. Remove it. Add the remaining 4 and divide by 4 to find the “mean” average. The answer is 3.537, which is closest to C (3.54)

18
Q
  1. Data Management
    Calcualte Results, Select Reference Ranges and Data

A 65 year old woman with interstitial lung disease has performed a submaximal exercise test on a treadmill while wearing a pulse oximeter and breathing 2 L/min supplemental oxygen. A pulmonary function technologist is viewing a graph of the SpO2 trends as shown below:

See: “NBRC Practice Exam - Question 17” image

The referring physician asks whether the patient is getting enough oxygen to prevent desaturation. Which of the following should the technologist recommend?

A. Oxygen at 2 L/min is adequate supplementation for submaximal exercise
B. More than 2 L/min oxygen should be used by this patient during exercise
C. The quality of the oximeter readings was not adequate to interpret the results
D. The patient does not currently need supplemental oxygen during exercise.

A

A. Oxygen at 2 L/min is adequate supplementation for submaximal exercise.

SpO2 remained above 85% during the exercise test.

19
Q
  1. Data Management
    Calcualte Results, Select Reference Ranges and Data

The following data are obtained at maximal workload during a room air pulmonary stress test performed at sea level (760 torr)

pH: 7.32
PaCO2: 28
PaO2: 75
HCO3: 19
BE: -11
RER: 1.2

What is the P(A-a)O2?

A. 39 torr
B. 46 torr
C. 52 torr
D. 60 torr

A

C. 52 torr

There is no explanation for this answer, and this is not the answer when you do Ketterings “quick” AA equation and then AA gradient. The book does not teach you how to account for RER so you will have to do it manually.

The closest you can get is to remember that normal RER is 0.8. If the RER is normal or unspecified, calculate as usual.

In this case, your RER is reported at 1.2

Do your AA equation. Answer is 119.

Do your AA gradient. Answer is 44.

Multiply 44 by the given RER of 1.2. Answer is 52.8

You already know the answer you get is the best possible result from the gas. Closest answer below is 52.

20
Q
  1. Data Management
    Calcualte Results, Select Reference Ranges and Data

A patient performs a combined Raw and Vtg maneuver in a plethysmograph. The following values are obtained:

Raw: 2.00
Vtg: 3.00

What is the patient’s SGaw?

A. 0.04
B. 0.17
C. 0.67
D. 1.50

A

B. 0.17

SGaw “specific airway conductance”

To find SGaw:

Start with 1 divided by Raw (2)

1 / (2) is 0.5

Now divide 0.5 by the Vtg of 3

0.5 / 3 is 0.167

Answer is B

*page C-22

21
Q
  1. Data Management
    Evaluate Reliability of Results

A 66 year old patient with liver cancer is referred for pulmonary function testing before his next chemotherapy treatment. The patient admits to smoking 1 hour ago. The DLCO measurements are at the lower limit of normal. A pulmonary function technologist should

A. assure DLCO measurements are corrected for Hct.
B reschedule, requesting the patient refrain from smoking for 24 hours.
C. correct the predicted DLCO for Hb and COHb.
D. have the patient breathe 100% oxygen for 5 minutes before repeating the DLCO.

A

C. correct the predicted DLCO for Hb and COHb.

  • page F-19 gives a little information regarding Hb but nothing specific.
  • not in the book but it is generally known that chemotherapy patients will have low Hb levels due to treatment. If Hb is out of range (12-16) you can correct for it after a DLCO test.

Predicted DLCO can be corrected by adding the COHb to the measured DLCO.

22
Q
  1. Data Management
    Evaluate Clinical Implications

a post lung transplant patient collects the following data on a home PFT device that reports spirometric and peak flow values.

Day__________1_______2_______3_______4
FEV1________3.75_____3.70____3.86_____3.80
Peak flow____480_____450_____400_____410

These results are consistent with

A. development of a restrictive defect on Day 3
B. onset of bronchospasm on Day 3
C. taking albuterol prior to testing on Day 4
D. inadequate expiratory effort on Days 3 and 4.

A

D. inadequate expiratory effor on Days 3 and 4.

Remember FEV1 is your best flow. Trust it. In this case, the FEV 1 has improved a little and is consistent. The peak flows however have dropped by almost 20% from day 1 to day 4. Suspect poor effort.

23
Q
  1. Data Management
    Evaluate Clinical Implications

A 15 year old patient has the following spirometry results:

____________________Measured_____Predicted
FVC___________________4.10__________4.10
FEV1__________________3.00__________3.50
FEV1/FVC_______________73%_________85%

These results indicate the patient has

A. an extrathoracic obstruction
B. mild restrictive disease
C. normal lung function
D. obstructive airway disease

A

D. obstructive airway disease

< 70% FEV1/FVC is considered obstructive in ADULTS. Per the Global Lung Initiative, in pediatrics patients a 5% decrease or more is considered obstructive.

*page B-19

24
Q
  1. Data Management
    Evaluate Clinical Implications

Two exercise tests performed 2 weeks apart on a 68 year old patient with severe COPD show the following:

Test 1 - 10am
FEV1 - 1.15 L (33% of predicted)
Resting IC - 1.50 L
Exercise IC - 0.50 L

Test 2 - 12pm
FEV1 - 1.05 L (30% of predicted)
Resting IC - 1.80 L
Exercise IC 1.20 L

These results indicate

A. significant improvement
B. no significant change
C. slight worsening of the patient’s condition
D. a need to repeat the tests at the same time of day.

A

A. significant improvement

Be careful!

The patient has COPD. We are not measuring for diagnosis. The patient already has severe COPD. We are looking for improvement from exercise testing.

The second test shows “significant improvement” in exercise testing, as the resting IC has improved by 20%, and the exercise IC has improved by almost 150%. The patient’s dynamic hyperinflation has decreased

25
Q
  1. Data Management
    Evaluate Clinical Implicaitons

An incremental exercise test is performed on a 10 year old 35kg (77 lb) patient with cystic fibrosis. The measured FEV1 is 0.9 L. The following data are obtained:

____________________Rest________Max Exercise
HR__________________85____________150
SpO2 (%)_____________94____________92
Ve (L/min)____________6.0____________34.0
VO2 (L.min)__________0.28___________0.75
VCO2 (L/min)_________0.21___________0.62
RER________________0.75___________0.83

Which of the following is the most likely conclusion?

A. ventilatory limitation
B. muscular weakness
C. deconditioning
D. cardiac limitation

A

A. Ventilatory Limitation

The RER didn’t increase as it normally should, and the VCO2 is lower than VO2 at maximal exercise.

26
Q
  1. Instrumentation/Equipment
    Troubleshooting

A constant volume plethysmograph is successfully calibrated at 8am. A gain of 0.02 volts/ml is recorded when a sine wave 50 ml signal is applied. The plethysmograph is recalibrated the next morning, and a gain of 0.1 volts/ml is observed. Which of the following is the most likely cause?

A. the box was not at thermal equilibrium during the first calibration
B. the box pressure transducer was not properly zeroed for the first calibration
C. the door seal developed a leak between the first and second calibration
D. the built in slow leak became obstructed after the first calibration

A

C. The door seal developed a leak between the first and second calibration

Look carefully at the values. There was a 5x increase in gain between day 1 and 2. A difference that large would indicate a leak.

A doesn’t apply because the difference is too large.

B is incorrect because an improper calibration in day one would lead to a smaller gain on day two if there were no other problems.

D doesn’t apply because if the leak became obstructed after the first calibration, the gain would be decreased on day two as well.

27
Q
  1. Procedures
    Perform the Procedure

The following bedside data were collected on a 32 year old male patient with sarcoidosis who is 172cm (6 ft) tall:

FVC 5.5L
FEV1 4.6L
MIP -25 cm H2O

Which of the following is the most likely reason for the MIP value?

A. it is caused by sarcoidosis
B. it is caused by hyperinflation
C. the patient has decreased muscle strength
D. the patient did not exert maximum effort

A

D. The patient did not exert maximum effort.

The patient performed well with the FVC and FEV1.

Muscle strength would be an issue if the patient had an equally poor FVC.

There is no indication of hyperinflation.

Sarcoidosis is restrictive, but should not reduce MIP dramatically.

28
Q
  1. Procedures
    Perform the Procedure

A pulmonary function technologist is reviewing an asthma management plan with a 16 year old boy and his parents. The parents express concern about their son’s increased coughing during athletic activities. The technologist should instruct the son to use which of the following of his previously prescribed medications 15 minutes prior to starting each activity?

A. levalbuterol (xopenex)
B. montelukast (singulair)
C. fluticasone and salmeterol (advair)
D. ipratropium MDI (atrovent)

A

A. levalbuterol

29
Q
  1. Procedures
    Evaluate Validity of Result

A patient without lung disease has an elevated RV with a normal FRC measured by N2 washout. Which of the following should a pulmonary function technologist do?

A. repeat the FRC measurement
B. repeat the vital capacity maneuver
C. check for a leak in the system
D. perform an inspiratory capacity maneuver.

A

B. repeat the vital capacity maneuver

You are testing with nitrogen washout, and the results say you have an elevated RV and normal FRC in a healthy patient. This indicates that the N2 is not washing out. If the N2 does not wash out, it is leaking into the system.

30
Q
  1. Data Management
    Evaluate Reliability of Results

A patient had the following pulmonary function test results at baseline and 6 months after starting radiation therapy for lymphoma:

FEV1
Baseline 3.90
6 months 3.23

FVC
Baseline 4.59
6 months 3.89

FEV1/FVC
Baseline 85%
6 months 83%

TLC
Baseline 6.10
6 months 5.10

DLCO
Baseline 23.20
6 months 16.40

VA
Baseline 5.90
6 months 5.02

Which of the following is most consistent with these results?

A. the quality of the test results is questionable
B. the patient has developed an obstruction
C. the patient has developed pneumonitis
D. there is an insignificant change in lung function

A

C. The patient has developed pneumonitis

Look at the results

No signs of obstruction in FEV1/FVC or FEV1
No signs the results are questionable
There is significant decrease in DLCO, TLC, VA.
All the clues point to a restrictive type of illness, and pneumonitis is restrictive.

Brian's Practice Course (32 decks)

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