Spirometry - B (Module)

Question 1

The technologist interviews a patient scheduled for spirometry testing. The patient states that he was a chicken farmer for 43 years and retired 2 years ago. The technologist should be concerned about the patient’s occupational exposure to

A. gases
B. lead
C. asbestos
D. dust

Answer 1

D. Dust

Contaminated chicken droppings commonly contain bacteria and fungi which will be carried in the dust.

Fungal infections like histoplasmosis can be carried in dust in a farm setting.

Gases are common in industrial settings.

Lead would be associated with lead based paints, and would be common in painters.

Asbestos would be associated with construction workers and insulation.

Question 2

Which of the following is considered a contraindication to spirometry testing?

A. eating a large meal within 2 hours of testing
B. consuming alcohol 30 minutes prior to testing
C. hemoptysis in the past 24 hours
D. stable vital signs for the past 12 hours.

Answer 2

C. hemoptysis in the past 24 hours

Hemoptysis in the past 24 hours is one of the 3 listed contraindications to spirometry. The other 2 are unstable vital signs, and inability to cooperate (sensorium)

*page B-9

Question 3

The following volumes and capacities are reported for a patient:

TLC: 5.9
IRV: 3.0
ERV: 1.3
FRC: 2.5
RV: 1.2
VC: 4.7
Vt: 0.4
IC: 3.7

Which of the following is erroneous?

A. TLC
B. VC
C. FRC
D. IC

Answer 3

D. IC

Add the volumes first and compare to the choices given. TLC, VC, and FRC are ok when compared to their comprised volumes. IC is listed as 3.7, but IRV plus Vt equals 3.4

IC is the erroneous value.

Question 4

The following spirometry results were obtained from a 22 year old male:

FVC:
Predicted: 5.4
Measured: 4.0
% of predicted: 74%

FEV1:
Predicted: 4.05
Measured: 3.6
% of predicted: 89%

FEV1/FVC:
Predicted: 75%
Measured: 90%

These results are most indicative of

A. normal pulmonary function
B. obstructive lung disease
C. restrictive lung disease
D. both obstructive and restrictive lung disease

Answer 4

C. restrictive lung disease

FVC % of predicted is <80% (restrictive)

FEV1/FVC is not <70% (normal)

You don’t have to consider the FEV1 because you are given FEV1/FVC ratio, which is a better value to use to indicate obstruction.

These results indicated a restrictive lung disease.

Question 5

The following spirometry results were obtained from a 42 year old female:

FVC:
Predicted: 4.4
Measured: 3.82
% of predicted: 87%

FEV1:
Predicted: 3.08
Measured: 2.88
% of predicted: 93%

FEV1/FVC:
Predicted: 70%
Measured: 75%

These results are most indicative of

A. normal pulmonary function
B. obstructive lung disease
C. restrictive lung disease
D. both obstructive and restrictive lung disease

Answer 5

A. normal pulmonary function

FVC % of predicted is not <80% (normal)

FEV1/FVC is not <70% (normal)

You don’t have to consider the FEV1 because you are given FEV1/FVC ratio, which is a better value to use to indicate obstruction.

Because none of the predicted values are lower than normal, the answer is normal pulmonary function.

Question 6

The following spirometry results were obtained from a 59 year old man who is a coal miner with a 50 pack year history of smoking cigarettes:

FVC:
Predicted: 4.4
Measured: 2.37
% of predicted: 54%

FEV1:
Predicted: 3.08
Measured: 1.46
% of predicted: 47%

FEV1/FVC:
Predicted: 70%
Measured: 62%

These results are most indicative of

A. normal pulmonary function
B. obstructive lung disease
C. restrictive lung disease
D. both obstructive and restrictive lung disease

Answer 6

D. both obstructive and restrictive lung disease

The FVC is <80% of predicted. (restrictive)

The FEV1/FVC is <70% (obstructive)

You don’t have to consider the FEV1 because you are given FEV1/FVC ratio, which is a better value to use to indicate obstruction.

Because both % of predicted were below their normal limits, the patient has both obstructive and restrictive lung disease.

Question 7

The following spirometry results were obtained from a 79 year old patient:

SVC:
Predicted: 4.8
Measured: 3.09

FEV1:
Predicted: 3.36
Measured: 2.95

FEV1/FVC:
Predicted: 70%
Measured: 90%

These results are most indicative of

A. mild restrictive dysfunction
B. moderate obstructive lung disease
C. moderate restrictive lung disease
D. severe restrictive lung disease

Answer 7

C. moderate restrictive lung disease

SVC is less than 80% of predicted. It looks like a little more than 60%. This is restrictive.

FEV1/FVC is normal. The patient is not obstructive.

The patient has restrictive lung disease

How restrictive?

<80 mild
<70 moderate
<60 moderate/sever
<50 severe
<35 very severe

The results are a little higher than 60% so the answer is moderate restrictive lung disease

Question 8

The technologist reviews the results of a pulmonary function flow volume loop study. The technologist determines that the patient has a fixed airway obstruction as evidenced by the decreased FEF 50% and FIF 50% indicating equal values on the flow volume loop. Which of the following is the most likely diagnosis?

A. vocal cord paralysis
B. tumor growing next to a mainstem bronchus
C. tracheal stenosis
D. patient fatigue

Answer 8

C. tracheal stenosis

*page B-25

Tracheal stenosis is listed as the only impairment that is a fixed airway obstruction. It will affect both inhalation and exhalation similarly, as noted in the question. This is the answer.

Vocal cord paralysis and a tumor in the mainstem bronchus are listed as variable.

Patient fatigue is indicated with worsening results after repeated attempts.

Question 9

The technologist reviews the results of a pre- and post-bronchodilator spirometry test. The technologist determines that the patient had an increase of 15% and 250ml in the post-bronchodilator FEV1 value. The technologist should interpret this as a/an

A. positive response to the bronchodilator
B. adverse reaction to the bronchodilator
C. non-reversible obstructive lung disease
D. reversible restrictive lung disease

Answer 9

A. positive response to the bronchodilator

A positive response has to be more than a 12% and 200ml improvement in FEV1 values.

*page B-27

Question 10

During a routine spirometry test, the technologist notes that the patient is unable to perform the FVC using the standard technique. The technologist should instruct the patient to

1. exhale as much as possible
2. stop exhaling after 4 seconds
3. inspire as deeply as possible

A. 1 only
B. 2 only
C. 1 and 2 only
D. 1 and 3 only

Answer 10

D. 1 and 3 only

1. exhale as much as possible
2. inspire as deeply as possible
   * page B-13

Technique:

1. inspire as deeply as possible
2. inspiratory plateau (breath hold)
3. exhale as forcefully as possible.
4. continue exhaling as hard as possible until an expiratory plateau occurs or expiration time of 15 seconds.

Modified technique:

4. (only difference from regular technique) After 4 seconds, instruct the patient to relax and exhale gently until expiratory plateau or 15 seconds occurs.

Question 11

The technologist analyzes the results of a flow volume loop obtained from spirometry testing from a 79 year old male patient scheduled for aortic valve replacement. The following graphics are obtained from the testing trials:

https://ketteringseminars.com/graphics/Q6510.PNG

(if image is unviewable, the picture shows 4 attempts with gradually worsening results)

The most likely cause is

A. poor patient effort
B. patient fatigue
C. mild obstructive disease
D. vocal cord paralysis

Answer 11

B. patient fatigue

Question 12

The technologist has just completed spirometry testing on a 16-year-old male patient. The patient is an avid runner and has no prior history of lung disease. The following results are measured and recorded:

SVC:
Predicted: 4.9
Measured: 4.0

FVC:
Predicted: 4.9
Measured: 4.8

FEV1:
Predicted: 3.4
Measured: 3.9

FEV1/FVC:
Predicted: 70%
Measured: 81%

The technologist evaluates the results for the SVC maneuver. The technologist should suspect the

A. patient’s effort on the SVC
B. patient did not exhale completely
C. presence of restrictive disease.
D. detection of small airway disease

Answer 12

A. patient’s effort on the SVC

*page B-13

“If the FVC is greater than the SVC, question the patient’s effort on the SVC.”

FVC and SVC should be equal.

Question 13

The technologist at a small rural hospital has a patient perform an MVV maneuver utilizing a Collins Water-Seal spirometer. During testing, the patient complains that he is unable to inhale and exhale appropriately. The technologist should

A. place nose clips on the patient
B. check the position of the free breathing valve
C. place the bell of the water seal in the mid position
D. check the circuit for a leak.

Answer 13

C. place the bell of the water seal in the mid position.

This is not covered in the study guide.

The only explanation is available in the module audio answers. (Spirometry - B - Question 13)

Question 14

The pulmonary function technologist performs spirometry testing at a local chemical plant after a recent chemical spill inside the plant. The majority of the employees tested had no significant pathology determined from these initial tests. To determine evidence of improvement and/or deterioration in the employees’ lung function the technologist should recommend

A. bronchoprovocation testing.
B. home testing for 24 months.
C. serial lung function testing for 5 years.
D. daily peak flow monitoring.

Answer 14

C. serial lung function testing for 5 years.

*page B-33

To determine improvement and/or deterioration, you’d need to perform repeated testing.

Serial lung function testing is the only choice explicitly noted in the study guide for this type of scenario.

Question 15

The following data was collected from a flow volume loop study:

FEF25:
Predicted: 8.6
Actual: 4.2

FEF50:
Predicted: 5.8
Actual 4.0

FEF75:
Predicted: 4.3
Actual: 3.9

FIF25:
Predicted: 5.1
Actual: 4.9

FIF50:
Predicted: 6.7
Actual: 6.5

FIF75:
Predicted: 6.3
Actual: 6.1

The technologist should interpret these results as

A. normal spirometry
B. variable extrathoracic obstruction
C. fixed airway obstruction
D. variable intrathoracic obstruction

Answer 15

D. variable intrathoracic obstruction

Only one side of the flow volume loop is bad. The expiratory side.

If only one side of the loop is affected, the obstruction is “variable”.

To determine if it is intrathoracic or extrathoracic, look at which side is normal. In this case, the INspiratory side of the loop is normal, so the obstruction is INtrathoracic.

The answer is a variable intrathoracic obstruction.