1
Q
What are the four areas the exam will include questions relating to?
A
- Evaluation of quality control data
- Evaluation of patient performance
- Assuring validity of test results
- Laboratory quality management
These areas are critical for understanding quality assurance in laboratory settings.
2
Q
Define calibration in the context of quality assurance.
A
The process in which the output signal from an instrument is adjusted to match a known input
Calibration ensures that the instrument provides accurate results.
3
Q
How often may calibration be required?
A
- Daily
- Monthly
- Quarterly
- Biannually
- Only when results are questionable
The frequency of calibration depends on the specific instrument and its usage.
4
Q
What is the purpose of quality control testing?
A
To evaluate the accuracy and precision of the equipment against a known standard
Regular quality control testing is essential for maintaining reliable laboratory results.
5
Q
Define accuracy in measurement.
A
The extent to which the measurement of a known quantity results in a value approximating that quantity
Accuracy is assessed by calculating the mean of repeated measurements.
6
Q
What is an example of accuracy in a spirometer measurement?
A
Multiple samples of air injected yield results of 2.9 L, 3.0 L, and 3.1 L, with a mean of 3.0 L
The spirometer is considered accurate if the mean approximates the known value.
7
Q
Define precision in measurement.
A
The extent to which repeated measurements of the same quantity can be reproduced
Precision indicates the consistency of measurements, regardless of their accuracy.
8
Q
What is an example of precision in a spirometer measurement?
A
Multiple samples of air injected yield results of 2.5 L, 2.5 L, and 2.5 L
The spirometer is considered precise if the results are similar.
9
Q
What is linearity in the context of measurements?
A
A series of measurements over the clinically significant or physiologic range
Linearity ensures that the instrument’s response is consistent across a range of values.
10
Q
How many data points are required to assess linearity?
A
A minimum of three data points
This is necessary to ensure accurate assessment of the instrument’s performance.
11
Q
What can cause pneumotachometers to become alinear?
A
- Moisture
- Contamination
- Debris
These factors can affect the accuracy and require frequent checks.
12
Q
What is required to assure linearity and accuracy in volume spirometers?
A
A series of injected volumes distributed over the clinically significant range
This ensures that the instrument performs accurately across different flow rates.
13
Q
What does repeatability refer to in quality assurance?
A
Variance within a test session
Example: Three successive pre-bronchodilation FVC efforts yield the same results.
14
Q
What does reproducibility refer to in quality assurance?
A
Variance across test sessions
Example: FVC is measured for a patient with normal lung function on three successive days and yields different results.
15
Q
What are biological controls in the context of PFT equipment?
A
Measured values from healthy people
Used to evaluate the function of PFT equipment.
16
Q
What is a correction factor?
A
A number used to compensate for errors of measurements
Example: Correction factor = Expected volume / Measured volume.
17
Q
Calculate the correction factor if a spirometer measures 3.075 L, 3.080 L, and 3.085 L with an expected volume of 3.0 L.
A
0.97
Mean of three trials = 3080 mL; Correction Factor = 3000 L / 3080 L.
18
Q
What is the role of the Occupational Safety and Health Administration (OSHA)?
A
Develops policies to address hazards in the workplace
Includes managing hazardous chemicals and maintaining MSDS.
19
Q
What must be maintained and available according to OSHA regulations?
A
Materials Safety Data Sheets (MSDS)
Required for hazardous chemicals or substances used in the lab.
20
Q
What are the required procedures for handling patients with blood-borne pathogens?
A
- Prevention of exposure of lab personnel and other patients
- Proper disposal of potentially contaminated equipment and patient care items
These procedures are mandated by OSHA.
21
Q
What is the role of the National Institute for Occupational Safety and Health (NIOSH)?
A
Conducting research and making recommendations for the prevention of work-related injury and illness
NIOSH is part of the CDC within the U.S. Department of Health and Human Services.
22
Q
What standards does NIOSH establish?
A
Standards for spirometry testing for persons with occupational exposure
Ensures safety and accuracy in testing.
23
Q
What does HHS stand for?
A
Health and Human Services
HHS supervises the Health Care Financing Administration (HCFA) which administers the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88).
24
Q
What are the Laboratory Improvement Amendments of 1988 also known as?
A
CLIA-88
CLIA-88 includes regulations for operating pulmonary function and blood gas laboratories.
25
What is the role of **The Joint Commission**?
Develops standards of quality for health care organizations
## Footnote
TJC accreditation is voluntary and standards are published for all areas of the hospital including pulmonary function and blood gas laboratories.
26
True or false: **TJC accreditation** is mandatory for health care organizations.
FALSE
## Footnote
TJC accreditation is voluntary.
27
What factors do **equipment performance standards** depend on?
* Type of equipment used
* Type of maintenance required
* Types of test signal for checking accuracy and precision
## Footnote
These standards ensure that the equipment operates correctly.
28
What factors do **patient performance standards** depend on?
* Technologist's ability to operate the equipment correctly
* Instruction and coaching of the patient
* Patient effort and cooperation
* Ensuring that the data collected meets acceptable standards
## Footnote
These standards are crucial for obtaining reliable test results.
29
What is the first step in the **calibration procedure**?
Follow manufacturer procedure for each piece of equipment
## Footnote
It is not permissible to recalibrate in between patients.
30
What displays are required in the **equipment display**?
* Volume
* Time
* Real flow time
## Footnote
Operators must visually confirm acceptable patient performance before proceeding.
31
What is the **2:1 ratio display** used for?
Flow-volume loops
## Footnote
It uses flow (vertical) and 1 L volume (horizontal).
32
What are the **minimal spirometry standards** for VC (Volumes)?
0.5 - 8 L/ = 3% of reading or + 0.05 L, whichever is greater
## Footnote
This standard ensures accurate measurement of vital capacity.
33
What is the accuracy requirement for **FVC (Flow Rates)**?
0.5 - 8 L + 3% of reading or + 0.05 L, whichever is greater
## Footnote
This ensures reliable flow rate measurements during spirometry tests.
34
What is the accuracy for **FEV** measurements?
Accuracy: * 10% of reading or * 0.3 L/sec (20 L/min), whichever is greater
## Footnote
This accuracy standard is critical for assessing forced expiratory volume.
35
What is the repeatability standard for **PEF (Peak Expiratory Flow)**?
+ 5% of reading or * 0.15 L/sec (10 L/min), whichever is greater
## Footnote
Ensures consistent results in peak flow measurements.
36
What is the **flow range** for FEF 25 - 75?
250 L/min at V, of 2 L
## Footnote
This indicates the flow rate during the middle portion of the forced expiratory maneuver.
37
What is the **time** for calculating all FEV values?
Time zero
## Footnote
This is the reference point for measuring forced expiratory volumes.
38
What is the **mean resistance** at 200, 400, 600 L/min?
< 2.5 cm H,O// sec
## Footnote
This measurement is important for assessing airway resistance.
39
What are the **biological controls** tested on a regular basis?
* Weekly or monthly testing
## Footnote
Regular testing ensures the reliability of spirometry equipment.
40
What is the **daily calibration** requirement for spirometry equipment?
Daily calibration with a 3.0 L syringe
## Footnote
This calibration ensures accuracy in volume measurements.
41
What is the accuracy range for the **3.0 L calibration syringe**?
Accuracy + 3.0% (Range 2.91 L - 3.09 L)
## Footnote
This accuracy range is crucial for ensuring precise calibration.
42
What are the **three flow ranges** for accuracy in spirometry?
* 1 - 2 L/sec
* 2 - 4 L/sec
* 4 - 8 L/sec
## Footnote
These ranges are essential for evaluating different flow rates during testing.
43
What is the **test signal** used for calibration?
3 L calibration syringe
## Footnote
This syringe is used to ensure the spirometer is functioning correctly.
44
What type of **waveforms** are used in spirometry testing?
* 24 standard waveforms
* 26 standard flow waveforms
## Footnote
These waveforms help in assessing the performance of the spirometry equipment.
45
What is the purpose of **Quality Control Devices** in testing equipment?
To ensure accurate and reliable test results
## Footnote
Quality control devices are essential for maintaining the integrity of testing processes.
46
Name a **large volume** syringe used for testing.
3 L syringe
## Footnote
This syringe is used for volume measurement in various tests.
47
What device is used for measuring **flowrate**?
Rotameter
## Footnote
A rotameter is crucial for determining the flow rate in respiratory tests.
48
What is the function of a **sine wave rotary pump**?
Used for MVV and body plethysmograph
## Footnote
This pump helps in measuring lung volumes and capacities.
49
What is an **explosive decompression device** used for?
FVC testing
## Footnote
This device utilizes air or CO2 for forced vital capacity measurements.
50
What are the two types of **commercially prepared controls** for Arterial Blood Gases?
* Blood-based
* Aqueous/fluorocarbon based
## Footnote
These controls are essential for accurate blood gas analysis.
51
What is the shelf life of **aqueous/fluorocarbon based controls**?
Approximately 1 year
## Footnote
These controls are packaged in 2 - 3 mL ampules.
52
What are the **three levels of controls** commonly used in plotting control runs?
* Acidotic (pH, PCO2, PO2)
* Normal (pH, PCO2, PO2)
* Alkalotic (pH, PCO2, PO2)
## Footnote
Each level is essential for assessing the performance of the analyzer.
53
What is the acceptable range for data points in quality control analysis?
+ 2 standard deviations (= 2 SD) from the mean value
## Footnote
This range indicates whether the electrode is 'in-control'.
54
True or false: An electrode that is 'out-of-control' should be repaired or replaced and recalibrated.
TRUE
## Footnote
Maintaining equipment functionality is crucial for accurate testing.
55
What are the **Westgard Rules** used for?
To differentiate between random errors and true out-of-control situations
## Footnote
This method of QC is called the multiple-rule method.
56
What is an example of a **warning situation** in Westgard Rules?
One control observation exceeds the mean + 2 SD (12s)
## Footnote
This indicates a potential issue that requires monitoring.
57
What constitutes an **out-of-control situation** according to Westgard Rules? Name one.
* One control observation exceeds the mean + 3 SD (13s)
* Two consecutive control observations exceed the mean + 2 SD or the mean - 2 SD
* Differences between two consecutive control runs exceed four SD (RAs)
* Four consecutive control runs exceed the mean +1 SD or the mean -1 SD
* Ten consecutive control runs are on the same side of the mean value # 1 SD
## Footnote
These situations indicate significant issues that require immediate action.
58
When using the **multiple-rule method**, what must be kept?
A history of the control runs
## Footnote
This is accomplished by utilizing a control chart, also called a Levey-Jennings plot.
59
What is plotted on the **Y-axis** of a control chart?
Mean + 2 SD
## Footnote
The number of control runs is plotted on the X-axis.
60
What is the purpose of applying the **multiple-rule method**?
To detect most out-of-control situations
## Footnote
This method allows for effective monitoring of control runs.
61
What are **Quality Control Charts** or **Levey-Jennings plots** used for?
To monitor the results of quality control procedures
## Footnote
They help visualize the performance of control runs over time.
62
In a control chart, what does the **+3 SD** line represent?
A threshold indicating a significant out-of-control situation
## Footnote
Values exceeding this line suggest immediate investigation is needed.
63
What does a **warning** situation look like in a control chart?
Run 8 exceeds the mean + 2 SD (12s)
## Footnote
This indicates caution but does not necessarily require action.
64
What does **+3 SD** indicate in quality assurance?
Out-of-control condition
## Footnote
This indicates that one value is greater than 3 standard deviations from the mean.
65
What does **+2 SD** signify in quality assurance?
Potential out-of-control condition
## Footnote
This indicates that two consecutive values are greater than 2 standard deviations from the mean.
66
In quality assurance, what does a run of **10 consecutive values** above or below the mean indicate?
Out-of-control condition
## Footnote
This is a violation of Rule 10x.
67
What is indicated by **4 consecutive runs** at **1 SD**?
Out-of-control condition
## Footnote
This is a violation of Rule 41s.
68
What does it mean if there are **2 values** that differ by more than **4 SD**?
Out-of-control condition
## Footnote
This indicates a significant deviation between two measurements.
69
What is the significance of **Example #3** in quality assurance?
Out-of-control condition due to 1 value > 3 SD
## Footnote
This example highlights a specific instance of deviation.
70
What does **Rule RAs** refer to in quality assurance?
Out-of-control condition due to specific run patterns
## Footnote
This rule identifies patterns that indicate a lack of control.
71
In quality assurance, what does **Example #4** illustrate?
Out-of-control condition due to 2 consecutive values > 2 SD
## Footnote
This example shows a specific violation of control limits.
72
What is indicated by **Runs 12 and 13** in Example #5?
Out-of-control condition due to differences > 4 SD
## Footnote
This highlights a significant deviation between two runs.
73
What does the term **Number of Runs** refer to?
The count of sequential data points in a quality control chart
## Footnote
This is used to analyze patterns and trends in data.
74
What must all **gas analyzers** (O,, N,, CO, CO, He) be before performing quality control tests?
Properly calibrated
## Footnote
Calibration ensures accurate measurements for quality control tests.
75
Proper calibration of gas analyzers must consider two parameters: _______ and _______.
* Physiologic range to be measured
* Sampling conditions of the actual test
## Footnote
These parameters are crucial for accurate gas analysis.
76
What is the measurement range for an **O₂ analyzer** during calibration?
* Inspired concentrations (F,O₂): 21% - 100%
* Exhaled concentrations (FE°): 12% - 21% (Stress Test)
## Footnote
These ranges are essential for proper calibration of the O₂ analyzer.
77
What is the most common technique used for **gas analyzers** calibration?
Two-point calibration
## Footnote
This technique uses a 'low' and a 'high' concentration at both ends of the physiologic range.
78
What does multiple-point calibration (3 or more points) determine about a gas analyzer?
If the gas analyzer is linear
## Footnote
Non-linear analyzers require a calibration curve to correct readings.
79
Infrared analyzers must be within _______ of linearity.
0.5%
## Footnote
This specification is important for ensuring the accuracy of infrared gas analyzers.
80
Quality control of gas analyzers involves one of two techniques: known concentrations of the gas or using a _______.
lung volume or Dico Simulator
## Footnote
These techniques help ensure the accuracy of gas measurements.
81
What is the first step in calibrating the **body plethysmograph**?
Calibrate the body plethysmograph prior to the procedure
## Footnote
This includes calibrating the mouth pressure transducer, box pressure transducer, and flow transducer.
82
What type of transducer is used for **mouth pressure** in a body plethysmograph?
Water or mercury barometer
## Footnote
This is part of the calibration process for the body plethysmograph.
83
What is the purpose of the **box pressure transducer** in body plethysmography?
Sine wave pump (30 mL)
## Footnote
It is used to measure pressure changes within the plethysmograph.
84
What is the **flow transducer** used in a body plethysmograph?
Rotameter or pneumotach
## Footnote
This device measures the flow of air during the procedure.
85
How is **quality control** of the body plethysmograph performed?
Using an isothermal lung model to validate volume measurement
## Footnote
This involves a glass bottle with a rubber stopper and water displacement.
86
What is used to measure the volume of the **isothermal lung model**?
Water displacement
## Footnote
This method ensures accurate volume measurement during quality control.
87
What material is typically used as a **heat sink** in the quality control process?
Copper (metal wool)
## Footnote
It helps maintain a constant temperature during measurements.
88
What is the most appropriate way to calibrate the **body box pressure transducer**?
Use of a sinusoidal pump
## Footnote
This method ensures accurate volume measurements in a constant volume body plethysmograph.
89
What is the acceptable range for the volume measured by the body plethysmograph?
+ 5% of the actual volume
## Footnote
This tolerance is crucial for ensuring the accuracy of the measurements.
90
What is **proficiency testing** in quality control?
Send specimen to different labs
## Footnote
This allows laboratories to compare their results using the same analyzers.
91
What does **multiple machine analysis** involve?
Processing patient samples on two or more machines
## Footnote
This helps identify discrepancies in results between different machines.
92
What is a **tonometer** used for in gas exchange?
Allows precision gas mixtures to be equilibrated with whole blood or buffer solution
## Footnote
This is essential for accurate gas tension measurements.
93
What is calculated from the fractional concentration of gases in a **tonometer**?
Expected gas tensions (torr)
## Footnote
These calculations are crucial for precise control of the PO2 electrode.
94
What is the **Acceptability and Usability Criterion** for BEV*?
BEV* is ≤ 5% of FVC or 0.1 L, whichever is greater
## Footnote
*BEV = back extrapolated volume
95
List the **Acceptability Requirements** for FEV and FVC.
* No faulty zero-flow setting
* No glottic closure during first 1 sec
* No glottic closure after 1 sec
* No cough during first 1 sec
* Achieve acceptable EOFE**
* No obstructed mouthpiece or spirometer
* No leaks
* If maximal inspiration after EOFE is > FVC, then FIVC - FVC must be ≤ 0.1 L or 5% of FVC, whichever is greater
## Footnote
**EOFE = end of forced exhalation
96
What are the **Repeatability Requirements** for FVC and FEV for patients older than 6 years?
* The difference between the two largest FVC values must be ≤ 0.150 L
* The difference between the two largest FEV values must be ≤ 0.150 L
97
What are the **Repeatability Requirements** for FVC and FEV for patients aged 6 years or younger?
* The difference between the two largest FVC values must be ≤ 0.100 L or 10% of the highest value, whichever is greater
* The difference between the two largest FEV values must be ≤ 0.100 L or 10% of the highest value, whichever is greater
98
True or false: A **cough during the first second** is acceptable in FEV and FVC measurements.
FALSE
## Footnote
Coughing during the first second violates the acceptability criteria.
99
What is the significance of **EOFE** in the context of FEV and FVC measurements?
EOFE is the end of forced exhalation
## Footnote
Achieving acceptable EOFE is a requirement for acceptability.
100
What does **FIVC - FVC** must be ≤ 0.1 L or 5% of FVC indicate?
It indicates a condition for acceptability if maximal inspiration after EOFE is greater than FVC
## Footnote
This ensures accurate measurement of lung function.
101
What is the **grading system** for FEV1 and FVC for patients aged over 6 years?
* A
* B
* D
* E
* F
* U
## Footnote
Each grade corresponds to specific criteria regarding the number of measurements and repeatability.
102
What is the maximum number of attempts for obtaining acceptable tests for **Forced Vital Capacity (FVC)**?
8 attempts
## Footnote
A minimum of three acceptable tests should be obtained.
103
What is the formula for determining the **'best test'** in FVC and FEV1?
'Best test' = highest FVC plus FEV1
## Footnote
This formula is used to record the results accurately.
104
What is the acceptable repeatability for **Grade A** in the grading system?
Within 0.150 L
## Footnote
This standard applies to both FEV1 and FVC measurements.
105
What is the minimum number of acceptable tests required for **Grade B**?
2 acceptable
## Footnote
This is part of the grading criteria for FEV1 and FVC.
106
True or false: A patient should repeat the FVC test if the **best test** shows a poor effort.
TRUE
## Footnote
Patients should be instructed carefully about the procedure.
107
What should be reported regardless of the trial that generated it in FVC testing?
* Highest FVC
* Highest FEV1
* Peak Flow
## Footnote
This ensures accurate reporting of the patient's lung function.
108
What is the acceptable repeatability for **Grade D** in the grading system?
Within 0.250 L
## Footnote
This indicates the level of precision required for acceptable measurements.
109
What should adults do during **FVC testing**?
Stand or sit erect
## Footnote
Proper posture is important for accurate lung function testing.
110
What is the acceptable repeatability for **Grade E** in the grading system?
> 0.250 L
## Footnote
This indicates a lower standard of repeatability compared to higher grades.
111
What should children do during the **testing**?
Sit
## Footnote
This is a quality assurance measure to ensure accurate results.
112
What should a patient wear during the testing?
Noseclips or manually pinch their nose
## Footnote
This helps to ensure proper breathing during the test.
113
What must be made as a **'hard copy'**?
A hard copy
## Footnote
This is a requirement for documentation purposes.
114
What does a sharp upward deflection indicate during testing?
Coughing
## Footnote
This is a specific response that can be measured.
115
What does early termination illustrate in the results?
A short horizontal line at the end of exhalation
## Footnote
This can indicate glottic closure.
116
What is **Back-extrapolation volume (BEV)** used for?
To determine the start of forced exhalation
## Footnote
It affects flowrate calculations but not volume.
117
What is the formula for **BEV (%)**?
Extrapolated Volume X 100 / FVC
## Footnote
This formula helps in calculating the percentage of BEV.
118
What must BEV be less than?
* 5% of the FVC
* 0.100 L
## Footnote
BEV must meet the greater of these two criteria.
119
What is **Hesitation Time**?
The time between maximal inspiration and Time Zero
## Footnote
This should be ≤ 2 seconds.
120
What should Hesitation Time be?
≤ 2 seconds
## Footnote
This is a standard measurement for quality assurance.
121
What should children do during the **testing**?
Sit
## Footnote
This is a quality assurance measure to ensure accurate results.
122
What should a patient wear during the testing?
Noseclips or manually pinch their nose
## Footnote
This helps to ensure proper breathing during the test.
123
What must be made as a **'hard copy'**?
A hard copy
## Footnote
This is a requirement for documentation purposes.
124
What does a sharp upward deflection indicate during testing?
Coughing
## Footnote
This is a specific response that can be measured.
125
What does early termination illustrate in the results?
A short horizontal line at the end of exhalation
## Footnote
This can indicate glottic closure.
126
What is **Back-extrapolation volume (BEV)** used for?
To determine the start of forced exhalation
## Footnote
It affects flowrate calculations but not volume.
127
What is the formula for **BEV (%)**?
Extrapolated Volume X 100 / FVC
## Footnote
This formula helps in calculating the percentage of BEV.
128
What must BEV be less than?
* 5% of the FVC
* 0.100 L
## Footnote
BEV must meet the greater of these two criteria.
129
What is **Hesitation Time**?
The time between maximal inspiration and Time Zero
## Footnote
This should be ≤ 2 seconds.
130
What should Hesitation Time be?
≤ 2 seconds
## Footnote
This is a standard measurement for quality assurance.
131
What is the **End of Forced Exhalation (EOFE)** assessed to ensure?
A true FVC has been achieved
## Footnote
EOFE is acceptable when specific indicators are achieved.
132
List the indicators that make **EOFE** acceptable.
* <0.25 L change in volume for at least 1 second (a plateau) with a single audio beep
* Forced expiratory time (FET) of 15 seconds with a double audio beep
* Patient cannot expire long enough to achieve a 1 second plateau
## Footnote
The first indicator is the most reliable for determining EOFE.
133
What is the maximum allowable variance in the end-expiratory level of the 3 breaths before the **Slow Vital Capacity (SVC)** maneuver?
100 mL
## Footnote
Large variances may indicate a leak or inconsistent breathing at FRC.
134
What should occur during the **SVC** maneuver tracing?
A smooth tracing with a volume plateau at both maximum inspiration and maximum expiration
## Footnote
This indicates no leaks, no cough, and no obstruction of the mouthpiece.
135
How many acceptable maneuvers should be within 10% or 0.150 L of each other for **SVC**?
At least 3
## Footnote
The SVC should also be within 5% of the best FVC recorded.
136
What does a significant difference greater than 5% between **SVC** and **FVC** indicate?
Poor patient effort or fatigue
## Footnote
An SVC significantly greater than the FVC could indicate obstructive lung disease.
137
What is the maximum number of measurements for **SVC**?
8
## Footnote
The largest SVC measured should be reported.
138
What should the **Maximum Voluntary Ventilation (MVV)** tracing show?
A continuous, rhythmic effort for at least 12 seconds
## Footnote
The end-expiratory level should remain constant unless there is significant air trapping.
139
What should the measured **MVV** not exceed?
The largest FEV multiplied by 40
## Footnote
If MVV exceeds this significantly, question the effort on the FVC.
140
How many acceptable efforts should be recorded for **MVV**?
At least 2
## Footnote
These efforts should be within 10% of each other.
141
What should be reported for **MVV**?
The best MVV measured
## Footnote
This ensures accurate representation of the patient's ventilatory capacity.
142
What is the purpose of ensuring a **flat system baseline** and stable % helium reading before testing?
To insure that no leaks are present
## Footnote
This is crucial for accurate helium dilution measurements.
143
What should be maintained by adding oxygen during the **helium dilution** test?
A consistent baseline
## Footnote
This is necessary as oxygen is consumed by the patient.
144
What does a pattern of **increasing rate and depth** indicate during the helium dilution test?
The CO2 absorber is either missing or exhausted
## Footnote
This can affect the accuracy of the test results.
145
When does the **end-of-test** occur in the helium dilution method?
When the helium concentration changes by less than 0.02% over a 30 second interval
## Footnote
This indicates that equilibrium has been reached.
146
What should be measured immediately following the **FRC measurement**?
* ERV
* SVC
## Footnote
These measurements are important for assessing lung volumes.
147
For patients with severe obstructive lung disease, what should be measured immediately after the **FRC**?
IC
## Footnote
This helps in calculating TLC.
148
What does **failure to achieve equilibrium** indicate during the helium dilution test?
A leak
## Footnote
This can compromise the accuracy of the test.
149
How long should you wait before repeating the helium dilution test to clear helium from the patient's lungs?
10 - 15 minutes
## Footnote
This waiting period is essential for accurate retesting.
150
What should be reported as the result of the helium dilution test?
The mean value of the three largest acceptable FRC measurements
## Footnote
This ensures reliability in the reported data.
151
What should the tracing show during the **Nitrogen (N2) Washout** test?
A regular pattern without increases or abrupt jumps in end-tidal N2%
## Footnote
The trend should be a gradually falling N2% concentration.
152
How long should it take for persons with normal lung function to complete the **N2 washout**?
3 minutes or less
## Footnote
Failure to do so indicates a leak.
153
What is the **end-of-test** criteria for the nitrogen washout?
N2 is 1.5% or less for three successive breaths
## Footnote
This indicates successful washout.
154
What is the expected outcome for patients with obstructive lung disease during the **N2 washout**?
Longer washout times and may not completely washout after 7 minutes
## Footnote
This reflects the severity of their condition.
155
How long should you allow between testing for the **N2 washout**?
15 minutes
## Footnote
This is necessary to ensure accurate results.
156
What should be reported as the result of the nitrogen washout test?
The mean of two acceptable results that are within 10% of each other
## Footnote
This ensures consistency in the measurements.
157
What should be done to the nitrogen analyzer before testing?
Zero it with 100% oxygen
## Footnote
This calibration is essential for accurate readings.
158
How often should **biological testing** be performed?
Weekly or monthly
## Footnote
Regular testing ensures the reliability of the equipment.
159
What should the oscilloscope or recorded tracing indicate during **Body Plethysmography (Vra)**?
That the patient panted correctly (P mouth/ box loop closed)
## Footnote
This is crucial for accurate volume measurements.
160
What does an **open loop** during panting indicate?
* Compression of gas in the oropharynx
* A leak
* Patient is panting too fast
## Footnote
These factors can compromise the accuracy of the test.
161
How many acceptable panting maneuvers should be obtained during Body Plethysmography?
A minimum of 3
## Footnote
The Vra values should be within 5% of each other.
162
What should the reported measurement be based on in Body Plethysmography?
The average of 3 or more acceptable maneuvers
## Footnote
This ensures reliability in the results.
163
What frequency and pressure should **gentle pants** occur at during Body Plethysmography?
At end-expiration (10 cm H2O) at a frequency of 0.5 - 1.0 Hz
## Footnote
This technique is important for accurate measurements.
164
What is an **acceptable maneuver** for Dico testing?
* Volume-time tracing shows a smooth, rapid inspiration
* Breath-hold baseline is flat
* Exhalation is smooth and rapid
## Footnote
These criteria ensure the reliability of the test results.
165
How long should the **patient be seated** before Dico testing?
At least 5 minutes
## Footnote
This allows for stabilization before testing.
166
What should the **inspired O2** level be at sea level?
21%
## Footnote
Oxygen should not be administered for at least 5 minutes prior to testing if tolerated by the patient.
167
What is the required **inspired volume** for healthy subjects during Dico testing?
Greater than 90% of the SVC in <2.5 seconds
## Footnote
This indicates adequate lung function.
168
What is the maximum **exhalation time** for subjects with moderate to severe airway obstruction?
Less than 4 seconds
## Footnote
This helps assess the severity of airway obstruction.
169
What should the **exhalation** time be for proper sampling?
< 4 seconds with clearance of deadspace
## Footnote
Proper sampling is crucial for accurate analysis of alveolar gas.
170
What is the stable **breath-hold time** range during Dico testing?
10 seconds (8 - 12 sec)
## Footnote
Stability is important for consistent results.
171
What should be avoided during the **breath-hold**?
* Leaks
* Valsalva maneuver
* Mueller maneuver
## Footnote
These factors can compromise the integrity of the test.
172
What is the acceptable range for **all efforts** in Dico testing?
Within 10% or 2 mL CO/min/mm Hg STPD
## Footnote
This ensures the accuracy of the test results.
173
How long should be allowed between **maneuvers** during Dico testing?
At least 4 minutes
## Footnote
This allows for clearance of gases from the lungs.
174
What is the **washout volume** range for Dico testing?
0.75 - 1.00 L
## Footnote
This volume is necessary for effective testing.
175
What is the required **sample collection volume** during Dico testing?
0.50 - 1.0 L
## Footnote
If the VC is < 1.0 L, the sample collected should be < 0.50 L.
176
What should be reported regarding **Dico values**?
Any adjustment of Dico values
## Footnote
Reporting adjustments is important for accurate interpretation.
177
What should the patient avoid on the day of **testing**?
* Smoking
* Alcohol for 4 hours prior
## Footnote
This helps ensure accurate test results.
178
When should the patient report about **smoking**?
When the last cigarette was smoked
## Footnote
This information is crucial for assessing test validity.
179
What is the **grade** based on in the Doo Grading System?
% inspired volume (Vi), breath holding time, and Breath-hold Time
## Footnote
The grading system categorizes performance into grades A, B, C, D, and F based on specific criteria.
180
What is the **criteria** for achieving Grade A in the Doo Grading System?
≥ 90% IVC/VC, 8 - 12 seconds sample collection time
## Footnote
IVC/VC = inspiratory VC / VC.
181
What should be reported if only one **Grade A maneuver** is achieved?
Report that value
## Footnote
This ensures that the best possible result is recorded.
182
What is the **criteria** for Grade F maneuvers?
Any test not meeting Grade A, B, C, or D
## Footnote
Grade F maneuvers are considered unusable.
183
What is the **zeroing requirement** for the flow analyzer in quality control?
Zeroed before each test
## Footnote
This ensures accurate measurements during testing.
184
What is the **daily calibration** requirement for the volume?
Volume calibration daily with 3.0 L syringe + 2.5% (0.075 L)
## Footnote
This ensures the accuracy of volume measurements.
185
How often should the **analyzer linearity test** be performed?
Quarterly
## Footnote
Regular testing ensures the analyzer maintains accuracy over time.
186
What is the **weekly requirement** for the spirometer?
Leak test the spirometer
## Footnote
This is crucial for ensuring the spirometer's accuracy and reliability.
187
What age group do the **Pediatric Testing Guidelines** apply to?
Children 2.5 - 6 years of age
## Footnote
Special considerations are made for this age group during testing.
188
What should be used to estimate a child's height in pediatric testing?
Ulnar length measured with calipers
## Footnote
This method provides a more accurate height estimation for children.
189
What is the **recommended position** for a child during testing?
Seated, using a small chair with a foot stool
## Footnote
Proper positioning is important for accurate test results.
190
What should be used when early termination occurs after 0.75 seconds in pediatric testing?
FEVO.75/FVC
## Footnote
This measure helps in assessing lung function accurately.
191
How many maneuvers may be required for children during testing?
More than 8 maneuvers
## Footnote
Children may need additional attempts to achieve reliable results.
192
True or false: **Moderate to severe asthma** may cause decreased flow rates with each effort.
TRUE
## Footnote
This condition can significantly impact respiratory performance.
193
True or false: **Mild asthma** may cause increased flow rates with each effort.
TRUE
## Footnote
Increased body temperature can lead to bronchodilation, improving flow rates.
194
What is the **grade** based on in the Doo Grading System?
% inspired volume (Vi), breath holding time, and Breath-hold Time
## Footnote
The grading system categorizes performance into grades A, B, C, D, and F based on specific criteria.
195
What is the **criteria** for achieving Grade A in the Doo Grading System?
≥ 90% IVC/VC, 8 - 12 seconds sample collection time
## Footnote
IVC/VC = inspiratory VC / VC.
196
What should be reported if only one **Grade A maneuver** is achieved?
Report that value
## Footnote
This ensures that the best possible result is recorded.
197
What is the **criteria** for Grade F maneuvers?
Any test not meeting Grade A, B, C, or D
## Footnote
Grade F maneuvers are considered unusable.
198
What is the **zeroing requirement** for the flow analyzer in quality control?
Zeroed before each test
## Footnote
This ensures accurate measurements during testing.
199
What is the **daily calibration** requirement for the volume?
Volume calibration daily with 3.0 L syringe + 2.5% (0.075 L)
## Footnote
This ensures the accuracy of volume measurements.
200
How often should the **analyzer linearity test** be performed?
Quarterly
## Footnote
Regular testing ensures the analyzer maintains accuracy over time.
201
What is the **weekly requirement** for the spirometer?
Leak test the spirometer
## Footnote
This is crucial for ensuring the spirometer's accuracy and reliability.
202
What age group do the **Pediatric Testing Guidelines** apply to?
Children 2.5 - 6 years of age
## Footnote
Special considerations are made for this age group during testing.
203
What should be used to estimate a child's height in pediatric testing?
Ulnar length measured with calipers
## Footnote
This method provides a more accurate height estimation for children.
204
What is the **recommended position** for a child during testing?
Seated, using a small chair with a foot stool
## Footnote
Proper positioning is important for accurate test results.
205
What should be used when early termination occurs after 0.75 seconds in pediatric testing?
FEVO.75/FVC
## Footnote
This measure helps in assessing lung function accurately.
206
How many maneuvers may be required for children during testing?
More than 8 maneuvers
## Footnote
Children may need additional attempts to achieve reliable results.
207
True or false: **Moderate to severe asthma** may cause decreased flow rates with each effort.
TRUE
## Footnote
This condition can significantly impact respiratory performance.
208
True or false: **Mild asthma** may cause increased flow rates with each effort.
TRUE
## Footnote
Increased body temperature can lead to bronchodilation, improving flow rates.
209
Pulmonary stress testing should be performed if there is a suspicion of **exercise-induced asthma**.
TRUE
## Footnote
This testing helps to confirm the diagnosis of asthma triggered by exercise.
210
What effect does **aspirin poisoning** have on hemoglobin in children?
Reduces available hemoglobin and causes cyanosis
## Footnote
Cyanosis is a bluish discoloration of the skin due to lack of oxygen.
211
Use an **MDI with spacer** to administer bronchodilator to a child aged _______.
5 or 6 years old
## Footnote
A metered-dose inhaler (MDI) with a spacer can improve medication delivery.
212
Younger children do better with a **small volume nebulizer (SVN)** with _______ or mask.
mouthpiece
## Footnote
This method is often more effective for younger patients.
213
Recommend **methacholine challenge testing** to evaluate a child with _______.
asthma
## Footnote
This test helps to assess airway hyperreactivity.
214
The two largest **FVC** should be within _______ of FVC (whichever is greater).
0.100 L or 10%
## Footnote
This ensures the reliability of the FVC measurements.
215
The two largest **SVC** (IVC or EVC) should be within _______ of VC (whichever is smaller).
0.100 L or 10%
## Footnote
This criterion is used to assess the consistency of lung volume measurements.
216
The two largest **FEV1** should be within _______ of FEV1 (whichever is greater).
0.100 L or 10%
## Footnote
This is important for evaluating lung function in children.
217
A parent may hold a child inside the **body plethysmograph** for testing. The weight of the adult must be accounted for and the adult must hold their _______ during the test.
breath
## Footnote
This is necessary to ensure accurate measurements during the test.
218
Grading system for **FEV1** and **FVC** for children < 6 years of age includes Grade A, which requires _______.
≥ 3 acceptable measurements within 0.100 L
## Footnote
This grade indicates high repeatability in the test results.
219
For Grade B in the grading system, the requirement is _______.
2 acceptable measurements within 0.150 L
## Footnote
This indicates a moderate level of repeatability.
220
For Grade C, the requirement is _______.
≥ 2 acceptable measurements within 0.200 L
## Footnote
This grade indicates lower repeatability compared to A and B.
221
Grade D indicates a difference of _______.
> 0.200 L
## Footnote
This grade signifies poor repeatability in the measurements.
222
Grade E requires _______ or 1 acceptable measurement.
≥ 2 acceptable
## Footnote
This grade allows for some flexibility in acceptable measurements.
223
Grade U indicates _______ acceptable AND ≥ 1 usable measurement.
0
## Footnote
This grade shows that no acceptable measurements were obtained.
224
Grade F indicates _______ acceptable and 0 usable.
0
## Footnote
This grade reflects a complete failure to obtain usable measurements.
225
FEV1 and FVC are each graded _______.
separately
## Footnote
This allows for a detailed assessment of lung function.
226
For reliability, use the values in the table OR _______ of the highest value, whichever is greater.
10%
## Footnote
This ensures that the measurements are consistent and reliable.
