Which of the following is true regarding the 5-breath dosimeter method of methacholine delivery system?

All of the above are true regarding the methacholine delivery system

Which of the following are the two methods used to deliver methocoline challenge?

Five-Breath Dosimeter (nebulizer) and 1-miniute tidal breathing

After methacholine challenge, JJ performs a postbronchodilator FEV1 below the target FEV1. What should be done?

follow lab protocol (may require another dose of bronchodilator)

Which of the following is not an indication to preform a bronchoprovocation challange?

Pt's with symptoms of bronchospasm with abnormal PFT/ bronchodilator study

Pt. has SOB and angina when exercising. In addition to per/post spirometry, which combination of test is appropriate?

Treadmill Exercise for 4-6 min at 85% of max HR / EVH at 30 x FEV(1) x 6min

What does a positive methacholine challenge represent?

baseline FEV1 is decreased by 20%

JJ performs methacholine challenge with 5-breath dosimeter. She has PD(20) between 1.0-4.0 mg/ml. What does this mean?

She has a FEV(1) decrease of 20% or greater at doses between 1-4 mg/ml

After applying 4mg/ml of methacholine a patient displays a 32% decrease in FEV1, which of the statements are true ?

Patient may have obstructive disorder (asthma)

Which of the following is not true regarding EVH?

To prevent resp acidosis from hypoventilation, O2 is added to the mix.

What is the goal heart rate range and duration of test for exercise bronchoprovocation challenge?

80-90% of the patients predicted max HR for 6-8 min

What is the target range for MVV when performing EVH? How long should hyperventilation occur? What risk can occur?

85-60 MVV/ 4-6 minutes/ Resp. Alkilosis

True "quantitive" challenge test that delivers a consistent dose of the drug best describes:

Five-breath dosimeter (nebulizer) method

When preforming the methacholine challenge FEV1 at 90 seconds is greater than the target FEV1, What must be done?

Dose is doubled and FVC maneuver is repeated

What is the preferred method to deliver methacholine? What device is used to generate the aerosol? Why is it preferred?

1-Min tidal volume/ SVN/ It is simple to use and set up

What are the two dosing schedules used to deliver methacholine? What are the starting doses? What is the maximum dose?

Quadrupling or Doubling/ .0625 or .03 mg/ml / 16 mg/ml

Which of the following is not true regarding safety precaution that are applied to methcholine administration?

A physician is not required to be near as long as the RT is ACLS qualified.

What must be documented to assist in the evaluation of test results as the it can affect the validity of the test?

Medications that the patients are currently taking

How does histamine produce bronchoconstriction? What is the delivery method used? What is a benefit of its use?

Uncertain pathway/ 5-breath method/ Quicker recovery than w/ methacholine

Evaluation of a hyperreactive response during or after vigorous exercise may be benifical for all of below, except:

Routine screening for military members and professional athletes

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Bronchprovocation PFT

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Answers

1
Which of the following is true regarding the 5-breath dosimeter method of methacholine delivery system?
All of the above are true regarding the methacholine delivery system
Standard driving pressure & activation time allow fixed volume of aerosol
Activated during inspiration, either automatically (flow sensor)or manually
standardized driving pressure (20 psi) /activation time (0.5–0.9 sec)
2
Which of the following is not a contraindication for administration of methacholine challenge?
(FEV1) < 60% predicted (adults or children) or 1.5L (adults)
Myocardial infarction or stroke in last 3 months
Controlled Hypertension
Known aortic aneurysm
3
Which of the following are the two methods used to deliver methocoline challenge?
Four-Breath Dosimeter (nebulizer) and 1-miniute tidal breathing
Five-Breath Dosimeter (nebulizer) and 1-miniute tidal breathing
Five-Breath Dosimeter (nebulizer) and 10-miniute tidal breathing
SVN and MVV
4
Prior to performing the exercise challenge test, the patients should:
All of the above
Ensure they clear of respiratory infections for 3-6 weeks prior testing
Follow appropriate medicaiton withholding guidelines for prescribed time
Refrain from vigorous exercise 4-6 hours before the test
5
After methacholine challenge, JJ performs a postbronchodilator FEV1 below the target FEV1. What should be done?
follow lab protocol (may require another dose of bronchodilator)
Repeat the exam.
Immediately administer ultra-short acting bronchodilator
Nothing, this is normal.
6
Which of the following is not an indication to preform a bronchoprovocation challange?
Pt's with symptoms of bronchospasm with abnormal PFT/ bronchodilator study
To identify /charcterize airway hyperresponsivness.
Assess changes in AHR and quantify the severity of AHR
Screen pt's at risk from environmental/occupation exposure to toxins
7
Pt. has SOB and angina when exercising. In addition to per/post spirometry, which combination of test is appropriate?
Cycle Ergometer ramp test @ 50W/mi / EVH @ MVV x 5 min
Cycle Ergometer ramp test @50W/Min / Treadmill for 4-6 min @ 85% of max HR
Treadmill Exercise for 4-6 min at 85% of max HR / EVH at 30 x FEV(1) x 6min
Treadmill Exercise for 4-6 min at 85% of max HR /EVH at MVV x 5min
8
What does a positive methacholine challenge represent?
baseline FEV1 is decreased by 20%
Postbronchodilator FEV1 is decreased by 20%
baseline FEV1 is Increased by 20%
baseline FEV1 is decreased by 40%
9
What are the two methods used to trigger an exercise-induced bronchospasm in medical setting?
Treadmill / Bike
Quadruple / double
5-breath method/ 1 minute tidal breathing
Swim/ Push-ups
10
Which of the following is a cholinergic bronchoconstrictor that stimulates nerve fibers that cause airway muscle spasms?
Provocholine
Mannitol
Histamine
All of the above
11
JJ performs methacholine challenge with 5-breath dosimeter. She has PD(20) between 1.0-4.0 mg/ml. What does this mean?
She has a FEV(1) increase of 20% or greater at doses between 1-4 mg/ml
She has a FEV(1) decrease of 20% or greater at doses between 1-4 mg/ml
She has a FEV(1) decrease of 20% or greater at doses less 1-4 mg/ml
She has a FEV(1) decrease of 20% or greater at doses greater than 1-4 mg/ml
12
After applying 4mg/ml of methacholine a patient displays a 32% decrease in FEV1, which of the statements are true ?
Patients airways are less sensitive / hyporesponsive
None of the above
Patient may have obstructive disorder (asthma)
Patients airways are hypothermic
13
Which of the following is not true regarding EVH?
Spirometry is performed after hyperventilation at 5min intervals for 30min
To prevent resp acidosis from hypoventilation, O2 is added to the mix.
10% decrease in FEV1 is consistent with airway hyperreactivity
In healthy PTs, EVH will cause bronchodilation
14
What is the goal heart rate range and duration of test for exercise bronchoprovocation challenge?
40-60-90% of the patients predicted max HR for 6-8 min
80-90% of the patients predicted max HR for 6-8 min
80-90% of the patients predicted max HR for 30 min
None of the above
15
TJ is preforming a methcholine challenge on JJ, he has calibrated, prepped his equipment what must he do next?
Describe and demonstrate procedure to the patient
All of the above.
Review the physicians orders
Introduce himself to the patient and verify the patient with 2 identifiers
16
Which of the following medications does not need to be withheld prior to both direct and indirect bronchial challenges?
Beta-Agonist Agents
Xanthenies
Antichollernergic agents
Melatonin agents
17
What is the target range for MVV when performing EVH? How long should hyperventilation occur? What risk can occur?
85-60 MVV/ 6-12 minutes/ Resp. Alkilosis
85-60 MVV/ 4-6 minutes/ Resp. Alkilosis
20-40 MVV/ 40-60minutes/ Resp. Acidosis
60-45 MVV/ 4-6 minutes/ Resp. Alkilosis
18
True "quantitive" challenge test that delivers a consistent dose of the drug best describes:
Accuracy of the methcholine challenge
10-dose tidal breath nebulizer
2-minute tidal breathing method
Five-breath dosimeter (nebulizer) method
19
Which of the following is not an agent used to assess airway hyperactivity?
Histamine
Methacholine
Euranic
Mannitol
20
When preforming the methacholine challenge FEV1 at 90 seconds is greater than the target FEV1, What must be done?
Test is considered positive and bronchodilator must be administered
None of the above
Dose is doubled and FVC maneuver is repeated
Dose is reduced in half and FVC maneuver is repeated.
21
What is the preferred method to deliver methacholine? What device is used to generate the aerosol? Why is it preferred?
5- breath dosimeter systen/ USN/ It is the most accurate system
1-Min tidal volume/ SVN/ It is simple to use and set up
2-Min tidal volume/ LVN/ It is more accurate
5- breath dosimeter systen/ MDI/ It prolongs period of aerosol production
22
Rick has a 11% decrease in FEV(1) after performing the exercise challenge test, what does this indicate?
None of the above
Postive response
A leak in the system
Negative response
23
What are the two dosing schedules used to deliver methacholine? What are the starting doses? What is the maximum dose?
Quadrupling or Ten-fold dosing / .0625 or .03 mg/ml / 4 mg/ml
Ten-fold dosing or Doubling/.03 mg/ml / 16 mg/ml
Quadrupling or Doubling/ .0625 or .03 mg/ml / 16 mg/ml
Quadrupling or Doubling/ 4 or 16 mg/ml / .03 mg/ml
24
Which of the following is not true regarding safety precaution that are applied to methcholine administration?
A well ventilated room and exhalation filter is required to preform test
RT's, if required, can initiate resuscitation and administer meds
If severe bronchospasm (adverse reaction) occurs, stop the test immediately
A physician is not required to be near as long as the RT is ACLS qualified.
25
What must be documented to assist in the evaluation of test results as the it can affect the validity of the test?
All of the above
Physical appearance of the patient
Repetition of positive affirmations repeated to the patient
Medications that the patients are currently taking
26
When performing a methacholine challenge, the RT verifies compliance with medication withholding, what is done next?
Perform acceptable and repeatable baseline spirometry
Deliver initial dose based on the protocol/agent selected.
Formulate dose concentrations based on challenge agent & manufacture guide
All of the above
27
How does histamine produce bronchoconstriction? What is the delivery method used? What is a benefit of its use?
Uncertain pathway/ 5-breath method/ slower response time than methacholine
Neuron stimulation/ 5-breath method/ Quicker recovery than w/ methacholine
Neuron stimulation/ Doubling dose method/ more cost efficient
Uncertain pathway/ 5-breath method/ Quicker recovery than w/ methacholine
28
Evaluation of a hyperreactive response during or after vigorous exercise may be benifical for all of below, except:
symptomatic patients who have a negative Methacholine Challenge
patients with known (EIB) whose therapy is being evaluated
Routine screening for military members and professional athletes
Pt's who have shortness of breath on exertion but have normal resting PFTs

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