RPFT RPFT Spirometry Technique & Maneuver Acceptability 1 — Questions and Answers
Question 1: According to ATS/ERS criteria, what is the minimum exhalation duration required for an acceptable FVC maneuver in adults?
- At least 6 seconds (Correct answer)
- At least 3 seconds
- At least 10 seconds
- At least 2 seconds
Correct answer: At least 6 seconds
ATS/ERS guidelines require adults to exhale for a minimum of 6 seconds (or until a plateau is reached) to ensure complete emptying and an accurate FVC.
Question 2: Which criterion defines an acceptable spirometry start of test for an FVC maneuver?
- Extrapolated volume less than 5% of FVC or 0.150 L, whichever is greater (Correct answer)
- Peak flow achieved within 0.5 seconds of exhalation start
- No cough detected in the first 2 seconds
- Back-extrapolated volume less than 10% of FVC
Correct answer: Extrapolated volume less than 5% of FVC or 0.150 L, whichever is greater
An acceptable start requires back-extrapolated volume (BEV) to be less than 5% of FVC or 150 mL, whichever is greater, confirming a sharp, maximal effort from the start.
Question 3: What is the repeatability criterion for FVC when selecting the best two acceptable maneuvers?
- The two largest FVC values must agree within 150 mL (Correct answer)
- The two largest FVC values must agree within 5% of the larger
- The two largest FVC values must be identical
- Repeatability within 200 mL is acceptable for all patients
Correct answer: The two largest FVC values must agree within 150 mL
ATS/ERS 2019 guidelines require the two highest acceptable FVC values to be within 150 mL to ensure reproducibility.
Question 4: A patient coughs forcefully during the first second of an FVC maneuver. How should the RPFT grade this trial?
- Unacceptable — cough during the first second may falsely alter FEV1 (Correct answer)
- Acceptable if the rest of the curve looks normal
- Acceptable because cough effort adds to expiratory flow
- Unacceptable only if the cough is audible
Correct answer: Unacceptable — cough during the first second may falsely alter FEV1
Coughing in the first second creates artifactual flow spikes that distort FEV1, making the maneuver unacceptable per ATS/ERS standards.
Question 5: Which flow-volume loop feature most strongly suggests a patient's effort was submaximal at the start of a forced expiratory maneuver?
- Rounded, blunted peak expiratory flow rather than a sharp spike (Correct answer)
- A plateau in the final 10% of exhalation
- An elevated FEV1/FVC ratio
- A scalloped appearance in the mid-expiratory portion
Correct answer: Rounded, blunted peak expiratory flow rather than a sharp spike
A rounded rather than sharp PEF spike on the flow-volume loop indicates the patient did not generate a maximal, abrupt initial effort.
Question 6: How many acceptable FVC maneuvers must be obtained before testing can be considered complete?
- A minimum of three acceptable maneuvers (Correct answer)
- Two acceptable maneuvers are sufficient
- One acceptable maneuver if reproducible
- Five maneuvers regardless of acceptability
Correct answer: A minimum of three acceptable maneuvers
ATS/ERS guidelines require at least three acceptable maneuvers, with the two best values meeting repeatability criteria, to ensure reliable results.
RPFT RPFT Spirometry Technique & Maneuver Acceptability 1
According to ATS/ERS criteria, what is the minimum exhalation duration required for an acceptable FVC maneuver in adults?