Download certified respiratory function scientist

AUSTRALIAN & NEW ZEALAND
SOCIETY OF RESPIRATORY SCIENCE Inc.
(www.anzsrs.org.au)
CERTIFIED RESPIRATORY FUNCTION SCIENTIST
(CRFS)
EXAMINATION STUDY GUIDE
February 2006
TABLE OF CONTENTS
INTRODUCTION ................................................................................................................................................ 1
ABOUT THE ANZSRS ........................................................................................................................................ 2
SECTION 1 ADMINISTRATIVE POLICIES AND EXAMINATION RULES ............................................ 3
CERTIFICATION EXAMINATION FOR RESPIRATORY FUNCTION SCIENTISTS................................. 3
QUALIFICATIONS FOR ADMISSION TO THE EXAMINATION................................................................ 3
APPLICATION FOR ADMISSION TO ATTEND THE EXAMINATION ...................................................... 3
ACCEPTANCE FOR EXAMINATION ............................................................................................................ 4
REIMBURSEMENT OF FEE............................................................................................................................ 4
EXAMINATION SCHEDULE.......................................................................................................................... 4
EXAMINATION RULES.................................................................................................................................. 5
REPORT OF RESULTS .................................................................................................................................... 6
RE-EXAMINATION......................................................................................................................................... 6
RELEASE OF INFORMATION........................................................................................................................ 6
YOUR STATUS AS A CRFS ............................................................................................................................ 6
SECTION 2 STUDY GUIDE............................................................................................................................... 7
EXAMINATION ADVICE ............................................................................................................................... 7
EXAMINATION CONTENT............................................................................................................................ 7
STUDY RESOURCES LIST ........................................................................................................................... 12
SELF-ASSESSMENT EXAMINATION......................................................................................................... 15
ANSWER KEY TO SELF-ASSESSMENT EXAMINATION ........................................................................ 41
CERTIFIED RESPIRATORY FUNCTION SCIENTIST APPLICATION FORM .................................... 44
INTRODUCTION
The Certification Examination for Respiratory Function Scientists was developed to
assess the professional knowledge of physiologists performing clinical respiratory
function testing and to set a uniform minimum standard of knowledge appropriate to the
competent performance of basic respiratory function testing in Australia and New
Zealand.
During 1992 and 1993 the Australian and New Zealand Society of Respiratory Science
(ANZSRS) conducted a series of meetings to describe the role and duties of australasian
clinical respiratory physiologists, and to gather other information that would define the
content and complexity of the Certification Examination for Respiratory Function
Scientists. Overseas organisations already providing credentialling examinations for
respiratory physiologists, including the United States of America National Board for
Respiratory Care, and the Canadian Association of CardioPulmonary Technologists,
were contacted for advice and assistance. The input of these organisations is gratefully
acknowledged. The examination was subsequently developed utilising established
examination development procedures by a committee composed of academics,
respiratory scientists and physicians.
This study guide was developed to assist candidates to prepare for the Certification
Examination for Respiratory Function Scientists. The study guide comprises two
sections:
SECTION ONE contains the admission policies, examination rules and other relevant
information concerning the administration of the examination. Any questions regarding
this information or your application to attend the examination should be directed to the
Secretary of the ANZSRS.
SECTION TWO presents the content upon which the examination is based together
with a list of references which can be used to direct your study. Also in this section is a
100-question self-assessment examination. The questions in the self-assessment
examination are similar in scope and difficulty to those in the actual Certification
Examination, consequently the self-assessment examination gives a valuable insight into
the depth of knowledge tested in the Certification Examination. The self-assessment
examination includes an answer key.
The material in this study guide is not intended to be a substitute for a commitment to a
thorough education in the theory and practical aspects of respiratory physiology and its
interpretation.
CRFS Examination Study Guide page 1
ABOUT THE ANZSRS
The Australian and New Zealand Society of Respiratory Science (ANZSRS) Inc. was
formed in 1980 to serve the professional needs of scientists employed in clinical
respiratory function laboratories. The members of the ANZSRS are drawn from all
regions of Australia and New Zealand. Society membership is approximately 250.
The aims of the ANZSRS are:
1. Provide a forum for scientific and technical communications between
members.
2. Advance the knowledge and practice of respiratory function measurement
and respiratory physiology.
3. Promote excellence in respiratory function measurement.
4. Support and encourage training and education in respiratory function
measurement.
5. Facilitate dialogue with other professional societies with common interests.
The ANZSRS organises an annual two-day scientific meeting comprising presentations
of original research, invited lectures and educational sessions.
In 1994 the ANZSRS developed and administered the first Australasian credentialling
examination for clinical respiratory physiologists. The examination is held regularly
throughout the year and in a number of locations throughout Australia and New Zealand.
Information about the activities of the ANZSRS, contact addresses and a copy of this
guide can be found on the Website www.anzsrs.org.au.
All correspondence to the ANZSRS, including requests for membership details and
application forms, should be directed to the Secretary of the society.
CRFS Examination Study Guide page 2
SECTION 1 ADMINISTRATIVE POLICIES AND EXAMINATION RULES
CERTIFICATION EXAMINATION FOR RESPIRATORY FUNCTION SCIENTISTS
The Certification Examination for Respiratory Function Scientists was developed to assess the
professional knowledge of physiologists performing clinical respiratory function testing and to
set a uniform minimum standard of knowledge appropriate to the competent performance of
basic respiratory function testing as practiced in Australia and New Zealand. The examination
consists of 100 multiple-choice questions covering Structure and Function of the Respiratory
System, Instrumentation/Equipment, Pharmacology and Diagnostic Procedures, and Data
Management. It was developed by an examination committee comprised of scientists, academics
and physicians whose knowledge and experience qualify them as experts in respiratory science
and its clinical application.
The examination questions are solicited from a variety of educators and practitioners. All
submitted questions undergo extensive review, and if necessary, revision, before acceptance.
QUALIFICATIONS FOR ADMISSION TO THE EXAMINATION
All applicants must be financial members of the Australian and New Zealand Society of
Respiratory Science Inc. In addition all applicants must satisfy one of the following
requirements:
1.
Hold an appropriate tertiary degree* and complete a minimum of one year of clinical
experience in the field of respiratory science, to be interpreted as a minimum of 35 hours
per week employed in a respiratory function laboratory.
2.
Complete five years of clinical experience in the field of respiratory science, to be
interpreted as a minimum of 20 hours per week employed in a respiratory function
laboratory.
* An appropriate degree shall be a bachelor or higher degree in science, paramedical
science or applied science including courses in subjects such as human physiology,
pharmacology, instrumentation and computing.
APPLICATION FOR ADMISSION TO ATTEND THE EXAMINATION
Candidates must apply for admission to the examination. Application forms are available from
the Secretary or the ANZSRS web-site. Candidates applying for admission to the examination
must submit a written application, all requested documentation and the appropriate fee as shown
on the application form.
CRFS Examination Study Guide page 3
IMPORTANT:
All correspondence from the ANZSRS, including your examination results,
will be mailed to the postal address provided on your application form. If
you change address during the period between applying for admission to the
examination and completing the examination it is your responsibility to
notify the ANZSRS of the change.
ACCEPTANCE FOR EXAMINATION
Within four (4) weeks of the ANZSRS receiving your application you will be notified whether
your application for admission to the examination was accepted. If your application was accepted
about two (2) weeks before the examination you will receive correspondence detailing the exact
location and time of the examination.
Examinations are held in the north and south islands of New Zealand and in the state capital
cities of Australia. The exact location of the examination in each city may change depending on
availability. Candidates will be advised of the exact location by means of the correspondence
sent to them about two (2) weeks prior to the examination date. A list of the cities in which the
examination can be scheduled is shown on the application form.
YOU WILL BE SCHEDULED TO ATTEMPT THE EXAMINATION IN THE CITY YOU
REQUEST ON YOUR APPLICATION FORM. IF YOU WISH TO CHANGE THIS CITY,
YOU MUST DO SO, IN WRITING AND YOUR REQUEST MUST BE RECEIVED BY THE
ANZSRS FOUR (4) WEEKS PRIOR TO THE DATE OF THE EXAMINATION.
REIMBURSEMENT OF FEE
1.
Candidates who submit a written request to be withdrawn from an examination which is
received by the ANZSRS no later than 30 days prior to the scheduled date of the
examination will receive refund of their examination fee, less a $20.00 processing
charge.
2.
Any scheduled candidate who fails to appear for an examination, for any reason, without
the above mentioned 30 days written notice, forfeits all examination fees and must
reapply for admission.
EXAMINATION SCHEDULE
1.
Bring your correspondence from the ANZSRS to the examination as you may be required
to show it to the supervisor.
2.
On the day of the examination you must provide one of the following documents bearing
your photograph and signature to gain admission to the examination: a driver's license,
employment identification card or a photograph bearing your signature and endorsed by a
member of the ANZSRS Board.
CRFS Examination Study Guide page 4
3.
Report to the examination location no later than 30 minutes before the scheduled
commencement time of the examination. Seating of candidates, distribution of
examination documents and testing instructions will begin about 15 minutes before the
commencement time. ANYONE WHO ARRIVES AFTER THE START OF THE
EXAMINATION WILL NOT BE ADMITTED.
4.
You will have two (2) hours to complete the examination. Additional time will not be
allowed. If you complete the examination early you may request permission to leave.
EXAMINATION RULES
1.
Bring soft lead pencils, sharpener, ruler, eraser and calculator with you to the
examination.
2.
No books, papers or other reference material may be taken into the examination room.
3.
No examination materials, forms or documents of any kind are to be taken from the
examination room.
4.
No questions relating to the content of the examination may be asked during the
examination. Listen carefully to the instructions given by the supervisor and read all
directions in the examination booklet thoroughly.
5.
Question Comments: You may comment on any question at the time of the examination
if you believe it is misleading or deficient in accuracy or content. A form for this
purpose is included with the examination. Each comment will be reviewed before
marking. Individual responses to question comments will not be provided. No question
comments will be considered after examination results are released to candidates.
6.
You must have the supervisor's permission to leave the test room during the examination.
You will not be allowed additional time to make up for the time lost.
7.
The supervisor may dismiss a candidate from the examination for any of the following
reasons:
- If the candidate's admission is unauthorised.
- If the candidate creates a disturbance, is abusive or otherwise uncooperative.
- If the candidate is suspected of giving or receiving help.
- If a candidate attempts to remove examination documents or notes from the
examination room.
- If a candidate attempts to take the examination for someone else.
CRFS Examination Study Guide page 5
REPORT OF RESULTS
You will be notified of your examination results within four (4) weeks of the examination. Your
total mark on the examination will be reported as a scaled mark. The scaled mark will be derived
from the total number of questions that you answered correctly. The scaled passing mark will be
80 percent. The reason for reporting scaled marks is that different editions of the examination
may vary somewhat in difficulty. To adjust, the raw scores on different editions of the exam will
be equated, so candidates of equal ability receive equal marks regardless of which edition of the
examination they might take. If the raw scores were not equated and converted to scaled marks,
candidates who took an easier edition of the examination would have an unwarranted advantage
over those who took a more difficult edition.
RE-EXAMINATION
Candidates who do not gain sufficient marks to achieve certification or who do not appear for a
scheduled examination may be admitted to any future examination by submitting a completed
application form. There is no additional fee for re-examination nor is there any limit to the
number of examinations that a candidate may attend to gain certification.
RELEASE OF INFORMATION
Information about candidates' specific examination results will not be released to any third party.
To ensure confidentiality, a candidate's results will not be released by telephone, even to the
candidate.
The ANZSRS will maintain a directory of those persons who have achieved the Certified
Respiratory Function Scientist (CRFS) credential. This directory will be available from the
Secretary without charge.
YOUR STATUS AS A CRFS
By passing the Certification Examination for Respiratory Function Scientists you will achieve
the Certified Respiratory Function Scientist (CRFS) credential. You will receive an official
certificate from the ANZSRS after the results are released.
CRFS Examination Study Guide page 6
SECTION 2 STUDY GUIDE
EXAMINATION ADVICE
The advice offered is presented primarily to familiarise you with the examination directions.
1. Read all instructions carefully.
2. The certification examination will be timed. You will have 2 hours to answer 100
multiple-choice questions.
3. For best results pace yourself by periodically checking your progress against the
available time. This will allow you to make any necessary adjustments.
4. As you take the examination, occasionally check the question number to be certain it
matches the corresponding answer line. This check will ensure that you are marking
your response to the appropriate question.
5. Be sure to record a single answer for each question, even the ones of which you are
not completely sure. You can note the questions you wish to reconsider in the test
booklet and return to them later. Avoid leaving any questions unanswered as this
will maximise your chances of passing and prevent mismarking your answer sheet.
EXAMINATION CONTENT
To begin your preparations in an organised and informed manner, you should know the areas that
will be assessed by the examination. The content of the examination is listed below.
CRFS EXAMINATION CONTENT OUTLINE
1.0
ANATOMY OF THE RESPIRATORY SYSTEM
1.1 Macroscopic structure
1.2
Upper and lower respiratory tracts
1.3
Gas exchanging tissues
1.4
Pulmonary and bronchial circulations
1.5
Nerve supply to the lungs
1.6
Muscles of respiration
1.7
Anatomy of the systemic circulation
CRFS Examination Study Guide page 7
2.0
FUNCTION OF THE RESPIRATORY SYSTEM
2.1 Ventilation
2.1.1 Lung volumes and capacities
2.1.2 Role of the respiratory centre, nerves, muscles and chemoreceptors in the control of ventilation
2.1.3 Tidal breathing and dead space ventilation
2.1.4 Distribution of ventilation
2.1.5 Lung compliance and elastance
2.1.6 Airway resistance and conductance
2.1.6.1 Laminar and turbulent flow
2.1.6.2 Effect of gas density and viscosity
2.1.7 Volume-time, flow-volume and pressure-flow relationships
3.0
2.2
Pulmonary gas exchange
2.3
Gas transport in the blood
2.4
Perfusion
2.4.1 Anatomical and physiological shunts
2.5
Ventilation/perfusion matching
2.6
Autonomic Nervous System
2.6.1 Sympathetic and Parasympathetic systems
TERMINOLOGY, GAS LAWS AND CORRECTION OF GAS VOLUMES
3.1 Abbreviations, symbols and units
3.2
Gas laws
3.2.1 Ideal, Boyle's, Charles', Dalton's, Fick’s (diffusion), Gay-Lussac's, Graham’s, Henry’s
3.2.2 Water vapour pressure
3.2.3 Definition and application of ATPD, ATPS, STPD and BTPS.
CRFS Examination Study Guide page 8
4.0
INSTRUMENTATION/EQUIPMENT
4.1 Principles of quality control
4.1.1 Analysis of quality control data
4.2
Principles of infection control in the respiratory laboratory
4.2.1 Cleaning procedures for respiratory equipment (disinfection and sterilisation)
4.2.2 Procedures to minimise cross-infection risks
4.3
Laboratory safety
4.3.1 Basic electrical safety
4.3.2 Storage and control of compressed gases
4.3.3 Cardiopulmonary resuscitation
4.4
Instrument characteristics: linearity, accuracy, precision, frequency response,
hysteresis, damping, response time
4.5
Principles of operation, set-up and/or calibration of
4.5.1 Volume measuring devices (spirometers: water seal, wedge etc.)
4.5.2 Flow measuring devices (pneumotachometer, hot wire, etc.)
4.5.3 Aerosol delivery devices
4.5.3.1 Metered dose inhalers and spacers
4.5.3.2 Breath activated inhalers
4.5.3.3 Jet and ultrasonic nebulisers
4.5.4 Computers
4.5.4.1 Analog to digital conversion and sampling rates
4.5.5 Gas analysers (helium, oxygen, carbon monoxide, carbon dioxide, nitrogen,
multi-gas)
4.5.6 Body plethysmograph
4.5.7 Pulse oximeters
4.6
Minimum performance specifications for:4.6.1 Volume measuring devices
4.6.2 Flow measuring devices
4.6.3 Gas analysers for DLCO measurements
CRFS Examination Study Guide page 9
4.7
Maintenance, performance of quality assurance and evaluation of quality assurance
data for:4.7.1 Volume measuring devices
4.7.2 Flow measuring devices
4.7.3 Gas analysers for DLCO measurements
5.0
PHARMACOLOGY AND DIAGNOSTIC PROCEDURES
5.1 Pharmacology
5.1.1 Types of medications, their mode of action, duration of effect and secondary
effects of drugs used to treat lung disease
5.1.1.1 Common medications with adverse pulmonary effects
5.1.2 Aerosol deposition in the lungs
5.1.3 Optimal technique for:5.1.3.1 Metered dose inhalers
5.1.3.2 Spacers
5.1.3.2 Breath activated inhalers
5.2 Diagnostic Procedures
5.2.1 Physiological basis for:
5.2.1.1 Spirometry
5.2.1.1.1 Volume-time and flow-volume
5.2.1.2 Flow-volume loop
5.2.1.3 Peak flow
5.2.1.4 Bronchodilator response
5.2.1.5 Lung volumes
5.2.1.5.1 Gas dilution
5.2.1.5.2
Nitrogen washout
5.2.1.5.3
Body plethysmography
5.2.1.6 Diffusing Capacity: single breath CO
5.2.2 Criteria for determining maximum effort, acceptable and reproducible efforts,
distinction between poor technique, technical problems and the effect of
abnormal function for:5.2.2.1 Spirometry
5.2.2.1.1 Volume-time and flow-volume
CRFS Examination Study Guide page 10
5.2.2.2 Flow-volume loop
5.2.2.3 Peak flow
5.2.2.4 Bronchodilator response
5.2.2.5 Lung volumes
5.2.2.5.1
Gas dilution
5.2.2.5.2
Nitrogen washout
5.2.2.5.3
Body plethysmography
5.2.2.6 Diffusing Capacity: single breath CO
6.0
DATA MANAGEMENT
6.1 Application of statistical methods to respiratory function data
6.1.1 Mean, standard deviation, confidence intervals, coefficient of variation,
normal distribution.
6.1.2 Linear regression
6.1.3 Predicted normal values and limits of normality
6.1.4 Derivation of reference equations
6.2
Clinical implications of height, armspan, age, sex, weight, race, posture, smoking
and occupational history, medications, patient symptoms to respiratory function and
the results of
6.2.1 Spirometry
6.2.1.1 Volume-time and flow-volume
6.2.2 Flow-volume loop
6.2.3 Peak flow
6.2.4 Bronchodilator response
6.2.5 Lung volumes
6.2.5.1 Gas dilution
6.2.5.2 Nitrogen washout
6.2.5.3 Body plethysmography
6.2.6
Diffusing Capacity: single breath CO
CRFS Examination Study Guide page 11
STUDY RESOURCES LIST
This list of study references is intended to complement the content outline. All books listed
are currently in print. The list is comprised of suggestions only and is not representative
of all the references which could assist candidates in preparing for the certification
examination, nor is it intended that candidates review all the listed references. Strongly
recommended references are underlined. Examination questions are not necessarily
referenced in any of the publications listed.
Note that references are grouped under headings which are most descriptive of the resource,
thus a reference listed under Anatomy will not be found again under another heading,
although its content may relate equally well to Physiology.
Recent ATS/ERS Lung Function Testing Standardisation Documents
Miller MR et al. General considerations for lung function testing. Eur Respir J 2005; 26: 153161.
Miller MR et al. Standardisation of spirometry. Eur Respir J 2005; 26: 319-338.
Wanger J et al. Standardisation of the measurement of lung volumes. Eur Respir J 2005; 26:
511-522.
MacIntyre N et al. Standardisation of the single-breath determination of carbon monoxide
uptake in the lung. Eur Respir J 2005; 26: 720-735.
Pellegrino R et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26: in
press.
Earlier ATS/ERS Lung Function Testing Standardisation Documents
Burrows B Pulmonary Terms and Symbols - a report of the ACCP-ATS joint committee on
pulmonary nomenclature. Chest 1975; 67: 583-593
Quanjer PH, ed. Standardized lung function testing. Report Working Party Standardization of
Lung Function Tests, European Community for Coal & Steel. Bull Eur Physiopathol Respir
1983; 19: Suppl. 5, 1-95.
Becklake M and Crapo RO. Lung function testing: selection of reference values and
interpretative strategies. Am Rev Respir Dis 1991; 144: 1202-1218.
Quanjer PH et al. Lung volumes and forced ventilatory flows. Report Working Party
Standardization of Lung Function Tests, European Community for Coal & Steel. Official
Statement of the European Respiratory Society. Eur Respir J 1993; 6: Suppl. 16, 5-40.
American Thoracic Society. Standarization of Spirometry: 1994 update. Am J Respir Crit
Care Med 1995; 152: 1107-1136.
American Thoracic Society. Single breath carbon monoxide diffusing capacity (transfer
factor). Recommendations for a standard technique-1995 update. Am J Respir Crit Care Med
1995; 152: 2185-2198.
CRFS Examination Study Guide page 12
Stocks J et al. Reference values for residual volume, functional residual capacity and total
lung capacity. Eur Respir J 1995; 8: 492-506.
Clausen JL et al. Measurement of lung volumes in humans: review and recommendations
from an ATS/ERS workshop. Eur Respir J 1997; 10: 1205-1206.
Coates AL et al. Measurement of lung volumes by plethysmography. Eur Respir J 1997; 10:
1415-1427.
Clausen JL et al. Lung volume equipment and infection control. Eur Respir J 1997; 10: 19281932.
Newth CJL et al. Multiple breath nitrogen washout techniques: including measurements with
patients on ventilators. Eur Respir J 1997; 10: 2174-2185
Brown R et al. Multiple breath helium dilution measurement of lung volumes in adults. Eur
Respir J 1998; 11: 246-255.
American Thoracic Society/ National Heart, Lung & Blood Institute Consensus Document
#12 – Lung volumes. www.thoracic.org/adobe/lungvolume.pdf
Anatomy
Des Jardins T Cardiopulmonary Anatomy and Physiology: Essentials for Respiratory Care.
(4th ed) Albany: Delmar Learning, 2002
Tortora GJ Principles of Human Anatomy. (7th ed) Harper and Row, 1994
Quality Control
Westgard JO Basic QC Practices: Training in Statistical Control for Healthcare
Laboratories (2nd ed) Westgard QC Inc., 2002.
Pathophysiology
Ali J et al Pulmonary Pathophysiology. New York: McGraw-Hill, 1999
West JB Pulmonary Pathophysiology-the essentials. (6th ed) Baltimore: Williams and
Wilkins, 2003
Pharmacology
Rau JL Respiratory Care Pharmacology. (6th ed) Chicago: Mosby Year Book, 2002
Physiology
Forster RE The Lung: Physiologic Basis of Pulmonary Function. (4th ed) Chicago: Mosby
Year Book, 1994
Leff AR and Schumacker PT Respiratory Physiology. Philadelphia: WB Saunders, 1993
Levitzky MG Pulmonary Physiology. (6th ed) New York: McGraw-Hill, 2003
CRFS Examination Study Guide page 13
West JB Respiratory Physiology - the essentials. (7th ed) Baltimore: Williams and Wilkins,
2004
Pulmonary Function Testing
Cotes JE Lung Function-Assessment and Application in Medicine (6th ed) Oxford:
Blackwell Scientific Publications, 2006
Hughes JMB and Pride NB Lung Function Tests: Physiological Principles and Clinical
Application. WB Saunders 1999 ISBN 0-7020-2350-7
Hyatt RE et al Interpretation of Pulmonary Function Tests. Philadelhia: Lippincott Williams
& Wilkins, 2003
Ruppel G Manual of Pulmonary Function Testing (8th ed) St Louis: Mosby Year Book, 2003
CRFS Examination Study Guide page 14
SELF-ASSESSMENT EXAMINATION
This section includes a 100 question, multiple-choice examination that is similar in
length and difficulty to the actual credentialling examination. The correct answers to the
self-assessment questions are attached at the end of the questions.
The CRFS Examination also consists of 100 multiple-choice questions and has a time
limit of 2 hours. Therefore, when you take this self-assessment examination, allow
yourself no more than 2 hours so you have the same amount of time as you will have
during the actual CRFS Examination.
Remember that these self-assessment questions sample the scope of content that may be
tested in the actual CRFS Examination. It is suggested that you take the self-assessment
examination, score your results, and refer to references supporting the correct answer for
any question you answered incorrectly or were unable to answer.
HOW TO COMPLETE THE ANSWER SHEET
An answer sheet, identical to the one you will use during the CRFS Examination, is
located on page 42. You should become familiar with how to correctly fill out this
answer sheet. Please refer to the answer sheet as you read the following information.
1.
The top area of the answer sheet provides spaces for you to print your name,
examination location (i.e. city) and the date.
2.
The lower section of the answer sheet is to record your answers to the
questions. The numbers on the left side of each column represent the 100
questions in the examination. The four lettered spaces ("A","B","C" and
"D") beside each number represent the possible answers for the question. To
indicate your answer to a question, blacken the space on the answer sheet
which corresponds to the option you believe is the best answer to the
question.
Remember to use only a soft lead pencil to complete your answer sheet on the day of the actual
CRFS Examination.
CANDIDATE COMMENT FORM
A candidate comment form, identical to that which will be included in the CRFS
Examination is shown on page 43. This form is available so that you may comment about
any question you believe is ambiguous or misleading in accuracy or content. To do so
use one of the spaces to record the question number and your concern about the question;
use only one space per question. The examination committee reviews all comments
before marking the examination. Individual replies to comments will not be made.
CRFS Examination Study Guide page 15
The following directions are taken from the CRFS Examination. You will read these directions
again before you begin the actual examination, but it cannot be overemphasised that all
directions must be followed exactly during the examination.
******************************************************************************
Certification Examination for Respiratory Function Scientists
IMPORTANT POINTS TO REMEMBER
1. Unless otherwise stated, laboratory values are reported at sea level with barometric pressure (PB) equal to 760
mm Hg.
2. The term "ATS/ERS recommendations" used in some questions refers to information on respiratory function
testing as presented in position papers published by the American Thoracic Society (ATS) and European
Respiratory Society (ERS). The respiratory terms and symbols used in the examination are from the American
College of Chest Physicians (ACCP) and ATS recommendations on pulmonary nomenclature.
3. An ATPS to BTPS conversion table is provided on the next page.
GENERAL INSTRUCTIONS
1. You will be given 2 hours to complete the examination, which consists of 100 multiple-choice questions.
2. Your mark is based on the number of questions you answer correctly. YOU ARE ASKED TO INDICATE
YOUR ANSWERS TO ALL QUESTIONS ON THE SEPARATE ANSWER SHEET PROVIDED. Although
you may make preliminary notes or calculations in the examination book, no credit will be given for anything
written in the examination book. The answer spaces are lettered to correspond with the letters of the suggested
answers to the questions in this book. After you have decided which of the suggested answers is correct, blacken
the corresponding space on the answer sheet. Give only one answer to each question. If you change an
answer, be sure that the previous mark is erased completely. USE ONLY SOFT LEAD PENCILS AND BE
SURE THAT EACH MARK IS BLACK AND COMPLETELY FILLS THE ANSWER SPACE.
Example:
Which of the following is the capital of Australia?
A. Brisbane
⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
B. Sydney
C. Melbourne
D. Canberra
3. A Candidate Comment Form is also enclosed. The form is to be used for comments on individual questions that
you believe may be ambiguous or misleading. The Examination Committee will only consider comments written
on this form at the examination.
DO NOT TURN THE PAGE UNTIL YOU ARE TOLD TO DO SO.
CRFS Examination Study Guide page 16
Certification Examination for Respiratory Function Scientists
Time - 2 hours
Directions:
Note:
Each of the questions or incomplete statements is followed by four suggested
answers or completions. Select the one that is best in each case and then blacken
the corresponding space on the answer sheet.
Please refer to the ATPS to BTPS Conversion Table below as necessary.
ATPS to BTPS Conversion Table
Gas Temperature (oC)
Conversion Factor
20
21
22
23
24
25
26
27
28
29
30
1.102
1.096
1.091
1.085
1.080
1.075
1.068
1.063
1.057
1.051
1.045
___________________________________________________________________
Q1
A rotameter is used to calibrate:
A - an oxygen analyser
B - a pneumotachograph
C - a wedge spirometer
D - a body plethysmograph
___________________________________________________________________
Q2
FRC is usually:
A - decreased in patients with airway obstruction
B - higher when measured by plethysmograph than by the helium dilution method in
patients with emphysema
C - increased in patients with obesity
D - higher when measured by the helium dilution method than by the nitrogen washout
method in patients with airway obstruction
CRFS Examination Study Guide page 17
Q3
The pressure-volume curve of the lung is a graphical representation of lung volume plotted
against:
A - pleural pressure
B - elastic recoil pressure of the lung
C - oesophageal pressure
D - alveolar pressure
___________________________________________________________________
Q4
Equal pressure point (EPP) is:
A - a pressure which exists during forced inspiration
B - the point at which the pressure inside the airways equals the pressure outside the
airways
C - a problem only with lung volumes above the normal tidal volume
D - not affected by changes in elastic recoil in the lung
___________________________________________________________________
Q5
The mechanism responsible for transporting the greatest amount of CO2 in the blood is:
A - carbamino compounds
B - dissolved CO2
C - bicarbonate ion
D - carboxyhaemoglobin
___________________________________________________________________
Q6
With normal respiratory function and metabolic rate, an increase in cardiac output will
result in:
A - increased arterial PO2
B - decreased arterial-venous content difference for oxygen
C - decreased mixed venous oxygen content
D - no change in mixed venous oxygen content
___________________________________________________________________
Q7
A respiratory scientist enters a patient's room to perform oximetry and finds the patient
unresponsive and not breathing. After calling for help, the scientist delivers 2 breaths.
What should the scientist do next?
A
B
C
D
-
continue rescue breathing
perform oximetry as requested
begin chest compressions
check for a pulse
CRFS Examination Study Guide page 18
Q8
Adjacent alveoli are often interconnected by stomata called pores of:
A - Forster
B - Kohn
C - Henry
D - Low
___________________________________________________________________
Q9
Small airway resistance increases with which of the following?
1 - asthma
2 - emphysema
3 - beta-adrenergic blockade
4 - cholinergic blockade
A - 1, 2 and 3
B - 1 and 3
C - 2 and 4
D - 4 only
___________________________________________________________________
Q10 Hypoventilation ALWAYS results in:
A - hypoxia
B - hypercapnia
C - respiratory alkalosis
D - hypoxia and hypercapnia
___________________________________________________________________
Q11 Particles greater than 10 microns in diameter are deposited mainly in the:
A - pharynx
B - trachea
C - alveoli
D - bronchioles
___________________________________________________________________
Q12 Minute volume is calculated by knowing the:
1
2
3
4
A
B
C
D
-
-
tidal volume
anatomical dead space
respiratory rate
alveolar ventilation
1, 2 and 3
1 and 3
2 and 4
1, 2, 3 and 4
Q13 A body plethysmograph is used to measure airway resistance because:
CRFS Examination Study Guide page 19
A - without it we cannot measure flow
B - it is not sensitive to changes in volume
C - alveolar pressure can be determined
D - it overcomes diffractive interference from lung compliance scatter.
___________________________________________________________________
Q14 Physiologic dead space may be defined as:
A - perfusion without adequate ventilation
B - ventilation without adequate perfusion
C - ventilation/perfusion ratio of 0.8
D - residual volume
___________________________________________________________________
Q15 During respiratory function testing complaints of tingling of lips and extremities are
usually associated with:
A - hyperventilation
B - hypoventilation
C - dyspnoea
D - atrial fibrillation
___________________________________________________________________
Q16 Functional Residual Capacity contains:
A - inspiratory reserve volume and tidal volume
B - vital capacity and residual volume
C - tidal volume and residual volume
D - expiratory reserve volume and residual volume
___________________________________________________________________
Q17 The approximate anatomic dead space of the average male is:
A - 300ml
B - 10ml per kg of body weight
C - 150ml
D - 50ml
___________________________________________________________________
Q18 In a cooperative normal patient, comparison of forced vital capacity and slow vital
capacity will show:
A - the forced vital capacity should be the larger
B - the slow vital capacity should be the larger
C - both should be the same
D - no correlation at all
Q19 The motor nerve to the diaphragm is the:
CRFS Examination Study Guide page 20
A - tympanic
B - vestibular
C - abducent
D - phrenic
___________________________________________________________________
Q20 Which of the following factors might account for a decreased DLCO in the absence of
pulmonary disease?
1
2
3
4
-
measurements made at altitude
decreased haemoglobin (anaemia)
increased pulmonary capillary blood volume
elevated carboxyhaemoglobin (COHb)
A - 1, 2, 3 and 4
B - 1, 3 and 4
C - 2, 3 and 4
D - 2 and 4
___________________________________________________________________
Q21 Pulmonary compliance is increased in:
A - sarcoidosis
B - kyphoscoliosis
C - emphysema
D - pulmonary edema
___________________________________________________________________
Q22 A COPD patient who is spontaneously breathing an FiO2 of 0.50 becomes sleepy and
unresponsive. The patient's reaction is most likely a result of:
A - insufficient oxygenation
B - increased PaCO2
C - increased intracranial pressure
D - decreased cardiac output
___________________________________________________________________
Q23 Which of the following cause hypoxaemia?
A
B
C
D
-
shunt
diffusion limitation
ventilation/perfusion mismatch
all of the above
CRFS Examination Study Guide page 21
Q24 Laminar flow in the airways is:
A - little affected by the viscosity of the gas and strongly affected by the density of the
gas
B - strongly affected by the viscosity of the gas and little affected by the density of the
gas
C - strongly affected by both viscosity and density of the gas
D - dependent only upon the airway size
___________________________________________________________________
Q25 When a volume of room air is added to a spirometer that contains 10% He, the He
concentration falls to 5%. If the spirometer originally contained 3L of air, how much
volume was added?
A - 1L
B - 2L
C - 3L
D - 4L
___________________________________________________________________
Q26 A conscious, uncomfortable awareness of the need for increased breathing is defined as:
A - apnoea
B - eupnoea
C - dyspnoea
D - orthopnoea
___________________________________________________________________
Q27 Which of the following will occur as a result of performing He equilibration lung volume
measurements with the patient in the supine, rather than the upright posture?
A - a decrease in RV
B - a decrease in FRC
C - an increase in TGV
D - an increase in TLC
___________________________________________________________________
Q28 The type of breathing pattern characterised by deep, rapid breathing with progressively
increasing and decreasing tidal volumes followed by an apnoeic episode is called:
A
B
C
D
-
Biot's respiration
Cheyne-Stokes respiration
Kussmaul's respiration
hyperventilation
Q29 Which of the following are capable of sterilising equipment?
CRFS Examination Study Guide page 22
1
2
3
4
-
autoclave
ethylene oxide
glutaraldehyde
alcohols
A - 1 and 2
B - 2 and 3
C - 1 and 4
D - 1, 2 and 3
___________________________________________________________________
Q30 Spirometry after bronchodilator administration shows a 20% increase in FVC. This is
highly suggestive of:
A - peripheral gas trapping
B - pulmonary fibrosis
C - pulmonary emboli
D - chronic bronchitis
___________________________________________________________________
Q31 According to ATS standards which of the following should be done to ensure reliable FEF
determinations?
A - the test should be repeated twice to make calculation of data easier.
B - the results should be obtained from a manoeuvre of full exhalation to RV, to full
inspiration to TLC, and then to full exhalation to RV.
C - the results should be measured from the best effort when the FEV1 and FVC are
reproducible within 5% of other curves.
D - the results should be averaged from all flow-volume loops.
___________________________________________________________________
Q32 A system utilising a one-way circuit and set-up for a He equilibration test is not
satisfactory for FVC and FEV1 measurements for which of the following reasons?
A
B
C
D
-
the addition of O2 is not necessary
the soda lime canister increases expiratory resistance
absorption of CO2 is not needed
the recording system is inadequate.
CRFS Examination Study Guide page 23
Q33 Pulmonary hypertension that results from pulmonary emphysema is characterised by an
increase in which of the following:
1 - pulmonary artery pressure
2 - intrapulmonary vascular resistance
3 - right ventricular pressure
A - 1 only
B - 2 only
C - 1 and 3
D - 1, 2 and 3
___________________________________________________________________
Q34 A prebronchodilator expiratory flow-volume curve is attempted by a patient who cannot
control his cough. An approximation of the curve may be obtained by instructing the
patient to do which of the following?
A - take a full breath, then expel the air forcefully despite coughing
B - blow out forcefully, through pursed lips
C - do a forced inspiration first, then a normal expiration
D - breathe in partially, then blow out slowly.
___________________________________________________________________
Q35 After an upright normal subject takes a vital capacity breath of 100% O2, the N2
concentration at the apex exceeds that at the base of the lung because:
A - airway closure at the base delays filling of that region
B - airway resistance of lower zones is high
C - the ventilation-perfusion ratio is high at the apex
D - the apical alveoli expand less than those at the base
___________________________________________________________________
Q36 Which of the following are required to perform a single breath DLCO test using the
traditional technique?
1
2
3
4
A
B
C
D
-
-
spirometer
1 L sample bag
0.3% CO, 10% He, balance N2
0.3% CO, 10% He, balance air
1 and 3
2 and 4
1, 2 and 3
1, 2 and 4
Q37 Which of the following statements best explains the ”maximum" flow-volume loop shown
CRFS Examination Study Guide page 24
below?
A - patient removed the mouthpiece during exhalation
B - patient failed to inhale maximally following complete exhalation
C - loop demonstrates the presence of an intrathoracic lesion
D - loop demonstrates the presence of an extrathoracic lesion.
________________________________________________________________
Q38 A respiratory scientist is measuring the SVC of a patient with a tracheostomy. When the
spirometer is connected to the tracheostomy tube, results are as follows:
Trial
1
2
3
SVC (L)
4.05
3.75
2.00
All of the following are possible explanations for this variability EXCEPT
A
B
C
D
-
air is leaking around the tracheostomy tube through the stoma
air is leaking around the tracheostomy tube through the mouth
the tracheostomy tube is too small
the tracheostomy tube is intermittently blocked by being pressed against the tracheal
wall
CRFS Examination Study Guide page 25
Q39 Mast cells in human lungs:
A - are situated mainly in the mucosal layers of the airways
B - release mediators if stimulated with histamine inhalation
C - may have their mediator release reduced by pretreatment with cromoglycate
D - are mostly situated in central rather than peripheral airways
___________________________________________________________________
Q40 Alveolar ventilation will increase in response to stimulation of:
A - the medullary chemorecepters by increased H+ ion concentration in the cerebrospinal fluid
B - the medullary chemorecepters by increased O2 concentration in the cerebro-spinal
fluid
C - the carotid chemoreceptors by decreased CO2 concentration in the blood
D - the carotid chemoreceptors by increased pH of arterial blood
___________________________________________________________________
Q41 If a patient fails to exhale fully while performing a VC manoeuvre during a He dilution
lung volume determination which of the following errors will result?
A - an RV that is too low
B - an RV that is too high
C - a TLC that is too low
D - a TLC that is too high
___________________________________________________________________
Q42 When setting up a system for measuring lung volumes by the He dilution technique, which
of the following components must be used?
1
2
3
4
A
B
C
D
-
-
water absorber
CO2 absorber
O2 analyser
CO2 analyser
2 only
1 and 2
2 and 4
3 and 4
CRFS Examination Study Guide page 26
Q43 A computer using an 8 bit analog to digital converter is set for a voltage range of 0 to 10
volts. If it is attached to a spirometer that produces 1 volt for every 2 L of volume
displacement, what is the smallest volume increment that the converter can detect?
A - 20 ml
B - 40 ml
C - 60 ml
D - 80 ml
___________________________________________________________________
Q44 Which of the following would MOST likely prolong He equilibration time?
A - emphysema
B - pneumonia
C - obesity
D - sarcoidosis
___________________________________________________________________
Q45 Determination of thoracic gas volume in a body plethysmograph is based on the principle
that:
A - flow is proportional to the square of pressure
B - pressure and volume vary inversely
C - gas volumes expand as temperature increases
D - volume varies directly with flow
___________________________________________________________________
Q46 RV on the diagram below is represented by which number?
A - 3
B - 5
C - 7
D - 9
Q47 The results of a patient's lung volume study are below:
CRFS Examination Study Guide page 27
Predicted
VC (L)
FRC (L)
IC (L)
ERV (L)
RV (L)
TLC (L)
RV/TLC (%)
3.00
2.55
1.82
1.18
1.37
4.37
31
Observed
3.27
2.00
2.42
0.85
1.15
5.43
21
Which of the observed results should be recalculated?
A - TLC only
B - TLC and RV/TLC
C - RV, TLC AND RV/TLC
D - none
___________________________________________________________________
Q48 When setting up gas and water absorbers for single breath TLCO using CO and He
analysers, which of the following is the correct order of the absorbers?
A - silica gel, soda lime
B - soda lime, silica gel
C - CaSO4 (drierite), soda lime
D - silica gel, CaSO4 (drierite)
___________________________________________________________________
Q49 The best test to verify the presence of airway narrowing in a patient who seems to be uncooperative and perhaps a malingerer is which of the following:
A - SGaw
B - FEV1/FVC
C - FIF50/FEF50
D - Cdyn
___________________________________________________________________
Q50 Failure to accurately calibrate a wire mesh pneumotachograph, which consistently
underestimates flow, may be caused by which of the following?
A
B
C
D
-
the flow source provides too high a flow
there is moisture accumulation in the mesh
the pneumotachograph has a hole in the mesh
turbulent flow has developed on the upstream side
CRFS Examination Study Guide page 28
Q51 When airway resistance is determined by using a body plethysmograph, the patient should
be instructed to:
A - perform a forced expiratory manoeuvre
B - pant with an open glottis
C - exhale passively from end tidal inspiration
D - exhale passively from TLC
___________________________________________________________________
Q52 A patient is noted to have a reduced FEF25-75% and FEV1. The FVC and Raw are normal.
Which of the following best explains these findings?
A - the site of dysfunction is in the peripheral airways
B - a fixed upper airway obstruction is present
C - there is decreased chest wall compliance
D - there was submaximal effort during the Raw measurement
___________________________________________________________________
Q53 A patient breathing 100% O2 (ie FiO2 = 1.00) is cyanotic and has a PaO2 of 50 mmHg.
The best explanation for these findings is:
A - increased COHb
B - diffusion limitation
C - ventilation/perfusion mismatch
D - a shunt
___________________________________________________________________
Q54 Increased ventilation during a He dilution test can be caused by all of the following
EXCEPT:
A - patient anxiety
B - an exhausted CO2 absorber
C - a leak in the circuit
D - no replenishment of O2 consumed during the test
___________________________________________________________________
Q55 Which blood gas parameter will ALWAYS be abnormally low in a patient with a Hb of
8.0 g/dl?
A
B
C
D
-
O2 content
CO2 partial pressure
O2 partial pressure
O2 saturation
CRFS Examination Study Guide page 29
Q56 When performing whole body plethysmography to measure thoracic gas volume, patients
are instructed to brace their jaws and cheeks with the hands for which of the following
reasons?
A - to stabilise the mouthpiece and minimise motion artefact
B - to help ensure a good seal around the mouthpiece and prevent pressure leaks
C - to help stabilise the tongue and prevent it from blocking the mouth piece opening
D - to prevent any volume changes inside the mouth
___________________________________________________________________
Q57 The spirogram below was obtained from a 35 year old male who smokes two packs of
cigarettes a day and frequently experiences a morning cough. Which of the following can
be concluded from the graph:
A
B
C
D
-
The FEV1/FVC ratio is within the normal range
the curve represents obstructive lung disease
a combined obstructive and restrictive defect is present
an advanced stage of restrictive defect is present
CRFS Examination Study Guide page 30
Q58 A 35 year old, 183 cm male complaining of shortness of breath with exercise has the
following spirometry data:
VC
FVC
FEV1
FEF25-75%
4.6 L
3.6 L
2.1 L
2.5 L/sec
Which of the following tests would be indicated as the next step in evaluation of the
patient's problem?
A - measure RV/TLC ratio
B - exercise induced asthma study
C - bronchodilator response
D - single breath DLCO
___________________________________________________________________
Q59 Correct conclusions about a 180cm, 40 years old male subject who has an FEV1/FVC ratio
of 65% include which of the following?
1
2
3
4
-
his FEV1/FVC ratio is below normal
he has obstructive lung disease
he has restrictive lung disease
he has diffusion impairment
A - 1 only
B - 3 only
C - 1, 2 and 4
D - 1 and 2
___________________________________________________________________
Q60 A patient has an FEV1 of 1.91 litres (52% of the predicted value). Which of the following
might result in this low value:
1
2
3
4
A
B
C
D
-
-
small airways obstruction
hesitation at the start of test
restriction due to fibrosis
an FVC greater than predicted
1, 2, 3 and 4
1, 3 and 4
1, 2 and 3
2 and 4
CRFS Examination Study Guide page 31
Q61 Carbon monoxide is used to measure transfer factor instead of oxygen because:
A - it does not react with haemoglobin
B - it diffuses more slowly than O2
C - there is little or no CO dissolved in pulmonary capillary blood
D - all of the above
___________________________________________________________________
Q62 DLCO may be decreased in emphysema due to:
1
2
3
4
-
increased distance from terminal bronchiole to alveolar-capillary membrane
decreased surface area
loss of pulmonary capillary bed
ventilation/perfusion abnormalities
A - 1, 2, 3 and 4
B - 2, 3 and 4
C - 2 and 4
D - 3 only
___________________________________________________________________
Q63 A shift in the oxygen-haemoglobin dissociation curve to the right:
A - occurs in the pulmonary capillaries
B - is prevented by a rise in blood H+ ion concentration
C - favours the passage of O2 to the tissues
D - increases the affinity of tissue cells for O2
___________________________________________________________________
Q64 According to the American Thoracic Society's recommendations, spirometer quality
controls include which of the following:
1
2
3
4
A
B
C
D
-
-
daily checks for leaks
daily check of FVC and FEV1 of at least one known subject
daily check of volume accuracy with a 3 litre syringe
quarterly calibration checks across the spirometer's range
1, 2, 3 and 4
1, 3 and 4
2 and 3
1 and 4
CRFS Examination Study Guide page 32
Q65 Which of the following may be used to perform quality control on a constant-volume,
variable-pressure body plethysmograph for measuring TGV:
1
2
3
4
-
comparison with gas dilution lung volume determinations
a 3 litre syringe with occlusion valve
an isothermal lung analog
a known subject who has been tested at least 10 times when the
plethysmograph was known to be functioning accurately
A - 1, 2, 3 and 4
B - 1, 2 and 3
C - 1, 3 and 4
D - 2 and 4
___________________________________________________________________
Q66 The residual volume of the lungs:
A - is the volume of air that remains in the lungs after expiring the resting tidal volume
of air
B - is generally greater at age 75 than at age 45
C - is less than 1 litre in the adult
D - increases in atelectasis
___________________________________________________________________
Q67 Which of the following formulas is correct?
A - vital capacity = inspiratory reserve volume + expiratory reserve volume
B - alveolar minute ventilation = (respiratory rate) x (tidal volume - anatomical dead
space)
C - vital capacity = inspiratory reserve volume + tidal volume
D - inspiratory reserve volume = vital capacity - resting tidal volume
___________________________________________________________________
Q68 The alveolar pressure is:
A
B
C
D
-
lower than the intrapleural pressure during inspiration
lower than the intrapleural pressure during expiration
higher than the intrapleural pressure during inspiration and expiration
lower than the intrapleural pressure during expiration
CRFS Examination Study Guide page 33
Q69 In emphysema there is an increased tendency for the bronchioles to collapse during a
forced expiration. This is due to:
A - a decrease in the elastic recoil of the lungs
B - a loss of collagenous tissue from the lungs
C - a failure of bronchiolar chondroblasts
D - excessive tone in the bronchiolar smooth muscle
___________________________________________________________________
Q70 What happens when the ventilation/perfusion ratio of a lung unit decreases? The alveoli in
that unit develop:
A - a higher PO2
B - lower PCO2
C - higher PO2 and lower PCO2
D - higher PCO2
___________________________________________________________________
Q71 A baffle is used on a nebuliser to:
A - break the aerosol into smaller particles
B - entrain room air
C - alter oxygen concentration
D - heat the gas above room temperature
___________________________________________________________________
Q72 Pulmonary surfactant:
A - facilitates O2 diffusion through alveolar membranes
B - facilitates CO2 diffusion through alveolar membranes
C - increases surface tension of the alveolar membrane
D - decreases the likelihood of alveolar collapse during expiration
___________________________________________________________________
Q73 The inspiratory flow-volume curve is particularly valuable for:
A
B
C
D
-
measuring the response to bronchodilator drugs
differentiating between chronic bronchitis and emphysema
detecting extra-thoracic airway obstruction
cleaning mucus from the airways
CRFS Examination Study Guide page 34
Q74 The respiratory pattern expected in a patient with grossly decreased lung compliance
would be:
A - slow and shallow
B - rapid and shallow
C - slow and deep
D - rapid and deep
___________________________________________________________________
Q75 At which lung volume is the pressure-volume curve nearly linear?
A - at RV
B - at TLC
C - at over the entire range of vital capacity
D - in the range of tidal volume
___________________________________________________________________
Q76 In a normal patient, if tidal volume is 0.5L, rate is 15/min and the dead space to tidal
volume ratio (VD/VT) is 0.30, what is the alveolar ventilation?
A - 2.25 L/min
B - 4.50 L/min
C - 5.25 L/min
D - 7.50 L/min
___________________________________________________________________
Q77 Which of the following is a pathological change common to asthma?
A - destruction of alveolar septa
B - destruction of pulmonary capillaries
C - epithelial desquamation
D - dilation of bronchial smooth muscle
___________________________________________________________________
Q78 What is the respiratory exchange ratio of a patient with the following values?
O2 uptake of 300 ml/min
Minute volume of 5.00 L/min (STPD)
Expired CO2 concentration of 5.00%
A
B
C
D
-
0.60
0.75
0.83
1.20
CRFS Examination Study Guide page 35
Q79 Regarding a single breath DLCO measurement, the initial alveolar PCO is calculated from:
A - mixed venous PCO2
B - inspiratory vital capacity
C - dilution of an inert trace gas
D - pulmonary capillary blood volume
___________________________________________________________________
Q80 The difference between intrapleural pressure and alveolar pressure is equivalent to which
of the following:
A - pleural pressure
B - transmural pressure
C - intrathoracic pressure
D - transpulmonary pressure
___________________________________________________________________
Q81 A square wave signal is applied to a strip chart recorder and the tracing shown below is
obtained. What does the tracing indicate?
A - overshoot
B - undershoot
C - damping
D - sine wave generation
___________________________________________________________________
Q82 Which of the following devices has the highest frequency response?
A
B
C
D
-
wedge spirometer
turbine peak flowmeter
water-seal spirometer
differential pressure pneumotachograph
CRFS Examination Study Guide page 36
Q83 Pulmonary function tests is an obese patient will commonly show:
A - a reduced ERV
B - a reduced FEF25-75%
C - an increased FRC
D - an increased IRV
___________________________________________________________________
Q84 Which of the following are used to calculate Raw with a body plethysmograph?
A - pleural pressure and flow at the mouth
B - mouth pressure, box pressure and flow at the mouth
C - pleural pressure and box volume
D - mouth pressure, box pressure and box volume
___________________________________________________________________
Q85 Under conditions of zero flow with the airway occluded, mouth pressure is approximately
equal to:
A - alveolar pressure
B - barometric pressure
C - oesophageal pressure
D - intrapleural pressure
___________________________________________________________________
Q86 In a normal adult, PEF is PRIMARILY dependent upon:
A - patient effort
B - lung compliance
C - patient position
D - chest wall compliance
___________________________________________________________________
Q87 Which of the following studies would produce the most accurate determination of TLC in
a patient with severe emphysema?
A
B
C
D
-
whole body plethysmography
helium dilution
nitrogen washout
single breath oxygen
CRFS Examination Study Guide page 37
Q88 During inspiration, the box pressure of a constant volume body plethysmograph:
A - decreases
B - increases
C - remains constant
D - varies in proportion to the patient's weight
___________________________________________________________________
Q89 A variable pressure (constant volume) body plethysmograph is calibrated for volume by:
A - direct measurement with a wedge spirometer
B - opening shutters and noting the pressure drop
C - noting the pressure change when a known volume of air is displaced
D - a pneumotachograph with flow integration to calculate pressure
___________________________________________________________________
Q90 A response in which the output is a straight line function of the input is descriptive of:
A - linearity
B - maximum gain
C - frequency response
D - hysteresis
___________________________________________________________________
Q91 A patient's vital capacity measured by a rolling dry seal spirometer at ambient temperature
(24°C) pressure saturated (ATPS) is 3.00L. When adjusted to BTPS conditions, the
corrected vital capacity is approximately:
A - 2.70 L
B - 2.85 L
C - 3.25 L
D - 3.45 L
___________________________________________________________________
Q92 In order to measure flow using a pneumotachograph system which of the following
electromechanical devices must also be used?
A
B
C
D
-
pressure gauge
spirometer
differential pressure transducer
rotameter
CRFS Examination Study Guide page 38
Q93 Why should you wait 10 to 15 minutes after a helium dilution FRC measurement before
repeating it on a patient with emphysema?
A - the patient must return to normal O2 consumption
B - a buildup of He in the lungs could be toxic
C - all the He must be cleared from the patient's lungs
D
all He must be cleared from the spirometer and the meter recalibrated
___________________________________________________________________
Q94 Dynamic collapse of airways occurs:
A - during vigorous inspiration
B - mostly in the respiratory bronchioles where walls are thin
C - in major bronchi during violent expiration because these airways have lower internal
pressure than do smaller airways further upstream (nearer the alveoli)
D - only in unusual disease conditions
___________________________________________________________________
Q95 Which of the following symptoms is NOT common in asthma:
A - early morning breathlessness
B - persistent cough
C - an increased sensitivity to inhaled histamine
D - pleuritic chest pain
___________________________________________________________________
Q96 Inhaled ipratropium bromide:
A - is synergistic with salbutamol in the treatment of asthma
B - is tasteless
C - stimulates the bronchial cholinergic receptors
D - reaches peak effect slower than salbutamol
___________________________________________________________________
Q97 Which of the following is a common side effect of steroid metered dose aerosol inhalers:
A
B
C
D
-
cataracts
adrenal suppression
osteoporosis
candidiasis
CRFS Examination Study Guide page 39
Q98 All of the following statements about maximal expiratory airflow are true EXCEPT:
A - it is affected by lung volume
B - it is affected by lung elastic recoil
C - it is effort-independent at high lung volumes
D - it is reduced at high lung volumes in severe asthma
___________________________________________________________________
Questions 99 and 100 refer to the flow-volume loop below, which was recorded at ATPS (26oC).
Q99 Which of the following values should be reported for PEF?
A - 4.7 L/sec
B - 8.8 L/sec
C - 9.4 L/sec
D - 10.0 L/sec
___________________________________________________________________
Q100
Which of the following should be reported for FVC?
A
B
C
D
-
3.36 L
3.60 L
3.84 L
4.80 L
END OF EXAMINATION QUESTIONS
CRFS Examination Study Guide page 40
ANSWER KEY TO SELF-ASSESSMENT EXAMINATION
The answers to questions on the previous 100 question self-assessment examination are indicated
below.
Question
Answer
Question
Answer
Question
Answer
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
B
B
B
B
C
B
D
B
A
B
A
B
C
B
A
D
C
C
D
D
C
B
D
B
C
C
B
B
D
A
C
B
D
34
35
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A
D
D
B
C
C
A
B
B
D
A
B
C
B
B
A
C
B
A
D
C
A
D
A
C
D
C
C
A
C
B
C
B
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B
C
A
D
A
D
C
B
D
C
C
C
C
D
A
D
A
B
A
A
A
B
C
A
C
C
C
C
D
D
D
C
D
C
CRFS Examination Study Guide page 41
CERTIFICATION EXAMINATION ANSWER SHEET
Name:_____________________________________________________________
(Please use block letters)
Examination Location:_________________________________________________
Date:_________________________________________________
IMPORTANT:
O USE PENCIL O MAKE DARK MARKS O EXAMPLE: ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
O ERASE COMPLETELY TO CHANGE
1 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
2 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
3 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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8 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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10 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
11 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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24 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
25 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
26 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
27 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
28 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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30 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
31 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
32 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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34 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
35 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
36 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
37 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
38 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
39 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
40 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
41 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
42 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
43 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
44 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
45 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
46 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
47 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
48 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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50 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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52 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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55 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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80 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
81 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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85 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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88 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
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99 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
100 ⁄A♣ ⁄B♣ ⁄C♣ ⁄D♣
CRFS Examination Study Guide page 42
CANDIDATE COMMENT FORM
If you believe any examination question is incorrect or flawed, describe your concern in the
large boxes.
Please indicate the question number and state clearly your comments, using a separate box
for each question.
Your comments will be reviewed but individual replies will not be made.
__________
Question #
_________
Question #
__________
Question #
__________
Question #
__________
Question #
__________
Question #
__________
Question #
__________
Question #
CRFS Examination Study Guide page 43
AUSTRALIAN & NEW ZEALAND SOCIETY OF RESPIRATORY SCIENCE
CERTIFIED RESPIRATORY FUNCTION SCIENTIST APPLICATION
FORM
APPLICANTS DETAILS: (Use block letters)
Surname:_______________ First Name:_____________ Middle Name:_______________
Mailing Address:_____________________________________________________________
Email Address: ______________________________________________________________
EMPLOYMENT DETAILS: (Use block letters)
Name of laboratory where employed:___________________________________________
Address of laboratory:_______________________________________________________
___________________________________________________________________________
Telephone number of laboratory:______________________________________________
Physician in charge: _________________________________________________________
All applicants must be financial members of the Australian and New Zealand Society of
Respiratory Science Inc. In addition all applicants must satisfy one of the following
admission requirements:
1. Hold an appropriate tertiary degree and complete a minimum of one year of clinical
experience in the field of respiratory science, to be interpreted as a minimum of 35
hours per week employed in a respiratory function laboratory.
2. Complete five years of clinical experience in the field of respiratory science, to be
interpreted as a minimum of 20 hours per week employed in a respiratory function
laboratory.
PLEASE CIRCLE BELOW, THE REQUIREMENT UNDER WHICH YOU ARE
REQUESTING ADMISSION TO THE EXAMINATION.
1.
2.
Note: Applicants requesting admission by requirement 1 must attach a
photocopied transcript of all courses or subjects taken.
CRFS Examination Study Guide page 44
EXAMINATION LOCATIONS:
Please circle the city where you wish to attend the examination:
WELLINGTON N.Z.
SYDNEY N.S.W.
CHRISTCHURCH N.Z. MELBOURNE VIC.
ADELAIDE S.A.
PERTH W.A.
PERTH W.A.
BRISBANE QLD.
HOBART TAS.
___________________________________________________________________
YEAR 2006 EXAMINATION SCHEDULE:
Examination Fees*
Examination Date
Application Deadline
New Applicant
Re-applicant
12 May 2006
14 April 2006
Aus or NZ$50
NIL
21 July 2006
23 June 2006
Aus or NZ$50
NIL
24 November 2006
27 October 2006
Aus or NZ$50
NIL
*Candidates based in Australia pay in Aus$. Candidates based in New Zealand pay in NZ$.
Note: This application form must be accompanied by the correct fee. Cheques should be
made payable to: ANZSRS CRFS.
Applications from Australian members (AUS$) should be returned to:
Stephen West
Respiratory Function
Level 2, CD Wing
Westmead Hospital
Westmead NSW 2145
AUSTRALIA
Applications from New Zealand members (NZ$) should be returned to:
Maureen Swanney
Respiratory Physiology Laboratory
Christchurch Hospital
Christchurch
NEW ZEALAND
CRFS Examination Study Guide page 45