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Pulmonology

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. The internal intercostals decrease the transverse diameter of the chest during
Significant pulmonary impairment
Air to move from the upper airway to the farthest alveolar reaches
Expiration
Pleural space

2. Coarse crackles are...
respiration
Increased Hb-O2 affinity
Louder - lower-pitched - and slightly longer in duration
Bicarbonate

3. The external intercostal muscles increase the antero-posterior chest diameter during
Partial pressure of oxygen in the alveoli
There is an inverse relationship between pressure and volume
Inspiration
release of O2 from Hb - as heat is a by-product of metabolism.

4. The primary muscles of respiration are the...
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Diaphragm and the intercostal muscles
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Significant pulmonary impairment

5. PAO2
Partial pressure of oxygen in the alveoli
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Total lung capacity (TLC)
Excessive secretions and abnormal airway collapsibility

6. Cyanosis
Inspiration
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Blue or bluish-gray discoloration of the skin or mucous membranes
Immediate oxygenation with or without intubation

7. Rhonchi occur during
right & left
Blue or bluish-gray discoloration of the skin or mucous membranes
Immediate oxygenation with or without intubation
Either inspiration or expiration

8. HCO3
Excessive secretions and abnormal airway collapsibility
Bicarbonate
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

9. 78.08% Atmospheric Composition
results in a lower than normal FEV1%
Nitrogen
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

10. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
A sensor placed over a translucent area of arterial pulsation
right and left mainstem bronchi
2 - each wavelength is partially absorbed by hemoglobin
Expiration

11. The purpose of respiration is to...
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
10 to 11 cm long and about 2 cm in diameter
50%
right & left

12. Apnea is defined as
Expiration
Pleural space
No respiration for > 20 seconds
Total lung capacity (TLC)

13. Pulse Oximetry does not detect
The amount of air that can be exhaled after expiration
Binding of O2 to Hb
Upper respiratory obstruction - usually in the trachea or larynx
Hypoventilation or modest changes in the PaO2

14. Rhonchi originate in the...
50%
Perfusion
Larger airways
Lung volumes - but no difficulty or delay in exhaling what volume they do have

15. The trachea bifurcates into its mainstem bronchi at the level of...
Bronchospasm - mucosal edema - or excessive secretions
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Spirometry
80 to 120% of predicted value

16. The vital capacity and the residual volume together constitute the...
10 to 11 cm long and about 2 cm in diameter
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
The volume of air left in the lungs after maximal expiration that cannot be exhaled due to the limit of elasticity - or because of the trapping of air in disease states
Total lung capacity (TLC)

17. Bohr Effect of pH: left shift
Binding of O2 to Hb
Increased Hb-O2 affinity
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Soft - high-pitched and crisp

18. Late inspiratory crackles result from
Mouth as well as through the chest wall
A tracing of the lung volume against time in seconds
Soft - high-pitched and crisp
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

19. increased volume results in
The volume of air that is forcefully expired during the first second after a deep breath - or the portion of the FVC exhaled in one second
Decreased pressure
Spirometry
Obstructive lung disease from restrictive lung disease

20. Chest Radiography: The most common chest X-ray series is the...
Altering the respiratory rate and/or the tidal volume
Postero-anterior (PA) and lateral view series
T4 or T5 - and just below the manubrio-sternal joint
A reduction in lung capacity - secondary to scarring or extraneous material

21. Examples of restrictive disease
Bicarbonate
There is an inverse relationship between pressure and volume
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
No respiration for > 20 seconds

22. 20.95% Atmospheric Composition
A sensor placed over a translucent area of arterial pulsation
Carboxyhemoglobin
Oxygen (O2)
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

23. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
Left upper lobe
Lung volumes - but find it difficult to exhale rapidly
The atmospheric pressure
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

24. Nitroglycerin applied to the probe area has been reported to...
release of O2 from Hb
The volume of air left in the lungs after maximal expiration that cannot be exhaled due to the limit of elasticity - or because of the trapping of air in disease states
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Overcome some of the problems associated with low blood flow to the probe site

25. terminal respiratory unit
Acinus
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Expiration
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

26. The parietal pleura lines the...
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Outer surface of each lung
require supplemental oxygenation and possibly ABG analysis

27. dead space ventilation
Air-filled - fluid-filled - or solid
Heard over the periphery of the lung - are soft - low-pitched sounds - heard throughout inspiration - continue without pause through expiration - fade away about one third of the way through expiration
Increased rate of breathing and is commonly associated with a decrease in tidal volume
The gas in the conducting airways does not participate in alveolar exchange

28. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Blue or bluish-gray discoloration of the skin or mucous membranes
Either inspiration or expiration
Carboxyhemoglobin
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

29. The accessory muscles are the...
The right middle lobe
Sternocleidomastoid - Scalene Muscles
Expiration
Partial pressure of carbon dioxide in the alveoli

30. Patients with obstructive disease have normal
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Lung volumes - but find it difficult to exhale rapidly
80 to 120% of predicted value
Lung volumes - but no difficulty or delay in exhaling what volume they do have

31. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Speed of airflow - the higher the flow - the greater the resistance
The volume of air that is forcefully expired during the first second after a deep breath - or the portion of the FVC exhaled in one second
Manubrio-sternal junction (angle of Louis)
Partial pressure of oxygen (PO2)

32. With restrictive disease - the flow-volume curve is...
reduced in size - compared with a normal curve - due to lower lung volume
Insufficient oxygenation of hemoglobin in the lungs
Increased work of breathing
70%

33. office-based spirometry is recommended for patients as young as
Blue or bluish-gray discoloration of the skin or mucous membranes
500 to 800 mL
respiration
5 years - to detect obstruction and determine its reversibility

34. Fine crackles are heard in
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
results in a lower than normal FEV1%
Pneumonia - obstructive lung disease - and late pulmonary edema
Interstitial diseases or early pulmonary edema

35. Spirometry normal range
Inspiration
80 to 120% of predicted value
The amount of air that can be exhaled after expiration
No

36. Orthopnea is defined as
Dyspnea upon assuming a recumbent position
80 to 120% of predicted value
Functional residual capacity (FRC)
Difficulty breathing or shortness of breath

37. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
Partial pressure of CO2 in the arterial blood
Saturated with oxygen or unsaturated
Fraction (%age) of inspired oxygen
Manubrio-sternal junction (angle of Louis)

38. Continuous lung sounds occur in the setting of...
Interstitial diseases or early pulmonary edema
80%
Upper respiratory obstruction - usually in the trachea or larynx
Bronchospasm - mucosal edema - or excessive secretions

39. The trachea is how long/wide?
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
10 to 11 cm long and about 2 cm in diameter
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Tongue

40. Bohr Effect of pH is graphed as
Ventilation - Diffusion - Perfusion
Diffusion
Oxygen-Hemoglobin Dissociation Curve
respiration

41. Pulmonary ventilation is varied by
Sternocleidomastoid - Scalene Muscles
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Larger airways
Altering the respiratory rate and/or the tidal volume

42. Dyspnea is defined as
Acinus
Obstructive lung disease from restrictive lung disease
Difficulty breathing or shortness of breath
The atmospheric pressure

43. most important factor that influences the oxygen carrying capacity of hemoglobin
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Partial pressure of oxygen (PO2)
Portable antero-posterior (AP) view
Dullness replaces resonance

44. Vesicular breath sounds
Heard over the periphery of the lung - are soft - low-pitched sounds - heard throughout inspiration - continue without pause through expiration - fade away about one third of the way through expiration
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Lung volumes - but find it difficult to exhale rapidly
Saturated with oxygen or unsaturated

45. The acini consist of the...
35 to 45 mmHg
Wheezes - high-pitched - musical sounds - distinct whistling quality
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

46. expiratory reserve
'adventitious' breath sounds
The amount of air that can be exhaled after expiration
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
5 years - to detect obstruction and determine its reversibility

47. Continuous lung sounds occur when air flows rapidly through bronchi that are...
Narrowed nearly to the point of closure
Increased work of breathing
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

48. Examples of obstructive disease
Lowered carbon dioxide level - results from hyperventilation
Diaphragm and the intercostal muscles
Alveoli to the blood
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

49. The upper airway accounts For what % of airway resistance?
Pneumonia - obstructive lung disease - and late pulmonary edema
Difficulty breathing or shortness of breath
50%
Heard over the periphery of the lung - are soft - low-pitched sounds - heard throughout inspiration - continue without pause through expiration - fade away about one third of the way through expiration

50. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Obstructive lung disease from restrictive lung disease
There is an inverse relationship between pressure and volume
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Lung volumes - but find it difficult to exhale rapidly

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Pulmonology

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