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Pulmonology

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Answer 50 questions in 15 minutes.
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1. Spirometry plots
Elasticity of the lung - reflects a measure of the ease of its distension - or the volume change resulting from the application of a pressure differential
The total amount of air in the lungs at the end of a maximal inhalation
A tracing of the lung volume against time in seconds
Perfusion

2. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
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 good effort
Diffusion
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

3. PACO2
Expiration
Dyspnea that awakens the patient several hours after going to sleep
Ventilation
Partial pressure of carbon dioxide in the alveoli

4. At rest - the use of accessory muscles is a sign of...
Significant pulmonary impairment
PaCO2
Decreased Hb-O2 affinity
right and left mainstem bronchi

5. normal adult tidal volume
500 to 800 mL
Immediate oxygenation with or without intubation
Narrowed nearly to the point of closure
Acinus

6. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
2 - each wavelength is partially absorbed by hemoglobin
Increased Hb-O2 affinity
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Mediastinum

7. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Increase the intrathoracic space
Soft - high-pitched and crisp
Partial pressure of CO2 in the arterial blood
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

8. Nitroglycerin applied to the probe area has been reported to...
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Overcome some of the problems associated with low blood flow to the probe site
Increased amounts of unsaturated hemoglobin in capillary blood
Significant pulmonary impairment

9. movement of blood through the capillaries in direct communication with the alveoli
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
right and left mainstem bronchi
Perfusion
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

10. Respiration involves
'scooped out' or bowl-shaped
Postero-anterior (PA) and lateral view series
Ventilation - Diffusion - Perfusion
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

11. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
Outer surface of each lung
Dullness replaces resonance
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
A sensor placed over a translucent area of arterial pulsation

12. An efficient approach to examination of the patient begins with
Observing the pattern of breathing
Right
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
The rib above it

13. The spirometry printout usually includes

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14. Rhonchi frequently clear after
Partial pressure of carbon dioxide in the alveoli
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Cough
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide

15. Continuous lung sounds
Wheezes - high-pitched - musical sounds - distinct whistling quality
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
A good effort

16. Obstructive Disease: Expiratory airflow is reduced more than
A reduction in lung capacity - secondary to scarring or extraneous material
The right middle lobe
Expiratory volume - and there is a prolonged expiratory time
Fraction (%age) of inspired oxygen

17. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
The gas in the conducting airways does not participate in alveolar exchange
Inspiration
Hypoventilation or modest changes in the PaO2
Partial pressure of CO2 in the arterial blood

18. forced expiratory volume in one second (FEV1)
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
Perfusion
Contracts
Either inspiration or expiration

19. Restrictive disease refers to...
Pulse oximetry
Diffusion
A reduction in lung capacity - secondary to scarring or extraneous material
10 to 11 cm long and about 2 cm in diameter

20. Examples of restrictive disease
Immediate oxygenation with or without intubation
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

21. inspiratory reserve
The amount of air that can be inhaled after normal inspiration
Binding of O2 to Hb
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
quickly - usually reaching a plateau within 6.0 seconds

22. Bohr Effect of pH: right shift
T4 or T5 - and just below the manubrio-sternal joint
Upper respiratory obstruction - usually in the trachea or larynx
70% occlusion of the airway
Decreased Hb-O2 affinity

23. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
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
Oxygen (O2)
Increased work of breathing
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

24. Pulse Oximetry is dependent on...
Lowered carbon dioxide level - results from hyperventilation
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Partial pressure of carbon dioxide in the alveoli
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

25. FEV1% in restrictive disease
Brief - discrete - non-musical sounds with a popping quality
Total lung capacity (TLC)
Normal to increased FEV1%
To assess response to treatment

26. most important factor that influences the oxygen carrying capacity of hemoglobin
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Partial pressure of carbon dioxide in the alveoli
The amount of air that can be exhaled after expiration
Partial pressure of oxygen (PO2)

27. Oximetry readings of < 94%
'adventitious' breath sounds
require supplemental oxygenation and possibly ABG analysis
Cough
No respiration for > 20 seconds

28. Patients with restrictive disease have low
Ventilation - Diffusion - Perfusion
Perfusion
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

29. Coarse crackles result from
80 to 120% of predicted value
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Air bubbles flowing through secretions or slightly closed airways during respiration
Spirometry

30. high CO2 = high acidity =
Oxygen (O2)
Increase the intrathoracic space
release of O2 from Hb
A tracing of the lung volume against time in seconds

31. Carbon dioxide moves from the...
Blood to the alveoli
Elasticity of the lung - reflects a measure of the ease of its distension - or the volume change resulting from the application of a pressure differential
The total amount of air that can be exhaled following a maximal inhalation
Left upper lobe

32. Normal lung sounds
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
No respiration for > 20 seconds
Interstitial diseases or early pulmonary edema
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

33. pH
Significant pulmonary impairment
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Partial pressure of oxygen in the alveoli
The negative logarithm of hydrogen ions in the blood

34. PaCO2
Partial pressure of oxygen in the alveoli
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
The total amount of air in the lungs at the end of a maximal inhalation
Partial pressure of CO2 in the arterial blood

35. Which lung has a horizontal fissure?
right
'adventitious' breath sounds
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
A reduction in lung capacity - secondary to scarring or extraneous material

36. increased volume results in
Ventilation - Diffusion - Perfusion
Spirometry
T4 or T5 - and just below the manubrio-sternal joint
Decreased pressure

37. The purpose of respiration is to...
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Partial pressure of oxygen in the alveoli
Ventilation
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide

38. The normal FEV1 /FVC ratio is...
70%
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
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Dyspnea upon assuming a recumbent position

39. What is the potential space between the visceral and parietal pleurae?
Larger airways
Pleural space
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
PaCO2

40. Inspiratory stridor becomes evident at about
70% occlusion of the airway
Manubrio-sternal junction (angle of Louis)
The amount of air that can be inhaled after normal inspiration
Increased work of breathing

41. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Partial pressure of CO2 in the arterial blood
Either continuous or discontinuous
Spirometry
Cough

42. During inspiration the diaphragm
Inspiration
Contracts
70%
The total amount of air in the lungs at the end of a maximal inhalation

43. Pulmonary ventilation is varied by
Mouth as well as through the chest wall
5 years - to detect obstruction and determine its reversibility
Partial pressure of oxygen in the alveoli
Altering the respiratory rate and/or the tidal volume

44. Which bronchus is more susceptible to aspiration of foreign bodies?
No respiration for > 20 seconds
right and left mainstem bronchi
Right
The total amount of air in the lungs at the end of a maximal inhalation

45. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Either inspiration or expiration
Cough
Spirometry
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

46. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Partial pressure of carbon dioxide in the alveoli
Obstructive lung disease from restrictive lung disease
Immediate oxygenation with or without intubation
PaCO2

47. PaO2
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
respiration
Partial pressure of O2 in the arterial blood
80 to 120% of predicted value

48. The acini consist of the...
The amount of air that can be exhaled after expiration
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

49. Apnea is defined as
Air-filled - fluid-filled - or solid
The amount of air that can be exhaled after expiration
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
No respiration for > 20 seconds

50. Fine crackles are...
Soft - high-pitched and crisp
Carboxyhemoglobin
Tongue
Oxygen-Hemoglobin Dissociation Curve

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Pulmonology

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