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Pulmonology

Instructions:

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. Percussion helps you establish whether the underlying tissues are...
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Air-filled - fluid-filled - or solid
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Increase the intrathoracic space

2. The main bronchi are divided into smaller branches that begin to subdivide into
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
release of O2 from Hb

3. PaCO2
release of O2 from Hb - as heat is a by-product of metabolism.
Air bubbles flowing through secretions or slightly closed airways during respiration
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Partial pressure of CO2 in the arterial blood

4. Typically - in the presence of obstructive disease - the flow-volume curve looks

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5. inspiratory reserve
The amount of air that can be inhaled after normal inspiration
release of O2 from Hb
The right middle lobe
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

6. A normal volume-time curve rises
quickly - usually reaching a plateau within 6.0 seconds
reduced in size - compared with a normal curve - due to lower lung volume
Lung volumes - but find it difficult to exhale rapidly
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

7. PACO2
release of O2 from Hb
Brief - discrete - non-musical sounds with a popping quality
Either inspiration or expiration
Partial pressure of carbon dioxide in the alveoli

8. Fine crackles are heard in
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
Interstitial diseases or early pulmonary edema
While ascultating remote from the bronchi & larynx - the examiner can hear the speaking pts laryngeal (bronchial) sounds - while not being able to distinguish the words
Air to move from the upper airway to the farthest alveolar reaches

9. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
right and left mainstem bronchi
Increased work of breathing
Wheezes - high-pitched - musical sounds - distinct whistling quality
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

10. The normal FEV1 /FVC ratio is...
Saturated with oxygen or unsaturated
results in a lower than normal FEV1%
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
70%

11. pH
The negative logarithm of hydrogen ions in the blood
The atmospheric pressure
Oxygen (O2)
'scooped out' or bowl-shaped

12. Restrictive disease refers to...
Diffusion
Left upper lobe
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
A reduction in lung capacity - secondary to scarring or extraneous material

13. Compliance
A reduction in lung capacity - secondary to scarring or extraneous material
Oxygen-Hemoglobin Dissociation Curve
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
A reliable and consistent classification of auditory findings

14. Spirometry plots
results in a lower than normal FEV1%
A good effort
'crackles' or 'rales'
A tracing of the lung volume against time in seconds

15. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Increase the intrathoracic space
Inflammation of the adjacent parietal pleura
'adventitious' breath sounds
Air to move from the upper airway to the farthest alveolar reaches

16. Central cyanosis results from
Perfusion
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Insufficient oxygenation of hemoglobin in the lungs
A reduction in lung capacity - secondary to scarring or extraneous material

17. normal subjects expel approximately how much of the FVC in the 1st second?
80%
Mediastinum
500 to 800 mL
Insufficient oxygenation of hemoglobin in the lungs

18. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
Dullness replaces resonance
5 years - to detect obstruction and determine its reversibility
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Functional residual capacity (FRC)

19. Oxygen moves from the...
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Alveoli to the blood
Lung volumes - but find it difficult to exhale rapidly
10 to 11 cm long and about 2 cm in diameter

20. What may prevent cyanosis from appearing?
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Increased Hb-O2 affinity
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
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

21. The most reliable site for detecting central cyanosis is the...
Tongue
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
reduced in size - compared with a normal curve - due to lower lung volume
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

22. PAO2
Partial pressure of oxygen in the alveoli
Oxygen (O2)
right & left
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

23. Which lung has a horizontal fissure?
Cough
right
Portable antero-posterior (AP) view
The negative logarithm of hydrogen ions in the blood

24. Bohr Effect of pH: right shift
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Normal to increased FEV1%
Decreased Hb-O2 affinity
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

25. The acini consist of the...
50%
Fraction (%age) of inspired oxygen
Increase the intrathoracic space
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

26. Pulse Oximetry does not detect
Hypoventilation or modest changes in the PaO2
Pneumonia - obstructive lung disease - and late pulmonary edema
80%
Binding of O2 to Hb

27. residual volume
Diffusion
Perfusion
A reliable and consistent classification of auditory findings
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

28. Pulse Oximetry is dependent on...
Sternocleidomastoid - Scalene Muscles
Soft - high-pitched and crisp
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Increased minute volume ventilation - which results in a lowered carbon dioxide level

29. Obstructive Disease: Expiratory airflow is reduced more than
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Expiratory volume - and there is a prolonged expiratory time
Acinus
Immediate oxygenation with or without intubation

30. The trachea bifurcates into its mainstem bronchi at the level of...
right & left
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Lowered carbon dioxide level - results from hyperventilation
Right

31. 78.08% Atmospheric Composition
Nitrogen
Either inspiration or expiration
quickly - usually reaching a plateau within 6.0 seconds
Bronchospasm - mucosal edema - or excessive secretions

32. The primary muscles of respiration are the...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
A sensor placed over a translucent area of arterial pulsation
To assess response to treatment
Diaphragm and the intercostal muscles

33. Respiration involves
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
50%
release of O2 from Hb
Ventilation - Diffusion - Perfusion

34. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Cough
right and left mainstem bronchi
Saturated with oxygen or unsaturated

35. Normal lung sounds
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Pleural space
A sensor placed over a translucent area of arterial pulsation
'adventitious' breath sounds

36. Coarse crackles are heard in
35 to 45 mmHg
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Spirometry
Pneumonia - obstructive lung disease - and late pulmonary edema

37. The best indicator of adequate ventilation is the...
Air to move from the upper airway to the farthest alveolar reaches
PaCO2
Either inspiration or expiration
A tracing of the lung volume against time in seconds

38. Orthopnea is quantified by
Increase the intrathoracic space
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
'adventitious' breath sounds
The rib above it

39. The vital capacity and the residual volume together constitute the...
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Decreased Hb-O2 affinity
Total lung capacity (TLC)
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide

40. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
right & left
Inflammation of the adjacent parietal pleura
Portable antero-posterior (AP) view
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

41. Normal range of PaCO2
35 to 45 mmHg
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Right
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

42. The muscles of expiration are the...
2 - each wavelength is partially absorbed by hemoglobin
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
80%
Dyspnea that awakens the patient several hours after going to sleep

43. Rhonchi originate in the...
While ascultating remote from the bronchi & larynx - the examiner can hear the speaking pts laryngeal (bronchial) sounds - while not being able to distinguish the words
Larger airways
Partial pressure of oxygen (PO2)
Dullness replaces resonance

44. Bronchial breath sounds
Either inspiration or expiration
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Narrowed nearly to the point of closure
Interstitial diseases or early pulmonary edema

45. Bohr Effect of pH is graphed as
Nitrogen
Right
Manubrio-sternal junction (angle of Louis)
Oxygen-Hemoglobin Dissociation Curve

46. Coarse crackles are...
Increased amounts of unsaturated hemoglobin in capillary blood
Louder - lower-pitched - and slightly longer in duration
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Functional residual capacity (FRC)

47. Spirometry is useful in distinguishing
Carboxyhemoglobin
Manubrio-sternal junction (angle of Louis)
Obstructive lung disease from restrictive lung disease
'scooped out' or bowl-shaped

48. During inspiration the diaphragm
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Hypoventilation or modest changes in the PaO2
Contracts
Difficulty breathing or shortness of breath

49. Spirometry: The result is stated as
The total amount of air that can be exhaled following a maximal inhalation
Decreased Hb-O2 affinity
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Postero-anterior (PA) and lateral view series

50. Inspiratory stridor indicates
Total lung capacity (TLC)
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
35 to 45 mmHg