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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. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Immediate oxygenation with or without intubation
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
Spirometry
'crackles' or 'rales'

2. Which lung has an oblique fissure?
The total amount of air in the lungs at the end of a maximal inhalation
right & left
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
Outer surface of each lung

3. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
Binding of O2 to Hb
Increased amounts of unsaturated hemoglobin in capillary blood
PaCO2
Perfusion

4. The active movement of gases between the ambient air and the lungs
release of O2 from Hb - as heat is a by-product of metabolism.
No
Ventilation
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)

5. Obstructive Disease: Expiratory airflow is reduced more than
right
'crackles' or 'rales'
Expiratory volume - and there is a prolonged expiratory time
Increase the intrathoracic space

6. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
Ventilation
Hypoventilation or modest changes in the PaO2
Increased work of breathing
2 - each wavelength is partially absorbed by hemoglobin

7. Pulmonary ventilation is varied by
Partial pressure of oxygen (PO2)
Altering the respiratory rate and/or the tidal volume
The atmospheric pressure
Diffusion

8. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
80%
Inspiration
Increased amounts of unsaturated hemoglobin in capillary blood
Upper respiratory obstruction - usually in the trachea or larynx

9. Rhonchi occur during
Increased amounts of unsaturated hemoglobin in capillary blood
70% occlusion of the airway
Either inspiration or expiration
Inspiration

10. normal subjects expel approximately how much of the FVC in the 1st second?
80%
Lowered carbon dioxide level - results from hyperventilation
Speed of airflow - the higher the flow - the greater the resistance
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

11. The primary muscles of respiration are the...
Mouth as well as through the chest wall
Increased work of breathing
Diaphragm and the intercostal muscles
To assess response to treatment

12. increased volume results in
The atmospheric pressure
Wheezes - high-pitched - musical sounds - distinct whistling quality
Decreased pressure
Lung volumes - but find it difficult to exhale rapidly

13. Central cyanosis results from
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Insufficient oxygenation of hemoglobin in the lungs
Diffusion
Increased Hb-O2 affinity

14. PaCO2
A good effort
Diffusion
Expiratory volume - and there is a prolonged expiratory time
Partial pressure of CO2 in the arterial blood

15. Coarse crackles are heard in
Cough
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Overcome some of the problems associated with low blood flow to the probe site
Pneumonia - obstructive lung disease - and late pulmonary edema

16. Abnormal lung sounds AKA

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17. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
A sensor placed over a translucent area of arterial pulsation
Increase the intrathoracic space
require supplemental oxygenation and possibly ABG analysis
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

18. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
Portable antero-posterior (AP) view
Diffusion
Larger airways
Increased Hb-O2 affinity

19. Examples of obstructive disease
Pneumonia - obstructive lung disease - and late pulmonary edema
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Increase the intrathoracic space

20. FEV1% in restrictive disease
Air bubbles flowing through secretions or slightly closed airways during respiration
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Normal to increased FEV1%

21. Examples of restrictive disease
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Mediastinum
require supplemental oxygenation and possibly ABG analysis

22. Vesicular breath sounds
Wheezes - high-pitched - musical sounds - distinct whistling quality
Larger airways
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
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

23. The vital capacity and the residual volume together constitute the...
Partial pressure of O2 in the arterial blood
Larger airways
Sternocleidomastoid - Scalene Muscles
Total lung capacity (TLC)

24. 78.08% Atmospheric Composition
The total amount of air in the lungs at the end of a maximal inhalation
Diaphragm - External Intercostals
Nitrogen
A sensor placed over a translucent area of arterial pulsation

25. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
The total amount of air in the lungs at the end of a maximal inhalation
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Upper respiratory obstruction - usually in the trachea or larynx

26. Airway resistance refers to...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
The atmospheric pressure
10 to 11 cm long and about 2 cm in diameter
Pressure required to drive air through the airways

27. Oximetry readings of < 94%
require supplemental oxygenation and possibly ABG analysis
right & left
Altering the respiratory rate and/or the tidal volume
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

28. pain in lung conditions usually arises from
A tracing of the lung volume against time in seconds
Inflammation of the adjacent parietal pleura
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
The rib above it

29. Spirometry plots
A good effort
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
A tracing of the lung volume against time in seconds
Increased minute volume ventilation - which results in a lowered carbon dioxide level

30. within limits - increased temperature =
release of O2 from Hb - as heat is a by-product of metabolism.
Overcome some of the problems associated with low blood flow to the probe site
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Perfusion

31. The muscles of expiration are the...
T4 or T5 - and just below the manubrio-sternal joint
Oxygen (O2)
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Obstructive lung disease from restrictive lung disease

32. During inspiration the diaphragm
Contracts
Bicarbonate
release of O2 from Hb - as heat is a by-product of metabolism.
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

33. The best indicator of adequate ventilation is the...
right & left
PaCO2
'adventitious' breath sounds
The gas in the conducting airways does not participate in alveolar exchange

34. vital capacity (VC)
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Decreased pressure
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
The total amount of air that can be exhaled following a maximal inhalation

35. The internal intercostals decrease the transverse diameter of the chest during
Contracts
Expiration
Manubrio-sternal junction (angle of Louis)
A reliable and consistent classification of auditory findings

36. Chest Radiography: The most common chest X-ray series is the...
Postero-anterior (PA) and lateral view series
Decreased pressure
Wheezes - high-pitched - musical sounds - distinct whistling quality
Diaphragm and the intercostal muscles

37. Which bronchus is more susceptible to aspiration of foreign bodies?
Right
Inflammation of the adjacent parietal pleura
2 - each wavelength is partially absorbed by hemoglobin
70%

38. Rhonchi are due to...
Excessive secretions and abnormal airway collapsibility
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Increased Hb-O2 affinity

39. Carbon dioxide moves from the...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Blood to the alveoli
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
The right middle lobe

40. Orthopnea is quantified by
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Perfusion
respiration
Air-filled - fluid-filled - or solid

41. Oxygen moves from the...
70% occlusion of the airway
Expiration
The gas in the conducting airways does not participate in alveolar exchange
Alveoli to the blood

42. forced vital capacity (FVC)
Diaphragm and the intercostal muscles
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Altering the respiratory rate and/or the tidal volume
Inflammation of the adjacent parietal pleura

43. the lingula is analogous to...
Either inspiration or expiration
The right middle lobe
Observing the pattern of breathing
Obstruction below the vocal cords (subglottic or tracheal obstruction)

44. The normal FEV1 /FVC ratio is...
Diffusion
Decreased pressure
Either continuous or discontinuous
70%

45. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
respiration
80 to 120% of predicted value
Air-filled - fluid-filled - or solid
Perfusion

46. A state-of-the-art - inexpensive - non-invasive - simple method to monitor a patient's percent hemoglobin saturation with oxygen (SaO2) - without having to obtain an arterial blood specimen
Blood to the alveoli
The amount of air that can be exhaled after expiration
Pulse oximetry
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

47. The external intercostal muscles increase the antero-posterior chest diameter during
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Inspiration
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Dyspnea upon assuming a recumbent position

48. Fine crackles are heard in
Excessive secretions and abnormal airway collapsibility
A reliable and consistent classification of auditory findings
Interstitial diseases or early pulmonary edema
Brief - discrete - non-musical sounds with a popping quality

49. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Partial pressure of oxygen (PO2)
Carboxyhemoglobin
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

50. FEV1/FVC
right
Tongue
A reduction in lung capacity - secondary to scarring or extraneous material
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)