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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. Egophony

2. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
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
Inside of the thoracic cavity wall and the upper surface of the diaphragm
2 - each wavelength is partially absorbed by hemoglobin
Total lung capacity (TLC)

3. Rhonchi
Difficulty breathing or shortness of breath
The examiner can clearly distinguish the word that the pt speak or whispers
Significant pulmonary impairment
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

4. inspiratory reserve
Contracts
Difficulty breathing or shortness of breath
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
The amount of air that can be inhaled after normal inspiration

5. The active movement of gases between the ambient air and the lungs
Ventilation
Either continuous or discontinuous
'scooped out' or bowl-shaped
A reduction in lung capacity - secondary to scarring or extraneous material

6. The acini consist of the...
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Ventilation - Diffusion - Perfusion
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

7. dead space ventilation
The atmospheric pressure
Air to move from the upper airway to the farthest alveolar reaches
Nitrogen
The gas in the conducting airways does not participate in alveolar exchange

8. An efficient approach to examination of the patient begins with
Altering the respiratory rate and/or the tidal volume
Observing the pattern of breathing
Dyspnea that awakens the patient several hours after going to sleep
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

9. Which lung has an oblique fissure?
right & left
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Alveoli to the blood
Expiration

10. The trachea divides into
Hypoventilation or modest changes in the PaO2
right and left mainstem bronchi
A reliable and consistent classification of auditory findings
Blood to the alveoli

11. Pulse Oximetry does not detect
Hypoventilation or modest changes in the PaO2
A sensor placed over a translucent area of arterial pulsation
Blood to the alveoli
Brief - discrete - non-musical sounds with a popping quality

12. The parietal pleura lines the...
Lowered carbon dioxide level - results from hyperventilation
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Inside of the thoracic cavity wall and the upper surface of the diaphragm
The atmospheric pressure

13. What occurs passively as muscles relax?
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Expiration
Spirometry
A reduction in lung capacity - secondary to scarring or extraneous material

14. Normal range of PaCO2
Wheezes - high-pitched - musical sounds - distinct whistling quality
35 to 45 mmHg
'crackles' or 'rales'
Tongue

15. The visceral pleura lines the...
Soft - high-pitched and crisp
Outer surface of each lung
Hypoventilation or modest changes in the PaO2
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

16. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
The total amount of air that can be exhaled following a maximal inhalation
Bicarbonate
Portable antero-posterior (AP) view
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

17. PACO2
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Partial pressure of carbon dioxide in the alveoli
35 to 45 mmHg
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

18. The trachea divides into right and left mainstem bronchi At what level?
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Brief - discrete - non-musical sounds with a popping quality
Decreased Hb-O2 affinity
T4 or T5 - and just below the manubrio-sternal joint

19. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Oxygen (O2)
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Spirometry
Cough

20. At rest - the use of accessory muscles is a sign of...
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
quickly - usually reaching a plateau within 6.0 seconds
No
Significant pulmonary impairment

21. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Pulse oximetry
Functional residual capacity (FRC)
right and left mainstem bronchi
respiration

22. The tracheo-bronchial tree is a tubular system that provides a pathway for
Air to move from the upper airway to the farthest alveolar reaches
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Blood to the alveoli
Partial pressure of oxygen (PO2)

23. Respiration involves
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
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
The total amount of air in the lungs at the end of a maximal inhalation
Ventilation - Diffusion - Perfusion

24. high CO2 = high acidity =
release of O2 from Hb
require supplemental oxygenation and possibly ABG analysis
The right middle lobe
80 to 120% of predicted value

25. Bronchophony
Altering the respiratory rate and/or the tidal volume
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
Acinus
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval

26. The muscles of inspiration are the...
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Diaphragm - External Intercostals
Tongue
Fraction (%age) of inspired oxygen

27. Bronchiovesicular breath sounds
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Pulse oximetry
Either inspiration or expiration

28. The muscles of expiration are the...
A sensor placed over a translucent area of arterial pulsation
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Diffusion
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

29. Boyle's Gas Law
Increased minute volume ventilation - which results in a lowered carbon dioxide level
PaCO2
quickly - usually reaching a plateau within 6.0 seconds
There is an inverse relationship between pressure and volume

30. Rhonchi occur during
Blue or bluish-gray discoloration of the skin or mucous membranes
Partial pressure of O2 in the arterial blood
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Either inspiration or expiration

31. Carbon dioxide moves from the...
Blood to the alveoli
Speed of airflow - the higher the flow - the greater the resistance
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
2 - each wavelength is partially absorbed by hemoglobin

32. Coarse crackles are heard in
Pneumonia - obstructive lung disease - and late pulmonary edema
Soft - high-pitched and crisp
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Tongue

33. During inspiration the diaphragm
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Mediastinum
Perfusion
Contracts

34. FIO2
Expiration
The negative logarithm of hydrogen ions in the blood
70%
Fraction (%age) of inspired oxygen

35. The normal FEV1 /FVC ratio is...
70%
The gas in the conducting airways does not participate in alveolar exchange
Partial pressure of CO2 in the arterial blood
The rib above it

36. expiratory reserve
Postero-anterior (PA) and lateral view series
Inside of the thoracic cavity wall and the upper surface of the diaphragm
The amount of air that can be exhaled after expiration
Ventilation - Diffusion - Perfusion

37. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
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
Saturated with oxygen or unsaturated
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Inflammation of the adjacent parietal pleura

38. PaO2
Hypoventilation or modest changes in the PaO2
respiration
Partial pressure of O2 in the arterial blood
Obstructive lung disease from restrictive lung disease

39. Rhonchi are due to...
Expiratory volume - and there is a prolonged expiratory time
Excessive secretions and abnormal airway collapsibility
Dyspnea upon assuming a recumbent position
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

40. Examples of restrictive disease
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Upper respiratory obstruction - usually in the trachea or larynx
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
right

41. 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
Altering the respiratory rate and/or the tidal volume
A tracing of the lung volume against time in seconds
Pulse oximetry
To assess response to treatment

42. Spirometry plots
Left upper lobe
Obstruction below the vocal cords (subglottic or tracheal obstruction)
A tracing of the lung volume against time in seconds
'scooped out' or bowl-shaped

43. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
release of O2 from Hb
No respiration for > 20 seconds
70% occlusion of the airway
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

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

45. Which lobe has an inferior tongue-like projection called the lingula?
Insufficient oxygenation of hemoglobin in the lungs
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Left upper lobe
Perfusion

46. Spirometry normal range
The amount of air that can be inhaled after normal inspiration
80 to 120% of predicted value
Contracts
Ventilation - Diffusion - Perfusion

47. residual volume
35 to 45 mmHg
Either inspiration or expiration
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
Cough

48. Tachypnea is an
Blue or bluish-gray discoloration of the skin or mucous membranes
Increased Hb-O2 affinity
The amount of air that can be inhaled after normal inspiration
Increased rate of breathing and is commonly associated with a decrease in tidal volume

49. 20.95% Atmospheric Composition
Oxygen (O2)
PaCO2
release of O2 from Hb - as heat is a by-product of metabolism.
Partial pressure of CO2 in the arterial blood

50. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Immediate oxygenation with or without intubation
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
right & left
5 years - to detect obstruction and determine its reversibility