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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. Oximetry readings of < 94%
Inflammation of the adjacent parietal pleura
Diaphragm - External Intercostals
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
require supplemental oxygenation and possibly ABG analysis

2. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Right
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
Increase the intrathoracic space
Ventilation

3. Fine crackles are...
Soft - high-pitched and crisp
Lung volumes - but find it difficult to exhale rapidly
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Expiratory volume - and there is a prolonged expiratory time

4. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
Cough
Saturated with oxygen or unsaturated
'crackles' or 'rales'
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

5. Examples of obstructive disease
Brief - discrete - non-musical sounds with a popping quality
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
The rib above it

6. Percussion helps you establish whether the underlying tissues are...
Air-filled - fluid-filled - or solid
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Decreased pressure
Partial pressure of carbon dioxide in the alveoli

7. Continuous lung sounds occur during...
The amount of air that can be inhaled after normal inspiration
Lowered carbon dioxide level - results from hyperventilation
Either inspiration or expiration
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval

8. Rhonchi occur during
A tracing of the lung volume against time in seconds
Blue or bluish-gray discoloration of the skin or mucous membranes
A reduction in lung capacity - secondary to scarring or extraneous material
Either inspiration or expiration

9. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Hypoventilation or modest changes in the PaO2
Increase the intrathoracic space
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Obstruction below the vocal cords (subglottic or tracheal obstruction)

10. Apnea is defined as
right
Larger airways
Tongue
No respiration for > 20 seconds

11. most important factor that influences the oxygen carrying capacity of hemoglobin
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Outer surface of each lung
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
Partial pressure of oxygen (PO2)

12. The spirometry printout usually includes

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13. Cyanosis
Bicarbonate
There is an inverse relationship between pressure and volume
Altering the respiratory rate and/or the tidal volume
Blue or bluish-gray discoloration of the skin or mucous membranes

14. Patients with obstructive disease have normal
Blood to the alveoli
Inspiration
Lung volumes - but find it difficult to exhale rapidly
'adventitious' breath sounds

15. Rhonchi originate in the...
quickly - usually reaching a plateau within 6.0 seconds
Excessive secretions and abnormal airway collapsibility
A tracing of the lung volume against time in seconds
Larger airways

16. What is the potential space between the visceral and parietal pleurae?
Pleural space
Hypoventilation or modest changes in the PaO2
Interstitial diseases or early pulmonary edema
10 to 11 cm long and about 2 cm in diameter

17. The accessory muscles are the...
Spirometry
Contracts
Sternocleidomastoid - Scalene Muscles
Difficulty breathing or shortness of breath

18. Bohr Effect of pH: left shift
Pressure required to drive air through the airways
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Diffusion
Increased Hb-O2 affinity

19. FEV1% in obstructive disease
Acinus
results in a lower than normal FEV1%
Observing the pattern of breathing
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

20. Egophony

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21. Which bronchus is more susceptible to aspiration of foreign bodies?
Functional residual capacity (FRC)
Right
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Ventilation

22. high CO2 = high acidity =
Decreased pressure
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Partial pressure of oxygen (PO2)
release of O2 from Hb

23. Pulse Oximetry does not detect
right and left mainstem bronchi
Hypoventilation or modest changes in the PaO2
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Acinus

24. normal subjects expel approximately how much of the FVC in the 1st second?
To assess response to treatment
80%
Postero-anterior (PA) and lateral view series
Diaphragm and the intercostal muscles

25. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
The amount of air that can be inhaled after normal inspiration
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Lowered carbon dioxide level - results from hyperventilation
Portable antero-posterior (AP) view

26. The visceral pleura lines the...
Pneumonia - obstructive lung disease - and late pulmonary edema
No respiration for > 20 seconds
Louder - lower-pitched - and slightly longer in duration
Outer surface of each lung

27. Restrictive Disease: Expiratory volume is reduced more than
Pulse oximetry
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Binding of O2 to Hb
Manubrio-sternal junction (angle of Louis)

28. Spirometry plots
Altering the respiratory rate and/or the tidal volume
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
A tracing of the lung volume against time in seconds
Nitrogen

29. Coarse crackles are...
5 years - to detect obstruction and determine its reversibility
Speed of airflow - the higher the flow - the greater the resistance
Louder - lower-pitched - and slightly longer in duration
Dullness replaces resonance

30. Continuous lung sounds
Wheezes - high-pitched - musical sounds - distinct whistling quality
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
A good effort
Spirometry

31. Spirometry can be used to determine the severity of functional impairment as well as
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
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
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
To assess response to treatment

32. Spirometry normal range
'scooped out' or bowl-shaped
Outer surface of each lung
80 to 120% of predicted value
Air to move from the upper airway to the farthest alveolar reaches

33. vital capacity (VC)
Perfusion
release of O2 from Hb - as heat is a by-product of metabolism.
Bicarbonate
The total amount of air that can be exhaled following a maximal inhalation

34. tidal volume (Vt)
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Total lung capacity (TLC)
No
require supplemental oxygenation and possibly ABG analysis

35. Normal range of PaCO2
35 to 45 mmHg
Right
Hypoventilation or modest changes in the PaO2
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

36. The most reliable site for detecting central cyanosis is the...
The amount of air that can be inhaled after normal inspiration
Carboxyhemoglobin
Tongue
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

37. Boyle's Gas Law
Spirometry
Either continuous or discontinuous
There is an inverse relationship between pressure and volume
Difficulty breathing or shortness of breath

38. The normal FEV1 /FVC ratio is...
Outer surface of each lung
70%
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Cough

39. Abnormal lung sounds AKA

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40. 78.08% Atmospheric Composition
Air to move from the upper airway to the farthest alveolar reaches
require supplemental oxygenation and possibly ABG analysis
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Nitrogen

41. Obstructive Disease: Expiratory airflow is reduced more than
Expiratory volume - and there is a prolonged expiratory time
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Lowered carbon dioxide level - results from hyperventilation

42. Spirometry is useful in distinguishing
Cough
right and left mainstem bronchi
Obstructive lung disease from restrictive lung disease
Nitrogen

43. Hyperventilation is defined as
Increased minute volume ventilation - which results in a lowered carbon dioxide level
There is an inverse relationship between pressure and volume
Blue or bluish-gray discoloration of the skin or mucous membranes
Significant pulmonary impairment

44. office-based spirometry is recommended for patients as young as
Increased Hb-O2 affinity
5 years - to detect obstruction and determine its reversibility
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Lung volumes - but no difficulty or delay in exhaling what volume they do have

45. What may prevent cyanosis from appearing?
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Larger airways
Observing the pattern of breathing
Tongue

46. Expiratory stridor indicates
Pleural space
Manubrio-sternal junction (angle of Louis)
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

47. The parietal pleura lines the...
Decreased pressure
Brief - discrete - non-musical sounds with a popping quality
Inside of the thoracic cavity wall and the upper surface of the diaphragm
The gas in the conducting airways does not participate in alveolar exchange

48. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Functional residual capacity (FRC)
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Right
Inspiration

49. HCO3
Either inspiration or expiration
Bicarbonate
A tracing of the lung volume against time in seconds
No

50. The muscles of inspiration are the...
Oxygen-Hemoglobin Dissociation Curve
Diaphragm - External Intercostals
Increased amounts of unsaturated hemoglobin in capillary blood
Hypoventilation or modest changes in the PaO2