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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. increased volume results in
Pleural space
Portable antero-posterior (AP) view
Decreased pressure
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

2. The spirometry printout usually includes

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3. Compliance
Diffusion
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
Dyspnea that awakens the patient several hours after going to sleep
Diaphragm and the intercostal muscles

4. Cyanosis is caused by
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
The amount of air that can be inhaled after normal inspiration
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Increased amounts of unsaturated hemoglobin in capillary blood

5. An efficient approach to examination of the patient begins with
Carboxyhemoglobin
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Observing the pattern of breathing
The right middle lobe

6. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
right
The gas in the conducting airways does not participate in alveolar exchange
Spirometry
Increased rate of breathing and is commonly associated with a decrease in tidal volume

7. Cyanosis appears when
Increased work of breathing
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
The amount of air that can be inhaled after normal inspiration

8. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Speed of airflow - the higher the flow - the greater the resistance
A good effort
35 to 45 mmHg
Upper respiratory obstruction - usually in the trachea or larynx

9. Continuous lung sounds occur during...
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Either inspiration or expiration
release of O2 from Hb - as heat is a by-product of metabolism.
Postero-anterior (PA) and lateral view series

10. Obstructive Disease: Expiratory airflow is reduced more than
Interstitial diseases or early pulmonary edema
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Expiratory volume - and there is a prolonged expiratory time
Louder - lower-pitched - and slightly longer in duration

11. FEV1% in restrictive disease
The amount of air that can be inhaled after normal inspiration
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Normal to increased FEV1%
T4 or T5 - and just below the manubrio-sternal joint

12. Expiratory stridor indicates
A reduction in lung capacity - secondary to scarring or extraneous material
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Spirometry

13. office-based spirometry is recommended for patients as young as
A tracing of the lung volume against time in seconds
Increased rate of breathing and is commonly associated with a decrease in tidal volume
5 years - to detect obstruction and determine its reversibility
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

14. The vital capacity and the residual volume together constitute the...
Total lung capacity (TLC)
Difficulty breathing or shortness of breath
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
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

15. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
Perfusion
5 years - to detect obstruction and determine its reversibility
Soft - high-pitched and crisp
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

16. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
2 - each wavelength is partially absorbed by hemoglobin
release of O2 from Hb - as heat is a by-product of metabolism.
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

17. Boyle's Gas Law
500 to 800 mL
There is an inverse relationship between pressure and volume
Sternocleidomastoid - Scalene Muscles
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

18. The normal FEV1 /FVC ratio is...
No
70%
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Larger airways

19. What may prevent cyanosis from appearing?
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Increased Hb-O2 affinity
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Immediate oxygenation with or without intubation

20. Bohr Effect of pH is graphed as
The right middle lobe
Postero-anterior (PA) and lateral view series
Spirometry
Oxygen-Hemoglobin Dissociation Curve

21. Dyspnea is defined as
Either inspiration or expiration
Total lung capacity (TLC)
Difficulty breathing or shortness of breath
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

22. What occurs passively as muscles relax?
Expiration
respiration
2 - each wavelength is partially absorbed by hemoglobin
Pneumonia - obstructive lung disease - and late pulmonary edema

23. Normal lung sounds
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Obstructive lung disease from restrictive lung disease
Normal to increased FEV1%
Partial pressure of CO2 in the arterial blood

24. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Decreased pressure
Increase the intrathoracic space
Oxygen (O2)
Postero-anterior (PA) and lateral view series

25. 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
Pulse oximetry
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
A reliable and consistent classification of auditory findings
Sternocleidomastoid - Scalene Muscles

26. Rhonchi are due to...
Fraction (%age) of inspired oxygen
Excessive secretions and abnormal airway collapsibility
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
To assess response to treatment

27. Auscultation of the chest depends on...
Diaphragm and the intercostal muscles
A reliable and consistent classification of auditory findings
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Partial pressure of CO2 in the arterial blood

28. terminal respiratory unit
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Dullness replaces resonance
Acinus
Pressure required to drive air through the airways

29. The parietal pleura lines the...
70% occlusion of the airway
Ventilation - Diffusion - Perfusion
respiration
Inside of the thoracic cavity wall and the upper surface of the diaphragm

30. Nitroglycerin applied to the probe area has been reported to...
Overcome some of the problems associated with low blood flow to the probe site
Immediate oxygenation with or without intubation
Brief - discrete - non-musical sounds with a popping quality
Ventilation - Diffusion - Perfusion

31. tidal volume (Vt)
Mediastinum
Soft - high-pitched and crisp
'scooped out' or bowl-shaped
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

32. 78.08% Atmospheric Composition
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Overcome some of the problems associated with low blood flow to the probe site
Inflammation of the adjacent parietal pleura
Nitrogen

33. During inspiration the diaphragm
Contracts
Immediate oxygenation with or without intubation
Inspiration
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

34. Patients with obstructive disease have normal
Lung volumes - but find it difficult to exhale rapidly
Larger airways
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Manubrio-sternal junction (angle of Louis)

35. The trachea bifurcates into its mainstem bronchi at the level of...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
50%
Increased work of breathing
Increased rate of breathing and is commonly associated with a decrease in tidal volume

36. Fine crackles are...
5 years - to detect obstruction and determine its reversibility
Soft - high-pitched and crisp
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Louder - lower-pitched - and slightly longer in duration

37. normal subjects expel approximately how much of the FVC in the 1st second?
35 to 45 mmHg
Partial pressure of oxygen in the alveoli
Dyspnea that awakens the patient several hours after going to sleep
80%

38. Vesicular breath sounds
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Decreased pressure
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

39. Pectoriloquy
Brief - discrete - non-musical sounds with a popping quality
Increased amounts of unsaturated hemoglobin in capillary blood
Interstitial diseases or early pulmonary edema
The examiner can clearly distinguish the word that the pt speak or whispers

40. Inspiratory stridor indicates
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Alveoli to the blood
Cough

41. Paroxysmal nocturnal dyspnea (PND) is...
To assess response to treatment
Dyspnea that awakens the patient several hours after going to sleep
Soft - high-pitched and crisp
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

42. Bohr Effect of pH: right shift
Right
Expiration
Inspiration
Decreased Hb-O2 affinity

43. The presence of pressure gradients causes respiratory gases to move from
Air to move from the upper airway to the farthest alveolar reaches
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
The gas in the conducting airways does not participate in alveolar exchange

44. Examples of restrictive disease
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
The atmospheric pressure
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

45. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Immediate oxygenation with or without intubation
release of O2 from Hb - as heat is a by-product of metabolism.
80%
Diffusion

46. dead space ventilation
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Increased Hb-O2 affinity
The gas in the conducting airways does not participate in alveolar exchange

47. Abnormal lung sounds are classified as
Either continuous or discontinuous
500 to 800 mL
Inspiration
Postero-anterior (PA) and lateral view series

48. Carbon dioxide moves from the...
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
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Dyspnea upon assuming a recumbent position
Blood to the alveoli

49. Obstructive disease refers to...
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Contracts
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Nitrogen

50. The tracheo-bronchial tree is a tubular system that provides a pathway for
Lung volumes - but find it difficult to exhale rapidly
The amount of air that can be inhaled after normal inspiration
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Air to move from the upper airway to the farthest alveolar reaches