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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. office-based spirometry is recommended for patients as young as
Expiration
5 years - to detect obstruction and determine its reversibility
Expiratory volume - and there is a prolonged expiratory time
50%

2. Spirometry normal range
require supplemental oxygenation and possibly ABG analysis
Interstitial diseases or early pulmonary edema
80 to 120% of predicted value
Partial pressure of carbon dioxide in the alveoli

3. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
require supplemental oxygenation and possibly ABG analysis
Increased work of breathing
Partial pressure of O2 in the arterial blood
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

4. The trachea divides into right and left mainstem bronchi At what level?
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
No respiration for > 20 seconds
Ventilation - Diffusion - Perfusion
T4 or T5 - and just below the manubrio-sternal joint

5. Egophony

6. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Diffusion
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Functional residual capacity (FRC)
The total amount of air in the lungs at the end of a maximal inhalation

7. Auscultation of the chest depends on...
Contracts
A reliable and consistent classification of auditory findings
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
Perfusion

8. movement of blood through the capillaries in direct communication with the alveoli
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Perfusion

9. The primary muscles of respiration are the...
Saturated with oxygen or unsaturated
Increased work of breathing
Diaphragm and the intercostal muscles
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

10. Which bronchus is more susceptible to aspiration of foreign bodies?
A reduction in lung capacity - secondary to scarring or extraneous material
Right
Brief - discrete - non-musical sounds with a popping quality
Overcome some of the problems associated with low blood flow to the probe site

11. tidal volume (Vt)
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Perfusion
Partial pressure of carbon dioxide in the alveoli
Lung volumes - but find it difficult to exhale rapidly

12. residual volume
Either inspiration or expiration
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
70%
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

13. high CO2 = high acidity =
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
A tracing of the lung volume against time in seconds
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
release of O2 from Hb

14. Spirometry plots
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
A tracing of the lung volume against time in seconds
Postero-anterior (PA) and lateral view series
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

15. The most reliable site for detecting central cyanosis is the...
Tongue
70% occlusion of the airway
The examiner can clearly distinguish the word that the pt speak or whispers
A tracing of the lung volume against time in seconds

16. PACO2
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Increased Hb-O2 affinity
Partial pressure of carbon dioxide in the alveoli
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

17. Spirometry is useful in distinguishing
require supplemental oxygenation and possibly ABG analysis
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
500 to 800 mL
Obstructive lung disease from restrictive lung disease

18. the lingula is analogous to...
The right middle lobe
Partial pressure of oxygen in the alveoli
Partial pressure of O2 in the arterial blood
A reliable and consistent classification of auditory findings

19. During inspiration the diaphragm
Significant pulmonary impairment
Contracts
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Partial pressure of CO2 in the arterial blood

20. The trachea divides into
Spirometry
right and left mainstem bronchi
Partial pressure of CO2 in the arterial blood
Inspiration

21. Examples of obstructive disease
Mediastinum
Difficulty breathing or shortness of breath
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Either inspiration or expiration

22. Bohr Effect of pH is graphed as
Oxygen-Hemoglobin Dissociation Curve
Spirometry
Oxygen (O2)
Upper respiratory obstruction - usually in the trachea or larynx

23. Carbon dioxide moves from the...
Blood to the alveoli
Pulse oximetry
Bicarbonate
right & left

24. inspiratory reserve
Blue or bluish-gray discoloration of the skin or mucous membranes
The amount of air that can be inhaled after normal inspiration
A tracing of the lung volume against time in seconds
Saturated with oxygen or unsaturated

25. The spirometry printout usually includes

26. 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
Soft - high-pitched and crisp
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Alveoli to the blood

27. The visceral pleura lines the...
Outer surface of each lung
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Blood to the alveoli
Lung volumes - but no difficulty or delay in exhaling what volume they do have

28. The normal FEV1 /FVC ratio is...
Pulse oximetry
Pneumonia - obstructive lung disease - and late pulmonary edema
There is an inverse relationship between pressure and volume
70%

29. The trachea is how long/wide?
There is an inverse relationship between pressure and volume
10 to 11 cm long and about 2 cm in diameter
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
The total amount of air in the lungs at the end of a maximal inhalation

30. Continuous lung sounds occur in the setting of...
Bronchospasm - mucosal edema - or excessive secretions
require supplemental oxygenation and possibly ABG analysis
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Saturated with oxygen or unsaturated

31. The vital capacity and the residual volume together constitute the...
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
'adventitious' breath sounds
Total lung capacity (TLC)
The total amount of air in the lungs at the end of a maximal inhalation

32. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
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
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Portable antero-posterior (AP) view
Nitrogen

33. What occurs passively as muscles relax?
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
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
The total amount of air in the lungs at the end of a maximal inhalation

34. Bohr Effect of pH: right shift
Perfusion
Decreased Hb-O2 affinity
Increased work of breathing
80%

35. Cyanosis
'scooped out' or bowl-shaped
Blue or bluish-gray discoloration of the skin or mucous membranes
No
Carboxyhemoglobin

36. Bronchophony
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
The examiner can clearly distinguish the word that the pt speak or whispers
Bicarbonate
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

37. Fine crackles are heard in
Expiratory volume - and there is a prolonged expiratory time
Interstitial diseases or early pulmonary edema
Outer surface of each lung
'adventitious' breath sounds

38. Bronchial breath sounds
Cough
Saturated with oxygen or unsaturated
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

39. Orthopnea is defined as
Dyspnea upon assuming a recumbent position
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Perfusion
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

40. Pulse Oximetry is dependent on...
quickly - usually reaching a plateau within 6.0 seconds
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
'adventitious' breath sounds
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

41. Rhonchi
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Diffusion
quickly - usually reaching a plateau within 6.0 seconds
Lung volumes - but no difficulty or delay in exhaling what volume they do have

42. Oximetry readings of < 94%
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Oxygen-Hemoglobin Dissociation Curve
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
require supplemental oxygenation and possibly ABG analysis

43. Discontinuous lung sounds are...
Brief - discrete - non-musical sounds with a popping quality
Oxygen (O2)
To assess response to treatment
Lowered carbon dioxide level - results from hyperventilation

44. What may prevent cyanosis from appearing?
5 years - to detect obstruction and determine its reversibility
Immediate oxygenation with or without intubation
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

45. Coarse crackles result from
Nitrogen
respiration
No
Air bubbles flowing through secretions or slightly closed airways during respiration

46. forced expiratory volume in one second (FEV1)
Decreased Hb-O2 affinity
Partial pressure of oxygen in the alveoli
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
Bicarbonate

47. The muscles of inspiration are the...
Diaphragm - External Intercostals
Mouth as well as through the chest wall
Oxygen-Hemoglobin Dissociation Curve
Perfusion

48. Rhonchi originate in the...
Either inspiration or expiration
Either continuous or discontinuous
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Larger airways

49. normal adult tidal volume
500 to 800 mL
No
release of O2 from Hb
Right

50. Spirometry: The result is stated as
Portable antero-posterior (AP) view
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Upper respiratory obstruction - usually in the trachea or larynx
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height