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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. Patients with obstructive disease have normal
Lung volumes - but find it difficult to exhale rapidly
Decreased pressure
80%
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

2. FEV1/FVC
80 to 120% of predicted value
Partial pressure of oxygen in the alveoli
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

3. Continuous lung sounds occur in the setting of...
Bronchospasm - mucosal edema - or excessive secretions
Dyspnea that awakens the patient several hours after going to sleep
Diaphragm and the intercostal muscles
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval

4. forced vital capacity (FVC)
Expiratory volume - and there is a prolonged expiratory time
Tongue
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
50%

5. Compliance
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
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
Carboxyhemoglobin
Mediastinum

6. Examples of restrictive disease
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
5 years - to detect obstruction and determine its reversibility
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Right

7. PaCO2
Partial pressure of CO2 in the arterial blood
Spirometry
70% occlusion of the airway
Diffusion

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

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9. The internal intercostals decrease the transverse diameter of the chest during
2 - each wavelength is partially absorbed by hemoglobin
release of O2 from Hb - as heat is a by-product of metabolism.
Expiration
The atmospheric pressure

10. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Mouth as well as through the chest wall
The total amount of air that can be exhaled following a maximal inhalation
Pneumonia - obstructive lung disease - and late pulmonary edema

11. Discontinuous lung sounds are also called

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12. Dyspnea is defined as
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Immediate oxygenation with or without intubation
Pressure required to drive air through the airways
Difficulty breathing or shortness of breath

13. With restrictive disease - the flow-volume curve is...
reduced in size - compared with a normal curve - due to lower lung volume
'scooped out' or bowl-shaped
To assess response to treatment
A good effort

14. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
A good effort
50%
Alveoli to the blood
Binding of O2 to Hb

15. Spirometry plots
Increased minute volume ventilation - which results in a lowered carbon dioxide level
To assess response to treatment
A tracing of the lung volume against time in seconds
Manubrio-sternal junction (angle of Louis)

16. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
The atmospheric pressure
The rib above it
A good effort
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

17. expiratory reserve
Spirometry
The amount of air that can be exhaled after expiration
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Increased amounts of unsaturated hemoglobin in capillary blood

18. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Manubrio-sternal junction (angle of Louis)
Outer surface of each lung
The amount of air that can be inhaled after normal inspiration
Interstitial diseases or early pulmonary edema

19. Spirometry can be used to determine the severity of functional impairment as well as
Larger airways
Tongue
To assess response to treatment
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

20. Oximetry readings of < 94%
require supplemental oxygenation and possibly ABG analysis
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
reduced in size - compared with a normal curve - due to lower lung volume
Obstruction below the vocal cords (subglottic or tracheal obstruction)

21. tidal volume (Vt)
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
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

22. increased volume results in
Decreased pressure
'adventitious' breath sounds
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
The total amount of air that can be exhaled following a maximal inhalation

23. The interspace between two ribs (intercostal space) is numbered by
The rib above it
A reliable and consistent classification of auditory findings
Ventilation - Diffusion - Perfusion
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

24. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Brief - discrete - non-musical sounds with a popping quality
Insufficient oxygenation of hemoglobin in the lungs
The gas in the conducting airways does not participate in alveolar exchange
Immediate oxygenation with or without intubation

25. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
'crackles' or 'rales'
Portable antero-posterior (AP) view

26. Which bronchus is wider - shorter - and more vertically placed?
Right
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

27. pain in lung conditions usually arises from
Inflammation of the adjacent parietal pleura
Acinus
Decreased Hb-O2 affinity
Carboxyhemoglobin

28. normal subjects expel approximately how much of the FVC in the 1st second?
80%
Interstitial diseases or early pulmonary edema
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
The rib above it

29. Bohr Effect of pH: right shift
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Decreased pressure
respiration
Decreased Hb-O2 affinity

30. dead space ventilation
The gas in the conducting airways does not participate in alveolar exchange
Right
Partial pressure of oxygen in the alveoli
Perfusion

31. Expiratory stridor indicates
Blood to the alveoli
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Mediastinum
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

32. Continuous lung sounds
A reliable and consistent classification of auditory findings
Wheezes - high-pitched - musical sounds - distinct whistling quality
Altering the respiratory rate and/or the tidal volume
Interstitial diseases or early pulmonary edema

33. Abnormal lung sounds are classified as
Diffusion
Narrowed nearly to the point of closure
Either continuous or discontinuous
respiration

34. Inspiratory stridor becomes evident at about
70% occlusion of the airway
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Increased work of breathing
The examiner can clearly distinguish the word that the pt speak or whispers

35. The presence of pressure gradients causes respiratory gases to move from
To assess response to treatment
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
Partial pressure of oxygen (PO2)
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

36. A normal volume-time curve rises
Expiration
A tracing of the lung volume against time in seconds
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
quickly - usually reaching a plateau within 6.0 seconds

37. Continuous lung sounds often audible at the...
Mouth as well as through the chest wall
Total lung capacity (TLC)
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Diffusion

38. FEV1% in obstructive disease
The negative logarithm of hydrogen ions in the blood
results in a lower than normal FEV1%
Wheezes - high-pitched - musical sounds - distinct whistling quality
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

39. The trachea is how long/wide?
10 to 11 cm long and about 2 cm in diameter
'adventitious' breath sounds
Partial pressure of O2 in the arterial blood
Brief - discrete - non-musical sounds with a popping quality

40. 20.95% Atmospheric Composition
Partial pressure of oxygen (PO2)
Oxygen (O2)
require supplemental oxygenation and possibly ABG analysis
Diaphragm and the intercostal muscles

41. At rest - the use of accessory muscles is a sign of...
Partial pressure of oxygen (PO2)
Perfusion
A good effort
Significant pulmonary impairment

42. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Expiration
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Spirometry
Ventilation - Diffusion - Perfusion

43. PAO2
Partial pressure of oxygen in the alveoli
Pneumonia - obstructive lung disease - and late pulmonary edema
Brief - discrete - non-musical sounds with a popping quality
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage

44. Does lung tissue have pain fibers?
No
5 years - to detect obstruction and determine its reversibility
A good effort
Expiration

45. HCO3
Lung volumes - but find it difficult to exhale rapidly
Partial pressure of oxygen (PO2)
Acinus
Bicarbonate

46. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
The rib above it
Spirometry
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
80 to 120% of predicted value

47. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Upper respiratory obstruction - usually in the trachea or larynx
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Bronchospasm - mucosal edema - or excessive secretions
Decreased pressure

48. forced expiratory volume in one second (FEV1)
Either continuous or discontinuous
Nitrogen
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
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

49. Carbon dioxide moves from the...
A sensor placed over a translucent area of arterial pulsation
Blood to the alveoli
Mediastinum
A reliable and consistent classification of auditory findings

50. FIO2
Observing the pattern of breathing
Pleural space
Fraction (%age) of inspired oxygen
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up