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Pulmonology

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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. At rest - the use of accessory muscles is a sign of...
Upper respiratory obstruction - usually in the trachea or larynx
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Significant pulmonary impairment
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

2. The trachea divides into right and left mainstem bronchi At what level?
T4 or T5 - and just below the manubrio-sternal joint
Partial pressure of CO2 in the arterial blood
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
80 to 120% of predicted value

3. Fine crackles are...
right
Diaphragm and the intercostal muscles
Expiration
Soft - high-pitched and crisp

4. An efficient approach to examination of the patient begins with
80 to 120% of predicted value
Partial pressure of carbon dioxide in the alveoli
Increased Hb-O2 affinity
Observing the pattern of breathing

5. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Narrowed nearly to the point of closure
Carboxyhemoglobin
Total lung capacity (TLC)
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

6. Rhonchi frequently clear after
Observing the pattern of breathing
Either inspiration or expiration
Cough
Either inspiration or expiration

7. The trachea divides into
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Blue or bluish-gray discoloration of the skin or mucous membranes
'scooped out' or bowl-shaped
right and left mainstem bronchi

8. Peripheral cyanosis results from
Carboxyhemoglobin
Increased Hb-O2 affinity
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Oxygen (O2)

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

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10. Paroxysmal nocturnal dyspnea (PND) is...
Dyspnea that awakens the patient several hours after going to sleep
80 to 120% of predicted value
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
A reduction in lung capacity - secondary to scarring or extraneous material

11. pH
Decreased Hb-O2 affinity
The negative logarithm of hydrogen ions in the blood
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

12. Rhonchi
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Portable antero-posterior (AP) view
Alveoli to the blood

13. Rhonchi originate in the...
Increased Hb-O2 affinity
Larger airways
Upper respiratory obstruction - usually in the trachea or larynx
The total amount of air that can be exhaled following a maximal inhalation

14. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
Expiratory volume - and there is a prolonged expiratory time
respiration
Spirometry
Diaphragm and the intercostal muscles

15. Tachypnea is an
Inspiration
The negative logarithm of hydrogen ions in the blood
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Pneumonia - obstructive lung disease - and late pulmonary edema

16. normal adult tidal volume
right and left mainstem bronchi
Inspiration
Decreased pressure
500 to 800 mL

17. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Diffusion
A sensor placed over a translucent area of arterial pulsation
results in a lower than normal FEV1%
Soft - high-pitched and crisp

18. Coarse crackles result from
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Air bubbles flowing through secretions or slightly closed airways during respiration
Lung volumes - but find it difficult to exhale rapidly
Binding of O2 to Hb

19. With restrictive disease - the flow-volume curve is...
Inspiration
No
Acinus
reduced in size - compared with a normal curve - due to lower lung volume

20. The trachea bifurcates into its mainstem bronchi at the level of...
Dyspnea upon assuming a recumbent position
Right
Narrowed nearly to the point of closure
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

21. The vital capacity and the residual volume together constitute the...
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Upper respiratory obstruction - usually in the trachea or larynx
Total lung capacity (TLC)

22. Percussion helps you establish whether the underlying tissues are...
Manubrio-sternal junction (angle of Louis)
Air-filled - fluid-filled - or solid
Dyspnea that awakens the patient several hours after going to sleep
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

23. forced vital capacity (FVC)
To assess response to treatment
Blue or bluish-gray discoloration of the skin or mucous membranes
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
No

24. The normal FEV1 /FVC ratio is...
Altering the respiratory rate and/or the tidal volume
There is an inverse relationship between pressure and volume
70%
respiration

25. Stridor is a high-pitched - noisy respiration - Which is indicative of...
The rib above it
Upper respiratory obstruction - usually in the trachea or larynx
A sensor placed over a translucent area of arterial pulsation
Excessive secretions and abnormal airway collapsibility

26. within limits - increased temperature =
Total lung capacity (TLC)
release of O2 from Hb
release of O2 from Hb - as heat is a by-product of metabolism.
10 to 11 cm long and about 2 cm in diameter

27. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
Alveoli to the blood
Blue or bluish-gray discoloration of the skin or mucous membranes
Mediastinum
Inside of the thoracic cavity wall and the upper surface of the diaphragm

28. Spirometry: The result is stated as
A good effort
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Increased Hb-O2 affinity
Total lung capacity (TLC)

29. Pulse Oximetry is dependent on...
Normal to increased FEV1%
Carboxyhemoglobin
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
To assess response to treatment

30. The presence of pressure gradients causes respiratory gases to move from
Oxygen-Hemoglobin Dissociation Curve
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
The negative logarithm of hydrogen ions in the blood
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

31. Auscultation of the chest depends on...
Inflammation of the adjacent parietal pleura
Altering the respiratory rate and/or the tidal volume
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
A reliable and consistent classification of auditory findings

32. Obstructive Disease: Expiratory airflow is reduced more than
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Alveoli to the blood
Expiratory volume - and there is a prolonged expiratory time

33. Continuous lung sounds occur in the setting of...
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Significant pulmonary impairment
2 - each wavelength is partially absorbed by hemoglobin
Bronchospasm - mucosal edema - or excessive secretions

34. Vesicular breath sounds
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
Decreased Hb-O2 affinity
Nitrogen
Manubrio-sternal junction (angle of Louis)

35. Spirometry is useful in distinguishing
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
10 to 11 cm long and about 2 cm in diameter
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Obstructive lung disease from restrictive lung disease

36. The main bronchi are divided into smaller branches that begin to subdivide into
Outer surface of each lung
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Diffusion

37. Spirometry normal range
Inflammation of the adjacent parietal pleura
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
80 to 120% of predicted value
The examiner can clearly distinguish the word that the pt speak or whispers

38. terminal respiratory unit
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Alveoli to the blood
Increased work of breathing
Acinus

39. 78.08% Atmospheric Composition
Pulse oximetry
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Nitrogen
To assess response to treatment

40. The internal intercostals decrease the transverse diameter of the chest during
Inspiration
Expiration
Hypoventilation or modest changes in the PaO2
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

41. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Wheezes - high-pitched - musical sounds - distinct whistling quality
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
The negative logarithm of hydrogen ions in the blood
Increase the intrathoracic space

42. vital capacity (VC)
The amount of air that can be exhaled after expiration
The total amount of air that can be exhaled following a maximal inhalation
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Expiratory volume - and there is a prolonged expiratory time

43. Pulse Oximetry does not detect
release of O2 from Hb
Hypoventilation or modest changes in the PaO2
Increased minute volume ventilation - which results in a lowered carbon dioxide level
The right middle lobe

44. The accessory muscles are the...
Soft - high-pitched and crisp
70%
No respiration for > 20 seconds
Sternocleidomastoid - Scalene Muscles

45. most important factor that influences the oxygen carrying capacity of hemoglobin
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Partial pressure of oxygen (PO2)
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

46. The muscles of expiration are the...
Increased Hb-O2 affinity
The total amount of air in the lungs at the end of a maximal inhalation
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

47. dead space ventilation
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
The gas in the conducting airways does not participate in alveolar exchange
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Spirometry

48. 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
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Obstructive lung disease from restrictive lung disease
80 to 120% of predicted value

49. Expiratory stridor indicates
Obstruction below the vocal cords (subglottic or tracheal obstruction)
5 years - to detect obstruction and determine its reversibility
Cough
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

50. inspiratory reserve
Perfusion
Alveoli to the blood
The amount of air that can be inhaled after normal inspiration
70%

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Pulmonology

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