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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. Continuous lung sounds occur during...
Air bubbles flowing through secretions or slightly closed airways during respiration
Cough
A sensor placed over a translucent area of arterial pulsation
Either inspiration or expiration

2. The upper airway accounts For what % of airway resistance?
50%
Binding of O2 to Hb
Portable antero-posterior (AP) view
Partial pressure of O2 in the arterial blood

3. Coarse crackles result from
Increased work of breathing
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
Air bubbles flowing through secretions or slightly closed airways during respiration
There is an inverse relationship between pressure and volume

4. Continuous lung sounds occur when air flows rapidly through bronchi that are...
Narrowed nearly to the point of closure
Excessive secretions and abnormal airway collapsibility
PaCO2
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL

5. normal adult tidal volume
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
500 to 800 mL
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

6. inspiratory reserve
right and left mainstem bronchi
The amount of air that can be inhaled after normal inspiration
Spirometry
80%

7. Rhonchi originate in the...
Louder - lower-pitched - and slightly longer in duration
Ventilation - Diffusion - Perfusion
Cough
Larger airways

8. The active movement of gases between the ambient air and the lungs
Ventilation
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Narrowed nearly to the point of closure
Right

9. normal subjects expel approximately how much of the FVC in the 1st second?
Blood to the alveoli
Excessive secretions and abnormal airway collapsibility
Partial pressure of oxygen (PO2)
80%

10. The vital capacity and the residual volume together constitute the...
Partial pressure of carbon dioxide in the alveoli
Pulse oximetry
Total lung capacity (TLC)
Narrowed nearly to the point of closure

11. low CO2 = low acidity =
Binding of O2 to Hb
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Dyspnea that awakens the patient several hours after going to sleep
Upper respiratory obstruction - usually in the trachea or larynx

12. The trachea bifurcates into its mainstem bronchi at the level of...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
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 amounts of unsaturated hemoglobin in capillary blood
Wheezes - high-pitched - musical sounds - distinct whistling quality

13. The presence of pressure gradients causes respiratory gases to move from
Louder - lower-pitched - and slightly longer in duration
Acinus
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Perfusion

14. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Saturated with oxygen or unsaturated
Perfusion
The negative logarithm of hydrogen ions in the blood

15. Bohr Effect of pH: left shift
Increased Hb-O2 affinity
Altering the respiratory rate and/or the tidal volume
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
'crackles' or 'rales'

16. Chest Radiography: The most common chest X-ray series is the...
Pleural space
Saturated with oxygen or unsaturated
A reliable and consistent classification of auditory findings
Postero-anterior (PA) and lateral view series

17. Oxygen moves from the...
Expiration
A sensor placed over a translucent area of arterial pulsation
Alveoli to the blood
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

18. expiratory reserve
Diaphragm and the intercostal muscles
The amount of air that can be exhaled after expiration
Nitrogen
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

19. FEV1% in restrictive disease
Normal to increased FEV1%
Nitrogen
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Louder - lower-pitched - and slightly longer in duration

20. Boyle's Gas Law
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Partial pressure of O2 in the arterial blood
There is an inverse relationship between pressure and volume
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

21. Late inspiratory crackles result from
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Mouth as well as through the chest wall
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

22. Apnea is defined as
No respiration for > 20 seconds
Overcome some of the problems associated with low blood flow to the probe site
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
Right

23. Resistance is dependent upon
Speed of airflow - the higher the flow - the greater the resistance
release of O2 from Hb - as heat is a by-product of metabolism.
right and left mainstem bronchi
Observing the pattern of breathing

24. Spirometry normal range
80 to 120% of predicted value
70%
The amount of air that can be exhaled after expiration
Either continuous or discontinuous

25. HCO3
Bicarbonate
respiration
Partial pressure of CO2 in the arterial blood
Lung volumes - but no difficulty or delay in exhaling what volume they do have

26. Spirometry plots
The gas in the conducting airways does not participate in alveolar exchange
70%
Increase the intrathoracic space
A tracing of the lung volume against time in seconds

27. office-based spirometry is recommended for patients as young as
Diffusion
5 years - to detect obstruction and determine its reversibility
Oxygen-Hemoglobin Dissociation Curve
PaCO2

28. Obstructive disease refers to...
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
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
The gas in the conducting airways does not participate in alveolar exchange
Fraction (%age) of inspired oxygen

29. Expiratory stridor indicates
Pressure required to drive air through the airways
Partial pressure of CO2 in the arterial blood
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Tongue

30. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
A good effort
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
Diaphragm and the intercostal muscles

31. The external intercostal muscles increase the antero-posterior chest diameter during
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Inspiration
Ventilation - Diffusion - Perfusion
Soft - high-pitched and crisp

32. Peripheral cyanosis results from
Partial pressure of oxygen in the alveoli
Excessive secretions and abnormal airway collapsibility
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Partial pressure of carbon dioxide in the alveoli

33. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
Increased amounts of unsaturated hemoglobin in capillary blood
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Binding of O2 to Hb
2 - each wavelength is partially absorbed by hemoglobin

34. The interspace between two ribs (intercostal space) is numbered by
Carboxyhemoglobin
Difficulty breathing or shortness of breath
The rib above it
right and left mainstem bronchi

35. Airway resistance refers to...
Increased amounts of unsaturated hemoglobin in capillary blood
Pressure required to drive air through the airways
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Either inspiration or expiration

36. The pattern of breathing refers to...
Manubrio-sternal junction (angle of Louis)
The examiner can clearly distinguish the word that the pt speak or whispers
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Wheezes - high-pitched - musical sounds - distinct whistling quality

37. With restrictive disease - the flow-volume curve is...
Significant pulmonary impairment
Immediate oxygenation with or without intubation
80 to 120% of predicted value
reduced in size - compared with a normal curve - due to lower lung volume

38. Carbon dioxide moves from the...
Blood to the alveoli
Diaphragm and the intercostal muscles
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
Contracts

39. The muscles of inspiration are the...
Diaphragm - External Intercostals
Partial pressure of O2 in the arterial blood
Dullness replaces resonance
70% occlusion of the airway

40. The acini consist of the...
Pulse oximetry
80%
The atmospheric pressure
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

41. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Perfusion
Normal to increased FEV1%
Manubrio-sternal junction (angle of Louis)
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

42. Continuous lung sounds often audible at the...
Right
Dullness replaces resonance
release of O2 from Hb - as heat is a by-product of metabolism.
Mouth as well as through the chest wall

43. Fine crackles are heard in
Interstitial diseases or early pulmonary edema
reduced in size - compared with a normal curve - due to lower lung volume
Pleural space
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

44. Normal range of PaCO2
A reliable and consistent classification of auditory findings
35 to 45 mmHg
Difficulty breathing or shortness of breath
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

45. Rhonchi
T4 or T5 - and just below the manubrio-sternal joint
Difficulty breathing or shortness of breath
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
right & left

46. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Spirometry
Brief - discrete - non-musical sounds with a popping quality
Lowered carbon dioxide level - results from hyperventilation
Inspiration

47. Nitroglycerin applied to the probe area has been reported to...
Postero-anterior (PA) and lateral view series
quickly - usually reaching a plateau within 6.0 seconds
Air to move from the upper airway to the farthest alveolar reaches
Overcome some of the problems associated with low blood flow to the probe site

48. vital capacity (VC)
Wheezes - high-pitched - musical sounds - distinct whistling quality
Air to move from the upper airway to the farthest alveolar reaches
The total amount of air that can be exhaled following a maximal inhalation
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

49. Spirometry: The result is stated as
release of O2 from Hb - as heat is a by-product of metabolism.
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Ventilation

50. Bronchiovesicular breath sounds
Hypoventilation or modest changes in the PaO2
reduced in size - compared with a normal curve - due to lower lung volume
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Blood to the alveoli