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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. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
The total amount of air that can be exhaled following a maximal inhalation
The atmospheric pressure
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Decreased Hb-O2 affinity

2. movement of blood through the capillaries in direct communication with the alveoli
Perfusion
Postero-anterior (PA) and lateral view series
Tongue
To assess response to treatment

3. Boyle's Gas Law
release of O2 from Hb
Pneumonia - obstructive lung disease - and late pulmonary edema
There is an inverse relationship between pressure and volume
50%

4. PAO2
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Partial pressure of oxygen in the alveoli
80 to 120% of predicted value
Lung volumes - but no difficulty or delay in exhaling what volume they do have

5. During inspiration the diaphragm
Expiratory volume - and there is a prolonged expiratory time
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Contracts
Ventilation

6. PaCO2
Partial pressure of CO2 in the arterial blood
Partial pressure of O2 in the arterial blood
Functional residual capacity (FRC)
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

7. total lung capacity (TLC)
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
The examiner can clearly distinguish the word that the pt speak or whispers
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
The total amount of air in the lungs at the end of a maximal inhalation

8. Expiratory stridor indicates
Obstruction below the vocal cords (subglottic or tracheal obstruction)
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
Nitrogen
respiration

9. Which bronchus is more susceptible to aspiration of foreign bodies?
Postero-anterior (PA) and lateral view series
quickly - usually reaching a plateau within 6.0 seconds
reduced in size - compared with a normal curve - due to lower lung volume
Right

10. Rhonchi are due to...
Spirometry
Excessive secretions and abnormal airway collapsibility
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
release of O2 from Hb

11. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
70% occlusion of the airway
Either inspiration or expiration
Increase the intrathoracic space
Cough

12. vital capacity (VC)
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
The total amount of air that can be exhaled following a maximal inhalation
The right middle lobe
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

13. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
Saturated with oxygen or unsaturated
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
The right middle lobe
Diaphragm and the intercostal muscles

14. Auscultation of the chest depends on...
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
'crackles' or 'rales'
A reliable and consistent classification of auditory findings
Dyspnea upon assuming a recumbent position

15. The trachea bifurcates into its mainstem bronchi at the level of...
Bicarbonate
The amount of air that can be inhaled after normal inspiration
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

16. An efficient approach to examination of the patient begins with
80 to 120% of predicted value
Dyspnea upon assuming a recumbent position
Observing the pattern of breathing
Spirometry

17. dead space ventilation
The gas in the conducting airways does not participate in alveolar exchange
Right
Interstitial diseases or early pulmonary edema
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide

18. The trachea divides into right and left mainstem bronchi At what level?
PaCO2
T4 or T5 - and just below the manubrio-sternal joint
Dyspnea that awakens the patient several hours after going to sleep
Ventilation

19. Pectoriloquy
The examiner can clearly distinguish the word that the pt speak or whispers
Partial pressure of CO2 in the arterial blood
Saturated with oxygen or unsaturated
The total amount of air that can be exhaled following a maximal inhalation

20. The most reliable site for detecting central cyanosis is the...
Tongue
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Blood to the alveoli
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

21. tidal volume (Vt)
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Outer surface of each lung
Expiration
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

22. The visceral pleura lines the...
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
5 years - to detect obstruction and determine its reversibility
Overcome some of the problems associated with low blood flow to the probe site
Outer surface of each lung

23. The presence of pressure gradients causes respiratory gases to move from
Either inspiration or expiration
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
release of O2 from Hb
A reduction in lung capacity - secondary to scarring or extraneous material

24. expiratory reserve
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 amount of air that can be exhaled after expiration
Diaphragm - External Intercostals
Carboxyhemoglobin

25. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
35 to 45 mmHg
Spirometry
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
Inflammation of the adjacent parietal pleura

26. Hyperventilation is defined as
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Hypoventilation or modest changes in the PaO2
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Speed of airflow - the higher the flow - the greater the resistance

27. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
Air to move from the upper airway to the farthest alveolar reaches
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
right
Increased work of breathing

28. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Spirometry
Ventilation - Diffusion - Perfusion
reduced in size - compared with a normal curve - due to lower lung volume

29. Cyanosis appears when
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
Ventilation
Increased minute volume ventilation - which results in a lowered carbon dioxide level
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL

30. Examples of restrictive disease
Partial pressure of carbon dioxide in the alveoli
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Pulse oximetry
70%

31. terminal respiratory unit
Right
Larger airways
Acinus
Air bubbles flowing through secretions or slightly closed airways during respiration

32. normal adult tidal volume
Tongue
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
500 to 800 mL

33. Discontinuous lung sounds are also called

34. Central cyanosis results from
Insufficient oxygenation of hemoglobin in the lungs
Dullness replaces resonance
right & left
quickly - usually reaching a plateau within 6.0 seconds

35. Inspiratory stridor becomes evident at about
'crackles' or 'rales'
Spirometry
70% occlusion of the airway
Lung volumes - but find it difficult to exhale rapidly

36. A normal volume-time curve rises
Cough
quickly - usually reaching a plateau within 6.0 seconds
Larger airways
release of O2 from Hb - as heat is a by-product of metabolism.

37. Continuous lung sounds
Wheezes - high-pitched - musical sounds - distinct whistling quality
Nitrogen
Pulse oximetry
Upper respiratory obstruction - usually in the trachea or larynx

38. FEV1% in obstructive disease
Diaphragm - External Intercostals
Decreased pressure
results in a lower than normal FEV1%
Spirometry

39. The trachea divides into
release of O2 from Hb
right and left mainstem bronchi
10 to 11 cm long and about 2 cm in diameter
Increased work of breathing

40. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Postero-anterior (PA) and lateral view series
Pneumonia - obstructive lung disease - and late pulmonary edema
Increased work of breathing
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

41. Rhonchi originate in the...
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Mouth as well as through the chest wall
Larger airways
A reliable and consistent classification of auditory findings

42. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Air-filled - fluid-filled - or solid
Carboxyhemoglobin
Difficulty breathing or shortness of breath
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

43. The best indicator of adequate ventilation is the...
Increased Hb-O2 affinity
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Diaphragm - External Intercostals
PaCO2

44. Chest Radiography: The most common chest X-ray series is the...
Postero-anterior (PA) and lateral view series
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Partial pressure of carbon dioxide in the alveoli
Wheezes - high-pitched - musical sounds - distinct whistling quality

45. Continuous lung sounds often audible at the...
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Diaphragm - External Intercostals
Mouth as well as through the chest wall
Observing the pattern of breathing

46. Oximetry readings of < 94%
Diaphragm and the intercostal muscles
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
Tongue
require supplemental oxygenation and possibly ABG analysis

47. pH
Inspiration
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
results in a lower than normal FEV1%
The negative logarithm of hydrogen ions in the blood

48. HCO3
Ventilation
The negative logarithm of hydrogen ions in the blood
Spirometry
Bicarbonate

49. The external intercostal muscles increase the antero-posterior chest diameter during
Decreased Hb-O2 affinity
The gas in the conducting airways does not participate in alveolar exchange
Inspiration
No

50. Restrictive disease refers to...
Diffusion
A reduction in lung capacity - secondary to scarring or extraneous material
5 years - to detect obstruction and determine its reversibility
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli