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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. Percussion helps you establish whether the underlying tissues are...
'scooped out' or bowl-shaped
Air-filled - fluid-filled - or solid
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Perfusion

2. Cyanosis is caused by
Right
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Increased amounts of unsaturated hemoglobin in capillary blood
Inflammation of the adjacent parietal pleura

3. PACO2
Pleural space
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
T4 or T5 - and just below the manubrio-sternal joint
Partial pressure of carbon dioxide in the alveoli

4. Spirometry normal range
80 to 120% of predicted value
Saturated with oxygen or unsaturated
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Spirometry

5. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Increase the intrathoracic space
Pleural space
Dullness replaces resonance
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

6. inspiratory reserve
The amount of air that can be inhaled after normal inspiration
Total lung capacity (TLC)
A tracing of the lung volume against time in seconds
Lowered carbon dioxide level - results from hyperventilation

7. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Either inspiration or expiration
Carboxyhemoglobin
release of O2 from Hb - as heat is a by-product of metabolism.

8. Continuous lung sounds
Observing the pattern of breathing
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Wheezes - high-pitched - musical sounds - distinct whistling quality
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

9. Expiratory stridor indicates
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Speed of airflow - the higher the flow - the greater the resistance
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Inspiration

10. The best indicator of adequate ventilation is the...
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Ventilation
The amount of air that can be inhaled after normal inspiration
PaCO2

11. Boyle's Gas Law
Narrowed nearly to the point of closure
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 site of obstruction above the vocal cords (supraglottic or glottic obstruction)
There is an inverse relationship between pressure and volume

12. Spirometry: The result is stated as
Acinus
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

13. tidal volume (Vt)
results in a lower than normal FEV1%
right & left
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

14. The accessory muscles are the...
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Sternocleidomastoid - Scalene Muscles
Soft - high-pitched and crisp

15. Inspiratory stridor becomes evident at about
Partial pressure of oxygen in the alveoli
70% occlusion of the airway
Oxygen-Hemoglobin Dissociation Curve
Mediastinum

16. Bronchial breath sounds
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
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
Manubrio-sternal junction (angle of Louis)

17. Peripheral cyanosis results from
Lowered carbon dioxide level - results from hyperventilation
80%
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Increase the intrathoracic space

18. The muscles of expiration are the...
Contracts
Blood to the alveoli
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Air-filled - fluid-filled - or solid

19. terminal respiratory unit
right & left
Spirometry
Acinus
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

20. Obstructive disease refers to...
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
A tracing of the lung volume against time in seconds
Partial pressure of CO2 in the arterial blood
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

21. Paroxysmal nocturnal dyspnea (PND) is...
Partial pressure of oxygen in the alveoli
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Dyspnea that awakens the patient several hours after going to sleep

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

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23. The parietal pleura lines the...
80 to 120% of predicted value
Inside of the thoracic cavity wall and the upper surface of the diaphragm
release of O2 from Hb - as heat is a by-product of metabolism.
A tracing of the lung volume against time in seconds

24. hypocapnia
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
5 years - to detect obstruction and determine its reversibility
Lowered carbon dioxide level - results from hyperventilation
Difficulty breathing or shortness of breath

25. Continuous lung sounds occur during...
require supplemental oxygenation and possibly ABG analysis
A sensor placed over a translucent area of arterial pulsation
Either inspiration or expiration
The total amount of air in the lungs at the end of a maximal inhalation

26. Cyanosis
Blue or bluish-gray discoloration of the skin or mucous membranes
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

27. increased volume results in
Oxygen-Hemoglobin Dissociation Curve
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Decreased pressure
'adventitious' breath sounds

28. What may prevent cyanosis from appearing?
Expiratory volume - and there is a prolonged expiratory time
Increase the intrathoracic space
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
The examiner can clearly distinguish the word that the pt speak or whispers

29. Restrictive Disease: Expiratory volume is reduced more than
10 to 11 cm long and about 2 cm in diameter
Partial pressure of carbon dioxide in the alveoli
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
The amount of air that can be inhaled after normal inspiration

30. FIO2
Air to move from the upper airway to the farthest alveolar reaches
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Left upper lobe
Fraction (%age) of inspired oxygen

31. Continuous lung sounds occur when air flows rapidly through bronchi that are...
Narrowed nearly to the point of closure
release of O2 from Hb - as heat is a by-product of metabolism.
Contracts
Blue or bluish-gray discoloration of the skin or mucous membranes

32. Bronchiovesicular breath sounds
Dullness replaces resonance
Either continuous or discontinuous
Narrowed nearly to the point of closure
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval

33. expiratory reserve
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
release of O2 from Hb - as heat is a by-product of metabolism.
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
The amount of air that can be exhaled after expiration

34. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
respiration
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
The rib above it
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

35. 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
Diaphragm and the intercostal muscles
Pulse oximetry
'crackles' or 'rales'
Significant pulmonary impairment

36. Spirometry plots
A tracing of the lung volume against time in seconds
Carboxyhemoglobin
Partial pressure of O2 in the arterial blood
70%

37. FEV1% in obstructive disease
Expiration
Binding of O2 to Hb
Either inspiration or expiration
results in a lower than normal FEV1%

38. The main bronchi are divided into smaller branches that begin to subdivide into
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Manubrio-sternal junction (angle of Louis)
Oxygen (O2)
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

39. Compliance
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
80%
10 to 11 cm long and about 2 cm in diameter
Overcome some of the problems associated with low blood flow to the probe site

40. PaCO2
Partial pressure of CO2 in the arterial blood
The rib above it
Alveoli to the blood
The atmospheric pressure

41. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Right
Spirometry
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
70% occlusion of the airway

42. The trachea bifurcates into its mainstem bronchi at the level of...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Right
Ventilation - Diffusion - Perfusion
'adventitious' breath sounds

43. Which lung has an oblique fissure?
right & left
Ventilation - Diffusion - Perfusion
quickly - usually reaching a plateau within 6.0 seconds
Either inspiration or expiration

44. total lung capacity (TLC)
The total amount of air in the lungs at the end of a maximal inhalation
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
70%
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

45. Pulmonary ventilation is varied by
Left upper lobe
No
Altering the respiratory rate and/or the tidal volume
Significant pulmonary impairment

46. office-based spirometry is recommended for patients as young as
Partial pressure of O2 in the arterial blood
5 years - to detect obstruction and determine its reversibility
No
Inspiration

47. Vesicular breath sounds
Bronchospasm - mucosal edema - or excessive secretions
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
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

48. pH
Hypoventilation or modest changes in the PaO2
The negative logarithm of hydrogen ions in the blood
T4 or T5 - and just below the manubrio-sternal joint
Either inspiration or expiration

49. forced vital capacity (FVC)
'crackles' or 'rales'
Tongue
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

50. 20.95% Atmospheric Composition
Pleural space
Oxygen (O2)
Wheezes - high-pitched - musical sounds - distinct whistling quality
Inflammation of the adjacent parietal pleura