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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. The external intercostal muscles increase the antero-posterior chest diameter during
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Inspiration
Pulse oximetry
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

2. forced vital capacity (FVC)
Oxygen (O2)
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
release of O2 from Hb
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

3. forced expiratory volume in one second (FEV1)
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
The negative logarithm of hydrogen ions in the blood
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
Diffusion

4. The muscles of inspiration are the...
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Cough
Diaphragm - External Intercostals
Left upper lobe

5. The primary muscles of respiration are the...
reduced in size - compared with a normal curve - due to lower lung volume
Diaphragm and the intercostal muscles
Bronchospasm - mucosal edema - or excessive secretions
Larger airways

6. normal subjects expel approximately how much of the FVC in the 1st second?
Acinus
80%
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Air bubbles flowing through secretions or slightly closed airways during respiration

7. Percussion helps you establish whether the underlying tissues are...
Partial pressure of oxygen in the alveoli
Air-filled - fluid-filled - or solid
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

8. within limits - increased temperature =
release of O2 from Hb - as heat is a by-product of metabolism.
PaCO2
The amount of air that can be exhaled after expiration
There is an inverse relationship between pressure and volume

9. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
PaCO2
Perfusion
Soft - high-pitched and crisp
35 to 45 mmHg

10. Which lung has a horizontal fissure?
70%
Increased work of breathing
right
Obstruction below the vocal cords (subglottic or tracheal obstruction)

11. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Excessive secretions and abnormal airway collapsibility
Bronchospasm - mucosal edema - or excessive secretions
respiration

12. tidal volume (Vt)
The right middle lobe
Ventilation
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Mouth as well as through the chest wall

13. The best indicator of adequate ventilation is the...
Speed of airflow - the higher the flow - the greater the resistance
PaCO2
A tracing of the lung volume against time in seconds
reduced in size - compared with a normal curve - due to lower lung volume

14. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
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
Alveoli to the blood
Spirometry
Right

15. Airway resistance refers to...
Expiration
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Pressure required to drive air through the airways
The amount of air that can be exhaled after expiration

16. Cyanosis
Blood to the alveoli
Narrowed nearly to the point of closure
Immediate oxygenation with or without intubation
Blue or bluish-gray discoloration of the skin or mucous membranes

17. Normal range of PaCO2
The total amount of air that can be exhaled following a maximal inhalation
Soft - high-pitched and crisp
35 to 45 mmHg
Pneumonia - obstructive lung disease - and late pulmonary edema

18. Pectoriloquy
The examiner can clearly distinguish the word that the pt speak or whispers
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Binding of O2 to Hb
quickly - usually reaching a plateau within 6.0 seconds

19. Examples of restrictive disease
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Increased amounts of unsaturated hemoglobin in capillary blood
Either continuous or discontinuous

20. hypocapnia
Inspiration
Lowered carbon dioxide level - results from hyperventilation
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

21. PaO2
Observing the pattern of breathing
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Mediastinum
Partial pressure of O2 in the arterial blood

22. FEV1/FVC
Obstruction below the vocal cords (subglottic or tracheal obstruction)
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
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
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

23. The trachea divides into right and left mainstem bronchi At what level?
Lowered carbon dioxide level - results from hyperventilation
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
T4 or T5 - and just below the manubrio-sternal joint

24. An efficient approach to examination of the patient begins with
Decreased Hb-O2 affinity
Partial pressure of oxygen in the alveoli
Observing the pattern of breathing
Manubrio-sternal junction (angle of Louis)

25. Stridor is a high-pitched - noisy respiration - Which is indicative of...
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
The gas in the conducting airways does not participate in alveolar exchange
release of O2 from Hb
Upper respiratory obstruction - usually in the trachea or larynx

26. movement of blood through the capillaries in direct communication with the alveoli
Perfusion
T4 or T5 - and just below the manubrio-sternal joint
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Either inspiration or expiration

27. Abnormal lung sounds AKA

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28. Which bronchus is wider - shorter - and more vertically placed?
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Blue or bluish-gray discoloration of the skin or mucous membranes
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Right

29. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Manubrio-sternal junction (angle of Louis)
5 years - to detect obstruction and determine its reversibility
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

30. Spirometry normal range
80 to 120% of predicted value
Carboxyhemoglobin
Air to move from the upper airway to the farthest alveolar reaches
Cough

31. FIO2
Contracts
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Fraction (%age) of inspired oxygen
Blood to the alveoli

32. pH
The amount of air that can be inhaled after normal inspiration
A reduction in lung capacity - secondary to scarring or extraneous material
Pulse oximetry
The negative logarithm of hydrogen ions in the blood

33. Obstructive Disease: Expiratory airflow is reduced more than
Expiratory volume - and there is a prolonged expiratory time
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
80 to 120% of predicted value
Carboxyhemoglobin

34. terminal respiratory unit
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Functional residual capacity (FRC)
Acinus
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

35. Patients with obstructive disease have normal
Pressure required to drive air through the airways
70%
Lung volumes - but find it difficult to exhale rapidly
respiration

36. Restrictive disease refers to...
Overcome some of the problems associated with low blood flow to the probe site
70%
Either inspiration or expiration
A reduction in lung capacity - secondary to scarring or extraneous material

37. Inspiratory stridor indicates
Inspiration
No respiration for > 20 seconds
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Diaphragm - External Intercostals

38. Coarse crackles are heard in
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Increased minute volume ventilation - which results in a lowered carbon dioxide level
There is an inverse relationship between pressure and volume
Pneumonia - obstructive lung disease - and late pulmonary edema

39. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Mouth as well as through the chest wall
No respiration for > 20 seconds
A sensor placed over a translucent area of arterial pulsation
Diffusion

40. Which lobe has an inferior tongue-like projection called the lingula?
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
results in a lower than normal FEV1%
Left upper lobe

41. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
A sensor placed over a translucent area of arterial pulsation
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
No respiration for > 20 seconds

42. PaCO2
Insufficient oxygenation of hemoglobin in the lungs
Either inspiration or expiration
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Partial pressure of CO2 in the arterial blood

43. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Louder - lower-pitched - and slightly longer in duration
Lung volumes - but no difficulty or delay in exhaling what volume they do have
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Manubrio-sternal junction (angle of Louis)

44. Spirometry can be used to determine the severity of functional impairment as well as
Air-filled - fluid-filled - or solid
To assess response to treatment
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Narrowed nearly to the point of closure

45. The trachea bifurcates into its mainstem bronchi at the level of...
Air to move from the upper airway to the farthest alveolar reaches
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Functional residual capacity (FRC)
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

46. Nitroglycerin applied to the probe area has been reported to...
Binding of O2 to Hb
Ventilation
Air bubbles flowing through secretions or slightly closed airways during respiration
Overcome some of the problems associated with low blood flow to the probe site

47. Late inspiratory crackles result from
T4 or T5 - and just below the manubrio-sternal joint
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Decreased Hb-O2 affinity
Inspiration

48. Rhonchi
A sensor placed over a translucent area of arterial pulsation
Diaphragm and the intercostal muscles
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

49. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Functional residual capacity (FRC)
Diaphragm and the intercostal muscles
Ventilation
Ventilation - Diffusion - Perfusion

50. What may prevent cyanosis from appearing?
Acinus
Obstructive lung disease from restrictive lung disease
reduced in size - compared with a normal curve - due to lower lung volume
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration