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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. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Soft - high-pitched and crisp
Left upper lobe
Upper respiratory obstruction - usually in the trachea or larynx
Spirometry

2. Paroxysmal nocturnal dyspnea (PND) is...
5 years - to detect obstruction and determine its reversibility
Dyspnea that awakens the patient several hours after going to sleep
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
Observing the pattern of breathing

3. inspiratory reserve
The amount of air that can be inhaled after normal inspiration
'adventitious' breath sounds
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Bicarbonate

4. Abnormal lung sounds AKA

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5. terminal respiratory unit
There is an inverse relationship between pressure and volume
Acinus
Upper respiratory obstruction - usually in the trachea or larynx
Expiration

6. Compliance
Increased Hb-O2 affinity
require supplemental oxygenation and possibly ABG analysis
Functional residual capacity (FRC)
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

7. Pulmonary ventilation is varied by
The amount of air that can be inhaled after normal inspiration
Right
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Altering the respiratory rate and/or the tidal volume

8. The active movement of gases between the ambient air and the lungs
Ventilation
Functional residual capacity (FRC)
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Increased rate of breathing and is commonly associated with a decrease in tidal volume

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

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10. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Larger airways
Cough
A sensor placed over a translucent area of arterial pulsation
Inspiration

11. Coarse crackles result from
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Functional residual capacity (FRC)
Air bubbles flowing through secretions or slightly closed airways during respiration
Upper respiratory obstruction - usually in the trachea or larynx

12. The pattern of breathing refers to...
Either continuous or discontinuous
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Expiration
A tracing of the lung volume against time in seconds

13. Late inspiratory crackles result from
Bronchospasm - mucosal edema - or excessive secretions
Acinus
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Expiratory volume - and there is a prolonged expiratory time

14. increased volume results in
Decreased pressure
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Increased Hb-O2 affinity

15. Factors that influence the oxygen carrying capacity of hemoglobin
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
Significant pulmonary impairment

16. HCO3
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Bicarbonate
5 years - to detect obstruction and determine its reversibility
Partial pressure of CO2 in the arterial blood

17. The presence of pressure gradients causes respiratory gases to move from
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
Ventilation - Diffusion - Perfusion
Saturated with oxygen or unsaturated
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

18. Bronchiovesicular breath sounds
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
The atmospheric pressure
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

19. The best indicator of adequate ventilation is the...
PaCO2
No
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Air to move from the upper airway to the farthest alveolar reaches

20. within limits - increased temperature =
release of O2 from Hb - as heat is a by-product of metabolism.
Partial pressure of oxygen in the alveoli
Expiration
Increased Hb-O2 affinity

21. Chest Radiography: The most common chest X-ray series is the...
Air bubbles flowing through secretions or slightly closed airways during respiration
Postero-anterior (PA) and lateral view series
Sternocleidomastoid - Scalene Muscles
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

22. Inspiratory stridor indicates
'adventitious' breath sounds
Increased amounts of unsaturated hemoglobin in capillary blood
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Air to move from the upper airway to the farthest alveolar reaches

23. The accessory muscles are the...
Sternocleidomastoid - Scalene Muscles
Speed of airflow - the higher the flow - the greater the resistance
Lung volumes - but find it difficult to exhale rapidly
The negative logarithm of hydrogen ions in the blood

24. the lingula is analogous to...
5 years - to detect obstruction and determine its reversibility
Ventilation
The right middle lobe
2 - each wavelength is partially absorbed by hemoglobin

25. The spirometry printout usually includes

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26. The muscles of expiration are the...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Upper respiratory obstruction - usually in the trachea or larynx
Pleural space
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

27. hypocapnia
Excessive secretions and abnormal airway collapsibility
Outer surface of each lung
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Lowered carbon dioxide level - results from hyperventilation

28. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
Significant pulmonary impairment
A reliable and consistent classification of auditory findings
A good effort
Increase the intrathoracic space

29. Coarse crackles are heard in
Pneumonia - obstructive lung disease - and late pulmonary edema
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
respiration
Increased work of breathing

30. Spirometry can be used to determine the severity of functional impairment as well as
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
To assess response to treatment
Partial pressure of carbon dioxide in the alveoli
70% occlusion of the airway

31. The tracheo-bronchial tree is a tubular system that provides a pathway for
Tongue
Bicarbonate
Air to move from the upper airway to the farthest alveolar reaches
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)

32. Pulse Oximetry does not detect
Outer surface of each lung
Oxygen-Hemoglobin Dissociation Curve
The examiner can clearly distinguish the word that the pt speak or whispers
Hypoventilation or modest changes in the PaO2

33. An efficient approach to examination of the patient begins with
T4 or T5 - and just below the manubrio-sternal joint
Observing the pattern of breathing
Inside of the thoracic cavity wall and the upper surface of the diaphragm
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

34. Fine crackles are...
Partial pressure of oxygen in the alveoli
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Soft - high-pitched and crisp
Left upper lobe

35. low CO2 = low acidity =
Air to move from the upper airway to the farthest alveolar reaches
80 to 120% of predicted value
Binding of O2 to Hb
Observing the pattern of breathing

36. The visceral pleura lines the...
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
70% occlusion of the airway
The total amount of air that can be exhaled following a maximal inhalation
Outer surface of each lung

37. Hyperventilation is defined as
Increased minute volume ventilation - which results in a lowered carbon dioxide level
A reduction in lung capacity - secondary to scarring or extraneous material
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

38. Which bronchus is more susceptible to aspiration of foreign bodies?
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Right
The examiner can clearly distinguish the word that the pt speak or whispers
Dyspnea upon assuming a recumbent position

39. Expiratory stridor indicates
Pleural space
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
The amount of air that can be exhaled after expiration
Obstruction below the vocal cords (subglottic or tracheal obstruction)

40. Bohr Effect of pH: left shift
50%
right
Increased Hb-O2 affinity
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

41. Bronchophony
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
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
Increase the intrathoracic space

42. Rhonchi frequently clear after
Significant pulmonary impairment
Cough
No respiration for > 20 seconds
Partial pressure of CO2 in the arterial blood

43. Pulse Oximetry is dependent on...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Increased Hb-O2 affinity
Decreased Hb-O2 affinity
Manubrio-sternal junction (angle of Louis)

44. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Outer surface of each lung
Either continuous or discontinuous

45. Normal range of PaCO2
Mediastinum
The right middle lobe
35 to 45 mmHg
Acinus

46. The internal intercostals decrease the transverse diameter of the chest during
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Pneumonia - obstructive lung disease - and late pulmonary edema
Expiration
Wheezes - high-pitched - musical sounds - distinct whistling quality

47. Fine crackles are heard in
Perfusion
Interstitial diseases or early pulmonary edema
Bronchospasm - mucosal edema - or excessive secretions
Dyspnea upon assuming a recumbent position

48. Oxygen moves from the...
Dullness replaces resonance
Alveoli to the blood
35 to 45 mmHg
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

49. Spirometry plots
Bronchospasm - mucosal edema - or excessive secretions
A tracing of the lung volume against time in seconds
Altering the respiratory rate and/or the tidal volume
The total amount of air that can be exhaled following a maximal inhalation

50. Peripheral cyanosis results from
5 years - to detect obstruction and determine its reversibility
Right
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
35 to 45 mmHg