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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. Pulse Oximetry does not detect
Hypoventilation or modest changes in the PaO2
Air to move from the upper airway to the farthest alveolar reaches
Partial pressure of oxygen (PO2)
right

2. The most reliable site for detecting central cyanosis is the...
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
Tongue
Sternocleidomastoid - Scalene Muscles

3. Abnormal lung sounds AKA

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4. low CO2 = low acidity =
Insufficient oxygenation of hemoglobin in the lungs
Increased Hb-O2 affinity
Carboxyhemoglobin
Binding of O2 to Hb

5. Continuous lung sounds occur when air flows rapidly through bronchi that are...
There is an inverse relationship between pressure and volume
Mediastinum
Narrowed nearly to the point of closure
Soft - high-pitched and crisp

6. Resistance is dependent upon
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Speed of airflow - the higher the flow - the greater the resistance
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Nitrogen

7. The primary muscles of respiration are the...
Diaphragm and the intercostal muscles
Spirometry
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Diffusion

8. An efficient approach to examination of the patient begins with
Expiratory volume - and there is a prolonged expiratory time
Observing the pattern of breathing
Increased minute volume ventilation - which results in a lowered carbon dioxide level
right

9. FIO2
Oxygen-Hemoglobin Dissociation Curve
Fraction (%age) of inspired oxygen
Either continuous or discontinuous
2 - each wavelength is partially absorbed by hemoglobin

10. The pattern of breathing refers to...
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
PaCO2
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

11. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
Pulse oximetry
50%
Diaphragm and the intercostal muscles
Perfusion

12. What occurs passively as muscles relax?
There is an inverse relationship between pressure and volume
Diffusion
Expiration
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

13. Restrictive disease refers to...
Portable antero-posterior (AP) view
Oxygen-Hemoglobin Dissociation Curve
A reduction in lung capacity - secondary to scarring or extraneous material
The amount of air that can be exhaled after expiration

14. Inspiratory stridor indicates
Spirometry
Portable antero-posterior (AP) view
Hypoventilation or modest changes in the PaO2
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)

15. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
80 to 120% of predicted value
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
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)

16. Rhonchi frequently clear after
Bronchospasm - mucosal edema - or excessive secretions
Cough
80 to 120% of predicted value
right and left mainstem bronchi

17. FEV1/FVC
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Perfusion
Right
Pulse oximetry

18. Normal lung sounds
Contracts
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Interstitial diseases or early pulmonary edema
Spirometry

19. terminal respiratory unit
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Acinus
Carboxyhemoglobin
Sternocleidomastoid - Scalene Muscles

20. movement of blood through the capillaries in direct communication with the alveoli
Air-filled - fluid-filled - or solid
Perfusion
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
70% occlusion of the airway

21. Hyperventilation is defined as
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Louder - lower-pitched - and slightly longer in duration
The total amount of air that can be exhaled following a maximal inhalation
Expiratory volume - and there is a prolonged expiratory time

22. Apnea is defined as
Alveoli to the blood
80%
No respiration for > 20 seconds
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

23. Abnormal lung sounds are classified as
500 to 800 mL
Either continuous or discontinuous
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

24. forced expiratory volume in one second (FEV1)
A good effort
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
Excessive secretions and abnormal airway collapsibility
Larger airways

25. Cyanosis is caused by
Increased amounts of unsaturated hemoglobin in capillary blood
Partial pressure of CO2 in the arterial blood
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Decreased pressure

26. The active movement of gases between the ambient air and the lungs
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Inflammation of the adjacent parietal pleura
Ventilation
Either inspiration or expiration

27. PaCO2
Air to move from the upper airway to the farthest alveolar reaches
Expiration
Partial pressure of CO2 in the arterial blood
Lowered carbon dioxide level - results from hyperventilation

28. pH
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
Alveoli to the blood
'scooped out' or bowl-shaped
The negative logarithm of hydrogen ions in the blood

29. expiratory reserve
The amount of air that can be exhaled after expiration
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Blood to the alveoli
Upper respiratory obstruction - usually in the trachea or larynx

30. within limits - increased temperature =
Pressure required to drive air through the airways
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
release of O2 from Hb - as heat is a by-product of metabolism.
Fraction (%age) of inspired oxygen

31. HCO3
The atmospheric pressure
Lowered carbon dioxide level - results from hyperventilation
Bicarbonate
Perfusion

32. Inspiratory stridor becomes evident at about
70% occlusion of the airway
A reliable and consistent classification of auditory findings
release of O2 from Hb - as heat is a by-product of metabolism.
Pleural space

33. Cyanosis appears when
The amount of air that can be exhaled after expiration
The total amount of air that can be exhaled following a maximal inhalation
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Contracts

34. Discontinuous lung sounds are...
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
35 to 45 mmHg
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Brief - discrete - non-musical sounds with a popping quality

35. Airway resistance refers to...
To assess response to treatment
Either continuous or discontinuous
Pressure required to drive air through the airways
Expiration

36. The internal intercostals decrease the transverse diameter of the chest during
35 to 45 mmHg
Diffusion
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Expiration

37. Which bronchus is wider - shorter - and more vertically placed?
Significant pulmonary impairment
Partial pressure of carbon dioxide in the alveoli
Right
The total amount of air that can be exhaled following a maximal inhalation

38. Bohr Effect of pH: left shift
Dyspnea that awakens the patient several hours after going to sleep
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Increased Hb-O2 affinity
Partial pressure of carbon dioxide in the alveoli

39. The muscles of inspiration are the...
Diaphragm - External Intercostals
Carboxyhemoglobin
Normal to increased FEV1%
Interstitial diseases or early pulmonary edema

40. Peripheral cyanosis results from
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Excessive secretions and abnormal airway collapsibility
Alveoli to the blood
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

41. Spirometry normal range
Increased amounts of unsaturated hemoglobin in capillary blood
Blood to the alveoli
80 to 120% of predicted value
Bicarbonate

42. What is the potential space between the visceral and parietal pleurae?
80 to 120% of predicted value
Pleural space
10 to 11 cm long and about 2 cm in diameter
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

43. forced vital capacity (FVC)
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Spirometry
Observing the pattern of breathing

44. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
respiration
Increased work of breathing
Pressure required to drive air through the airways
Dullness replaces resonance

45. dead space ventilation
Either inspiration or expiration
The gas in the conducting airways does not participate in alveolar exchange
Pleural space
Postero-anterior (PA) and lateral view series

46. high CO2 = high acidity =
50%
Saturated with oxygen or unsaturated
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
release of O2 from Hb

47. Dyspnea is defined as
Difficulty breathing or shortness of breath
Increase the intrathoracic space
Mouth as well as through the chest wall
Either inspiration or expiration

48. 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
Interstitial diseases or early pulmonary edema
Spirometry
Pulse oximetry
Partial pressure of O2 in the arterial blood

49. Pulse Oximetry is dependent on...
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
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
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
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

50. Bronchial breath sounds
The total amount of air in the lungs at the end of a maximal inhalation
Excessive secretions and abnormal airway collapsibility
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase