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Pulmonology

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 movement of air back and forth from the deepest reaches of the alveoli to the outside environment
Total lung capacity (TLC)
respiration
To assess response to treatment
Decreased pressure

2. PaO2
Perfusion
Partial pressure of O2 in the arterial blood
The gas in the conducting airways does not participate in alveolar exchange
Speed of airflow - the higher the flow - the greater the resistance

3. inspiratory reserve
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Partial pressure of carbon dioxide in the alveoli
The amount of air that can be inhaled after normal inspiration

4. Which lobe has an inferior tongue-like projection called the lingula?
Left upper lobe
The amount of air that can be inhaled after normal inspiration
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
The amount of air that can be exhaled after expiration

5. The muscles of inspiration are the...
Diaphragm - External Intercostals
quickly - usually reaching a plateau within 6.0 seconds
The atmospheric pressure
right and left mainstem bronchi

6. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Normal to increased FEV1%
Contracts
Manubrio-sternal junction (angle of Louis)
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

7. Oxygen moves from the...
Alveoli to the blood
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Ventilation
Dyspnea that awakens the patient several hours after going to sleep

8. Rhonchi are due to...
The gas in the conducting airways does not participate in alveolar exchange
Diffusion
Speed of airflow - the higher the flow - the greater the resistance
Excessive secretions and abnormal airway collapsibility

9. Vesicular breath sounds
The rib above it
The negative logarithm of hydrogen ions in the blood
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
Partial pressure of O2 in the arterial blood

10. Tachypnea is an
Hypoventilation or modest changes in the PaO2
'adventitious' breath sounds
Increased rate of breathing and is commonly associated with a decrease in tidal volume
A tracing of the lung volume against time in seconds

11. Continuous lung sounds often audible at the...
Mouth as well as through the chest wall
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
right and left mainstem bronchi

12. Which bronchus is wider - shorter - and more vertically placed?
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Ventilation
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Right

13. At rest - the use of accessory muscles is a sign of...
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Significant pulmonary impairment
Dullness replaces resonance
Oxygen (O2)

14. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
No
Outer surface of each lung
Lowered carbon dioxide level - results from hyperventilation
A sensor placed over a translucent area of arterial pulsation

15. The upper airway accounts For what % of airway resistance?
Right
50%
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
500 to 800 mL

16. Inspiratory stridor indicates
Increased work of breathing
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Binding of O2 to Hb

17. The normal FEV1 /FVC ratio is...
70%
Blue or bluish-gray discoloration of the skin or mucous membranes
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Narrowed nearly to the point of closure

18. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
Altering the respiratory rate and/or the tidal volume
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Louder - lower-pitched - and slightly longer in duration
A good effort

19. Pulmonary ventilation is varied by
Altering the respiratory rate and/or the tidal volume
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Expiratory volume - and there is a prolonged expiratory time
80 to 120% of predicted value

20. dead space ventilation
The gas in the conducting airways does not participate in alveolar exchange
Either inspiration or expiration
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
A sensor placed over a translucent area of arterial pulsation

21. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Inspiration
PaCO2
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Spirometry

22. The vital capacity and the residual volume together constitute the...
Total lung capacity (TLC)
The rib above it
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Diffusion

23. Bohr Effect of pH is graphed as
Oxygen-Hemoglobin Dissociation Curve
reduced in size - compared with a normal curve - due to lower lung volume
PaCO2
'crackles' or 'rales'

24. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
The examiner can clearly distinguish the word that the pt speak or whispers
Increased work of breathing
Ventilation
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

25. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
T4 or T5 - and just below the manubrio-sternal joint
Immediate oxygenation with or without intubation
right
release of O2 from Hb

26. Obstructive Disease: Expiratory airflow is reduced more than
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Expiratory volume - and there is a prolonged expiratory time
Partial pressure of oxygen (PO2)
Hypoventilation or modest changes in the PaO2

27. What may prevent cyanosis from appearing?
Cough
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Diaphragm - External Intercostals
80%

28. Peripheral cyanosis results from
Perfusion
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Air to move from the upper airway to the farthest alveolar reaches
Oxygen (O2)

29. FIO2
Fraction (%age) of inspired oxygen
Dyspnea that awakens the patient several hours after going to sleep
Partial pressure of carbon dioxide in the alveoli
Dullness replaces resonance

30. PAO2
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Hypoventilation or modest changes in the PaO2
Decreased Hb-O2 affinity
Partial pressure of oxygen in the alveoli

31. gas exchange across the alveolar-pulmonary capillary membranes
A reliable and consistent classification of auditory findings
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
10 to 11 cm long and about 2 cm in diameter
Diffusion

32. The trachea divides into right and left mainstem bronchi At what level?
Diffusion
Spirometry
Air bubbles flowing through secretions or slightly closed airways during respiration
T4 or T5 - and just below the manubrio-sternal joint

33. Expiratory stridor indicates
Functional residual capacity (FRC)
Pneumonia - obstructive lung disease - and late pulmonary edema
Either continuous or discontinuous
Obstruction below the vocal cords (subglottic or tracheal obstruction)

34. Airway resistance refers to...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Pressure required to drive air through the airways
Bicarbonate
Increased minute volume ventilation - which results in a lowered carbon dioxide level

35. FEV1% in obstructive disease
Pleural space
'scooped out' or bowl-shaped
results in a lower than normal FEV1%
80%

36. normal subjects expel approximately how much of the FVC in the 1st second?
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
The rib above it
80%

37. The tracheo-bronchial tree is a tubular system that provides a pathway for
10 to 11 cm long and about 2 cm in diameter
Air-filled - fluid-filled - or solid
Air to move from the upper airway to the farthest alveolar reaches
The examiner can clearly distinguish the word that the pt speak or whispers

38. The accessory muscles are the...
Sternocleidomastoid - Scalene Muscles
Cough
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
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

39. Bronchiovesicular breath sounds
10 to 11 cm long and about 2 cm in diameter
The atmospheric pressure
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Air bubbles flowing through secretions or slightly closed airways during respiration

40. Egophony

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41. Patients with restrictive disease have low
There is an inverse relationship between pressure and volume
The right middle lobe
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Wheezes - high-pitched - musical sounds - distinct whistling quality

42. Factors that influence the oxygen carrying capacity of hemoglobin
Total lung capacity (TLC)
Increased amounts of unsaturated hemoglobin in capillary blood
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

43. Bronchophony
right & left
Either continuous or discontinuous
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

44. Auscultation of the chest depends on...
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 reliable and consistent classification of auditory findings
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
quickly - usually reaching a plateau within 6.0 seconds

45. The trachea divides into
right and left mainstem bronchi
Excessive secretions and abnormal airway collapsibility
reduced in size - compared with a normal curve - due to lower lung volume
Observing the pattern of breathing

46. The muscles of expiration are the...
Either inspiration or expiration
Sternocleidomastoid - Scalene Muscles
Significant pulmonary impairment
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

47. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
Either inspiration or expiration
Portable antero-posterior (AP) view
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
right

48. normal adult tidal volume
Fraction (%age) of inspired oxygen
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Immediate oxygenation with or without intubation
500 to 800 mL

49. Which lung has an oblique fissure?
right & left
Right
results in a lower than normal FEV1%
Significant pulmonary impairment

50. What occurs passively as muscles relax?
Binding of O2 to Hb
Expiration
A good effort
Normal to increased FEV1%