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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. Inspiratory stridor becomes evident at about
70% occlusion of the airway
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 amount of air that can be exhaled after expiration
Upper respiratory obstruction - usually in the trachea or larynx

2. Discontinuous lung sounds are...
Brief - discrete - non-musical sounds with a popping quality
Air bubbles flowing through secretions or slightly closed airways during respiration
Speed of airflow - the higher the flow - the greater the resistance
Tongue

3. residual volume
Decreased Hb-O2 affinity
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
Spirometry
The examiner can clearly distinguish the word that the pt speak or whispers

4. An efficient approach to examination of the patient begins with
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Observing the pattern of breathing
Increase the intrathoracic space
Insufficient oxygenation of hemoglobin in the lungs

5. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Overcome some of the problems associated with low blood flow to the probe site
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Inspiration
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

6. forced expiratory volume in one second (FEV1)
Significant pulmonary impairment
respiration
A reduction in lung capacity - secondary to scarring or extraneous material
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

7. FEV1% in restrictive disease
Normal to increased FEV1%
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Significant pulmonary impairment
release of O2 from Hb - as heat is a by-product of metabolism.

8. Abnormal lung sounds AKA

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9. hypocapnia
Lowered carbon dioxide level - results from hyperventilation
Total lung capacity (TLC)
Ventilation
release of O2 from Hb

10. The internal intercostals decrease the transverse diameter of the chest during
Left upper lobe
quickly - usually reaching a plateau within 6.0 seconds
Expiration
Narrowed nearly to the point of closure

11. The external intercostal muscles increase the antero-posterior chest diameter during
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
No
2 - each wavelength is partially absorbed by hemoglobin
Inspiration

12. The main bronchi are divided into smaller branches that begin to subdivide into
No respiration for > 20 seconds
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Nitrogen
Tongue

13. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
Perfusion
Oxygen-Hemoglobin Dissociation Curve
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Manubrio-sternal junction (angle of Louis)

14. Hyperventilation is defined as
Insufficient oxygenation of hemoglobin in the lungs
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Increased minute volume ventilation - which results in a lowered carbon dioxide level
The examiner can clearly distinguish the word that the pt speak or whispers

15. The vital capacity and the residual volume together constitute the...
Total lung capacity (TLC)
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Bicarbonate
Partial pressure of carbon dioxide in the alveoli

16. The primary muscles of respiration are the...
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Cough
Diaphragm and the intercostal muscles
80%

17. 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
Pulse oximetry
The amount of air that can be inhaled after normal inspiration
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
80%

18. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
Outer surface of each lung
T4 or T5 - and just below the manubrio-sternal joint
The atmospheric pressure
Pressure required to drive air through the airways

19. Abnormal lung sounds are classified as
Either continuous or discontinuous
No respiration for > 20 seconds
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Postero-anterior (PA) and lateral view series

20. At rest - the use of accessory muscles is a sign of...
Portable antero-posterior (AP) view
Significant pulmonary impairment
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Obstructive lung disease from restrictive lung disease

21. The spirometry printout usually includes

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22. Bohr Effect of pH: right shift
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Diffusion
Decreased Hb-O2 affinity

23. Restrictive Disease: Expiratory volume is reduced more than
Excessive secretions and abnormal airway collapsibility
A tracing of the lung volume against time in seconds
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Soft - high-pitched and crisp

24. During inspiration the diaphragm
Contracts
'crackles' or 'rales'
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

25. The upper airway accounts For what % of airway resistance?
Blood to the alveoli
'crackles' or 'rales'
50%
Ventilation

26. dead space ventilation
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Partial pressure of oxygen in the alveoli
The gas in the conducting airways does not participate in alveolar exchange
The amount of air that can be exhaled after expiration

27. Expiratory stridor indicates
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Narrowed nearly to the point of closure
Sternocleidomastoid - Scalene Muscles
Inspiration

28. office-based spirometry is recommended for patients as young as
Observing the pattern of breathing
5 years - to detect obstruction and determine its reversibility
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Difficulty breathing or shortness of breath

29. The active movement of gases between the ambient air and the lungs
Ventilation
35 to 45 mmHg
Increased work of breathing
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

30. Which lobe has an inferior tongue-like projection called the lingula?
Increased amounts of unsaturated hemoglobin in capillary blood
T4 or T5 - and just below the manubrio-sternal joint
Brief - discrete - non-musical sounds with a popping quality
Left upper lobe

31. The accessory muscles are the...
Sternocleidomastoid - Scalene Muscles
Inside of the thoracic cavity wall and the upper surface of the diaphragm
80%
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

32. The tracheo-bronchial tree is a tubular system that provides a pathway for
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Larger airways
Air to move from the upper airway to the farthest alveolar reaches
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

33. Which bronchus is more susceptible to aspiration of foreign bodies?
Right
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Bicarbonate
Pneumonia - obstructive lung disease - and late pulmonary edema

34. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Mediastinum
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
Diffusion
Carboxyhemoglobin

35. the lingula is analogous to...
Manubrio-sternal junction (angle of Louis)
Ventilation
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
The right middle lobe

36. Continuous lung sounds occur when air flows rapidly through bronchi that are...
50%
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
right and left mainstem bronchi
Narrowed nearly to the point of closure

37. Cyanosis appears when
The atmospheric pressure
Perfusion
Inspiration
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL

38. high CO2 = high acidity =
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
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
release of O2 from Hb

39. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
Mediastinum
Binding of O2 to Hb
Carboxyhemoglobin
Diaphragm and the intercostal muscles

40. 78.08% Atmospheric Composition
Decreased Hb-O2 affinity
Nitrogen
Normal to increased FEV1%
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL

41. The normal FEV1 /FVC ratio is...
Pulse oximetry
The atmospheric pressure
70%
Partial pressure of carbon dioxide in the alveoli

42. Coarse crackles result from
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Either continuous or discontinuous
Increased amounts of unsaturated hemoglobin in capillary blood
Air bubbles flowing through secretions or slightly closed airways during respiration

43. What may prevent cyanosis from appearing?
Either continuous or discontinuous
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Mediastinum
Perfusion

44. 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
Saturated with oxygen or unsaturated
Air-filled - fluid-filled - or solid
Air bubbles flowing through secretions or slightly closed airways during respiration

45. The visceral pleura lines the...
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Outer surface of each lung
Dullness replaces resonance

46. 20.95% Atmospheric Composition
A good effort
Oxygen (O2)
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
50%

47. Late inspiratory crackles result from
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Right
release of O2 from Hb - as heat is a by-product of metabolism.

48. Inspiratory stridor indicates
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Either inspiration or expiration
The negative logarithm of hydrogen ions in the blood

49. The best indicator of adequate ventilation is the...
5 years - to detect obstruction and determine its reversibility
PaCO2
70%
Either continuous or discontinuous

50. PaCO2
2 - each wavelength is partially absorbed by hemoglobin
Bronchospasm - mucosal edema - or excessive secretions
Partial pressure of CO2 in the arterial blood
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