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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. Normal lung sounds
Bronchospasm - mucosal edema - or excessive secretions
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Saturated with oxygen or unsaturated

2. Spirometry normal range
T4 or T5 - and just below the manubrio-sternal joint
The negative logarithm of hydrogen ions in the blood
Diaphragm and the intercostal muscles
80 to 120% of predicted value

3. Boyle's Gas Law
Speed of airflow - the higher the flow - the greater the resistance
Obstruction below the vocal cords (subglottic or tracheal obstruction)
There is an inverse relationship between pressure and volume
Wheezes - high-pitched - musical sounds - distinct whistling quality

4. PAO2
Insufficient oxygenation of hemoglobin in the lungs
Air-filled - fluid-filled - or solid
Partial pressure of oxygen in the alveoli
Binding of O2 to Hb

5. The trachea bifurcates into its mainstem bronchi at the level of...
Obstructive lung disease from restrictive lung disease
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

6. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
Increased work of breathing
Mouth as well as through the chest wall
A tracing of the lung volume against time in seconds
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

7. PaCO2
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
respiration
Partial pressure of CO2 in the arterial blood
The atmospheric pressure

8. The most reliable site for detecting central cyanosis is the...
Overcome some of the problems associated with low blood flow to the probe site
No respiration for > 20 seconds
Upper respiratory obstruction - usually in the trachea or larynx
Tongue

9. Late inspiratory crackles result from
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
The total amount of air that can be exhaled following a maximal inhalation

10. Expiratory stridor indicates
respiration
Decreased pressure
Obstruction below the vocal cords (subglottic or tracheal obstruction)
PaCO2

11. within limits - increased temperature =
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
release of O2 from Hb - as heat is a by-product of metabolism.
Expiration

12. The main bronchi are divided into smaller branches that begin to subdivide into
Acinus
Air-filled - fluid-filled - or solid
PaCO2
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

13. Tachypnea is an
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Carboxyhemoglobin
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Pleural space

14. At rest - the use of accessory muscles is a sign of...
Portable antero-posterior (AP) view
Significant pulmonary impairment
The total amount of air that can be exhaled following a maximal inhalation
Mediastinum

15. Continuous lung sounds occur when air flows rapidly through bronchi that are...
Narrowed nearly to the point of closure
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Dullness replaces resonance
Perfusion

16. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
The gas in the conducting airways does not participate in alveolar exchange
Mediastinum
Difficulty breathing or shortness of breath
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

17. The best indicator of adequate ventilation is the...
Diffusion
80 to 120% of predicted value
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
PaCO2

18. HCO3
Bicarbonate
Spirometry
The amount of air that can be exhaled after expiration
Larger airways

19. residual volume
Increased Hb-O2 affinity
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
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

20. The pattern of breathing refers to...
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Speed of airflow - the higher the flow - the greater the resistance
Dyspnea that awakens the patient several hours after going to sleep
Pressure required to drive air through the airways

21. The trachea divides into right and left mainstem bronchi At what level?
Saturated with oxygen or unsaturated
Postero-anterior (PA) and lateral view series
T4 or T5 - and just below the manubrio-sternal joint
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

22. The muscles of expiration are the...
Increased Hb-O2 affinity
Partial pressure of O2 in the arterial blood
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Right

23. What may prevent cyanosis from appearing?
Dullness replaces resonance
quickly - usually reaching a plateau within 6.0 seconds
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
The right middle lobe

24. The muscles of inspiration are the...
The total amount of air that can be exhaled following a maximal inhalation
Nitrogen
Diaphragm - External Intercostals
Dyspnea upon assuming a recumbent position

25. Airway resistance refers to...
Fraction (%age) of inspired oxygen
Pressure required to drive air through the airways
Dyspnea upon assuming a recumbent position
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

26. Peripheral cyanosis results from
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Increased Hb-O2 affinity
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
Nitrogen

27. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
The right middle lobe
Immediate oxygenation with or without intubation
Upper respiratory obstruction - usually in the trachea or larynx

28. The accessory muscles are the...
Perfusion
Sternocleidomastoid - Scalene Muscles
Mouth as well as through the chest wall
Louder - lower-pitched - and slightly longer in duration

29. The vital capacity and the residual volume together constitute the...
Lung volumes - but find it difficult to exhale rapidly
Total lung capacity (TLC)
Inspiration
Mediastinum

30. most important factor that influences the oxygen carrying capacity of hemoglobin
Partial pressure of oxygen (PO2)
Tongue
Excessive secretions and abnormal airway collapsibility
Bicarbonate

31. Pulmonary ventilation is varied by
A reliable and consistent classification of auditory findings
Altering the respiratory rate and/or the tidal volume
Expiratory volume - and there is a prolonged expiratory time
Pleural space

32. forced vital capacity (FVC)
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Blood to the alveoli
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Diffusion

33. Inspiratory stridor becomes evident at about
Saturated with oxygen or unsaturated
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
70% occlusion of the airway
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

34. Continuous lung sounds often audible at the...
Interstitial diseases or early pulmonary edema
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Mouth as well as through the chest wall
Perfusion

35. Coarse crackles are...
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Obstructive lung disease from restrictive lung disease
Altering the respiratory rate and/or the tidal volume
Louder - lower-pitched - and slightly longer in duration

36. expiratory reserve
Oxygen-Hemoglobin Dissociation Curve
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
The amount of air that can be exhaled after expiration
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)

37. Orthopnea is quantified by
80%
The right middle lobe
The atmospheric pressure
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

38. FEV1% in restrictive disease
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Normal to increased FEV1%
Pleural space
Postero-anterior (PA) and lateral view series

39. Rhonchi
right
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Obstructive lung disease from restrictive lung disease
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

40. hypocapnia
Pleural space
A reduction in lung capacity - secondary to scarring or extraneous material
Diffusion
Lowered carbon dioxide level - results from hyperventilation

41. Examples of restrictive disease
Right
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

42. FEV1/FVC
Binding of O2 to Hb
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Oxygen (O2)
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

43. What is the potential space between the visceral and parietal pleurae?
Partial pressure of O2 in the arterial blood
Inspiration
right and left mainstem bronchi
Pleural space

44. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Immediate oxygenation with or without intubation
Ventilation
Mediastinum
Inspiration

45. Rhonchi occur during
Cough
Diffusion
Lung volumes - but find it difficult to exhale rapidly
Either inspiration or expiration

46. Which lung has an oblique fissure?
Oxygen (O2)
right & left
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Mediastinum

47. tidal volume (Vt)
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Blue or bluish-gray discoloration of the skin or mucous membranes

48. Bronchial breath sounds
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Larger airways
Expiration

49. Examples of obstructive disease
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Decreased pressure
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Increase the intrathoracic space

50. Oximetry readings of < 94%
Right
Postero-anterior (PA) and lateral view series
'scooped out' or bowl-shaped
require supplemental oxygenation and possibly ABG analysis