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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. Discontinuous lung sounds are...
Brief - discrete - non-musical sounds with a popping quality
Excessive secretions and abnormal airway collapsibility
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Oxygen (O2)

2. Orthopnea is quantified by
Pneumonia - obstructive lung disease - and late pulmonary edema
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
The rib above it
Speed of airflow - the higher the flow - the greater the resistance

3. Does lung tissue have pain fibers?
Altering the respiratory rate and/or the tidal volume
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Binding of O2 to Hb
No

4. Cyanosis appears when
Increased minute volume ventilation - which results in a lowered carbon dioxide level
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
release of O2 from Hb - as heat is a by-product of metabolism.
quickly - usually reaching a plateau within 6.0 seconds

5. PACO2
Partial pressure of carbon dioxide in the alveoli
Bronchospasm - mucosal edema - or excessive secretions
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
results in a lower than normal FEV1%

6. Restrictive Disease: Expiratory volume is reduced more than
Right
Postero-anterior (PA) and lateral view series
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Partial pressure of O2 in the arterial blood

7. Egophony

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8. expiratory reserve
The amount of air that can be exhaled after expiration
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Either inspiration or expiration

9. Restrictive disease refers to...
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Inflammation of the adjacent parietal pleura
10 to 11 cm long and about 2 cm in diameter
A reduction in lung capacity - secondary to scarring or extraneous material

10. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Manubrio-sternal junction (angle of Louis)
Expiratory volume - and there is a prolonged expiratory time
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Inspiration

11. movement of blood through the capillaries in direct communication with the alveoli
The right middle lobe
Perfusion
Alveoli to the blood
Normal to increased FEV1%

12. Auscultation of the chest depends on...
Significant pulmonary impairment
70%
A reliable and consistent classification of auditory findings
Expiratory volume - and there is a prolonged expiratory time

13. The muscles of inspiration are the...
reduced in size - compared with a normal curve - due to lower lung volume
Perfusion
Decreased Hb-O2 affinity
Diaphragm - External Intercostals

14. Carbon dioxide moves from the...
Blood to the alveoli
Expiratory volume - and there is a prolonged expiratory time
Sternocleidomastoid - Scalene Muscles
require supplemental oxygenation and possibly ABG analysis

15. With restrictive disease - the flow-volume curve is...
Air bubbles flowing through secretions or slightly closed airways during respiration
500 to 800 mL
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
reduced in size - compared with a normal curve - due to lower lung volume

16. The pattern of breathing refers to...
Acinus
Hypoventilation or modest changes in the PaO2
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Soft - high-pitched and crisp

17. most important factor that influences the oxygen carrying capacity of hemoglobin
Saturated with oxygen or unsaturated
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Outer surface of each lung
Partial pressure of oxygen (PO2)

18. 78.08% Atmospheric Composition
Total lung capacity (TLC)
Either inspiration or expiration
Manubrio-sternal junction (angle of Louis)
Nitrogen

19. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Carboxyhemoglobin
The total amount of air in the lungs at the end of a maximal inhalation
Observing the pattern of breathing
Perfusion

20. The main bronchi are divided into smaller branches that begin to subdivide into
No respiration for > 20 seconds
Partial pressure of oxygen (PO2)
Pleural space
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

21. At rest - the use of accessory muscles is a sign of...
Dullness replaces resonance
A tracing of the lung volume against time in seconds
Significant pulmonary impairment
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

22. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Larger airways
Diffusion
70% occlusion of the airway
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

23. pain in lung conditions usually arises from
Mouth as well as through the chest wall
Inflammation of the adjacent parietal pleura
Carboxyhemoglobin
The total amount of air that can be exhaled following a maximal inhalation

24. Rhonchi occur during
Brief - discrete - non-musical sounds with a popping quality
Either inspiration or expiration
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Observing the pattern of breathing

25. 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
Obstruction below the vocal cords (subglottic or tracheal obstruction)
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

26. The vital capacity and the residual volume together constitute the...
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Outer surface of each lung
Total lung capacity (TLC)
The amount of air that can be exhaled after expiration

27. forced expiratory volume in one second (FEV1)
Mouth as well as through the chest wall
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
Perfusion
Air-filled - fluid-filled - or solid

28. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
right & left
Air-filled - fluid-filled - or solid
Partial pressure of carbon dioxide in the alveoli
Dullness replaces resonance

29. Obstructive disease refers to...
Oxygen-Hemoglobin Dissociation Curve
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Ventilation
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

30. Vesicular breath sounds
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
Bicarbonate
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Pressure required to drive air through the airways

31. Patients with obstructive disease have normal
Ventilation
Lung volumes - but find it difficult to exhale rapidly
Fraction (%age) of inspired oxygen
Alveoli to the blood

32. 20.95% Atmospheric Composition
80%
Oxygen (O2)
Expiration
Lowered carbon dioxide level - results from hyperventilation

33. Which lung has a horizontal fissure?
release of O2 from Hb - as heat is a by-product of metabolism.
Louder - lower-pitched - and slightly longer in duration
right
Left upper lobe

34. Central cyanosis results from
Insufficient oxygenation of hemoglobin in the lungs
The total amount of air that can be exhaled following a maximal inhalation
50%
Right

35. Rhonchi
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
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
35 to 45 mmHg
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

36. The purpose of respiration is to...
Right
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Functional residual capacity (FRC)

37. Rhonchi originate in the...
Larger airways
Lung volumes - but no difficulty or delay in exhaling what volume they do have
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
PaCO2

38. Bronchiovesicular breath sounds
Decreased pressure
Mouth as well as through the chest wall
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Increased Hb-O2 affinity

39. Spirometry is useful in distinguishing
Lung volumes - but find it difficult to exhale rapidly
Acinus
quickly - usually reaching a plateau within 6.0 seconds
Obstructive lung disease from restrictive lung disease

40. gas exchange across the alveolar-pulmonary capillary membranes
Diffusion
80 to 120% of predicted value
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
The atmospheric pressure

41. Apnea is defined as
No respiration for > 20 seconds
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
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
To assess response to treatment

42. Which lung has an oblique fissure?
right & left
release of O2 from Hb - as heat is a by-product of metabolism.
Difficulty breathing or shortness of breath
Either inspiration or expiration

43. Spirometry normal range
Hypoventilation or modest changes in the PaO2
Inspiration
Acinus
80 to 120% of predicted value

44. Which lobe has an inferior tongue-like projection called the lingula?
Left upper lobe
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
release of O2 from Hb - as heat is a by-product of metabolism.
A reduction in lung capacity - secondary to scarring or extraneous material

45. Examples of obstructive disease
Oxygen (O2)
Total lung capacity (TLC)
Portable antero-posterior (AP) view
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

46. Airway resistance refers to...
Pressure required to drive air through the airways
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
No respiration for > 20 seconds
Ventilation - Diffusion - Perfusion

47. 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
Air to move from the upper airway to the farthest alveolar reaches
Perfusion
Pleural space

48. Nitroglycerin applied to the probe area has been reported to...
Overcome some of the problems associated with low blood flow to the probe site
Pleural space
Inspiration
right

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

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50. Expiratory stridor indicates
Blue or bluish-gray discoloration of the skin or mucous membranes
Obstruction below the vocal cords (subglottic or tracheal obstruction)
respiration
Air to move from the upper airway to the farthest alveolar reaches