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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. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
A reliable and consistent classification of auditory findings
Soft - high-pitched and crisp

2. Discontinuous lung sounds are also called

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3. Patients with restrictive disease have low
Either inspiration or expiration
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
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Partial pressure of oxygen (PO2)

4. Orthopnea is quantified by
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
right and left mainstem bronchi
Lung volumes - but no difficulty or delay in exhaling what volume they do have
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

5. Boyle's Gas Law
Observing the pattern of breathing
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
There is an inverse relationship between pressure and volume

6. The main bronchi are divided into smaller branches that begin to subdivide into
Perfusion
Postero-anterior (PA) and lateral view series
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Speed of airflow - the higher the flow - the greater the resistance

7. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Functional residual capacity (FRC)
'adventitious' breath sounds
Decreased Hb-O2 affinity
Bicarbonate

8. 78.08% Atmospheric Composition
Nitrogen
Soft - high-pitched and crisp
Expiratory volume - and there is a prolonged expiratory time
No

9. The internal intercostals decrease the transverse diameter of the chest during
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 examiner can clearly distinguish the word that the pt speak or whispers
Air bubbles flowing through secretions or slightly closed airways during respiration
Expiration

10. Pulmonary ventilation is varied by
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Altering the respiratory rate and/or the tidal volume
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
2 - each wavelength is partially absorbed by hemoglobin

11. Auscultation of the chest depends on...
A reliable and consistent classification of auditory findings
The total amount of air that can be exhaled following a maximal inhalation
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Functional residual capacity (FRC)

12. 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
Contracts
Tongue
Right

13. Cyanosis appears when
Blue or bluish-gray discoloration of the skin or mucous membranes
Overcome some of the problems associated with low blood flow to the probe site
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Increased rate of breathing and is commonly associated with a decrease in tidal volume

14. Pulse Oximetry does not detect
The total amount of air in the lungs at the end of a maximal inhalation
Partial pressure of CO2 in the arterial blood
Increase the intrathoracic space
Hypoventilation or modest changes in the PaO2

15. The acini consist of the...
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Bicarbonate
2 - each wavelength is partially absorbed by hemoglobin
Diffusion

16. The trachea divides into right and left mainstem bronchi At what level?
T4 or T5 - and just below the manubrio-sternal joint
The amount of air that can be exhaled after expiration
Cough
Interstitial diseases or early pulmonary edema

17. The normal FEV1 /FVC ratio is...
70%
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Carboxyhemoglobin

18. The external intercostal muscles increase the antero-posterior chest diameter during
Inspiration
Normal to increased FEV1%
Upper respiratory obstruction - usually in the trachea or larynx
The negative logarithm of hydrogen ions in the blood

19. The interspace between two ribs (intercostal space) is numbered by
10 to 11 cm long and about 2 cm in diameter
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Pneumonia - obstructive lung disease - and late pulmonary edema
The rib above it

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

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21. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Pneumonia - obstructive lung disease - and late pulmonary edema
Upper respiratory obstruction - usually in the trachea or larynx
Postero-anterior (PA) and lateral view series
No respiration for > 20 seconds

22. vital capacity (VC)
Blood to the alveoli
Increased amounts of unsaturated hemoglobin in capillary blood
Alveoli to the blood
The total amount of air that can be exhaled following a maximal inhalation

23. What may prevent cyanosis from appearing?
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
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
Dyspnea that awakens the patient several hours after going to sleep

24. Compliance
Narrowed nearly to the point of closure
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
quickly - usually reaching a plateau within 6.0 seconds
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

25. Bohr Effect of pH: right shift
70% occlusion of the airway
Decreased Hb-O2 affinity
Sternocleidomastoid - Scalene Muscles
Alveoli to the blood

26. Discontinuous lung sounds are...
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Brief - discrete - non-musical sounds with a popping quality
Larger airways
Overcome some of the problems associated with low blood flow to the probe site

27. PaO2
Either continuous or discontinuous
Contracts
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Partial pressure of O2 in the arterial blood

28. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
The negative logarithm of hydrogen ions in the blood
Inspiration
Partial pressure of CO2 in the arterial blood
Manubrio-sternal junction (angle of Louis)

29. expiratory reserve
The rib above it
The amount of air that can be exhaled after expiration
Upper respiratory obstruction - usually in the trachea or larynx
Inspiration

30. Resistance is dependent upon
Speed of airflow - the higher the flow - the greater the resistance
Inflammation of the adjacent parietal pleura
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Total lung capacity (TLC)

31. Normal range of PaCO2
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Overcome some of the problems associated with low blood flow to the probe site
35 to 45 mmHg
Mediastinum

32. Bohr Effect of pH is graphed as
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Oxygen-Hemoglobin Dissociation Curve
Increased amounts of unsaturated hemoglobin in capillary blood
Dyspnea that awakens the patient several hours after going to sleep

33. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Increased work of breathing
right & left

34. normal adult tidal volume
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
500 to 800 mL
Increased amounts of unsaturated hemoglobin in capillary blood
Carboxyhemoglobin

35. Abnormal lung sounds AKA

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36. Orthopnea is defined as
'scooped out' or bowl-shaped
Dyspnea upon assuming a recumbent position
Increased work of breathing
Functional residual capacity (FRC)

37. residual volume
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
Pulse oximetry
Obstruction below the vocal cords (subglottic or tracheal obstruction)
'adventitious' breath sounds

38. Which lobe has an inferior tongue-like projection called the lingula?
'scooped out' or bowl-shaped
Ventilation - Diffusion - Perfusion
Left upper lobe
The amount of air that can be inhaled after normal inspiration

39. dead space ventilation
Increase the intrathoracic space
The gas in the conducting airways does not participate in alveolar exchange
Increased work of breathing
Either inspiration or expiration

40. Tachypnea is an
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Bronchospasm - mucosal edema - or excessive secretions
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Increased rate of breathing and is commonly associated with a decrease in tidal volume

41. Hyperventilation is defined as
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Difficulty breathing or shortness of breath
release of O2 from Hb - as heat is a by-product of metabolism.
Obstructive lung disease from restrictive lung disease

42. The trachea bifurcates into its mainstem bronchi at the level of...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Partial pressure of O2 in the arterial blood
'crackles' or 'rales'
Either inspiration or expiration

43. FIO2
release of O2 from Hb
Fraction (%age) of inspired oxygen
Partial pressure of carbon dioxide in the alveoli
80 to 120% of predicted value

44. Bronchial breath sounds
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
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
Either continuous or discontinuous
Inflammation of the adjacent parietal pleura

45. low CO2 = low acidity =
Normal to increased FEV1%
35 to 45 mmHg
Outer surface of each lung
Binding of O2 to Hb

46. Abnormal lung sounds are classified as
Either continuous or discontinuous
The total amount of air that can be exhaled following a maximal inhalation
The gas in the conducting airways does not participate in alveolar exchange
The rib above it

47. What occurs passively as muscles relax?
Expiration
Ventilation - Diffusion - Perfusion
Partial pressure of CO2 in the arterial blood
Acinus

48. total lung capacity (TLC)
Oxygen-Hemoglobin Dissociation Curve
The total amount of air in the lungs at the end of a maximal inhalation
PaCO2
Immediate oxygenation with or without intubation

49. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Functional residual capacity (FRC)
Left upper lobe
Spirometry
'adventitious' breath sounds

50. Continuous lung sounds occur when air flows rapidly through bronchi that are...
Narrowed nearly to the point of closure
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Difficulty breathing or shortness of breath
Louder - lower-pitched - and slightly longer in duration