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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. During inspiration the diaphragm
Increase the intrathoracic space
Expiration
Contracts
Hypoventilation or modest changes in the PaO2

2. FEV1% in restrictive disease
Normal to increased FEV1%
Air-filled - fluid-filled - or solid
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

3. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
80%
Manubrio-sternal junction (angle of Louis)
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Lung volumes - but no difficulty or delay in exhaling what volume they do have

4. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
Increased amounts of unsaturated hemoglobin in capillary blood
Inspiration
Decreased Hb-O2 affinity
A good effort

5. What may prevent cyanosis from appearing?
Normal to increased FEV1%
A reliable and consistent classification of auditory findings
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Interstitial diseases or early pulmonary edema

6. Obstructive Disease: Expiratory airflow is reduced more than
Ventilation
Expiratory volume - and there is a prolonged expiratory time
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Diaphragm - External Intercostals

7. Stridor is a high-pitched - noisy respiration - Which is indicative of...
A reduction in lung capacity - secondary to scarring or extraneous material
80%
Speed of airflow - the higher the flow - the greater the resistance
Upper respiratory obstruction - usually in the trachea or larynx

8. Apnea is defined as
Oxygen (O2)
No respiration for > 20 seconds
A sensor placed over a translucent area of arterial pulsation
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

9. The main bronchi are divided into smaller branches that begin to subdivide into
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Increased rate of breathing and is commonly associated with a decrease in tidal volume
T4 or T5 - and just below the manubrio-sternal joint
release of O2 from Hb

10. dead space ventilation
The gas in the conducting airways does not participate in alveolar exchange
Inspiration
Pulse oximetry
Contracts

11. pain in lung conditions usually arises from
Inflammation of the adjacent parietal pleura
Blood to the alveoli
Oxygen (O2)
No

12. terminal respiratory unit
Narrowed nearly to the point of closure
A tracing of the lung volume against time in seconds
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Acinus

13. Rhonchi occur during
Partial pressure of carbon dioxide in the alveoli
Dyspnea that awakens the patient several hours after going to sleep
Carboxyhemoglobin
Either inspiration or expiration

14. forced vital capacity (FVC)
Dullness replaces resonance
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Acinus

15. 20.95% Atmospheric Composition
Oxygen (O2)
2 - each wavelength is partially absorbed by hemoglobin
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Upper respiratory obstruction - usually in the trachea or larynx

16. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
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
Upper respiratory obstruction - usually in the trachea or larynx
Increased work of breathing
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

17. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Increase the intrathoracic space
The gas in the conducting airways does not participate in alveolar exchange
Pressure required to drive air through the airways
The total amount of air in the lungs at the end of a maximal inhalation

18. The primary muscles of respiration are the...
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
Diaphragm and the intercostal muscles
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

19. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
respiration
Lung volumes - but find it difficult to exhale rapidly
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
The examiner can clearly distinguish the word that the pt speak or whispers

20. Pulse Oximetry is dependent on...
Interstitial diseases or early pulmonary edema
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Pneumonia - obstructive lung disease - and late pulmonary edema
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

21. Rhonchi originate in the...
To assess response to treatment
Larger airways
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Contracts

22. PAO2
80%
Partial pressure of oxygen in the alveoli
Manubrio-sternal junction (angle of Louis)
Expiration

23. The accessory muscles are the...
Air to move from the upper airway to the farthest alveolar reaches
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
No
Sternocleidomastoid - Scalene Muscles

24. Bohr Effect of pH is graphed as
Oxygen-Hemoglobin Dissociation Curve
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Saturated with oxygen or unsaturated
2 - each wavelength is partially absorbed by hemoglobin

25. Fine crackles are...
Blue or bluish-gray discoloration of the skin or mucous membranes
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Perfusion
Soft - high-pitched and crisp

26. 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
Total lung capacity (TLC)
Partial pressure of oxygen (PO2)
'scooped out' or bowl-shaped

27. Patients with restrictive disease have low
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Nitrogen
80 to 120% of predicted value
respiration

28. The acini consist of the...
Blue or bluish-gray discoloration of the skin or mucous membranes
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
Pressure required to drive air through the airways
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

29. Spirometry plots
A tracing of the lung volume against time in seconds
2 - each wavelength is partially absorbed by hemoglobin
Right
right

30. Which lung has a horizontal fissure?
Upper respiratory obstruction - usually in the trachea or larynx
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 rib above it
right

31. Coarse crackles result from
Air bubbles flowing through secretions or slightly closed airways during respiration
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
right & left

32. 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
Bicarbonate
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
The amount of air that can be inhaled after normal inspiration

33. normal subjects expel approximately how much of the FVC in the 1st second?
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
80%
Ventilation - Diffusion - Perfusion
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage

34. Bohr Effect of pH: left shift
Lowered carbon dioxide level - results from hyperventilation
Increased Hb-O2 affinity
Pulse oximetry
Altering the respiratory rate and/or the tidal volume

35. The external intercostal muscles increase the antero-posterior chest diameter during
Partial pressure of oxygen in the alveoli
Inspiration
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Perfusion

36. office-based spirometry is recommended for patients as young as
5 years - to detect obstruction and determine its reversibility
Blood to the alveoli
Left upper lobe
The rib above it

37. Abnormal lung sounds are classified as
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Either continuous or discontinuous
Blue or bluish-gray discoloration of the skin or mucous membranes
70%

38. Discontinuous lung sounds are also called

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39. HCO3
Difficulty breathing or shortness of breath
Bicarbonate
There is an inverse relationship between pressure and volume
Left upper lobe

40. residual volume
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
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
Partial pressure of oxygen in the alveoli
Air to move from the upper airway to the farthest alveolar reaches

41. Rhonchi frequently clear after
500 to 800 mL
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Air-filled - fluid-filled - or solid
Cough

42. normal adult tidal volume
Narrowed nearly to the point of closure
Diffusion
Increase the intrathoracic space
500 to 800 mL

43. Continuous lung sounds occur in the setting of...
Diaphragm - External Intercostals
Bronchospasm - mucosal edema - or excessive secretions
2 - each wavelength is partially absorbed by hemoglobin
reduced in size - compared with a normal curve - due to lower lung volume

44. pH
'crackles' or 'rales'
The negative logarithm of hydrogen ions in the blood
The gas in the conducting airways does not participate in alveolar exchange
Manubrio-sternal junction (angle of Louis)

45. Egophony

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46. Continuous lung sounds often audible at the...
reduced in size - compared with a normal curve - due to lower lung volume
Expiration
Spirometry
Mouth as well as through the chest wall

47. The purpose of respiration is to...
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Expiration
'crackles' or 'rales'
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

48. Cyanosis
Air bubbles flowing through secretions or slightly closed airways during respiration
Blue or bluish-gray discoloration of the skin or mucous membranes
Immediate oxygenation with or without intubation
Interstitial diseases or early pulmonary edema

49. Pulse Oximetry does not detect
Right
Hypoventilation or modest changes in the PaO2
right and left mainstem bronchi
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

50. Continuous lung sounds
Wheezes - high-pitched - musical sounds - distinct whistling quality
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Immediate oxygenation with or without intubation
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up