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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. Cyanosis appears when
PaCO2
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Diaphragm and the intercostal muscles
Inspiration

2. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Inspiration
The rib above it
Partial pressure of O2 in the arterial blood
Diffusion

3. Cyanosis is caused by
Increased amounts of unsaturated hemoglobin in capillary blood
Outer surface of each lung
70%
Partial pressure of carbon dioxide in the alveoli

4. The purpose of respiration is to...
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Speed of airflow - the higher the flow - the greater the resistance
Partial pressure of oxygen in the alveoli
Dyspnea that awakens the patient several hours after going to sleep

5. Discontinuous lung sounds are also called

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6. Cyanosis
The gas in the conducting airways does not participate in alveolar exchange
Obstructive lung disease from restrictive lung disease
The right middle lobe
Blue or bluish-gray discoloration of the skin or mucous membranes

7. Dyspnea is defined as
Upper respiratory obstruction - usually in the trachea or larynx
Perfusion
Insufficient oxygenation of hemoglobin in the lungs
Difficulty breathing or shortness of breath

8. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
Dullness replaces resonance
A sensor placed over a translucent area of arterial pulsation
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
Inspiration

9. Bronchophony
Decreased Hb-O2 affinity
Either continuous or discontinuous
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
right and left mainstem bronchi

10. At rest - the use of accessory muscles is a sign of...
Decreased Hb-O2 affinity
The total amount of air that can be exhaled following a maximal inhalation
Significant pulmonary impairment
Fraction (%age) of inspired oxygen

11. pain in lung conditions usually arises from
Inflammation of the adjacent parietal pleura
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Narrowed nearly to the point of closure
Portable antero-posterior (AP) view

12. Which bronchus is wider - shorter - and more vertically placed?
Right
Partial pressure of carbon dioxide in the alveoli
A tracing of the lung volume against time in seconds
Observing the pattern of breathing

13. Bronchiovesicular breath sounds
Partial pressure of oxygen (PO2)
Saturated with oxygen or unsaturated
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Mouth as well as through the chest wall

14. Apnea is defined as
No respiration for > 20 seconds
Narrowed nearly to the point of closure
50%
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

15. Restrictive disease refers to...
A reduction in lung capacity - secondary to scarring or extraneous material
Insufficient oxygenation of hemoglobin in the lungs
Either inspiration or expiration
A reliable and consistent classification of auditory findings

16. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Left upper lobe
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Functional residual capacity (FRC)

17. The external intercostal muscles increase the antero-posterior chest diameter during
release of O2 from Hb
The rib above it
Mediastinum
Inspiration

18. Nitroglycerin applied to the probe area has been reported to...
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Overcome some of the problems associated with low blood flow to the probe site
Increased amounts of unsaturated hemoglobin in capillary blood
quickly - usually reaching a plateau within 6.0 seconds

19. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
right & left
quickly - usually reaching a plateau within 6.0 seconds
Manubrio-sternal junction (angle of Louis)
Pulse oximetry

20. Continuous lung sounds occur during...
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Either inspiration or expiration
Manubrio-sternal junction (angle of Louis)
The examiner can clearly distinguish the word that the pt speak or whispers

21. The acini consist of the...
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
PaCO2
Oxygen (O2)
Blue or bluish-gray discoloration of the skin or mucous membranes

22. Pulse Oximetry does not detect
Hypoventilation or modest changes in the PaO2
Air bubbles flowing through secretions or slightly closed airways during respiration
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
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)

23. normal adult tidal volume
70% occlusion of the airway
The examiner can clearly distinguish the word that the pt speak or whispers
500 to 800 mL
80%

24. office-based spirometry is recommended for patients as young as
Diaphragm and the intercostal muscles
Immediate oxygenation with or without intubation
5 years - to detect obstruction and determine its reversibility
Wheezes - high-pitched - musical sounds - distinct whistling quality

25. hypocapnia
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
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
Lowered carbon dioxide level - results from hyperventilation
Spirometry

26. The trachea is how long/wide?
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
10 to 11 cm long and about 2 cm in diameter
right and left mainstem bronchi
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

27. PACO2
Partial pressure of carbon dioxide in the alveoli
Pulse oximetry
Increased amounts of unsaturated hemoglobin in capillary blood
Air-filled - fluid-filled - or solid

28. Rhonchi occur during
A reduction in lung capacity - secondary to scarring or extraneous material
Either inspiration or expiration
Blue or bluish-gray discoloration of the skin or mucous membranes
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

29. PaCO2
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
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
Partial pressure of CO2 in the arterial blood

30. FEV1/FVC
respiration
right and left mainstem bronchi
Carboxyhemoglobin
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

31. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Increased amounts of unsaturated hemoglobin in capillary blood
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Inspiration

32. Fine crackles are heard in
The amount of air that can be exhaled after expiration
Air-filled - fluid-filled - or solid
Upper respiratory obstruction - usually in the trachea or larynx
Interstitial diseases or early pulmonary edema

33. Egophony

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34. Normal lung sounds
Carboxyhemoglobin
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Binding of O2 to Hb
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

35. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Wheezes - high-pitched - musical sounds - distinct whistling quality
Nitrogen
Carboxyhemoglobin
Mouth as well as through the chest wall

36. terminal respiratory unit
Dullness replaces resonance
Spirometry
Acinus
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage

37. 20.95% Atmospheric Composition
Narrowed nearly to the point of closure
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Oxygen (O2)
80 to 120% of predicted value

38. movement of blood through the capillaries in direct communication with the alveoli
Perfusion
Mouth as well as through the chest wall
Postero-anterior (PA) and lateral view series
right and left mainstem bronchi

39. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Air to move from the upper airway to the farthest alveolar reaches
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
respiration
A reliable and consistent classification of auditory findings

40. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
Difficulty breathing or shortness of breath
Increased work of breathing
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
release of O2 from Hb

41. Inspiratory stridor becomes evident at about
results in a lower than normal FEV1%
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
70% occlusion of the airway
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

42. Continuous lung sounds
Perfusion
Difficulty breathing or shortness of breath
Wheezes - high-pitched - musical sounds - distinct whistling quality
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide

43. The trachea divides into
35 to 45 mmHg
Lowered carbon dioxide level - results from hyperventilation
right and left mainstem bronchi
The rib above it

44. Spirometry: The result is stated as
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Right
Tongue

45. vital capacity (VC)
500 to 800 mL
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
The total amount of air that can be exhaled following a maximal inhalation

46. The trachea bifurcates into its mainstem bronchi at the level of...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
right
A sensor placed over a translucent area of arterial pulsation
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

47. Discontinuous lung sounds are...
Brief - discrete - non-musical sounds with a popping quality
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Wheezes - high-pitched - musical sounds - distinct whistling quality

48. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
Diaphragm - External Intercostals
respiration
Difficulty breathing or shortness of breath
Binding of O2 to Hb

49. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
A good effort
Upper respiratory obstruction - usually in the trachea or larynx
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
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

50. Vesicular breath sounds
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
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
Ventilation - Diffusion - Perfusion
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up