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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. An efficient approach to examination of the patient begins with
The negative logarithm of hydrogen ions in the blood
Observing the pattern of breathing
Blue or bluish-gray discoloration of the skin or mucous membranes
Increased minute volume ventilation - which results in a lowered carbon dioxide level

2. Oximetry readings of < 94%
Mouth as well as through the chest wall
Increased Hb-O2 affinity
70% occlusion of the airway
require supplemental oxygenation and possibly ABG analysis

3. Inspiratory stridor becomes evident at about
The amount of air that can be exhaled after expiration
70% occlusion of the airway
quickly - usually reaching a plateau within 6.0 seconds
Excessive secretions and abnormal airway collapsibility

4. low CO2 = low acidity =
Binding of O2 to Hb
Inflammation of the adjacent parietal pleura
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Partial pressure of carbon dioxide in the alveoli

5. the lingula is analogous to...
Difficulty breathing or shortness of breath
Saturated with oxygen or unsaturated
Decreased Hb-O2 affinity
The right middle lobe

6. A normal volume-time curve rises
quickly - usually reaching a plateau within 6.0 seconds
A reduction in lung capacity - secondary to scarring or extraneous material
Left upper lobe
The gas in the conducting airways does not participate in alveolar exchange

7. Central cyanosis results from
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Pulse oximetry
Tongue
Insufficient oxygenation of hemoglobin in the lungs

8. Airway resistance refers to...
Fraction (%age) of inspired oxygen
Increased amounts of unsaturated hemoglobin in capillary blood
Pressure required to drive air through the airways
Postero-anterior (PA) and lateral view series

9. The trachea bifurcates into its mainstem bronchi at the level of...
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Spirometry
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Fraction (%age) of inspired oxygen

10. Examples of restrictive disease
The amount of air that can be exhaled after expiration
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
50%
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

11. pain in lung conditions usually arises from
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
70%
Inflammation of the adjacent parietal pleura

12. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
The total amount of air that can be exhaled following a maximal inhalation
Inspiration
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Carboxyhemoglobin

13. terminal respiratory unit
Manubrio-sternal junction (angle of Louis)
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Acinus
right & left

14. Cyanosis appears when
Lowered carbon dioxide level - results from hyperventilation
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Difficulty breathing or shortness of breath
50%

15. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Blood to the alveoli
Spirometry
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Saturated with oxygen or unsaturated

16. Coarse crackles are heard in
Increased work of breathing
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Pneumonia - obstructive lung disease - and late pulmonary edema
Decreased pressure

17. Bohr Effect of pH is graphed as
Oxygen-Hemoglobin Dissociation Curve
Immediate oxygenation with or without intubation
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Tongue

18. Egophony

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19. Spirometry is useful in distinguishing
Cough
Obstructive lung disease from restrictive lung disease
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
'adventitious' breath sounds

20. Rhonchi frequently clear after
Larger airways
Cough
Total lung capacity (TLC)
T4 or T5 - and just below the manubrio-sternal joint

21. Stridor is a high-pitched - noisy respiration - Which is indicative of...
A reduction in lung capacity - secondary to scarring or extraneous material
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
Upper respiratory obstruction - usually in the trachea or larynx

22. The parietal pleura lines the...
Wheezes - high-pitched - musical sounds - distinct whistling quality
Ventilation - Diffusion - Perfusion
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

23. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Obstructive lung disease from restrictive lung disease
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
2 - each wavelength is partially absorbed by hemoglobin
Portable antero-posterior (AP) view

24. The upper airway accounts For what % of airway resistance?
respiration
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
50%

25. forced vital capacity (FVC)
The right middle lobe
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
35 to 45 mmHg
Immediate oxygenation with or without intubation

26. FEV1/FVC
Dullness replaces resonance
results in a lower than normal FEV1%
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

27. Continuous lung sounds occur in the setting of...
Right
Bronchospasm - mucosal edema - or excessive secretions
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Narrowed nearly to the point of closure

28. Restrictive disease refers to...
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
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
A reduction in lung capacity - secondary to scarring or extraneous material

29. PACO2
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Partial pressure of carbon dioxide in the alveoli
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

30. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
Pneumonia - obstructive lung disease - and late pulmonary edema
Perfusion
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
Obstruction below the vocal cords (subglottic or tracheal obstruction)

31. Percussion helps you establish whether the underlying tissues are...
Increase the intrathoracic space
Air-filled - fluid-filled - or solid
PaCO2
Air to move from the upper airway to the farthest alveolar reaches

32. Late inspiratory crackles result from
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
There is an inverse relationship between pressure and volume
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

33. Spirometry can be used to determine the severity of functional impairment as well as
To assess response to treatment
Lung volumes - but find it difficult to exhale rapidly
Functional residual capacity (FRC)
quickly - usually reaching a plateau within 6.0 seconds

34. normal adult tidal volume
Total lung capacity (TLC)
500 to 800 mL
Mediastinum
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

35. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
right
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
2 - each wavelength is partially absorbed by hemoglobin

36. 20.95% Atmospheric Composition
Oxygen (O2)
Right
The right middle lobe
Tongue

37. Hyperventilation is defined as
The total amount of air in the lungs at the end of a maximal inhalation
Diffusion
Expiration
Increased minute volume ventilation - which results in a lowered carbon dioxide level

38. The visceral pleura lines the...
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Observing the pattern of breathing
Partial pressure of O2 in the arterial blood
Outer surface of each lung

39. PAO2
reduced in size - compared with a normal curve - due to lower lung volume
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
50%
Partial pressure of oxygen in the alveoli

40. What may prevent cyanosis from appearing?
right & left
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

41. Tachypnea is an
Increased rate of breathing and is commonly associated with a decrease in tidal volume
right
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Binding of O2 to Hb

42. Nitroglycerin applied to the probe area has been reported to...
Either continuous or discontinuous
Overcome some of the problems associated with low blood flow to the probe site
Pulse oximetry
Wheezes - high-pitched - musical sounds - distinct whistling quality

43. dead space ventilation
Immediate oxygenation with or without intubation
Air to move from the upper airway to the farthest alveolar reaches
The gas in the conducting airways does not participate in alveolar exchange
Postero-anterior (PA) and lateral view series

44. Abnormal lung sounds AKA

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45. hypocapnia
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
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Lowered carbon dioxide level - results from hyperventilation
Blood to the alveoli

46. Does lung tissue have pain fibers?
Increased rate of breathing and is commonly associated with a decrease in tidal volume
A tracing of the lung volume against time in seconds
The negative logarithm of hydrogen ions in the blood
No

47. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
Mediastinum
Partial pressure of O2 in the arterial blood
Fraction (%age) of inspired oxygen
Altering the respiratory rate and/or the tidal volume

48. The presence of pressure gradients causes respiratory gases to move from
Left upper lobe
results in a lower than normal FEV1%
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Narrowed nearly to the point of closure

49. The best indicator of adequate ventilation is the...
Portable antero-posterior (AP) view
Decreased pressure
PaCO2
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

50. Coarse crackles result from
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
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 bubbles flowing through secretions or slightly closed airways during respiration
Increased Hb-O2 affinity