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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. The active movement of gases between the ambient air and the lungs
Cough
Ventilation
Nitrogen
Increased Hb-O2 affinity

2. Chest Radiography: The most common chest X-ray series is the...
Carboxyhemoglobin
Postero-anterior (PA) and lateral view series
Expiration
Dyspnea that awakens the patient several hours after going to sleep

3. Bohr Effect of pH is graphed as
To assess response to treatment
Obstructive lung disease from restrictive lung disease
Alveoli to the blood
Oxygen-Hemoglobin Dissociation Curve

4. Continuous lung sounds occur when air flows rapidly through bronchi that are...
A good effort
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Either inspiration or expiration
Narrowed nearly to the point of closure

5. Respiration involves
Mouth as well as through the chest wall
PaCO2
Ventilation - Diffusion - 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

6. The presence of pressure gradients causes respiratory gases to move from
80%
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
No respiration for > 20 seconds
Expiratory volume - and there is a prolonged expiratory time

7. The muscles of expiration are the...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Sternocleidomastoid - Scalene Muscles
2 - each wavelength is partially absorbed by hemoglobin
70%

8. Bronchophony
Perfusion
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
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Outer surface of each lung

9. Oximetry readings of < 94%
Oxygen-Hemoglobin Dissociation Curve
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
No
require supplemental oxygenation and possibly ABG analysis

10. Factors that influence the oxygen carrying capacity of hemoglobin
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Either continuous or discontinuous
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Right

11. The purpose of respiration is to...
release of O2 from Hb
Observing the pattern of breathing
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

12. Tachypnea is an
'adventitious' breath sounds
Right
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Pneumonia - obstructive lung disease - and late pulmonary edema

13. normal adult tidal volume
80%
Pneumonia - obstructive lung disease - and late pulmonary edema
Insufficient oxygenation of hemoglobin in the lungs
500 to 800 mL

14. Paroxysmal nocturnal dyspnea (PND) is...
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Either inspiration or expiration
Dyspnea that awakens the patient several hours after going to sleep
Lung volumes - but no difficulty or delay in exhaling what volume they do have

15. Airway resistance refers to...
A sensor placed over a translucent area of arterial pulsation
Binding of O2 to Hb
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Pressure required to drive air through the airways

16. most important factor that influences the oxygen carrying capacity of hemoglobin
Partial pressure of oxygen (PO2)
Ventilation - Diffusion - Perfusion
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)

17. dead space ventilation
Increased work of breathing
The gas in the conducting airways does not participate in alveolar exchange
35 to 45 mmHg
50%

18. Cyanosis
Pressure required to drive air through the airways
Blue or bluish-gray discoloration of the skin or mucous membranes
Dullness replaces resonance
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

19. 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
Bicarbonate
release of O2 from Hb - as heat is a by-product of metabolism.
Pulse oximetry
70%

20. Discontinuous lung sounds are...
Brief - discrete - non-musical sounds with a popping quality
quickly - usually reaching a plateau within 6.0 seconds
Mediastinum
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

21. Bronchial breath sounds
Left upper lobe
To assess response to treatment
The amount of air that can be inhaled after normal inspiration
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

22. Spirometry is useful in distinguishing
Right
Either inspiration or expiration
Obstructive lung disease from restrictive lung disease
Increased rate of breathing and is commonly associated with a decrease in tidal volume

23. Coarse crackles are heard in
Pneumonia - obstructive lung disease - and late pulmonary edema
Either inspiration or expiration
Either continuous or discontinuous
Sternocleidomastoid - Scalene Muscles

24. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
Larger airways
Contracts
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Saturated with oxygen or unsaturated

25. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Pneumonia - obstructive lung disease - and late pulmonary edema
Functional residual capacity (FRC)
The total amount of air in the lungs at the end of a maximal inhalation
'crackles' or 'rales'

26. the lingula is analogous to...
Acinus
Oxygen (O2)
Carboxyhemoglobin
The right middle lobe

27. Examples of restrictive disease
Left upper lobe
Tongue
A reduction in lung capacity - secondary to scarring or extraneous material
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

28. FIO2
5 years - to detect obstruction and determine its reversibility
Right
Fraction (%age) of inspired oxygen
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

29. Compliance
The right middle lobe
Expiration
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
A reliable and consistent classification of auditory findings

30. With restrictive disease - the flow-volume curve is...
The amount of air that can be inhaled after normal inspiration
The gas in the conducting airways does not participate in alveolar exchange
Spirometry
reduced in size - compared with a normal curve - due to lower lung volume

31. The muscles of inspiration are the...
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Diaphragm - External Intercostals
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

32. Rhonchi
Contracts
Outer surface of each lung
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

33. 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
Pleural space
Normal to increased FEV1%
Soft - high-pitched and crisp

34. movement of blood through the capillaries in direct communication with the alveoli
Partial pressure of carbon dioxide in the alveoli
Total lung capacity (TLC)
Perfusion
Carboxyhemoglobin

35. The best indicator of adequate ventilation is the...
Decreased Hb-O2 affinity
10 to 11 cm long and about 2 cm in diameter
Sternocleidomastoid - Scalene Muscles
PaCO2

36. Which bronchus is wider - shorter - and more vertically placed?
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
Altering the respiratory rate and/or the tidal volume
Right
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

37. Apnea is defined as
No respiration for > 20 seconds
80%
Obstructive lung disease from restrictive lung disease
Significant pulmonary impairment

38. Discontinuous lung sounds are also called

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39. high CO2 = high acidity =
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
release of O2 from Hb
Diffusion

40. The vital capacity and the residual volume together constitute the...
Lung volumes - but find it difficult to exhale rapidly
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Right
Total lung capacity (TLC)

41. What may prevent cyanosis from appearing?
Interstitial diseases or early pulmonary edema
Fraction (%age) of inspired oxygen
The examiner can clearly distinguish the word that the pt speak or whispers
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

42. Pulmonary ventilation is varied by
Altering the respiratory rate and/or the tidal volume
Right
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Sternocleidomastoid - Scalene Muscles

43. Continuous lung sounds occur in the setting of...
Dyspnea that awakens the patient several hours after going to sleep
Bronchospasm - mucosal edema - or excessive secretions
respiration
Wheezes - high-pitched - musical sounds - distinct whistling quality

44. Auscultation of the chest depends on...
A reliable and consistent classification of auditory findings
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

45. Normal range of PaCO2
A reliable and consistent classification of auditory findings
35 to 45 mmHg
Partial pressure of CO2 in the arterial blood
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

46. Orthopnea is quantified by
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
release of O2 from Hb
Air to move from the upper airway to the farthest alveolar reaches
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

47. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Diffusion
Manubrio-sternal junction (angle of Louis)
The total amount of air that can be exhaled following a maximal inhalation
right & left

48. Fine crackles are heard in
Difficulty breathing or shortness of breath
Interstitial diseases or early pulmonary edema
Upper respiratory obstruction - usually in the trachea or larynx
require supplemental oxygenation and possibly ABG analysis

49. normal subjects expel approximately how much of the FVC in the 1st second?
The atmospheric pressure
right and left mainstem bronchi
80%
A sensor placed over a translucent area of arterial pulsation

50. pH
The negative logarithm of hydrogen ions in the blood
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL