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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. office-based spirometry is recommended for patients as young as
Carboxyhemoglobin
right
5 years - to detect obstruction and determine its reversibility
Increased amounts of unsaturated hemoglobin in capillary blood

2. Which bronchus is wider - shorter - and more vertically placed?
Saturated with oxygen or unsaturated
Right
Increase the intrathoracic space
Expiration

3. vital capacity (VC)
The total amount of air that can be exhaled following a maximal inhalation
A reduction in lung capacity - secondary to scarring or extraneous material
Inspiration
A sensor placed over a translucent area of arterial pulsation

4. The primary muscles of respiration are the...
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Blood to the alveoli
Diaphragm and the intercostal muscles
Overcome some of the problems associated with low blood flow to the probe site

5. Continuous lung sounds
Larger airways
To assess response to treatment
Wheezes - high-pitched - musical sounds - distinct whistling quality
Diaphragm - External Intercostals

6. FEV1/FVC
Mediastinum
Immediate oxygenation with or without intubation
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
respiration

7. Boyle's Gas Law
Acinus
Soft - high-pitched and crisp
There is an inverse relationship between pressure and volume
Carboxyhemoglobin

8. Bohr Effect of pH: right shift
Decreased Hb-O2 affinity
Right
80%
Wheezes - high-pitched - musical sounds - distinct whistling quality

9. The muscles of inspiration are the...
Diaphragm - External Intercostals
Either inspiration or expiration
right and left mainstem bronchi
2 - each wavelength is partially absorbed by hemoglobin

10. The active movement of gases between the ambient air and the lungs
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Ventilation
The right middle lobe
Air bubbles flowing through secretions or slightly closed airways during respiration

11. Rhonchi originate in the...
Larger airways
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
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Lung volumes - but find it difficult to exhale rapidly

12. Spirometry can be used to determine the severity of functional impairment as well as
To assess response to treatment
Dyspnea upon assuming a recumbent position
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
release of O2 from Hb - as heat is a by-product of metabolism.

13. Which lung has an oblique fissure?
Hypoventilation or modest changes in the PaO2
right & left
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Partial pressure of O2 in the arterial blood

14. 20.95% Atmospheric Composition
80 to 120% of predicted value
Oxygen (O2)
Significant pulmonary impairment
Bicarbonate

15. Percussion helps you establish whether the underlying tissues are...
quickly - usually reaching a plateau within 6.0 seconds
Air-filled - fluid-filled - or solid
To assess response to treatment
Pressure required to drive air through the airways

16. tidal volume (Vt)
Postero-anterior (PA) and lateral view series
Brief - discrete - non-musical sounds with a popping quality
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Inside of the thoracic cavity wall and the upper surface of the diaphragm

17. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
Interstitial diseases or early pulmonary edema
Expiration
Pneumonia - obstructive lung disease - and late pulmonary edema
Portable antero-posterior (AP) view

18. The external intercostal muscles increase the antero-posterior chest diameter during
Inspiration
Air bubbles flowing through secretions or slightly closed airways during respiration
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval

19. Coarse crackles result from
Decreased pressure
Air bubbles flowing through secretions or slightly closed airways during respiration
Either inspiration or expiration
The negative logarithm of hydrogen ions in the blood

20. Restrictive Disease: Expiratory volume is reduced more than
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Carboxyhemoglobin
Normal to increased FEV1%
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

21. forced expiratory volume in one second (FEV1)
Pleural space
Pneumonia - obstructive lung disease - and late pulmonary edema
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
Expiration

22. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
35 to 45 mmHg
Alveoli to the blood
2 - each wavelength is partially absorbed by hemoglobin
Total lung capacity (TLC)

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

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24. Peripheral cyanosis results from
Oxygen (O2)
Ventilation
There is an inverse relationship between pressure and volume
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

25. Stridor is a high-pitched - noisy respiration - Which is indicative of...
The amount of air that can be exhaled after expiration
Upper respiratory obstruction - usually in the trachea or larynx
Inside of the thoracic cavity wall and the upper surface of the diaphragm
80%

26. Paroxysmal nocturnal dyspnea (PND) is...
Dyspnea that awakens the patient several hours after going to sleep
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
results in a lower than normal FEV1%
T4 or T5 - and just below the manubrio-sternal joint

27. The normal FEV1 /FVC ratio is...
70%
Left upper lobe
results in a lower than normal FEV1%
Immediate oxygenation with or without intubation

28. pH
Dyspnea upon assuming a recumbent position
The negative logarithm of hydrogen ions in the blood
Immediate oxygenation with or without intubation
Ventilation

29. The visceral pleura lines the...
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Outer surface of each lung
Air to move from the upper airway to the farthest alveolar reaches
Partial pressure of O2 in the arterial blood

30. Orthopnea is quantified by
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Perfusion
results in a lower than normal FEV1%
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

31. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
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
Partial pressure of oxygen in the alveoli
Increased work of breathing
Increased rate of breathing and is commonly associated with a decrease in tidal volume

32. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
Acinus
respiration
Diffusion
A reduction in lung capacity - secondary to scarring or extraneous material

33. pain in lung conditions usually arises from
Inflammation of the adjacent parietal pleura
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Increase the intrathoracic space
Outer surface of each lung

34. normal adult tidal volume
The rib above it
500 to 800 mL
The atmospheric pressure
Tongue

35. Which lung has a horizontal fissure?
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
T4 or T5 - and just below the manubrio-sternal joint
right
70% occlusion of the airway

36. dead space ventilation
Expiration
The gas in the conducting airways does not participate in alveolar exchange
Carboxyhemoglobin
right & left

37. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Alveoli to the blood
Saturated with oxygen or unsaturated
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

38. Examples of restrictive disease
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Right
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Expiratory volume - and there is a prolonged expiratory time

39. Orthopnea is defined as
The total amount of air that can be exhaled following a maximal inhalation
quickly - usually reaching a plateau within 6.0 seconds
Right
Dyspnea upon assuming a recumbent position

40. Obstructive disease refers to...
A reduction in lung capacity - secondary to scarring or extraneous material
results in a lower than normal FEV1%
reduced in size - compared with a normal curve - due to lower lung volume
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage

41. Pulse Oximetry is dependent on...
70%
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Perfusion
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

42. low CO2 = low acidity =
A reduction in lung capacity - secondary to scarring or extraneous material
A reliable and consistent classification of auditory findings
Binding of O2 to Hb
Air bubbles flowing through secretions or slightly closed airways during respiration

43. An efficient approach to examination of the patient begins with
500 to 800 mL
Observing the pattern of breathing
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
Significant pulmonary impairment

44. Bronchiovesicular breath sounds
10 to 11 cm long and about 2 cm in diameter
Lowered carbon dioxide level - results from hyperventilation
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Oxygen (O2)

45. Bohr Effect of pH: left shift
The negative logarithm of hydrogen ions in the blood
T4 or T5 - and just below the manubrio-sternal joint
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Increased Hb-O2 affinity

46. What may prevent cyanosis from appearing?
Bronchospasm - mucosal edema - or excessive secretions
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
A sensor placed over a translucent area of arterial pulsation
Acinus

47. Bronchial breath sounds
Partial pressure of oxygen in the alveoli
quickly - usually reaching a plateau within 6.0 seconds
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

48. The pattern of breathing refers to...
Outer surface of each lung
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Manubrio-sternal junction (angle of Louis)
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

49. Spirometry: The result is stated as
Obstructive lung disease from restrictive lung disease
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Blue or bluish-gray discoloration of the skin or mucous membranes

50. Inspiratory stridor becomes evident at about
A reliable and consistent classification of auditory findings
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
70% occlusion of the airway