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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. Oxygen moves from the...
The amount of air that can be inhaled after normal inspiration
Alveoli to the blood
Mediastinum
'adventitious' breath sounds

2. Rhonchi
Oxygen (O2)
Expiration
Inspiration
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

3. Bronchial breath sounds
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Decreased Hb-O2 affinity
Inspiration
Increased amounts of unsaturated hemoglobin in capillary blood

4. Vesicular breath sounds
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Bronchospasm - mucosal edema - or excessive secretions
Expiration
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

5. Hyperventilation is defined as
Speed of airflow - the higher the flow - the greater the resistance
Diffusion
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Increased minute volume ventilation - which results in a lowered carbon dioxide level

6. increased volume results in
Decreased pressure
release of O2 from Hb - as heat is a by-product of metabolism.
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
A good effort

7. inspiratory reserve
The amount of air that can be inhaled after normal inspiration
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
Diaphragm and the intercostal muscles

8. Spirometry: The result is stated as
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
There is an inverse relationship between pressure and volume
Louder - lower-pitched - and slightly longer in duration
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

9. 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
Pneumonia - obstructive lung disease - and late pulmonary edema
Tongue
Hypoventilation or modest changes in the PaO2

10. Central cyanosis results from
The total amount of air in the lungs at the end of a maximal inhalation
Insufficient oxygenation of hemoglobin in the lungs
Perfusion
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

11. Cyanosis is caused by
Increased amounts of unsaturated hemoglobin in capillary blood
Either continuous or discontinuous
Left upper lobe
70%

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

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13. Spirometry is useful in distinguishing
right
Obstructive lung disease from restrictive lung disease
Increased amounts of unsaturated hemoglobin in capillary blood
The amount of air that can be inhaled after normal inspiration

14. PACO2
Partial pressure of carbon dioxide in the alveoli
Perfusion
Either inspiration or expiration
No respiration for > 20 seconds

15. Rhonchi frequently clear after
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
5 years - to detect obstruction and determine its reversibility
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Cough

16. The muscles of inspiration are the...
Ventilation
Diaphragm - External Intercostals
Narrowed nearly to the point of closure
70%

17. Pulse Oximetry is dependent on...
Alveoli to the blood
A reduction in lung capacity - secondary to scarring or extraneous material
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

18. Patients with obstructive disease have normal
500 to 800 mL
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Lung volumes - but find it difficult to exhale rapidly
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

19. Continuous lung sounds often audible at the...
Mouth as well as through the chest wall
Narrowed nearly to the point of closure
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Binding of O2 to Hb

20. Pectoriloquy
Lung volumes - but find it difficult to exhale rapidly
The examiner can clearly distinguish the word that the pt speak or whispers
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Inside of the thoracic cavity wall and the upper surface of the diaphragm

21. Abnormal lung sounds are classified as
Either continuous or discontinuous
Expiration
Bronchospasm - mucosal edema - or excessive secretions
The total amount of air in the lungs at the end of a maximal inhalation

22. within limits - increased temperature =
Obstructive lung disease from restrictive lung disease
The examiner can clearly distinguish the word that the pt speak or whispers
Air-filled - fluid-filled - or solid
release of O2 from Hb - as heat is a by-product of metabolism.

23. most important factor that influences the oxygen carrying capacity of hemoglobin
Lowered carbon dioxide level - results from hyperventilation
No
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
Partial pressure of oxygen (PO2)

24. Discontinuous lung sounds are also called

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25. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
release of O2 from Hb - as heat is a by-product of metabolism.
The examiner can clearly distinguish the word that the pt speak or whispers
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Mediastinum

26. Orthopnea is quantified by
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
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
Air to move from the upper airway to the farthest alveolar reaches

27. The visceral pleura lines the...
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Outer surface of each lung
Right
Binding of O2 to Hb

28. Inspiratory stridor indicates
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
right & left
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

29. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
T4 or T5 - and just below the manubrio-sternal joint
Spirometry
Louder - lower-pitched - and slightly longer in duration
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

30. FEV1/FVC
The total amount of air in the lungs at the end of a maximal inhalation
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
The right middle lobe
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

31. The normal FEV1 /FVC ratio is...
Pleural space
right
Inside of the thoracic cavity wall and the upper surface of the diaphragm
70%

32. hypocapnia
Lowered carbon dioxide level - results from hyperventilation
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Obstructive lung disease from restrictive lung disease
Increase the intrathoracic space

33. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Total lung capacity (TLC)
Dullness replaces resonance
Functional residual capacity (FRC)
Obstruction below the vocal cords (subglottic or tracheal obstruction)

34. What occurs passively as muscles relax?
No
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
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
Expiration

35. forced expiratory volume in one second (FEV1)
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
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
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
The total amount of air in the lungs at the end of a maximal inhalation

36. The trachea is how long/wide?
10 to 11 cm long and about 2 cm in diameter
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Diffusion
Partial pressure of O2 in the arterial blood

37. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Bicarbonate
Carboxyhemoglobin
Expiration
Altering the respiratory rate and/or the tidal volume

38. A normal volume-time curve rises
Pulse oximetry
quickly - usually reaching a plateau within 6.0 seconds
Dullness replaces resonance
70%

39. pain in lung conditions usually arises from
Tongue
Speed of airflow - the higher the flow - the greater the resistance
Excessive secretions and abnormal airway collapsibility
Inflammation of the adjacent parietal pleura

40. Carbon dioxide moves from the...
Increased Hb-O2 affinity
Nitrogen
Blood to the alveoli
Hypoventilation or modest changes in the PaO2

41. Continuous lung sounds occur during...
'scooped out' or bowl-shaped
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Either inspiration or expiration
The gas in the conducting airways does not participate in alveolar exchange

42. The presence of pressure gradients causes respiratory gases to move from
Air-filled - fluid-filled - or solid
5 years - to detect obstruction and determine its reversibility
Oxygen (O2)
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

43. Chest Radiography: The most common chest X-ray series is the...
Postero-anterior (PA) and lateral view series
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Mediastinum
To assess response to treatment

44. low CO2 = low acidity =
Sternocleidomastoid - Scalene Muscles
Binding of O2 to Hb
2 - each wavelength is partially absorbed by hemoglobin
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

45. office-based spirometry is recommended for patients as young as
Ventilation
5 years - to detect obstruction and determine its reversibility
Difficulty breathing or shortness of breath
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

46. Expiratory stridor indicates
80 to 120% of predicted value
To assess response to treatment
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Obstruction below the vocal cords (subglottic or tracheal obstruction)

47. Normal range of PaCO2
Pneumonia - obstructive lung disease - and late pulmonary edema
Spirometry
35 to 45 mmHg
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

48. movement of blood through the capillaries in direct communication with the alveoli
Upper respiratory obstruction - usually in the trachea or larynx
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
The gas in the conducting airways does not participate in alveolar exchange
Perfusion

49. With restrictive disease - the flow-volume curve is...
Increased Hb-O2 affinity
reduced in size - compared with a normal curve - due to lower lung volume
Mouth as well as through the chest wall
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

50. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
Total lung capacity (TLC)
Perfusion
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
A reliable and consistent classification of auditory findings