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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
Blue or bluish-gray discoloration of the skin or mucous membranes
Nitrogen
Left upper lobe
Acinus

2. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
Ventilation - Diffusion - Perfusion
The atmospheric pressure
Diaphragm and the intercostal muscles
Dyspnea upon assuming a recumbent position

3. An efficient approach to examination of the patient begins with
Either inspiration or expiration
Observing the pattern of breathing
'crackles' or 'rales'
The total amount of air in the lungs at the end of a maximal inhalation

4. Nitroglycerin applied to the probe area has been reported to...
Overcome some of the problems associated with low blood flow to the probe site
Larger airways
Increased amounts of unsaturated hemoglobin in capillary blood
Air to move from the upper airway to the farthest alveolar reaches

5. The main bronchi are divided into smaller branches that begin to subdivide into
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Hypoventilation or modest changes in the PaO2

6. Orthopnea is quantified by
Fraction (%age) of inspired oxygen
A sensor placed over a translucent area of arterial pulsation
Dyspnea upon assuming a recumbent position
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

7. The muscles of expiration are the...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Total lung capacity (TLC)
Pressure required to drive air through the airways
Outer surface of each lung

8. Pulse Oximetry is dependent on...
Air-filled - fluid-filled - or solid
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
The total amount of air that can be exhaled following a maximal inhalation
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

9. Airway resistance refers to...
Either inspiration or expiration
Sternocleidomastoid - Scalene Muscles
Pressure required to drive air through the airways
70%

10. Obstructive disease refers to...
Observing the pattern of breathing
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
require supplemental oxygenation and possibly ABG analysis
80%

11. The tracheo-bronchial tree is a tubular system that provides a pathway for
No
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Air to move from the upper airway to the farthest alveolar reaches
35 to 45 mmHg

12. Oximetry readings of < 94%
require supplemental oxygenation and possibly ABG analysis
Expiration
Increased amounts of unsaturated hemoglobin in capillary blood
Decreased pressure

13. Normal range of PaCO2
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
Interstitial diseases or early pulmonary edema
35 to 45 mmHg
right & left

14. Pulmonary ventilation is varied by
Altering the respiratory rate and/or the tidal volume
Diffusion
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
reduced in size - compared with a normal curve - due to lower lung volume

15. 78.08% Atmospheric Composition
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Left upper lobe
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Nitrogen

16. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
Dullness replaces resonance
Mediastinum
The total amount of air in the lungs at the end of a maximal inhalation
Perfusion

17. Which lung has a horizontal fissure?
Inspiration
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
Pulse oximetry

18. Tachypnea is an
The gas in the conducting airways does not participate in alveolar exchange
Right
80 to 120% of predicted value
Increased rate of breathing and is commonly associated with a decrease in tidal volume

19. office-based spirometry is recommended for patients as young as
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
5 years - to detect obstruction and determine its reversibility
Either continuous or discontinuous

20. Spirometry: The result is stated as
Diffusion
A good effort
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Difficulty breathing or shortness of breath

21. Spirometry normal range
The examiner can clearly distinguish the word that the pt speak or whispers
right & left
80 to 120% of predicted value
Alveoli to the blood

22. Bohr Effect of pH is graphed as
Oxygen-Hemoglobin Dissociation Curve
Total lung capacity (TLC)
Nitrogen
Increased amounts of unsaturated hemoglobin in capillary blood

23. FIO2
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
PaCO2
Fraction (%age) of inspired oxygen

24. 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
Difficulty breathing or shortness of breath
respiration
Pulse oximetry
Altering the respiratory rate and/or the tidal volume

25. The parietal pleura lines the...
The total amount of air that can be exhaled following a maximal inhalation
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Tongue
Inside of the thoracic cavity wall and the upper surface of the diaphragm

26. PaO2
Partial pressure of O2 in the arterial blood
Partial pressure of oxygen in the alveoli
Sternocleidomastoid - Scalene Muscles
Blue or bluish-gray discoloration of the skin or mucous membranes

27. The interspace between two ribs (intercostal space) is numbered by
To assess response to treatment
Decreased Hb-O2 affinity
Partial pressure of oxygen in the alveoli
The rib above it

28. 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
results in a lower than normal FEV1%
Louder - lower-pitched - and slightly longer in duration
Alveoli to the blood

29. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
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
Ventilation - Diffusion - Perfusion
Upper respiratory obstruction - usually in the trachea or larynx

30. What may prevent cyanosis from appearing?
right
Inspiration
Perfusion
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

31. Normal lung sounds
Brief - discrete - non-musical sounds with a popping quality
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Air-filled - fluid-filled - or solid
'adventitious' breath sounds

32. terminal respiratory unit
Acinus
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
release of O2 from Hb - as heat is a by-product of metabolism.
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

33. Central cyanosis results from
Insufficient oxygenation of hemoglobin in the lungs
Expiration
Air bubbles flowing through secretions or slightly closed airways during respiration
Oxygen-Hemoglobin Dissociation Curve

34. Expiratory stridor indicates
Pleural space
Altering the respiratory rate and/or the tidal volume
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Obstruction below the vocal cords (subglottic or tracheal obstruction)

35. The upper airway accounts For what % of airway resistance?
50%
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
'crackles' or 'rales'
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

36. Late inspiratory crackles result from
Dyspnea upon assuming a recumbent position
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
quickly - usually reaching a plateau within 6.0 seconds

37. Dyspnea is defined as
'scooped out' or bowl-shaped
Difficulty breathing or shortness of breath
quickly - usually reaching a plateau within 6.0 seconds
Dullness replaces resonance

38. Boyle's Gas Law
There is an inverse relationship between pressure and volume
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

39. PACO2
Pressure required to drive air through the airways
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
Partial pressure of carbon dioxide in the alveoli
Expiration

40. within limits - increased temperature =
respiration
'adventitious' breath sounds
Increased rate of breathing and is commonly associated with a decrease in tidal volume
release of O2 from Hb - as heat is a by-product of metabolism.

41. Discontinuous lung sounds are...
'scooped out' or bowl-shaped
The total amount of air that can be exhaled following a maximal inhalation
Brief - discrete - non-musical sounds with a popping quality
results in a lower than normal FEV1%

42. residual volume
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
35 to 45 mmHg
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
The amount of air that can be inhaled after normal inspiration

43. The visceral pleura lines the...
Excessive secretions and abnormal airway collapsibility
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Binding of O2 to Hb
Outer surface of each lung

44. movement of blood through the capillaries in direct communication with the alveoli
Perfusion
A reliable and consistent classification of auditory findings
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Brief - discrete - non-musical sounds with a popping quality

45. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Right
The total amount of air in the lungs at the end of a maximal inhalation
Manubrio-sternal junction (angle of Louis)
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

46. Spirometry plots
To assess response to treatment
A tracing of the lung volume against time in seconds
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Narrowed nearly to the point of closure

47. Rhonchi
Obstructive lung disease from restrictive lung disease
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
'scooped out' or bowl-shaped
Excessive secretions and abnormal airway collapsibility

48. Fine crackles are...
Soft - high-pitched and crisp
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
require supplemental oxygenation and possibly ABG analysis
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

49. Which bronchus is more susceptible to aspiration of foreign bodies?
Diffusion
Right
PaCO2
80 to 120% of predicted value

50. The trachea divides into right and left mainstem bronchi At what level?
Pleural space
T4 or T5 - and just below the manubrio-sternal joint
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Lung volumes - but no difficulty or delay in exhaling what volume they do have