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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. Carbon dioxide moves from the...
Blood to the alveoli
Oxygen-Hemoglobin Dissociation Curve
Pleural space
Perfusion

2. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
Functional residual capacity (FRC)
'adventitious' breath sounds
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
respiration

3. Rhonchi originate in the...
right & left
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Nitrogen
Larger airways

4. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Fraction (%age) of inspired oxygen
Carboxyhemoglobin
Partial pressure of oxygen (PO2)
Larger airways

5. What occurs passively as muscles relax?
Blood to the alveoli
Bicarbonate
2 - each wavelength is partially absorbed by hemoglobin
Expiration

6. Boyle's Gas Law
There is an inverse relationship between pressure and volume
Wheezes - high-pitched - musical sounds - distinct whistling quality
PaCO2
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

7. Normal lung sounds
Narrowed nearly to the point of closure
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

8. vital capacity (VC)
The total amount of air that can be exhaled following a maximal inhalation
50%
Interstitial diseases or early pulmonary edema
Air to move from the upper airway to the farthest alveolar reaches

9. Spirometry plots
A tracing of the lung volume against time in seconds
Lowered carbon dioxide level - results from hyperventilation
Wheezes - high-pitched - musical sounds - distinct whistling quality
Acinus

10. Fine crackles are...
Soft - high-pitched and crisp
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Normal to increased FEV1%

11. HCO3
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Bicarbonate
Tongue
Mouth as well as through the chest wall

12. Apnea is defined as
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
No respiration for > 20 seconds
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

13. Continuous lung sounds
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Wheezes - high-pitched - musical sounds - distinct whistling quality
Upper respiratory obstruction - usually in the trachea or larynx
Air bubbles flowing through secretions or slightly closed airways during respiration

14. The tracheo-bronchial tree is a tubular system that provides a pathway for
Air to move from the upper airway to the farthest alveolar reaches
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Either inspiration or expiration
Partial pressure of O2 in the arterial blood

15. The upper airway accounts For what % of airway resistance?
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Decreased pressure
50%
2 - each wavelength is partially absorbed by hemoglobin

16. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Diaphragm - External Intercostals
Lung volumes - but find it difficult to exhale rapidly
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Dyspnea that awakens the patient several hours after going to sleep

17. PAO2
Partial pressure of oxygen in the alveoli
Total lung capacity (TLC)
Spirometry
Nitrogen

18. Continuous lung sounds occur when air flows rapidly through bronchi that are...
10 to 11 cm long and about 2 cm in diameter
Narrowed nearly to the point of closure
reduced in size - compared with a normal curve - due to lower lung volume
Normal to increased FEV1%

19. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Difficulty breathing or shortness of breath
Inspiration
Oxygen-Hemoglobin Dissociation Curve
Decreased pressure

20. expiratory reserve
Either continuous or discontinuous
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
release of O2 from Hb
The amount of air that can be exhaled after expiration

21. Examples of restrictive disease
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Partial pressure of O2 in the arterial blood
Normal to increased FEV1%
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

22. tidal volume (Vt)
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Ventilation - Diffusion - Perfusion
No
The atmospheric pressure

23. low CO2 = low acidity =
results in a lower than normal FEV1%
Binding of O2 to Hb
Dyspnea upon assuming a recumbent position
Pressure required to drive air through the airways

24. gas exchange across the alveolar-pulmonary capillary membranes
Blue or bluish-gray discoloration of the skin or mucous membranes
Pressure required to drive air through the airways
Either inspiration or expiration
Diffusion

25. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Dyspnea that awakens the patient several hours after going to sleep
The atmospheric pressure
Spirometry

26. movement of blood through the capillaries in direct communication with the alveoli
Cough
Perfusion
Inspiration
The amount of air that can be exhaled after expiration

27. Peripheral cyanosis results from
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Contracts
A reduction in lung capacity - secondary to scarring or extraneous material
Expiration

28. inspiratory reserve
Alveoli to the blood
The rib above it
The amount of air that can be inhaled after normal inspiration
Significant pulmonary impairment

29. hypocapnia
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Lowered carbon dioxide level - results from hyperventilation
Observing the pattern of breathing

30. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Increased amounts of unsaturated hemoglobin in capillary blood
Partial pressure of CO2 in the arterial blood
Diffusion
The atmospheric pressure

31. Bronchiovesicular breath sounds
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Carboxyhemoglobin
Blood to the alveoli
Louder - lower-pitched - and slightly longer in duration

32. Rhonchi
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Right
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval

33. Tachypnea is an
Increased rate of breathing and is commonly associated with a decrease in tidal volume
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Increase the intrathoracic space
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

34. pH
The amount of air that can be exhaled after expiration
Wheezes - high-pitched - musical sounds - distinct whistling quality
The negative logarithm of hydrogen ions in the blood
Brief - discrete - non-musical sounds with a popping quality

35. Bohr Effect of pH: left shift
T4 or T5 - and just below the manubrio-sternal joint
Increased Hb-O2 affinity
Excessive secretions and abnormal airway collapsibility
Contracts

36. Bohr Effect of pH: right shift
Decreased Hb-O2 affinity
Dyspnea that awakens the patient several hours after going to sleep
'scooped out' or bowl-shaped
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

37. Hyperventilation is defined as
Alveoli to the blood
Either continuous or discontinuous
80 to 120% of predicted value
Increased minute volume ventilation - which results in a lowered carbon dioxide level

38. Examples of obstructive disease
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Hypoventilation or modest changes in the PaO2
Oxygen-Hemoglobin Dissociation Curve
Inside of the thoracic cavity wall and the upper surface of the diaphragm

39. The muscles of inspiration are the...
Dyspnea upon assuming a recumbent position
Observing the pattern of breathing
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Diaphragm - External Intercostals

40. Discontinuous lung sounds are...
Functional residual capacity (FRC)
Increase the intrathoracic space
A reduction in lung capacity - secondary to scarring or extraneous material
Brief - discrete - non-musical sounds with a popping quality

41. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
'adventitious' breath sounds
No respiration for > 20 seconds
Increase the intrathoracic space

42. PaO2
Manubrio-sternal junction (angle of Louis)
Expiration
Air to move from the upper airway to the farthest alveolar reaches
Partial pressure of O2 in the arterial blood

43. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Bicarbonate
Upper respiratory obstruction - usually in the trachea or larynx
Perfusion
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

44. Obstructive Disease: Expiratory airflow is reduced more than
Bicarbonate
Cough
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Expiratory volume - and there is a prolonged expiratory time

45. Pulse Oximetry is dependent on...
Brief - discrete - non-musical sounds with a popping quality
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Hypoventilation or modest changes in the PaO2

46. Late inspiratory crackles result from
Functional residual capacity (FRC)
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Significant pulmonary impairment

47. FIO2
Larger airways
Fraction (%age) of inspired oxygen
release of O2 from Hb - as heat is a by-product of metabolism.
Air bubbles flowing through secretions or slightly closed airways during respiration

48. Bohr Effect of pH is graphed as
Mouth as well as through the chest wall
Oxygen-Hemoglobin Dissociation Curve
Inspiration
Portable antero-posterior (AP) view

49. Fine crackles are heard in
Mediastinum
Difficulty breathing or shortness of breath
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Interstitial diseases or early pulmonary edema

50. The parietal pleura lines the...
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Increased work of breathing
Altering the respiratory rate and/or the tidal volume
Either inspiration or expiration