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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 vital capacity and the residual volume together constitute the...
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Total lung capacity (TLC)
results in a lower than normal FEV1%
Increased work of breathing

2. gas exchange across the alveolar-pulmonary capillary membranes
Diffusion
Blood to the alveoli
Pulse oximetry
Expiration

3. The visceral pleura lines the...
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Outer surface of each lung
Left upper lobe
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

4. Pulmonary ventilation is varied by
Spirometry
Diffusion
Altering the respiratory rate and/or the tidal volume
Lung volumes - but find it difficult to exhale rapidly

5. Coarse crackles are heard in
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Pneumonia - obstructive lung disease - and late pulmonary edema
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
The atmospheric pressure

6. The presence of pressure gradients causes respiratory gases to move from
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Sternocleidomastoid - Scalene Muscles
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

7. The interspace between two ribs (intercostal space) is numbered by
The total amount of air in the lungs at the end of a maximal inhalation
The rib above it
Air bubbles flowing through secretions or slightly closed airways during respiration
Increased Hb-O2 affinity

8. Patients with obstructive disease have normal
Expiration
right and left mainstem bronchi
Contracts
Lung volumes - but find it difficult to exhale rapidly

9. What may prevent cyanosis from appearing?
Decreased Hb-O2 affinity
Interstitial diseases or early pulmonary edema
Functional residual capacity (FRC)
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

10. PaCO2
Pulse oximetry
Diffusion
Either inspiration or expiration
Partial pressure of CO2 in the arterial blood

11. The best indicator of adequate ventilation is the...
Significant pulmonary impairment
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
PaCO2
There is an inverse relationship between pressure and volume

12. FEV1% in obstructive disease
results in a lower than normal FEV1%
Left upper lobe
Brief - discrete - non-musical sounds with a popping quality
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

13. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
A sensor placed over a translucent area of arterial pulsation
Nitrogen
right and left mainstem bronchi
Air to move from the upper airway to the farthest alveolar reaches

14. The main bronchi are divided into smaller branches that begin to subdivide into
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
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
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
Observing the pattern of breathing

15. The upper airway accounts For what % of airway resistance?
No respiration for > 20 seconds
Partial pressure of carbon dioxide in the alveoli
Manubrio-sternal junction (angle of Louis)
50%

16. tidal volume (Vt)
Pneumonia - obstructive lung disease - and late pulmonary edema
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
The total amount of air in the lungs at the end of a maximal inhalation
Inflammation of the adjacent parietal pleura

17. The pattern of breathing refers to...
70% occlusion of the airway
A sensor placed over a translucent area of arterial pulsation
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Obstruction below the vocal cords (subglottic or tracheal obstruction)

18. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Mediastinum
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Overcome some of the problems associated with low blood flow to the probe site
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

19. Spirometry normal range
Expiration
Louder - lower-pitched - and slightly longer in duration
80 to 120% of predicted value
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

20. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Carboxyhemoglobin
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
Air bubbles flowing through secretions or slightly closed airways during respiration
Nitrogen

21. Factors that influence the oxygen carrying capacity of hemoglobin
Excessive secretions and abnormal airway collapsibility
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Mouth as well as through the chest wall

22. Percussion helps you establish whether the underlying tissues are...
The rib above it
Overcome some of the problems associated with low blood flow to the probe site
Air-filled - fluid-filled - or solid
Inside of the thoracic cavity wall and the upper surface of the diaphragm

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

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24. Spirometry plots
Upper respiratory obstruction - usually in the trachea or larynx
Increased Hb-O2 affinity
A tracing of the lung volume against time in seconds
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

25. The tracheo-bronchial tree is a tubular system that provides a pathway for
Lung volumes - but no difficulty or delay in exhaling what volume they do have
A good effort
Air to move from the upper airway to the farthest alveolar reaches
require supplemental oxygenation and possibly ABG analysis

26. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
Alveoli to the blood
Increased amounts of unsaturated hemoglobin in capillary blood
A good effort
10 to 11 cm long and about 2 cm in diameter

27. Late inspiratory crackles result from
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Diffusion
A sensor placed over a translucent area of arterial pulsation
respiration

28. Continuous lung sounds often audible at the...
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Decreased Hb-O2 affinity
T4 or T5 - and just below the manubrio-sternal joint
Mouth as well as through the chest wall

29. Patients with restrictive disease have low
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Obstructive lung disease from restrictive lung disease
No
Lung volumes - but no difficulty or delay in exhaling what volume they do have

30. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
Difficulty breathing or shortness of breath
Oxygen (O2)
Portable antero-posterior (AP) view
Inspiration

31. During inspiration the diaphragm
Increased Hb-O2 affinity
Blood to the alveoli
Contracts
500 to 800 mL

32. Normal range of PaCO2
35 to 45 mmHg
Either continuous or discontinuous
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Upper respiratory obstruction - usually in the trachea or larynx

33. A normal volume-time curve rises
The rib above it
Louder - lower-pitched - and slightly longer in duration
quickly - usually reaching a plateau within 6.0 seconds
Upper respiratory obstruction - usually in the trachea or larynx

34. 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
Right
Partial pressure of CO2 in the arterial blood
5 years - to detect obstruction and determine its reversibility

35. Airway resistance refers to...
Lowered carbon dioxide level - results from hyperventilation
Increased work of breathing
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Pressure required to drive air through the airways

36. the lingula is analogous to...
The right middle lobe
Perfusion
Upper respiratory obstruction - usually in the trachea or larynx
Soft - high-pitched and crisp

37. Which bronchus is more susceptible to aspiration of foreign bodies?
Right
Inflammation of the adjacent parietal pleura
Expiratory volume - and there is a prolonged expiratory time
Immediate oxygenation with or without intubation

38. Cyanosis appears when
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
The total amount of air that can be exhaled following a maximal inhalation
respiration
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

39. Oximetry readings of < 94%
require supplemental oxygenation and possibly ABG analysis
Mouth as well as through the chest wall
reduced in size - compared with a normal curve - due to lower lung volume
Soft - high-pitched and crisp

40. forced expiratory volume in one second (FEV1)
Upper respiratory obstruction - usually in the trachea or larynx
Total lung capacity (TLC)
Partial pressure of carbon dioxide in the alveoli
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

41. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Air to move from the upper airway to the farthest alveolar reaches
Manubrio-sternal junction (angle of Louis)
T4 or T5 - and just below the manubrio-sternal joint
right

42. The normal FEV1 /FVC ratio is...
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
There is an inverse relationship between pressure and volume
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
70%

43. most important factor that influences the oxygen carrying capacity of hemoglobin
Mouth as well as through the chest wall
Partial pressure of oxygen (PO2)
Ventilation - Diffusion - Perfusion
Increased Hb-O2 affinity

44. Discontinuous lung sounds are...
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
Oxygen-Hemoglobin Dissociation Curve
Brief - discrete - non-musical sounds with a popping quality

45. movement of blood through the capillaries in direct communication with the alveoli
Expiration
Either inspiration or expiration
Perfusion
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage

46. low CO2 = low acidity =
Binding of O2 to Hb
Pressure required to drive air through the airways
The total amount of air that can be exhaled following a maximal inhalation
Interstitial diseases or early pulmonary edema

47. Which lung has a horizontal fissure?
Total lung capacity (TLC)
right
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
PaCO2

48. At rest - the use of accessory muscles is a sign of...
The total amount of air in the lungs at the end of a maximal inhalation
'scooped out' or bowl-shaped
Oxygen-Hemoglobin Dissociation Curve
Significant pulmonary impairment

49. Spirometry is useful in distinguishing
The right middle lobe
80%
Total lung capacity (TLC)
Obstructive lung disease from restrictive lung disease

50. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
No respiration for > 20 seconds
Perfusion
Inflammation of the adjacent parietal pleura
Dyspnea that awakens the patient several hours after going to sleep