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Pulmonology

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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. Fine crackles are heard in
Interstitial diseases or early pulmonary edema
10 to 11 cm long and about 2 cm in diameter
Dyspnea that awakens the patient several hours after going to sleep
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

2. PACO2
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Perfusion
Spirometry
Partial pressure of carbon dioxide in the alveoli

3. PAO2
Partial pressure of oxygen in the alveoli
Inflammation of the adjacent parietal pleura
right & left
Saturated with oxygen or unsaturated

4. What may prevent cyanosis from appearing?
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Oxygen-Hemoglobin Dissociation Curve
Expiratory volume - and there is a prolonged expiratory time
To assess response to treatment

5. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
Mediastinum
To assess response to treatment
Lowered carbon dioxide level - results from hyperventilation
Increased amounts of unsaturated hemoglobin in capillary blood

6. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
reduced in size - compared with a normal curve - due to lower lung volume
Increased work of breathing
'scooped out' or bowl-shaped
Increase the intrathoracic space

7. vital capacity (VC)
Diaphragm and the intercostal muscles
reduced in size - compared with a normal curve - due to lower lung volume
The total amount of air that can be exhaled following a maximal inhalation
Lowered carbon dioxide level - results from hyperventilation

8. movement of blood through the capillaries in direct communication with the alveoli
require supplemental oxygenation and possibly ABG analysis
release of O2 from Hb - as heat is a by-product of metabolism.
Oxygen-Hemoglobin Dissociation Curve
Perfusion

9. Coarse crackles are heard in
Pneumonia - obstructive lung disease - and late pulmonary edema
right
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Lowered carbon dioxide level - results from hyperventilation

10. The accessory muscles are the...
Speed of airflow - the higher the flow - the greater the resistance
Carboxyhemoglobin
Sternocleidomastoid - Scalene Muscles
respiration

11. office-based spirometry is recommended for patients as young as
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Partial pressure of O2 in the arterial blood
Partial pressure of oxygen (PO2)
5 years - to detect obstruction and determine its reversibility

12. PaO2
500 to 800 mL
Partial pressure of O2 in the arterial blood
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Hypoventilation or modest changes in the PaO2

13. Peripheral cyanosis results from
Air bubbles flowing through secretions or slightly closed airways during respiration
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Carboxyhemoglobin
Mouth as well as through the chest wall

14. Cyanosis is caused by
Increased amounts of unsaturated hemoglobin in capillary blood
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
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
right & left

15. Rhonchi
Contracts
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Difficulty breathing or shortness of breath
Fraction (%age) of inspired oxygen

16. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Saturated with oxygen or unsaturated
Mediastinum
No

17. Which lung has an oblique fissure?
right & left
Either inspiration or expiration
The examiner can clearly distinguish the word that the pt speak or whispers
70% occlusion of the airway

18. FEV1/FVC
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
'scooped out' or bowl-shaped
Postero-anterior (PA) and lateral view series
Spirometry

19. gas exchange across the alveolar-pulmonary capillary membranes
'adventitious' breath sounds
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Bronchospasm - mucosal edema - or excessive secretions
Diffusion

20. Chest Radiography: The most common chest X-ray series is the...
Diaphragm and the intercostal muscles
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
Postero-anterior (PA) and lateral view series
The rib above it

21. The visceral pleura lines the...
Partial pressure of oxygen (PO2)
Outer surface of each lung
Expiration
Louder - lower-pitched - and slightly longer in duration

22. Spirometry plots
Upper respiratory obstruction - usually in the trachea or larynx
A tracing of the lung volume against time in seconds
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Pleural space

23. The tracheo-bronchial tree is a tubular system that provides a pathway for
Louder - lower-pitched - and slightly longer in duration
Air to move from the upper airway to the farthest alveolar reaches
Binding of O2 to Hb
Bicarbonate

24. Airway resistance refers to...
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
35 to 45 mmHg
Pressure required to drive air through the airways
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

25. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Carboxyhemoglobin
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Nitrogen

26. Rhonchi are due to...
Air to move from the upper airway to the farthest alveolar reaches
T4 or T5 - and just below the manubrio-sternal joint
right
Excessive secretions and abnormal airway collapsibility

27. Pulse Oximetry is dependent on...
Partial pressure of oxygen (PO2)
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Postero-anterior (PA) and lateral view series
Right

28. Oxygen moves from the...
Alveoli to the blood
Either continuous or discontinuous
Pulse oximetry
Binding of O2 to Hb

29. Patients with restrictive disease have low
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Bronchospasm - mucosal edema - or excessive secretions
right and left mainstem bronchi
80%

30. Egophony

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

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32. Inspiratory stridor becomes evident at about
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Diaphragm - External Intercostals
Pleural space
70% occlusion of the airway

33. What is the potential space between the visceral and parietal pleurae?
Pleural space
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
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

34. Nitroglycerin applied to the probe area has been reported to...
Overcome some of the problems associated with low blood flow to the probe site
Inspiration
Ventilation
Left upper lobe

35. Discontinuous lung sounds are also called

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36. Discontinuous lung sounds are...
Partial pressure of oxygen in the alveoli
No
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Brief - discrete - non-musical sounds with a popping quality

37. The trachea divides into
Dullness replaces resonance
Ventilation - Diffusion - Perfusion
Nitrogen
right and left mainstem bronchi

38. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Either inspiration or expiration
A sensor placed over a translucent area of arterial pulsation
Partial pressure of O2 in the arterial blood

39. The trachea bifurcates into its mainstem bronchi at the level of...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Saturated with oxygen or unsaturated
Altering the respiratory rate and/or the tidal volume
The right middle lobe

40. Paroxysmal nocturnal dyspnea (PND) is...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Partial pressure of oxygen in the alveoli
Dyspnea that awakens the patient several hours after going to sleep
Bronchospasm - mucosal edema - or excessive secretions

41. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Obstructive lung disease from restrictive lung disease
To assess response to treatment
Diffusion
Air-filled - fluid-filled - or solid

42. A normal volume-time curve rises
Blood to the alveoli
PaCO2
Observing the pattern of breathing
quickly - usually reaching a plateau within 6.0 seconds

43. Oximetry readings of < 94%
Speed of airflow - the higher the flow - the greater the resistance
Binding of O2 to Hb
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
require supplemental oxygenation and possibly ABG analysis

44. Tachypnea is an
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Expiration
Overcome some of the problems associated with low blood flow to the probe site
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

45. Boyle's Gas Law
A reliable and consistent classification of auditory findings
Sternocleidomastoid - Scalene Muscles
The rib above it
There is an inverse relationship between pressure and volume

46. forced expiratory volume in one second (FEV1)
No respiration for > 20 seconds
Inspiration
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
A reliable and consistent classification of auditory findings

47. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Observing the pattern of breathing
Pressure required to drive air through the airways
Upper respiratory obstruction - usually in the trachea or larynx
Soft - high-pitched and crisp

48. Spirometry normal range
Functional residual capacity (FRC)
80 to 120% of predicted value
Increase the intrathoracic space
Narrowed nearly to the point of closure

49. pain in lung conditions usually arises from
respiration
Inflammation of the adjacent parietal pleura
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Inspiration

50. forced vital capacity (FVC)
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Speed of airflow - the higher the flow - the greater the resistance
Pressure required to drive air through the airways
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible