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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. Spirometry plots
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
35 to 45 mmHg
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
A tracing of the lung volume against time in seconds

2. Inspiratory stridor indicates
Alveoli to the blood
Louder - lower-pitched - and slightly longer in duration
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Significant pulmonary impairment

3. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Spirometry
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Larger airways
require supplemental oxygenation and possibly ABG analysis

4. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Dullness replaces resonance
Diaphragm - External Intercostals
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Diffusion

5. Rhonchi frequently clear after
Acinus
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Wheezes - high-pitched - musical sounds - distinct whistling quality
Cough

6. Which lobe has an inferior tongue-like projection called the lingula?
Mediastinum
Increased work of breathing
Left upper lobe
Air to move from the upper airway to the farthest alveolar reaches

7. Bohr Effect of pH: right shift
Decreased pressure
Normal to increased FEV1%
Decreased Hb-O2 affinity
Immediate oxygenation with or without intubation

8. Cyanosis
Spirometry
Blue or bluish-gray discoloration of the skin or mucous membranes
Either inspiration or expiration
Observing the pattern of breathing

9. The tracheo-bronchial tree is a tubular system that provides a pathway for
Contracts
Air to move from the upper airway to the farthest alveolar reaches
A reduction in lung capacity - secondary to scarring or extraneous material
T4 or T5 - and just below the manubrio-sternal joint

10. Airway resistance refers to...
'crackles' or 'rales'
Increased amounts of unsaturated hemoglobin in capillary blood
Diffusion
Pressure required to drive air through the airways

11. Bohr Effect of pH is graphed as
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Oxygen-Hemoglobin Dissociation Curve
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
The examiner can clearly distinguish the word that the pt speak or whispers

12. Pulse Oximetry is dependent on...
Bronchospasm - mucosal edema - or excessive secretions
Either continuous or discontinuous
Obstructive lung disease from restrictive lung disease
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

13. Spirometry can be used to determine the severity of functional impairment as well as
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Increase the intrathoracic space
To assess response to treatment
The amount of air that can be inhaled after normal inspiration

14. Restrictive disease refers to...
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
A reduction in lung capacity - secondary to scarring or extraneous material
To assess response to treatment
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

15. terminal respiratory unit
Acinus
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Upper respiratory obstruction - usually in the trachea or larynx

16. the lingula is analogous to...
Ventilation - Diffusion - Perfusion
Increase the intrathoracic space
Decreased pressure
The right middle lobe

17. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
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 & left
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Perfusion

18. Egophony

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19. Spirometry is useful in distinguishing
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Obstructive lung disease from restrictive lung disease
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Upper respiratory obstruction - usually in the trachea or larynx

20. The trachea is how long/wide?
10 to 11 cm long and about 2 cm in diameter
Inspiration
Increased work of breathing
Inspiration

21. Pulse Oximetry does not detect
Cough
Immediate oxygenation with or without intubation
Hypoventilation or modest changes in the PaO2
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

22. The pattern of breathing refers to...
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Sternocleidomastoid - Scalene Muscles
Decreased Hb-O2 affinity
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

23. within limits - increased temperature =
release of O2 from Hb - as heat is a by-product of metabolism.
A tracing of the lung volume against time in seconds
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Contracts

24. 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
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
Lung volumes - but find it difficult to exhale rapidly
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

25. The trachea bifurcates into its mainstem bronchi at the level of...
Contracts
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Pleural space
Right

26. The upper airway accounts For what % of airway resistance?
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
50%
right & left
Soft - high-pitched and crisp

27. Fine crackles are heard in
Interstitial diseases or early pulmonary edema
Dullness replaces resonance
A reliable and consistent classification of auditory findings
Diffusion

28. 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
Blue or bluish-gray discoloration of the skin or mucous membranes
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Partial pressure of oxygen (PO2)

29. Does lung tissue have pain fibers?
70%
Spirometry
No
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

30. Late inspiratory crackles result from
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Brief - discrete - non-musical sounds with a popping quality

31. Oxygen moves from the...
quickly - usually reaching a plateau within 6.0 seconds
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Alveoli to the blood

32. Oximetry readings of < 94%
require supplemental oxygenation and possibly ABG analysis
Tongue
Brief - discrete - non-musical sounds with a popping quality
Ventilation - Diffusion - Perfusion

33. Central cyanosis results from
Diaphragm - External Intercostals
Either continuous or discontinuous
Dyspnea that awakens the patient several hours after going to sleep
Insufficient oxygenation of hemoglobin in the lungs

34. FEV1% in obstructive disease
Oxygen-Hemoglobin Dissociation Curve
results in a lower than normal FEV1%
Air to move from the upper airway to the farthest alveolar reaches
Expiration

35. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
2 - each wavelength is partially absorbed by hemoglobin
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Increased work of breathing
Increase the intrathoracic space

36. The main bronchi are divided into smaller branches that begin to subdivide into
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Mediastinum
Total lung capacity (TLC)

37. The vital capacity and the residual volume together constitute the...
Manubrio-sternal junction (angle of Louis)
Total lung capacity (TLC)
2 - each wavelength is partially absorbed by hemoglobin
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

38. expiratory reserve
Diffusion
The amount of air that can be exhaled after expiration
Pleural space
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

39. Coarse crackles are...
Expiratory volume - and there is a prolonged expiratory time
Difficulty breathing or shortness of breath
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Louder - lower-pitched - and slightly longer in duration

40. The primary muscles of respiration are the...
Diaphragm and the intercostal muscles
Louder - lower-pitched - and slightly longer in duration
quickly - usually reaching a plateau within 6.0 seconds
The negative logarithm of hydrogen ions in the blood

41. Cyanosis is caused by
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Sternocleidomastoid - Scalene Muscles
Increased amounts of unsaturated hemoglobin in capillary blood
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

42. Tachypnea is an
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Observing the pattern of breathing
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Inspiration

43. Respiration involves
Acinus
Ventilation - Diffusion - Perfusion
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
No respiration for > 20 seconds

44. Continuous lung sounds often audible at the...
50%
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Mouth as well as through the chest wall
Upper respiratory obstruction - usually in the trachea or larynx

45. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Pneumonia - obstructive lung disease - and late pulmonary edema
Immediate oxygenation with or without intubation
right and left mainstem bronchi

46. 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
Lung volumes - but find it difficult to exhale rapidly
respiration
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

47. PaCO2
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
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
Ventilation - Diffusion - Perfusion
Partial pressure of CO2 in the arterial blood

48. What is the potential space between the visceral and parietal pleurae?
Pleural space
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Wheezes - high-pitched - musical sounds - distinct whistling quality
Lowered carbon dioxide level - results from hyperventilation

49. dead space ventilation
Interstitial diseases or early pulmonary edema
Overcome some of the problems associated with low blood flow to the probe site
The gas in the conducting airways does not participate in alveolar exchange
A reliable and consistent classification of auditory findings

50. Percussion helps you establish whether the underlying tissues are...
Air-filled - fluid-filled - or solid
'crackles' or 'rales'
A sensor placed over a translucent area of arterial pulsation
results in a lower than normal FEV1%