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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. Paroxysmal nocturnal dyspnea (PND) is...
right and left mainstem bronchi
Cough
Dyspnea that awakens the patient several hours after going to sleep
Air bubbles flowing through secretions or slightly closed airways during respiration

2. Oxygen moves from the...
Wheezes - high-pitched - musical sounds - distinct whistling quality
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
Alveoli to the blood
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

3. Hyperventilation is defined as
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Increased minute volume ventilation - which results in a lowered carbon dioxide level
results in a lower than normal FEV1%
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

4. The trachea divides into
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Oxygen (O2)
right and left mainstem bronchi
5 years - to detect obstruction and determine its reversibility

5. The pattern of breathing refers to...
Wheezes - high-pitched - musical sounds - distinct whistling quality
Pneumonia - obstructive lung disease - and late pulmonary edema
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
70%

6. Central cyanosis results from
The negative logarithm of hydrogen ions in the blood
The right middle lobe
Insufficient oxygenation of hemoglobin in the lungs
Blue or bluish-gray discoloration of the skin or mucous membranes

7. increased volume results in
Dyspnea upon assuming a recumbent position
Decreased pressure
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Significant pulmonary impairment

8. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Significant pulmonary impairment
Outer surface of each lung
Mediastinum

9. Pulmonary ventilation is varied by
Diaphragm and the intercostal muscles
Pressure required to drive air through the airways
The amount of air that can be inhaled after normal inspiration
Altering the respiratory rate and/or the tidal volume

10. Which lung has an oblique fissure?
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
right & left
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

11. Does lung tissue have pain fibers?
right and left mainstem bronchi
Either inspiration or expiration
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
No

12. With restrictive disease - the flow-volume curve is...
Obstructive lung disease from restrictive lung disease
Dullness replaces resonance
reduced in size - compared with a normal curve - due to lower lung volume
Right

13. the lingula is analogous to...
Pulse oximetry
The right middle lobe
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
quickly - usually reaching a plateau within 6.0 seconds

14. dead space ventilation
Diffusion
Larger airways
The gas in the conducting airways does not participate in alveolar exchange
Louder - lower-pitched - and slightly longer in duration

15. Coarse crackles are heard in
Pneumonia - obstructive lung disease - and late pulmonary edema
Portable antero-posterior (AP) view
Functional residual capacity (FRC)
Either inspiration or expiration

16. The primary muscles of respiration are the...
Diaphragm and the intercostal muscles
Wheezes - high-pitched - musical sounds - distinct whistling quality
A reliable and consistent classification of auditory findings
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

17. 20.95% Atmospheric Composition
Lung volumes - but find it difficult to exhale rapidly
Narrowed nearly to the point of closure
Upper respiratory obstruction - usually in the trachea or larynx
Oxygen (O2)

18. Spirometry can be used to determine the severity of functional impairment as well as
To assess response to treatment
The atmospheric pressure
The right middle lobe
The amount of air that can be inhaled after normal inspiration

19. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Decreased pressure
Inspiration
Soft - high-pitched and crisp
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

20. residual volume
Carboxyhemoglobin
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
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Right

21. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Mediastinum
Speed of airflow - the higher the flow - the greater the resistance
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

22. Respiration involves
Ventilation - Diffusion - Perfusion
Narrowed nearly to the point of closure
Bronchospasm - mucosal edema - or excessive secretions
A sensor placed over a translucent area of arterial pulsation

23. What may prevent cyanosis from appearing?
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Speed of airflow - the higher the flow - the greater the resistance
Either inspiration or expiration
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

24. Normal range of PaCO2
Ventilation
release of O2 from Hb - as heat is a by-product of metabolism.
Blue or bluish-gray discoloration of the skin or mucous membranes
35 to 45 mmHg

25. The purpose of respiration is to...
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Blood to the alveoli
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Contracts

26. The normal FEV1 /FVC ratio is...
Interstitial diseases or early pulmonary edema
Air-filled - fluid-filled - or solid
Dyspnea upon assuming a recumbent position
70%

27. forced vital capacity (FVC)
Speed of airflow - the higher the flow - the greater the resistance
Air bubbles flowing through secretions or slightly closed airways during respiration
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Decreased pressure

28. movement of blood through the capillaries in direct communication with the alveoli
Perfusion
Pneumonia - obstructive lung disease - and late pulmonary edema
Either continuous or discontinuous
Contracts

29. Obstructive Disease: Expiratory airflow is reduced more than
Expiratory volume - and there is a prolonged expiratory time
right & left
Hypoventilation or modest changes in the PaO2
Functional residual capacity (FRC)

30. Examples of obstructive disease
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
80 to 120% of predicted value
10 to 11 cm long and about 2 cm in diameter
Observing the pattern of breathing

31. Airway resistance refers to...
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Pressure required to drive air through the airways
Partial pressure of oxygen in the alveoli

32. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Upper respiratory obstruction - usually in the trachea or larynx
Postero-anterior (PA) and lateral view series
Spirometry
Pressure required to drive air through the airways

33. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
respiration
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
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
Inflammation of the adjacent parietal pleura

34. Restrictive Disease: Expiratory volume is reduced more than
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Increased work of breathing
No respiration for > 20 seconds
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

35. Auscultation of the chest depends on...
A reliable and consistent classification of auditory findings
Soft - high-pitched and crisp
quickly - usually reaching a plateau within 6.0 seconds
Carboxyhemoglobin

36. Resistance is dependent upon
Speed of airflow - the higher the flow - the greater the resistance
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
Dyspnea upon assuming a recumbent position
Spirometry

37. Discontinuous lung sounds are also called

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38. Which lobe has an inferior tongue-like projection called the lingula?
A reduction in lung capacity - secondary to scarring or extraneous material
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Either continuous or discontinuous
Left upper lobe

39. Which bronchus is wider - shorter - and more vertically placed?
Carboxyhemoglobin
Right
Partial pressure of CO2 in the arterial blood
80 to 120% of predicted value

40. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
Right
Oxygen (O2)
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Increased work of breathing

41. Bronchiovesicular breath sounds
results in a lower than normal FEV1%
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Increased Hb-O2 affinity

42. Spirometry is useful in distinguishing
80%
Obstructive lung disease from restrictive lung disease
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
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

43. The trachea divides into right and left mainstem bronchi At what level?
T4 or T5 - and just below the manubrio-sternal joint
Pressure required to drive air through the airways
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

44. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Pulse oximetry
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

45. The best indicator of adequate ventilation is the...
Blue or bluish-gray discoloration of the skin or mucous membranes
Left upper lobe
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
PaCO2

46. The acini consist of the...
Acinus
Outer surface of each lung
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
The atmospheric pressure

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

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48. At rest - the use of accessory muscles is a sign of...
Significant pulmonary impairment
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
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Ventilation

49. Fine crackles are...
Soft - high-pitched and crisp
Overcome some of the problems associated with low blood flow to the probe site
'adventitious' breath sounds
Speed of airflow - the higher the flow - the greater the resistance

50. FEV1/FVC
Increased amounts of unsaturated hemoglobin in capillary blood
Pleural space
The negative logarithm of hydrogen ions in the blood
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)