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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. total lung capacity (TLC)
Blood to the alveoli
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Increased rate of breathing and is commonly associated with a decrease in tidal volume
The total amount of air in the lungs at the end of a maximal inhalation

2. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
The examiner can clearly distinguish the word that the pt speak or whispers
A good effort
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Fraction (%age) of inspired oxygen

3. The presence of pressure gradients causes respiratory gases to move from
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Decreased pressure
Insufficient oxygenation of hemoglobin in the lungs
Mouth as well as through the chest wall

4. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
Brief - discrete - non-musical sounds with a popping quality
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Portable antero-posterior (AP) view
release of O2 from Hb

5. Late inspiratory crackles result from
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Mouth as well as through the chest wall
Bronchospasm - mucosal edema - or excessive secretions
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

6. terminal respiratory unit
Mediastinum
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Saturated with oxygen or unsaturated
Acinus

7. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
'scooped out' or bowl-shaped
Postero-anterior (PA) and lateral view series
respiration
There is an inverse relationship between pressure and volume

8. Bohr Effect of pH: right shift
Increased amounts of unsaturated hemoglobin in capillary blood
The negative logarithm of hydrogen ions in the blood
Dullness replaces resonance
Decreased Hb-O2 affinity

9. Respiration involves
The negative logarithm of hydrogen ions in the blood
Diffusion
right
Ventilation - Diffusion - Perfusion

10. The trachea is how long/wide?
Partial pressure of carbon dioxide in the alveoli
The gas in the conducting airways does not participate in alveolar exchange
Lung volumes - but no difficulty or delay in exhaling what volume they do have
10 to 11 cm long and about 2 cm in diameter

11. During inspiration the diaphragm
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Dyspnea that awakens the patient several hours after going to sleep
Contracts
quickly - usually reaching a plateau within 6.0 seconds

12. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Insufficient oxygenation of hemoglobin in the lungs
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Increase the intrathoracic space
Partial pressure of carbon dioxide in the alveoli

13. vital capacity (VC)
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
5 years - to detect obstruction and determine its reversibility
Mouth as well as through the chest wall
The total amount of air that can be exhaled following a maximal inhalation

14. Inspiratory stridor becomes evident at about
70% occlusion of the airway
Either continuous or discontinuous
Tongue
Decreased Hb-O2 affinity

15. PaCO2
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Fraction (%age) of inspired oxygen
Partial pressure of CO2 in the arterial blood
Oxygen (O2)

16. The accessory muscles are the...
Sternocleidomastoid - Scalene Muscles
Air to move from the upper airway to the farthest alveolar reaches
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
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

17. Cyanosis is caused by
Increased amounts of unsaturated hemoglobin in capillary blood
'adventitious' breath sounds
Inside of the thoracic cavity wall and the upper surface of the diaphragm
The gas in the conducting airways does not participate in alveolar exchange

18. Continuous lung sounds occur in the setting of...
Bronchospasm - mucosal edema - or excessive secretions
Contracts
Saturated with oxygen or unsaturated
Alveoli to the blood

19. gas exchange across the alveolar-pulmonary capillary membranes
Outer surface of each lung
Decreased Hb-O2 affinity
Acinus
Diffusion

20. Restrictive Disease: Expiratory volume is reduced more than
release of O2 from Hb
No
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Tongue

21. Oxygen moves from the...
Increased amounts of unsaturated hemoglobin in capillary blood
Alveoli to the blood
Inspiration
Increase the intrathoracic space

22. Spirometry normal range
Obstructive lung disease from restrictive lung disease
Ventilation - Diffusion - Perfusion
5 years - to detect obstruction and determine its reversibility
80 to 120% of predicted value

23. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Air to move from the upper airway to the farthest alveolar reaches
Bronchospasm - mucosal edema - or excessive secretions

24. Expiratory stridor indicates
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Partial pressure of oxygen (PO2)
Pleural space
Nitrogen

25. Orthopnea is quantified by
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Binding of O2 to Hb
70% occlusion of the airway
Fraction (%age) of inspired oxygen

26. Which bronchus is more susceptible to aspiration of foreign bodies?
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Brief - discrete - non-musical sounds with a popping quality
Right
Pleural space

27. The muscles of inspiration are the...
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Either continuous or discontinuous
Left upper lobe
Diaphragm - External Intercostals

28. Tachypnea is an
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Contracts
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Spirometry

29. Oximetry readings of < 94%
Oxygen (O2)
require supplemental oxygenation and possibly ABG analysis
Increased amounts of unsaturated hemoglobin in capillary blood
Overcome some of the problems associated with low blood flow to the probe site

30. Paroxysmal nocturnal dyspnea (PND) is...
Right
Dyspnea that awakens the patient several hours after going to sleep
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Obstructive lung disease from restrictive lung disease

31. Cyanosis
Acinus
Difficulty breathing or shortness of breath
Blue or bluish-gray discoloration of the skin or mucous membranes
Partial pressure of O2 in the arterial blood

32. Peripheral cyanosis results from
Right
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
require supplemental oxygenation and possibly ABG analysis
Perfusion

33. What may prevent cyanosis from appearing?
The rib above it
Cough
Overcome some of the problems associated with low blood flow to the probe site
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

34. Central cyanosis results from
Decreased pressure
Inflammation of the adjacent parietal pleura
Insufficient oxygenation of hemoglobin in the lungs
Increased amounts of unsaturated hemoglobin in capillary blood

35. The acini consist of the...
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
500 to 800 mL
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Diaphragm and the intercostal muscles

36. Spirometry is useful in distinguishing
Obstructive lung disease from restrictive lung disease
50%
Contracts
Diffusion

37. within limits - increased temperature =
Diaphragm - External Intercostals
Acinus
Functional residual capacity (FRC)
release of O2 from Hb - as heat is a by-product of metabolism.

38. Spirometry can be used to determine the severity of functional impairment as well as
The amount of air that can be inhaled after normal inspiration
Right
To assess response to treatment
Increased Hb-O2 affinity

39. The best indicator of adequate ventilation is the...
Bicarbonate
T4 or T5 - and just below the manubrio-sternal joint
PaCO2
Inside of the thoracic cavity wall and the upper surface of the diaphragm

40. FEV1% in restrictive disease
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Normal to increased FEV1%
Ventilation

41. forced expiratory volume in one second (FEV1)
Contracts
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
respiration
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

42. Discontinuous lung sounds are...
'scooped out' or bowl-shaped
Alveoli to the blood
Brief - discrete - non-musical sounds with a popping quality
Acinus

43. HCO3
Bicarbonate
Alveoli to the blood
Oxygen (O2)
80 to 120% of predicted value

44. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
release of O2 from Hb - as heat is a by-product of metabolism.
Perfusion
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Speed of airflow - the higher the flow - the greater the resistance

45. Bronchophony
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
The amount of air that can be exhaled after expiration
10 to 11 cm long and about 2 cm in diameter
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

46. Obstructive disease refers to...
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Dyspnea upon assuming a recumbent position
Spirometry

47. FEV1% in obstructive disease
results in a lower than normal FEV1%
Outer surface of each lung
Normal to increased FEV1%
The amount of air that can be exhaled after expiration

48. Compliance
Diffusion
Contracts
Observing the pattern of breathing
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

49. The pattern of breathing refers to...
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Hypoventilation or modest changes in the PaO2
Oxygen (O2)

50. Obstructive Disease: Expiratory airflow is reduced more than
Speed of airflow - the higher the flow - the greater the resistance
Expiratory volume - and there is a prolonged expiratory time
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Spirometry