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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. Boyle's Gas Law
No
10 to 11 cm long and about 2 cm in diameter
There is an inverse relationship between pressure and volume
Partial pressure of O2 in the arterial blood

2. The active movement of gases between the ambient air and the lungs
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
Diaphragm and the intercostal muscles
Ventilation
Functional residual capacity (FRC)

3. Continuous lung sounds occur during...
Pressure required to drive air through the airways
Partial pressure of oxygen in the alveoli
A tracing of the lung volume against time in seconds
Either inspiration or expiration

4. Factors that influence the oxygen carrying capacity of hemoglobin
right
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Insufficient oxygenation of hemoglobin in the lungs

5. Continuous lung sounds
50%
Wheezes - high-pitched - musical sounds - distinct whistling quality
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
right & left

6. Egophony

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7. Respiration involves
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
Diffusion
Ventilation - Diffusion - Perfusion
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

8. Restrictive disease refers to...
Insufficient oxygenation of hemoglobin in the lungs
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Either continuous or discontinuous
A reduction in lung capacity - secondary to scarring or extraneous material

9. Bronchophony
right and left mainstem bronchi
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
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
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

10. Percussion helps you establish whether the underlying tissues are...
Spirometry
Air-filled - fluid-filled - or solid
'adventitious' breath sounds
A reduction in lung capacity - secondary to scarring or extraneous material

11. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
70% occlusion of the airway
80%
Increase the intrathoracic space
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

12. Resistance is dependent upon
Decreased pressure
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Pneumonia - obstructive lung disease - and late pulmonary edema
Speed of airflow - the higher the flow - the greater the resistance

13. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Decreased pressure
Cough
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

14. Which bronchus is more susceptible to aspiration of foreign bodies?
Altering the respiratory rate and/or the tidal volume
Right
Expiratory volume - and there is a prolonged expiratory time
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

15. Normal lung sounds
release of O2 from Hb
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
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
Partial pressure of O2 in the arterial blood

16. Discontinuous lung sounds are...
The right middle lobe
Expiration
Brief - discrete - non-musical sounds with a popping quality
Functional residual capacity (FRC)

17. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
50%
Saturated with oxygen or unsaturated
respiration
Diffusion

18. The vital capacity and the residual volume together constitute the...
Total lung capacity (TLC)
To assess response to treatment
There is an inverse relationship between pressure and volume
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

19. Rhonchi originate in the...
The negative logarithm of hydrogen ions in the blood
Speed of airflow - the higher the flow - the greater the resistance
Expiration
Larger airways

20. hypocapnia
Lowered carbon dioxide level - results from hyperventilation
Increased Hb-O2 affinity
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Decreased pressure

21. residual volume
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
Dullness replaces resonance
Either continuous or discontinuous
Blood to the alveoli

22. The tracheo-bronchial tree is a tubular system that provides a pathway for
Air to move from the upper airway to the farthest alveolar reaches
'adventitious' breath sounds
A tracing of the lung volume against time in seconds
Louder - lower-pitched - and slightly longer in duration

23. Coarse crackles result from
Partial pressure of oxygen in the alveoli
Air bubbles flowing through secretions or slightly closed airways during respiration
The rib above it
Mediastinum

24. FIO2
Portable antero-posterior (AP) view
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Fraction (%age) of inspired oxygen
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

25. Rhonchi
Carboxyhemoglobin
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Manubrio-sternal junction (angle of Louis)

26. The external intercostal muscles increase the antero-posterior chest diameter during
Increased Hb-O2 affinity
Inspiration
Left upper lobe
Cough

27. FEV1% in obstructive disease
Speed of airflow - the higher the flow - the greater the resistance
The atmospheric pressure
results in a lower than normal FEV1%
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

28. The best indicator of adequate ventilation is the...
Immediate oxygenation with or without intubation
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
PaCO2

29. The normal FEV1 /FVC ratio is...
Expiration
Obstructive lung disease from restrictive lung disease
70%
Partial pressure of O2 in the arterial blood

30. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
release of O2 from Hb - as heat is a by-product of metabolism.
Dullness replaces resonance
Insufficient oxygenation of hemoglobin in the lungs
Interstitial diseases or early pulmonary edema

31. total lung capacity (TLC)
Hypoventilation or modest changes in the PaO2
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
The total amount of air in the lungs at the end of a maximal inhalation
Narrowed nearly to the point of closure

32. The visceral pleura lines the...
Outer surface of each lung
Portable antero-posterior (AP) view
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Increased rate of breathing and is commonly associated with a decrease in tidal volume

33. Compliance
The total amount of air in the lungs at the end of a maximal inhalation
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
Mediastinum
Upper respiratory obstruction - usually in the trachea or larynx

34. The most reliable site for detecting central cyanosis is the...
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Dullness replaces resonance
Tongue
The atmospheric pressure

35. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
Partial pressure of O2 in the arterial blood
A sensor placed over a translucent area of arterial pulsation
Perfusion
right and left mainstem bronchi

36. FEV1% in restrictive disease
Left upper lobe
Dyspnea upon assuming a recumbent position
Narrowed nearly to the point of closure
Normal to increased FEV1%

37. pH
No respiration for > 20 seconds
The negative logarithm of hydrogen ions in the blood
Carboxyhemoglobin
T4 or T5 - and just below the manubrio-sternal joint

38. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Spirometry
'adventitious' breath sounds
2 - each wavelength is partially absorbed by hemoglobin

39. Pulse Oximetry does not detect
A good effort
Perfusion
Increased work of breathing
Hypoventilation or modest changes in the PaO2

40. What is the potential space between the visceral and parietal pleurae?
Pleural space
Diffusion
Larger airways
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide

41. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
80 to 120% of predicted value
results in a lower than normal FEV1%
Manubrio-sternal junction (angle of Louis)
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL

42. Dyspnea is defined as
Pneumonia - obstructive lung disease - and late pulmonary edema
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Difficulty breathing or shortness of breath
require supplemental oxygenation and possibly ABG analysis

43. Abnormal lung sounds AKA

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44. The muscles of inspiration are the...
Diaphragm - External Intercostals
Lung volumes - but find it difficult to exhale rapidly
Cough
Inspiration

45. A state-of-the-art - inexpensive - non-invasive - simple method to monitor a patient's percent hemoglobin saturation with oxygen (SaO2) - without having to obtain an arterial blood specimen
Fraction (%age) of inspired oxygen
Pulse oximetry
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
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

46. office-based spirometry is recommended for patients as young as
5 years - to detect obstruction and determine its reversibility
Oxygen (O2)
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
release of O2 from Hb

47. Bohr Effect of pH: right shift
500 to 800 mL
Bronchospasm - mucosal edema - or excessive secretions
Decreased Hb-O2 affinity
Manubrio-sternal junction (angle of Louis)

48. The accessory muscles are the...
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Sternocleidomastoid - Scalene Muscles
50%

49. The trachea bifurcates into its mainstem bronchi at the level of...
No respiration for > 20 seconds
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Air bubbles flowing through secretions or slightly closed airways during respiration
Left upper lobe

50. During inspiration the diaphragm
Outer surface of each lung
Manubrio-sternal junction (angle of Louis)
Contracts
Air to move from the upper airway to the farthest alveolar reaches