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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. The trachea bifurcates into its mainstem bronchi at the level of...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
'scooped out' or bowl-shaped
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Fraction (%age) of inspired oxygen

2. Which bronchus is wider - shorter - and more vertically placed?
Right
Spirometry
The amount of air that can be exhaled after expiration
Speed of airflow - the higher the flow - the greater the resistance

3. FEV1% in obstructive disease
results in a lower than normal FEV1%
right & left
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
The atmospheric pressure

4. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Manubrio-sternal junction (angle of Louis)
The amount of air that can be inhaled after normal inspiration
Nitrogen
T4 or T5 - and just below the manubrio-sternal joint

5. The acini consist of the...
Acinus
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
10 to 11 cm long and about 2 cm in diameter
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

6. Spirometry plots
Mediastinum
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
A tracing of the lung volume against time in seconds
Pulse oximetry

7. Resistance is dependent upon
Speed of airflow - the higher the flow - the greater the resistance
Postero-anterior (PA) and lateral view series
The rib above it
Spirometry

8. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
A sensor placed over a translucent area of arterial pulsation
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Narrowed nearly to the point of closure
Brief - discrete - non-musical sounds with a popping quality

9. The best indicator of adequate ventilation is the...
PaCO2
Brief - discrete - non-musical sounds with a popping quality
Cough
Alveoli to the blood

10. Orthopnea is defined as
The rib above it
Dyspnea upon assuming a recumbent position
Blood to the alveoli
Observing the pattern of breathing

11. Auscultation of the chest depends on...
Larger airways
Binding of O2 to Hb
A reliable and consistent classification of auditory findings
Pneumonia - obstructive lung disease - and late pulmonary edema

12. The internal intercostals decrease the transverse diameter of the chest during
80 to 120% of predicted value
Expiration
Cough
35 to 45 mmHg

13. The accessory muscles are the...
There is an inverse relationship between pressure and volume
The amount of air that can be exhaled after expiration
Sternocleidomastoid - Scalene Muscles
A tracing of the lung volume against time in seconds

14. The muscles of expiration are the...
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Tongue

15. FEV1% in restrictive disease
Lowered carbon dioxide level - results from hyperventilation
Normal to increased FEV1%
Overcome some of the problems associated with low blood flow to the probe site
Ventilation - Diffusion - Perfusion

16. What may prevent cyanosis from appearing?
A tracing of the lung volume against time in seconds
Binding of O2 to Hb
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Lung volumes - but find it difficult to exhale rapidly

17. The tracheo-bronchial tree is a tubular system that provides a pathway for
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
A good effort
Dullness replaces resonance
Air to move from the upper airway to the farthest alveolar reaches

18. Bronchiovesicular breath sounds
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Dullness replaces resonance
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling 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

19. HCO3
Air to move from the upper airway to the farthest alveolar reaches
Increased Hb-O2 affinity
Bicarbonate
A tracing of the lung volume against time in seconds

20. Continuous lung sounds occur in the setting of...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Mouth as well as through the chest wall
Bronchospasm - mucosal edema - or excessive secretions
Oxygen (O2)

21. Oxygen moves from the...
Mediastinum
Inspiration
Alveoli to the blood
Partial pressure of oxygen in the alveoli

22. PaO2
Hypoventilation or modest changes in the PaO2
Partial pressure of O2 in the arterial blood
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Expiratory volume - and there is a prolonged expiratory time

23. pain in lung conditions usually arises from
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Inflammation of the adjacent parietal pleura
Left upper lobe

24. Pulse Oximetry is dependent on...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
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
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

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

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26. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
quickly - usually reaching a plateau within 6.0 seconds
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Observing the pattern of breathing
2 - each wavelength is partially absorbed by hemoglobin

27. Central cyanosis results from
Diffusion
respiration
70% occlusion of the airway
Insufficient oxygenation of hemoglobin in the lungs

28. The parietal pleura lines the...
Obstructive lung disease from restrictive lung disease
Inside of the thoracic cavity wall and the upper surface of the diaphragm
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Postero-anterior (PA) and lateral view series

29. PaCO2
release of O2 from Hb - as heat is a by-product of metabolism.
reduced in size - compared with a normal curve - due to lower lung volume
Partial pressure of CO2 in the arterial blood
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

30. The main bronchi are divided into smaller branches that begin to subdivide into
Increased Hb-O2 affinity
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Expiration
Either inspiration or expiration

31. expiratory reserve
The amount of air that can be exhaled after expiration
Pressure required to drive air through the airways
Significant pulmonary impairment
Tongue

32. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
Mediastinum
Perfusion
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

33. The primary muscles of respiration are the...
Dullness replaces resonance
Pneumonia - obstructive lung disease - and late pulmonary edema
To assess response to treatment
Diaphragm and the intercostal muscles

34. most important factor that influences the oxygen carrying capacity of hemoglobin
The atmospheric pressure
Increased minute volume ventilation - which results in a lowered carbon dioxide level
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Partial pressure of oxygen (PO2)

35. 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
Dyspnea upon assuming a recumbent position
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
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

36. dead space ventilation
Total lung capacity (TLC)
Binding of O2 to Hb
The gas in the conducting airways does not participate in alveolar exchange
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)

37. The trachea divides into right and left mainstem bronchi At what level?
T4 or T5 - and just below the manubrio-sternal joint
'adventitious' breath sounds
70%
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

38. Obstructive Disease: Expiratory airflow is reduced more than
Partial pressure of CO2 in the arterial blood
Nitrogen
Pneumonia - obstructive lung disease - and late pulmonary edema
Expiratory volume - and there is a prolonged expiratory time

39. Normal lung sounds
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Pleural space
Partial pressure of O2 in the arterial blood

40. tidal volume (Vt)
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Manubrio-sternal junction (angle of Louis)
70%
Nitrogen

41. within limits - increased temperature =
Partial pressure of O2 in the arterial blood
A reduction in lung capacity - secondary to scarring or extraneous material
Increased Hb-O2 affinity
release of O2 from Hb - as heat is a by-product of metabolism.

42. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Ventilation
'scooped out' or bowl-shaped
Right
Diffusion

43. Spirometry normal range
Binding of O2 to Hb
80 to 120% of predicted value
Portable antero-posterior (AP) view
Immediate oxygenation with or without intubation

44. With restrictive disease - the flow-volume curve is...
reduced in size - compared with a normal curve - due to lower lung volume
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Partial pressure of oxygen in the alveoli
release of O2 from Hb - as heat is a by-product of metabolism.

45. The trachea is how long/wide?
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
10 to 11 cm long and about 2 cm in diameter
Oxygen (O2)
Blue or bluish-gray discoloration of the skin or mucous membranes

46. Bohr Effect of pH is graphed as
Partial pressure of O2 in the arterial blood
Oxygen-Hemoglobin Dissociation Curve
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Tongue

47. Restrictive disease refers to...
70% occlusion of the airway
Expiratory volume - and there is a prolonged expiratory time
Partial pressure of O2 in the arterial blood
A reduction in lung capacity - secondary to scarring or extraneous material

48. Rhonchi originate in the...
Increased amounts of unsaturated hemoglobin in capillary blood
The gas in the conducting airways does not participate in alveolar exchange
Larger airways
80%

49. The upper airway accounts For what % of airway resistance?
right & left
Partial pressure of oxygen in the alveoli
Oxygen (O2)
50%

50. PACO2
Partial pressure of carbon dioxide in the alveoli
35 to 45 mmHg
Immediate oxygenation with or without intubation
Diffusion

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Pulmonology

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