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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. Normal range of PaCO2
35 to 45 mmHg
Either inspiration or expiration
Outer surface of each lung
Partial pressure of CO2 in the arterial blood

2. pain in lung conditions usually arises from
The rib above it
Sternocleidomastoid - Scalene Muscles
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
Inflammation of the adjacent parietal pleura

3. The muscles of expiration are the...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
'adventitious' breath sounds
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Blue or bluish-gray discoloration of the skin or mucous membranes

4. Dyspnea is defined as
No
Blood to the alveoli
Pleural space
Difficulty breathing or shortness of breath

5. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
The atmospheric pressure
Wheezes - high-pitched - musical sounds - distinct whistling quality
The examiner can clearly distinguish the word that the pt speak or whispers
respiration

6. Coarse crackles result from
Air bubbles flowing through secretions or slightly closed airways during respiration
Soft - high-pitched and crisp
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Pleural space

7. A normal volume-time curve rises
Either inspiration or expiration
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
The examiner can clearly distinguish the word that the pt speak or whispers
quickly - usually reaching a plateau within 6.0 seconds

8. Rhonchi frequently clear after
Cough
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Partial pressure of carbon dioxide in the alveoli

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

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10. Continuous lung sounds
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
To assess response to treatment
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

11. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Increase the intrathoracic space
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Bicarbonate
Increased minute volume ventilation - which results in a lowered carbon dioxide level

12. forced vital capacity (FVC)
Right
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Outer surface of each lung

13. Vesicular breath sounds
respiration
A reduction in lung capacity - secondary to scarring or extraneous material
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
Hypoventilation or modest changes in the PaO2

14. terminal respiratory unit
Acinus
Observing the pattern of breathing
Inspiration
right & left

15. increased volume results in
Decreased pressure
500 to 800 mL
Total lung capacity (TLC)
The negative logarithm of hydrogen ions in the blood

16. Auscultation of the chest depends on...
A reliable and consistent classification of auditory findings
'crackles' or 'rales'
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
A tracing of the lung volume against time in seconds

17. within limits - increased temperature =
Right
Fraction (%age) of inspired oxygen
The atmospheric pressure
release of O2 from Hb - as heat is a by-product of metabolism.

18. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
Partial pressure of oxygen in the alveoli
quickly - usually reaching a plateau within 6.0 seconds
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
A sensor placed over a translucent area of arterial pulsation

19. 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
Perfusion
Interstitial diseases or early pulmonary edema
Increased minute volume ventilation - which results in a lowered carbon dioxide level

20. expiratory reserve
Difficulty breathing or shortness of breath
The amount of air that can be exhaled after expiration
Total lung capacity (TLC)
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

21. Cyanosis appears when
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Functional residual capacity (FRC)
Pneumonia - obstructive lung disease - and late pulmonary edema
Partial pressure of CO2 in the arterial blood

22. The active movement of gases between the ambient air and the lungs
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Ventilation
Either continuous or discontinuous
'scooped out' or bowl-shaped

23. HCO3
Pneumonia - obstructive lung disease - and late pulmonary edema
'scooped out' or bowl-shaped
right and left mainstem bronchi
Bicarbonate

24. Pectoriloquy
Overcome some of the problems associated with low blood flow to the probe site
The examiner can clearly distinguish the word that the pt speak or whispers
The total amount of air in the lungs at the end of a maximal inhalation
Fraction (%age) of inspired oxygen

25. Rhonchi
Air bubbles flowing through secretions or slightly closed airways during respiration
Expiration
Dullness replaces resonance
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

26. dead space ventilation
Obstruction below the vocal cords (subglottic or tracheal obstruction)
The gas in the conducting airways does not participate in alveolar exchange
Spirometry
10 to 11 cm long and about 2 cm in diameter

27. high CO2 = high acidity =
release of O2 from Hb
80 to 120% of predicted value
Upper respiratory obstruction - usually in the trachea or larynx
Ventilation

28. Airway resistance refers to...
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Pressure required to drive air through the airways
Narrowed nearly to the point of closure
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

29. Nitroglycerin applied to the probe area has been reported to...
Overcome some of the problems associated with low blood flow to the probe site
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
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Hypoventilation or modest changes in the PaO2

30. Rhonchi occur during
Obstructive lung disease from restrictive lung disease
Either inspiration or expiration
Narrowed nearly to the point of closure
Air bubbles flowing through secretions or slightly closed airways during respiration

31. Which lung has an oblique fissure?
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Increased work of breathing
'scooped out' or bowl-shaped
right & left

32. forced expiratory volume in one second (FEV1)
Obstructive lung disease from restrictive lung disease
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
Inspiration
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

33. The external intercostal muscles increase the antero-posterior chest diameter during
Inspiration
Partial pressure of O2 in the arterial blood
Bronchospasm - mucosal edema - or excessive secretions
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

34. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
Dullness replaces resonance
Increased amounts of unsaturated hemoglobin in capillary blood
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Diffusion

35. Compliance
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
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
The examiner can clearly distinguish the word that the pt speak or whispers
Either inspiration or expiration

36. What is the potential space between the visceral and parietal pleurae?
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
right & left
Postero-anterior (PA) and lateral view series
Pleural space

37. At rest - the use of accessory muscles is a sign of...
Insufficient oxygenation of hemoglobin in the lungs
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
Immediate oxygenation with or without intubation
Significant pulmonary impairment

38. The spirometry printout usually includes

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39. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
A sensor placed over a translucent area of arterial pulsation
Spirometry
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Pressure required to drive air through the airways

40. The normal FEV1 /FVC ratio is...
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
70%
The rib above it
Expiratory volume - and there is a prolonged expiratory time

41. FEV1% in restrictive disease
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
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
reduced in size - compared with a normal curve - due to lower lung volume
Normal to increased FEV1%

42. The pattern of breathing refers to...
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Mouth as well as through the chest wall
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Alveoli to the blood

43. Peripheral cyanosis results from
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Sternocleidomastoid - Scalene Muscles
Larger airways
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

44. Which bronchus is more susceptible to aspiration of foreign bodies?
quickly - usually reaching a plateau within 6.0 seconds
Dyspnea upon assuming a recumbent position
Right
Diffusion

45. The acini consist of the...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Expiratory volume - and there is a prolonged expiratory time
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Insufficient oxygenation of hemoglobin in the lungs

46. PACO2
Right
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Partial pressure of carbon dioxide in the alveoli
Inflammation of the adjacent parietal pleura

47. Egophony

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48. low CO2 = low acidity =
Binding of O2 to Hb
Pressure required to drive air through the airways
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
require supplemental oxygenation and possibly ABG analysis

49. normal adult tidal volume
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
release of O2 from Hb
500 to 800 mL
The total amount of air in the lungs at the end of a maximal inhalation

50. Orthopnea is defined as
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Dyspnea upon assuming a recumbent position
Carboxyhemoglobin