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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. Spirometry can be used to determine the severity of functional impairment as well as
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
To assess response to treatment
80 to 120% of predicted value
Lung volumes - but find it difficult to exhale rapidly

2. Percussion helps you establish whether the underlying tissues are...
Ventilation - Diffusion - Perfusion
Air-filled - fluid-filled - or solid
Carboxyhemoglobin
A good effort

3. The acini consist of the...
Dyspnea that awakens the patient several hours after going to sleep
Manubrio-sternal junction (angle of Louis)
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Either continuous or discontinuous

4. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Pulse oximetry
No
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
The atmospheric pressure

5. Which lung has a horizontal fissure?
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
right
Either continuous or discontinuous
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

6. The internal intercostals decrease the transverse diameter of the chest during
Left upper lobe
No respiration for > 20 seconds
Expiration
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

7. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Diffusion
Perfusion
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

8. The active movement of gases between the ambient air and the lungs
There is an inverse relationship between pressure and volume
Dyspnea that awakens the patient several hours after going to sleep
Increased work of breathing
Ventilation

9. During inspiration the diaphragm
Spirometry
Contracts
A tracing of the lung volume against time in seconds
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

10. What may prevent cyanosis from appearing?
'crackles' or 'rales'
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
To assess response to treatment
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

11. FEV1% in obstructive disease
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
results in a lower than normal FEV1%
Bicarbonate
50%

12. Which lobe has an inferior tongue-like projection called the lingula?
Ventilation - Diffusion - Perfusion
Left upper lobe
Soft - high-pitched and crisp
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

13. Orthopnea is defined as
release of O2 from Hb
Dyspnea upon assuming a recumbent position
Obstructive lung disease from restrictive lung disease
Bronchospasm - mucosal edema - or excessive secretions

14. The interspace between two ribs (intercostal space) is numbered by
No respiration for > 20 seconds
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
Functional residual capacity (FRC)
The rib above it

15. Resistance is dependent upon
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Obstructive lung disease from restrictive lung disease
'crackles' or 'rales'
Speed of airflow - the higher the flow - the greater the resistance

16. Pulse Oximetry is dependent on...
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
No respiration for > 20 seconds
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Partial pressure of CO2 in the arterial blood

17. Patients with obstructive disease have normal
Lung volumes - but find it difficult to exhale rapidly
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Perfusion
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

18. Abnormal lung sounds are classified as
Functional residual capacity (FRC)
Ventilation
Either continuous or discontinuous
require supplemental oxygenation and possibly ABG analysis

19. Cyanosis
Blue or bluish-gray discoloration of the skin or mucous membranes
70%
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Mouth as well as through the chest wall

20. gas exchange across the alveolar-pulmonary capillary membranes
'adventitious' breath sounds
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Diffusion
PaCO2

21. Discontinuous lung sounds are also called

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22. Inspiratory stridor indicates
The amount of air that can be exhaled after expiration
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
The atmospheric pressure
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)

23. Compliance
Normal to increased FEV1%
A good effort
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
Left upper lobe

24. Continuous lung sounds often audible at the...
Mouth as well as through the chest wall
80%
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Ventilation

25. PAO2
Increase the intrathoracic space
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Overcome some of the problems associated with low blood flow to the probe site
Partial pressure of oxygen in the alveoli

26. Rhonchi are due to...
Excessive secretions and abnormal airway collapsibility
Decreased Hb-O2 affinity
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

27. The best indicator of adequate ventilation is the...
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Ventilation - Diffusion - Perfusion
Oxygen (O2)
PaCO2

28. The pattern of breathing refers to...
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
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 gas in the conducting airways does not participate in alveolar exchange

29. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Immediate oxygenation with or without intubation
Narrowed nearly to the point of closure
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Upper respiratory obstruction - usually in the trachea or larynx

30. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
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
Saturated with oxygen or unsaturated
A sensor placed over a translucent area of arterial pulsation
Interstitial diseases or early pulmonary edema

31. Hyperventilation is defined as
Either inspiration or expiration
Soft - high-pitched and crisp
PaCO2
Increased minute volume ventilation - which results in a lowered carbon dioxide level

32. The trachea bifurcates into its mainstem bronchi at the level of...
Decreased pressure
Outer surface of each lung
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Decreased Hb-O2 affinity

33. The trachea divides into right and left mainstem bronchi At what level?
The right middle lobe
T4 or T5 - and just below the manubrio-sternal joint
Diffusion
results in a lower than normal FEV1%

34. Inspiratory stridor becomes evident at about
Dullness replaces resonance
Mediastinum
Spirometry
70% occlusion of the airway

35. forced expiratory volume in one second (FEV1)
require supplemental oxygenation and possibly ABG analysis
Partial pressure of CO2 in the arterial blood
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
Mediastinum

36. tidal volume (Vt)
Increased rate of breathing and is commonly associated with a decrease in tidal volume
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Either inspiration or expiration

37. Does lung tissue have pain fibers?
500 to 800 mL
Left upper lobe
No
Inspiration

38. The parietal pleura lines the...
Partial pressure of CO2 in the arterial blood
There is an inverse relationship between pressure and volume
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Inspiration

39. The muscles of inspiration are the...
Diaphragm - External Intercostals
Partial pressure of oxygen in the alveoli
Significant pulmonary impairment
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

40. Vesicular breath sounds
Inspiration
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
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

41. 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
Immediate oxygenation with or without intubation
A sensor placed over a translucent area of arterial pulsation
right

42. Orthopnea is quantified by
Either inspiration or expiration
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Pneumonia - obstructive lung disease - and late pulmonary edema

43. Continuous lung sounds occur when air flows rapidly through bronchi that are...
Right
Narrowed nearly to the point of closure
'adventitious' breath sounds
The gas in the conducting airways does not participate in alveolar exchange

44. Fine crackles are heard in
Interstitial diseases or early pulmonary edema
The negative logarithm of hydrogen ions in the blood
Lung volumes - but find it difficult to exhale rapidly
Dyspnea that awakens the patient several hours after going to sleep

45. Peripheral cyanosis results from
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
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
5 years - to detect obstruction and determine its reversibility
Expiration

46. normal subjects expel approximately how much of the FVC in the 1st second?
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
80%
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage

47. The vital capacity and the residual volume together constitute the...
70% occlusion of the airway
Total lung capacity (TLC)
Lung volumes - but find it difficult to exhale rapidly
50%

48. Coarse crackles are heard in
Pneumonia - obstructive lung disease - and late pulmonary edema
Mediastinum
respiration
reduced in size - compared with a normal curve - due to lower lung volume

49. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Blue or bluish-gray discoloration of the skin or mucous membranes
respiration
Increased rate of breathing and is commonly associated with a decrease in tidal volume

50. Airway resistance refers to...
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Diaphragm and the intercostal muscles
The gas in the conducting airways does not participate in alveolar exchange
Pressure required to drive air through the airways