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Pulmonology

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Cyanosis is caused by
No
Either continuous or discontinuous
The total amount of air in the lungs at the end of a maximal inhalation
Increased amounts of unsaturated hemoglobin in capillary blood

2. Cyanosis appears when
There is an inverse relationship between pressure and volume
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Expiration
Postero-anterior (PA) and lateral view series

3. residual volume
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
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
Lung volumes - but no difficulty or delay in exhaling what volume they do have
70% occlusion of the airway

4. Continuous lung sounds often audible at the...
Mouth as well as through the chest wall
quickly - usually reaching a plateau within 6.0 seconds
The amount of air that can be inhaled after normal inspiration
35 to 45 mmHg

5. The accessory muscles are the...
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
Binding of O2 to Hb
Sternocleidomastoid - Scalene Muscles
Narrowed nearly to the point of closure

6. What may prevent cyanosis from appearing?
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Pneumonia - obstructive lung disease - and late pulmonary edema
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Partial pressure of oxygen (PO2)

7. Restrictive Disease: Expiratory volume is reduced more than
Increased Hb-O2 affinity
The examiner can clearly distinguish the word that the pt speak or whispers
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
A tracing of the lung volume against time in seconds

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

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9. Rhonchi frequently clear after
Cough
Increase the intrathoracic space
respiration
Decreased Hb-O2 affinity

10. Nitroglycerin applied to the probe area has been reported to...
Air-filled - fluid-filled - or solid
Overcome some of the problems associated with low blood flow to the probe site
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Increased amounts of unsaturated hemoglobin in capillary blood

11. Orthopnea is quantified by
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
release of O2 from Hb - as heat is a by-product of metabolism.
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

12. PAO2
Obstructive lung disease from restrictive lung disease
Inflammation of the adjacent parietal pleura
Partial pressure of oxygen in the alveoli
Partial pressure of carbon dioxide in the alveoli

13. movement of blood through the capillaries in direct communication with the alveoli
Air-filled - fluid-filled - or solid
80 to 120% of predicted value
Perfusion
Tongue

14. Inspiratory stridor indicates
Perfusion
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
'adventitious' breath sounds
The atmospheric pressure

15. Airway resistance refers to...
Speed of airflow - the higher the flow - the greater the resistance
Pressure required to drive air through the airways
Binding of O2 to Hb
quickly - usually reaching a plateau within 6.0 seconds

16. Central cyanosis results from
80%
T4 or T5 - and just below the manubrio-sternal joint
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Insufficient oxygenation of hemoglobin in the lungs

17. Bronchial breath sounds
Total lung capacity (TLC)
Hypoventilation or modest changes in the PaO2
Alveoli to the blood
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

18. The trachea divides into right and left mainstem bronchi At what level?
T4 or T5 - and just below the manubrio-sternal joint
A sensor placed over a translucent area of arterial pulsation
The total amount of air that can be exhaled following a maximal inhalation
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

19. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
Dullness replaces resonance
Oxygen-Hemoglobin Dissociation Curve
Alveoli to the blood
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

20. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
Mediastinum
reduced in size - compared with a normal curve - due to lower lung volume
Mouth as well as through the chest wall
Partial pressure of carbon dioxide in the alveoli

21. Auscultation of the chest depends on...
A reliable and consistent classification of auditory findings
Partial pressure of CO2 in the arterial blood
Contracts
Expiration

22. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
Hypoventilation or modest changes in the PaO2
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
A sensor placed over a translucent area of arterial pulsation
Cough

23. The external intercostal muscles increase the antero-posterior chest diameter during
The rib above it
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Portable antero-posterior (AP) view
Inspiration

24. The muscles of expiration are the...
Upper respiratory obstruction - usually in the trachea or larynx
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'
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

25. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
There is an inverse relationship between pressure and volume
Mouth as well as through the chest wall
Inspiration
Lowered carbon dioxide level - results from hyperventilation

26. Spirometry can be used to determine the severity of functional impairment as well as
Partial pressure of O2 in the arterial blood
Dyspnea that awakens the patient several hours after going to sleep
To assess response to treatment
Lowered carbon dioxide level - results from hyperventilation

27. The normal FEV1 /FVC ratio is...
70%
Oxygen-Hemoglobin Dissociation Curve
Hypoventilation or modest changes in the PaO2
Louder - lower-pitched - and slightly longer in duration

28. Bohr Effect of pH: left shift
Increased Hb-O2 affinity
Insufficient oxygenation of hemoglobin in the lungs
The amount of air that can be inhaled after normal inspiration
Pleural space

29. normal adult tidal volume
Spirometry
Blue or bluish-gray discoloration of the skin or mucous membranes
Postero-anterior (PA) and lateral view series
500 to 800 mL

30. within limits - increased temperature =
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
A reduction in lung capacity - secondary to scarring or extraneous material
Difficulty breathing or shortness of breath
release of O2 from Hb - as heat is a by-product of metabolism.

31. Respiration involves
Ventilation - Diffusion - Perfusion
Dyspnea upon assuming a recumbent position
quickly - usually reaching a plateau within 6.0 seconds
Oxygen (O2)

32. The main bronchi are divided into smaller branches that begin to subdivide into
Expiration
70% occlusion of the airway
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
results in a lower than normal FEV1%

33. FEV1% in obstructive disease
Increase the intrathoracic space
Upper respiratory obstruction - usually in the trachea or larynx
The total amount of air that can be exhaled following a maximal inhalation
results in a lower than normal FEV1%

34. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
50%
Manubrio-sternal junction (angle of Louis)
Spirometry
The examiner can clearly distinguish the word that the pt speak or whispers

35. The presence of pressure gradients causes respiratory gases to move from
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Either continuous or discontinuous

36. forced expiratory volume in one second (FEV1)
Wheezes - high-pitched - musical sounds - distinct whistling quality
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
require supplemental oxygenation and possibly ABG analysis
Expiratory volume - and there is a prolonged expiratory time

37. Coarse crackles are heard in
Increase the intrathoracic space
Postero-anterior (PA) and lateral view series
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Pneumonia - obstructive lung disease - and late pulmonary edema

38. The muscles of inspiration are the...
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Diaphragm - External Intercostals
Louder - lower-pitched - and slightly longer in duration
Observing the pattern of breathing

39. Patients with restrictive disease have low
Lung volumes - but find it difficult to exhale rapidly
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Right
Immediate oxygenation with or without intubation

40. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Decreased Hb-O2 affinity
The rib above it
Functional residual capacity (FRC)
70% occlusion of the airway

41. total lung capacity (TLC)
The total amount of air in the lungs at the end of a maximal inhalation
Pulse oximetry
Portable antero-posterior (AP) view
Diaphragm - External Intercostals

42. The trachea bifurcates into its mainstem bronchi at the level of...
Interstitial diseases or early pulmonary edema
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
'adventitious' breath sounds
Soft - high-pitched and crisp

43. Normal lung sounds
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Bicarbonate
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
right & left

44. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Speed of airflow - the higher the flow - the greater the resistance
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Louder - lower-pitched - and slightly longer in duration
The gas in the conducting airways does not participate in alveolar exchange

45. Bronchophony
The rib above it
Decreased Hb-O2 affinity
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
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

46. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Increase the intrathoracic space
Normal to increased FEV1%
Perfusion
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

47. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
Overcome some of the problems associated with low blood flow to the probe site
Increase the intrathoracic space
Speed of airflow - the higher the flow - the greater the resistance
respiration

48. The vital capacity and the residual volume together constitute the...
Speed of airflow - the higher the flow - the greater the resistance
Excessive secretions and abnormal airway collapsibility
Total lung capacity (TLC)
80 to 120% of predicted value

49. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Difficulty breathing or shortness of breath
results in a lower than normal FEV1%
80%

50. vital capacity (VC)
The total amount of air that can be exhaled following a maximal inhalation
Dyspnea that awakens the patient several hours after going to sleep
Saturated with oxygen or unsaturated
Partial pressure of CO2 in the arterial blood