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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. Patients with restrictive disease have low
Altering the respiratory rate and/or the tidal volume
Sternocleidomastoid - Scalene Muscles
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Spirometry

2. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Air bubbles flowing through secretions or slightly closed airways during respiration
Left upper lobe
Manubrio-sternal junction (angle of Louis)
results in a lower than normal FEV1%

3. Continuous lung sounds often audible at the...
Hypoventilation or modest changes in the PaO2
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Mouth as well as through the chest wall
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

4. Hyperventilation is defined as
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Saturated with oxygen or unsaturated
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Obstruction below the vocal cords (subglottic or tracheal obstruction)

5. What occurs passively as muscles relax?
Bronchospasm - mucosal edema - or excessive secretions
Altering the respiratory rate and/or the tidal volume
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Expiration

6. The trachea divides into
Decreased Hb-O2 affinity
Acinus
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
right and left mainstem bronchi

7. Tachypnea is an
Acinus
Lowered carbon dioxide level - results from hyperventilation
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle

8. Expiratory stridor indicates
Obstruction below the vocal cords (subglottic or tracheal obstruction)
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Narrowed nearly to the point of closure

9. forced vital capacity (FVC)
A sensor placed over a translucent area of arterial pulsation
Mouth as well as through the chest wall
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
A tracing of the lung volume against time in seconds

10. Patients with obstructive disease have normal
Portable antero-posterior (AP) view
Lung volumes - but find it difficult to exhale rapidly
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Obstructive lung disease from restrictive lung disease

11. PACO2
Interstitial diseases or early pulmonary edema
Right
Partial pressure of carbon dioxide in the alveoli
The negative logarithm of hydrogen ions in the blood

12. movement of blood through the capillaries in direct communication with the alveoli
Mouth as well as through the chest wall
Decreased Hb-O2 affinity
release of O2 from Hb - as heat is a by-product of metabolism.
Perfusion

13. The most reliable site for detecting central cyanosis is the...
Tongue
Manubrio-sternal junction (angle of Louis)
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Upper respiratory obstruction - usually in the trachea or larynx

14. Does lung tissue have pain fibers?
Blue or bluish-gray discoloration of the skin or mucous membranes
Decreased Hb-O2 affinity
No
Perfusion

15. Percussion helps you establish whether the underlying tissues are...
70% occlusion of the airway
Carboxyhemoglobin
Blue or bluish-gray discoloration of the skin or mucous membranes
Air-filled - fluid-filled - or solid

16. pH
PaCO2
The negative logarithm of hydrogen ions in the blood
Tongue
Blue or bluish-gray discoloration of the skin or mucous membranes

17. The internal intercostals decrease the transverse diameter of the chest during
Larger airways
Immediate oxygenation with or without intubation
Binding of O2 to Hb
Expiration

18. Rhonchi occur during
The amount of air that can be exhaled after expiration
Expiratory volume - and there is a prolonged expiratory time
results in a lower than normal FEV1%
Either inspiration or expiration

19. forced expiratory volume in one second (FEV1)
80%
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
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
Air to move from the upper airway to the farthest alveolar reaches

20. Continuous lung sounds occur in the setting of...
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Bronchospasm - mucosal edema - or excessive secretions
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Air to move from the upper airway to the farthest alveolar reaches

21. tidal volume (Vt)
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Soft - high-pitched and crisp
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

22. pain in lung conditions usually arises from
Perfusion
Inflammation of the adjacent parietal pleura
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Cough

23. Bohr Effect of pH is graphed as
Oxygen-Hemoglobin Dissociation Curve
Either inspiration or expiration
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
The total amount of air in the lungs at the end of a maximal inhalation

24. The vital capacity and the residual volume together constitute the...
Carboxyhemoglobin
Total lung capacity (TLC)
The total amount of air that can be exhaled following a maximal inhalation
Fraction (%age) of inspired oxygen

25. The acini consist of the...
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Partial pressure of O2 in the arterial blood
right & left
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

26. Vesicular breath sounds
Portable antero-posterior (AP) view
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
Perfusion
Carboxyhemoglobin

27. The trachea bifurcates into its mainstem bronchi at the level of...
reduced in size - compared with a normal curve - due to lower lung volume
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Partial pressure of O2 in the arterial blood
Inspiration

28. The parietal pleura lines the...
Lowered carbon dioxide level - results from hyperventilation
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

29. FIO2
The gas in the conducting airways does not participate in alveolar exchange
Fraction (%age) of inspired oxygen
70%
Mouth as well as through the chest wall

30. With restrictive disease - the flow-volume curve is...
reduced in size - compared with a normal curve - due to lower lung volume
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
The negative logarithm of hydrogen ions in the blood
Dyspnea upon assuming a recumbent position

31. The presence of pressure gradients causes respiratory gases to move from
The right middle lobe
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
T4 or T5 - and just below the manubrio-sternal joint
release of O2 from Hb

32. The best indicator of adequate ventilation is the...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
PaCO2
A reduction in lung capacity - secondary to scarring or extraneous material
The examiner can clearly distinguish the word that the pt speak or whispers

33. vital capacity (VC)
T4 or T5 - and just below the manubrio-sternal joint
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
The total amount of air in the lungs at the end of a maximal inhalation
The total amount of air that can be exhaled following a maximal inhalation

34. Abnormal lung sounds are classified as
Observing the pattern of breathing
Contracts
Either continuous or discontinuous
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

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

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36. Bronchial breath sounds
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
right & left
Normal to increased FEV1%
Lowered carbon dioxide level - results from hyperventilation

37. Obstructive Disease: Expiratory airflow is reduced more than
Expiratory volume - and there is a prolonged expiratory time
Increased amounts of unsaturated hemoglobin in capillary blood
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
reduced in size - compared with a normal curve - due to lower lung volume

38. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
Mediastinum
T4 or T5 - and just below the manubrio-sternal joint
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Either continuous or discontinuous

39. FEV1% in restrictive disease
There is an inverse relationship between pressure and volume
T4 or T5 - and just below the manubrio-sternal joint
Saturated with oxygen or unsaturated
Normal to increased FEV1%

40. Bohr Effect of pH: left shift
release of O2 from Hb - as heat is a by-product of metabolism.
Left upper lobe
Increased Hb-O2 affinity
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

41. A normal volume-time curve rises
Bronchospasm - mucosal edema - or excessive secretions
Mediastinum
70% occlusion of the airway
quickly - usually reaching a plateau within 6.0 seconds

42. 20.95% Atmospheric Composition
quickly - usually reaching a plateau within 6.0 seconds
500 to 800 mL
Oxygen (O2)
Manubrio-sternal junction (angle of Louis)

43. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Fraction (%age) of inspired oxygen
Immediate oxygenation with or without intubation
Diaphragm and the intercostal muscles
Expiration

44. Spirometry: The result is stated as
Diaphragm - External Intercostals
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Spirometry
Brief - discrete - non-musical sounds with a popping quality

45. What may prevent cyanosis from appearing?
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
A sensor placed over a translucent area of arterial pulsation
Obstruction below the vocal cords (subglottic or tracheal obstruction)

46. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Spirometry
'scooped out' or bowl-shaped
Saturated with oxygen or unsaturated

47. Spirometry can be used to determine the severity of functional impairment as well as
To assess response to treatment
Alveoli to the blood
Immediate oxygenation with or without intubation
T4 or T5 - and just below the manubrio-sternal joint

48. gas exchange across the alveolar-pulmonary capillary membranes
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Air-filled - fluid-filled - or solid
Diffusion
Nitrogen

49. Spirometry plots
A tracing of the lung volume against time in seconds
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Obstructive lung disease from restrictive lung disease
Brief - discrete - non-musical sounds with a popping quality

50. Which bronchus is wider - shorter - and more vertically placed?
Right
500 to 800 mL
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
10 to 11 cm long and about 2 cm in diameter