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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. pain in lung conditions usually arises from
Diaphragm and the intercostal muscles
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Inflammation of the adjacent parietal pleura
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

2. The trachea bifurcates into its mainstem bronchi at the level of...
Excessive secretions and abnormal airway collapsibility
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Bronchospasm - mucosal edema - or excessive secretions
No respiration for > 20 seconds

3. most important factor that influences the oxygen carrying capacity of hemoglobin
Lowered carbon dioxide level - results from hyperventilation
Partial pressure of oxygen (PO2)
The total amount of air in the lungs at the end of a maximal inhalation
quickly - usually reaching a plateau within 6.0 seconds

4. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Immediate oxygenation with or without intubation
results in a lower than normal FEV1%
Diffusion
Increase the intrathoracic space

5. A normal volume-time curve rises
quickly - usually reaching a plateau within 6.0 seconds
No
Pneumonia - obstructive lung disease - and late pulmonary edema
Dyspnea that awakens the patient several hours after going to sleep

6. office-based spirometry is recommended for patients as young as
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Significant pulmonary impairment
Increased amounts of unsaturated hemoglobin in capillary blood
5 years - to detect obstruction and determine its reversibility

7. Obstructive disease refers to...
Increased amounts of unsaturated hemoglobin in capillary blood
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Dyspnea upon assuming a recumbent position
Postero-anterior (PA) and lateral view series

8. Airway resistance refers to...
Immediate oxygenation with or without intubation
Pressure required to drive air through the airways
Manubrio-sternal junction (angle of Louis)
Postero-anterior (PA) and lateral view series

9. Boyle's Gas Law
There is an inverse relationship between pressure and volume
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Spirometry
'crackles' or 'rales'

10. 20.95% Atmospheric Composition
Mouth as well as through the chest wall
Oxygen (O2)
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Decreased pressure

11. At rest - the use of accessory muscles is a sign of...
Significant pulmonary impairment
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Expiration
Right

12. Continuous lung sounds often audible at the...
Air to move from the upper airway to the farthest alveolar reaches
Expiratory volume - and there is a prolonged expiratory time
Blue or bluish-gray discoloration of the skin or mucous membranes
Mouth as well as through the chest wall

13. low CO2 = low acidity =
Binding of O2 to Hb
Functional residual capacity (FRC)
Inspiration
Carboxyhemoglobin

14. Paroxysmal nocturnal dyspnea (PND) is...
500 to 800 mL
Dyspnea that awakens the patient several hours after going to sleep
Difficulty breathing or shortness of breath
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

15. The trachea divides into right and left mainstem bronchi At what level?
Expiratory volume - and there is a prolonged expiratory time
Mediastinum
Perfusion
T4 or T5 - and just below the manubrio-sternal joint

16. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
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
Saturated with oxygen or unsaturated
Obstructive lung disease from restrictive lung disease

17. The internal intercostals decrease the transverse diameter of the chest during
Inflammation of the adjacent parietal pleura
Expiration
70% occlusion of the airway
right and left mainstem bronchi

18. Abnormal lung sounds are classified as
respiration
Either continuous or discontinuous
Soft - high-pitched and crisp
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

19. 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
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
A reduction in lung capacity - secondary to scarring or extraneous material
Partial pressure of O2 in the arterial blood

20. A state-of-the-art - inexpensive - non-invasive - simple method to monitor a patient's percent hemoglobin saturation with oxygen (SaO2) - without having to obtain an arterial blood specimen
35 to 45 mmHg
Pulse oximetry
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 right middle lobe

21. Peripheral cyanosis results from
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
reduced in size - compared with a normal curve - due to lower lung volume
Mouth as well as through the chest wall
Blue or bluish-gray discoloration of the skin or mucous membranes

22. the lingula is analogous to...
'adventitious' breath sounds
The right middle lobe
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
Tongue

23. Cyanosis
Partial pressure of oxygen in the alveoli
Blue or bluish-gray discoloration of the skin or mucous membranes
Lowered carbon dioxide level - results from hyperventilation
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

24. The primary muscles of respiration are the...
Ventilation - Diffusion - Perfusion
Mouth as well as through the chest wall
Diaphragm and the intercostal muscles
To assess response to treatment

25. Nitroglycerin applied to the probe area has been reported to...
Overcome some of the problems associated with low blood flow to the probe site
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
50%
Portable antero-posterior (AP) view

26. The most reliable site for detecting central cyanosis is the...
results in a lower than normal FEV1%
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
Tongue
Overcome some of the problems associated with low blood flow to the probe site

27. Normal lung sounds
A tracing of the lung volume against time in seconds
Expiration
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Perfusion

28. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Inspiration

29. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
A sensor placed over a translucent area of arterial pulsation
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
Expiration

30. Does lung tissue have pain fibers?
No
Diaphragm - External Intercostals
Difficulty breathing or shortness of breath
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL

31. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Spirometry
Pneumonia - obstructive lung disease - and late pulmonary edema
Speed of airflow - the higher the flow - the greater the resistance
Soft - high-pitched and crisp

32. The spirometry printout usually includes

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33. Discontinuous lung sounds are...
Ventilation
Ventilation - Diffusion - Perfusion
Brief - discrete - non-musical sounds with a popping quality
Diffusion

34. The interspace between two ribs (intercostal space) is numbered by
The rib above it
10 to 11 cm long and about 2 cm in diameter
Hypoventilation or modest changes in the PaO2
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

35. Pulmonary ventilation is varied by
Diaphragm and the intercostal muscles
The atmospheric pressure
Altering the respiratory rate and/or the tidal volume
Mouth as well as through the chest wall

36. normal adult tidal volume
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
500 to 800 mL
'crackles' or 'rales'
Expiration

37. total lung capacity (TLC)
The atmospheric pressure
The total amount of air in the lungs at the end of a maximal inhalation
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Bicarbonate

38. expiratory reserve
Normal to increased FEV1%
Saturated with oxygen or unsaturated
The amount of air that can be exhaled after expiration
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

39. PaCO2
right & left
right
release of O2 from Hb - as heat is a by-product of metabolism.
Partial pressure of CO2 in the arterial blood

40. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
Pleural space
Wheezes - high-pitched - musical sounds - distinct whistling quality
respiration
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

41. Which bronchus is wider - shorter - and more vertically placed?
Partial pressure of oxygen in the alveoli
Dyspnea that awakens the patient several hours after going to sleep
Right
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

42. high CO2 = high acidity =
A reduction in lung capacity - secondary to scarring or extraneous material
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Carboxyhemoglobin
release of O2 from Hb

43. The tracheo-bronchial tree is a tubular system that provides a pathway for
Manubrio-sternal junction (angle of Louis)
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Air to move from the upper airway to the farthest alveolar reaches
Observing the pattern of breathing

44. An efficient approach to examination of the patient begins with
release of O2 from Hb
Observing the pattern of breathing
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Increased Hb-O2 affinity

45. Coarse crackles are heard in
Partial pressure of CO2 in the arterial blood
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Pneumonia - obstructive lung disease - and late pulmonary edema
Saturated with oxygen or unsaturated

46. With restrictive disease - the flow-volume curve is...
reduced in size - compared with a normal curve - due to lower lung volume
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Larger airways
Either continuous or discontinuous

47. Auscultation of the chest depends on...
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Blood to the alveoli
A reliable and consistent classification of auditory findings

48. The muscles of inspiration are the...
No
70%
Diaphragm - External Intercostals
The gas in the conducting airways does not participate in alveolar exchange

49. Which lung has an oblique fissure?
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
right & left
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

50. Carbon dioxide moves from the...
Contracts
Blood to the alveoli
quickly - usually reaching a plateau within 6.0 seconds
release of O2 from Hb - as heat is a by-product of metabolism.