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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. Peripheral cyanosis results from
'scooped out' or bowl-shaped
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Cough
'adventitious' breath sounds

2. The best indicator of adequate ventilation is the...
Partial pressure of oxygen (PO2)
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
PaCO2
Insufficient oxygenation of hemoglobin in the lungs

3. Which bronchus is more susceptible to aspiration of foreign bodies?
PaCO2
Left upper lobe
Right
Increased amounts of unsaturated hemoglobin in capillary blood

4. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
Portable antero-posterior (AP) view
Speed of airflow - the higher the flow - the greater the resistance
Increased work of breathing
Larger airways

5. Bohr Effect of pH: right shift
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Manubrio-sternal junction (angle of Louis)
Increased Hb-O2 affinity
Decreased Hb-O2 affinity

6. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Spirometry
Functional residual capacity (FRC)
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Hypoventilation or modest changes in the PaO2

7. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
The atmospheric pressure
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Altering the respiratory rate and/or the tidal volume

8. increased volume results in
Decreased pressure
Spirometry
Diffusion
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

9. Which lung has an oblique fissure?
right & left
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Air bubbles flowing through secretions or slightly closed airways during respiration
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

10. Rhonchi
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Binding of O2 to Hb
35 to 45 mmHg
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

11. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Pressure required to drive air through the airways
The gas in the conducting airways does not participate in alveolar exchange
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

12. The normal FEV1 /FVC ratio is...
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Increased Hb-O2 affinity
Acinus
70%

13. Boyle's Gas Law
There is an inverse relationship between pressure and volume
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
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
Pneumonia - obstructive lung disease - and late pulmonary edema

14. Continuous lung sounds occur during...
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Air-filled - fluid-filled - or solid
Saturated with oxygen or unsaturated
Either inspiration or expiration

15. Spirometry normal range
80 to 120% of predicted value
A tracing of the lung volume against time in seconds
Outer surface of each lung
2 - each wavelength is partially absorbed by hemoglobin

16. Abnormal lung sounds AKA

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17. PaCO2
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Partial pressure of CO2 in the arterial blood
Carboxyhemoglobin
Air to move from the upper airway to the farthest alveolar reaches

18. Rhonchi occur during
Dyspnea that awakens the patient several hours after going to sleep
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
Either inspiration or expiration
Partial pressure of oxygen in the alveoli

19. Coarse crackles are heard in
Cough
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Blood to the alveoli
Pneumonia - obstructive lung disease - and late pulmonary edema

20. Discontinuous lung sounds are also called

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21. Late inspiratory crackles result from
Ventilation
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
respiration
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

22. Restrictive Disease: Expiratory volume is reduced more than
Pleural space
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
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
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

23. Coarse crackles result from
Alveoli to the blood
Air bubbles flowing through secretions or slightly closed airways during respiration
reduced in size - compared with a normal curve - due to lower lung volume
Right

24. Apnea is defined as
Inflammation of the adjacent parietal pleura
No respiration for > 20 seconds
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
'adventitious' breath sounds

25. The purpose of respiration is to...
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
Perfusion
Speed of airflow - the higher the flow - the greater the resistance

26. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Diffusion
Either inspiration or expiration
Upper respiratory obstruction - usually in the trachea or larynx
Manubrio-sternal junction (angle of Louis)

27. FEV1/FVC
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Blue or bluish-gray discoloration of the skin or mucous membranes
Dullness replaces resonance
Perfusion

28. The presence of pressure gradients causes respiratory gases to move from
respiration
Air bubbles flowing through secretions or slightly closed airways during respiration
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Air-filled - fluid-filled - or solid

29. Spirometry: The result is stated as
Blue or bluish-gray discoloration of the skin or mucous membranes
A tracing of the lung volume against time in seconds
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
release of O2 from Hb

30. The active movement of gases between the ambient air and the lungs
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Partial pressure of oxygen in the alveoli
Ventilation
right & left

31. Central cyanosis results from
Either inspiration or expiration
A reduction in lung capacity - secondary to scarring or extraneous material
Portable antero-posterior (AP) view
Insufficient oxygenation of hemoglobin in the lungs

32. Bohr Effect of pH: left shift
Bicarbonate
Lowered carbon dioxide level - results from hyperventilation
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Increased Hb-O2 affinity

33. The interspace between two ribs (intercostal space) is numbered by
Either inspiration or expiration
Obstruction below the vocal cords (subglottic or tracheal obstruction)
The rib above it
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

34. PaO2
Partial pressure of oxygen in the alveoli
Diaphragm - External Intercostals
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
Partial pressure of O2 in the arterial blood

35. Coarse crackles are...
Obstructive lung disease from restrictive lung disease
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Louder - lower-pitched - and slightly longer in duration

36. total lung capacity (TLC)
PaCO2
The total amount of air in the lungs at the end of a maximal inhalation
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Either inspiration or expiration

37. Inspiratory stridor indicates
Right
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Mouth as well as through the chest wall
Expiration

38. Nitroglycerin applied to the probe area has been reported to...
Ventilation - Diffusion - Perfusion
Overcome some of the problems associated with low blood flow to the probe site
Immediate oxygenation with or without intubation
Pulse oximetry

39. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Inspiration
Total lung capacity (TLC)
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Functional residual capacity (FRC)

40. Tachypnea is an
Diaphragm and the intercostal muscles
release of O2 from Hb - as heat is a by-product of metabolism.
A tracing of the lung volume against time in seconds
Increased rate of breathing and is commonly associated with a decrease in tidal volume

41. Which lobe has an inferior tongue-like projection called the lingula?
Left upper lobe
Manubrio-sternal junction (angle of Louis)
50%
Right

42. Rhonchi frequently clear after
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
80%
Decreased Hb-O2 affinity
Cough

43. The trachea divides into
The rib above it
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
right and left mainstem bronchi
respiration

44. The internal intercostals decrease the transverse diameter of the chest during
Observing the pattern of breathing
right & left
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Expiration

45. Continuous lung sounds occur when air flows rapidly through bronchi that are...
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Narrowed nearly to the point of closure
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
results in a lower than normal FEV1%

46. The trachea divides into right and left mainstem bronchi At what level?
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
results in a lower than normal FEV1%
T4 or T5 - and just below the manubrio-sternal joint

47. normal subjects expel approximately how much of the FVC in the 1st second?
Partial pressure of carbon dioxide in the alveoli
80%
right and left mainstem bronchi
To assess response to treatment

48. Restrictive disease refers to...
A reduction in lung capacity - secondary to scarring or extraneous material
The amount of air that can be inhaled after normal inspiration
Oxygen (O2)
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

49. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Partial pressure of CO2 in the arterial blood
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Oxygen (O2)
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

50. During inspiration the diaphragm
Inflammation of the adjacent parietal pleura
Binding of O2 to Hb
No respiration for > 20 seconds
Contracts