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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. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Decreased pressure
A reduction in lung capacity - secondary to scarring or extraneous material
Lung volumes - but find it difficult to exhale rapidly
Functional residual capacity (FRC)

2. Factors that influence the oxygen carrying capacity of hemoglobin
Mediastinum
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Sternocleidomastoid - Scalene Muscles
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

3. What occurs passively as muscles relax?
Increased amounts of unsaturated hemoglobin in capillary blood
10 to 11 cm long and about 2 cm in diameter
80 to 120% of predicted value
Expiration

4. The trachea is how long/wide?
Left upper lobe
Normal to increased FEV1%
10 to 11 cm long and about 2 cm in diameter
80%

5. Which lobe has an inferior tongue-like projection called the lingula?
The right middle lobe
Inspiration
Perfusion
Left upper lobe

6. The internal intercostals decrease the transverse diameter of the chest during
Inflammation of the adjacent parietal pleura
A good effort
Expiration
A tracing of the lung volume against time in seconds

7. The muscles of inspiration are the...
Dullness replaces resonance
Inflammation of the adjacent parietal pleura
Diaphragm - External Intercostals
A good effort

8. Fine crackles are...
Increased amounts of unsaturated hemoglobin in capillary blood
Ventilation
Soft - high-pitched and crisp
Brief - discrete - non-musical sounds with a popping quality

9. the lingula is analogous to...
Partial pressure of oxygen in the alveoli
The right middle lobe
Lung volumes - but find it difficult to exhale rapidly
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

10. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Cough
A good effort
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
Manubrio-sternal junction (angle of Louis)

11. Percussion helps you establish whether the underlying tissues are...
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Air-filled - fluid-filled - or solid
Pressure required to drive air through the airways

12. within limits - increased temperature =
Dullness replaces resonance
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
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
release of O2 from Hb - as heat is a by-product of metabolism.

13. The acini consist of the...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Perfusion
The examiner can clearly distinguish the word that the pt speak or whispers
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

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

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15. high CO2 = high acidity =
The amount of air that can be exhaled after expiration
Inspiration
release of O2 from Hb
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

16. movement of blood through the capillaries in direct communication with the alveoli
Spirometry
Perfusion
Decreased Hb-O2 affinity
Right

17. Resistance is dependent upon
Expiratory volume - and there is a prolonged expiratory time
quickly - usually reaching a plateau within 6.0 seconds
Speed of airflow - the higher the flow - the greater the resistance
results in a lower than normal FEV1%

18. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
respiration
Normal to increased FEV1%
Alveoli to the blood
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

19. Which bronchus is wider - shorter - and more vertically placed?
Spirometry
Right
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Obstruction below the vocal cords (subglottic or tracheal obstruction)

20. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
Contracts
respiration
Saturated with oxygen or unsaturated
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

21. A normal volume-time curve rises
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Alveoli to the blood
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
quickly - usually reaching a plateau within 6.0 seconds

22. Pulse Oximetry: The oximeter's probe has a source of light of How many wavelengths?
2 - each wavelength is partially absorbed by hemoglobin
T4 or T5 - and just below the manubrio-sternal joint
Ventilation - Diffusion - Perfusion
Mediastinum

23. expiratory reserve
The amount of air that can be exhaled after expiration
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Diffusion
The amount of air that can be inhaled after normal inspiration

24. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
A good effort
Carboxyhemoglobin
Functional residual capacity (FRC)
80 to 120% of predicted value

25. What may prevent cyanosis from appearing?
Excessive secretions and abnormal airway collapsibility
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
reduced in size - compared with a normal curve - due to lower lung volume
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration

26. Continuous lung sounds occur when air flows rapidly through bronchi that are...
Diffusion
Narrowed nearly to the point of closure
Immediate oxygenation with or without intubation
quickly - usually reaching a plateau within 6.0 seconds

27. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
quickly - usually reaching a plateau within 6.0 seconds
Carboxyhemoglobin
Increased work of breathing
The right middle lobe

28. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Partial pressure of carbon dioxide in the alveoli
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Functional residual capacity (FRC)
Immediate oxygenation with or without intubation

29. Orthopnea is quantified by
Air bubbles flowing through secretions or slightly closed airways during respiration
Either inspiration or expiration
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Increased work of breathing

30. PACO2
Partial pressure of carbon dioxide in the alveoli
Larger airways
Excessive secretions and abnormal airway collapsibility
Partial pressure of oxygen in the alveoli

31. The trachea bifurcates into its mainstem bronchi at the level of...
Manubrio-sternal junction (angle of Louis)
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Fraction (%age) of inspired oxygen
Partial pressure of carbon dioxide in the alveoli

32. Coarse crackles result from
quickly - usually reaching a plateau within 6.0 seconds
Diffusion
Air bubbles flowing through secretions or slightly closed airways during respiration
Obstruction below the vocal cords (subglottic or tracheal obstruction)

33. Boyle's Gas Law
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Sternocleidomastoid - Scalene Muscles
There is an inverse relationship between pressure and volume
'scooped out' or bowl-shaped

34. terminal respiratory unit
Acinus
Portable antero-posterior (AP) view
Observing the pattern of breathing
Oxygen-Hemoglobin Dissociation Curve

35. Cyanosis
Blue or bluish-gray discoloration of the skin or mucous membranes
Louder - lower-pitched - and slightly longer in duration
Total lung capacity (TLC)
Altering the respiratory rate and/or the tidal volume

36. Which lung has a horizontal fissure?
35 to 45 mmHg
Partial pressure of CO2 in the arterial blood
right
Functional residual capacity (FRC)

37. FEV1/FVC
'scooped out' or bowl-shaped
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Oxygen (O2)
Alveoli to the blood

38. The trachea divides into
Nitrogen
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
Louder - lower-pitched - and slightly longer in duration
right and left mainstem bronchi

39. Pulse Oximetry does not detect
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
results in a lower than normal FEV1%
Hypoventilation or modest changes in the PaO2
5 years - to detect obstruction and determine its reversibility

40. Apnea is defined as
Binding of O2 to Hb
No respiration for > 20 seconds
Decreased pressure
Contracts

41. Respiration involves
Total lung capacity (TLC)
Ventilation - Diffusion - Perfusion
A reliable and consistent classification of auditory findings
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

42. Examples of obstructive disease
Mouth as well as through the chest wall
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Blue or bluish-gray discoloration of the skin or mucous membranes

43. Nitroglycerin applied to the probe area has been reported to...
Overcome some of the problems associated with low blood flow to the probe site
The gas in the conducting airways does not participate in alveolar exchange
There is an inverse relationship between pressure and volume
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

44. The presence of pressure gradients causes respiratory gases to move from
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
quickly - usually reaching a plateau within 6.0 seconds
Blood to the alveoli

45. Pectoriloquy
The examiner can clearly distinguish the word that the pt speak or whispers
To assess response to treatment
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
A reduction in lung capacity - secondary to scarring or extraneous material

46. The main bronchi are divided into smaller branches that begin to subdivide into
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
80%
PaCO2
Increased work of breathing

47. Continuous lung sounds occur during...
respiration
'scooped out' or bowl-shaped
Either inspiration or expiration
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

48. Vesicular breath sounds
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
Immediate oxygenation with or without intubation
To assess response to treatment
Acinus

49. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Portable antero-posterior (AP) view
Either continuous or discontinuous
Diaphragm and the intercostal muscles

50. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
The atmospheric pressure
require supplemental oxygenation and possibly ABG analysis
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Increased minute volume ventilation - which results in a lowered carbon dioxide level