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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. office-based spirometry is recommended for patients as young as
5 years - to detect obstruction and determine its reversibility
Spirometry
The atmospheric pressure
Altering the respiratory rate and/or the tidal volume

2. Continuous lung sounds often audible at the...
Fraction (%age) of inspired oxygen
Mouth as well as through the chest wall
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
35 to 45 mmHg

3. The presence of pressure gradients causes respiratory gases to move from
Inflammation of the adjacent parietal pleura
Contracts
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
10 to 11 cm long and about 2 cm in diameter

4. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
Alveoli to the blood
right
No
A sensor placed over a translucent area of arterial pulsation

5. Rhonchi originate in the...
Pleural space
Air to move from the upper airway to the farthest alveolar reaches
Larger airways
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL

6. Peripheral cyanosis results from
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
quickly - usually reaching a plateau within 6.0 seconds
Binding of O2 to Hb
Upper respiratory obstruction - usually in the trachea or larynx

7. An efficient approach to examination of the patient begins with
Spirometry
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Observing the pattern of breathing

8. Discontinuous lung sounds are...
Brief - discrete - non-musical sounds with a popping quality
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Altering the respiratory rate and/or the tidal volume
The right middle lobe

9. increased volume results in
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Decreased pressure
Fraction (%age) of inspired oxygen
right

10. Discontinuous lung sounds are also called

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11. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
The atmospheric pressure
Dyspnea upon assuming a recumbent position
Saturated with oxygen or unsaturated
Brief - discrete - non-musical sounds with a popping quality

12. What may prevent cyanosis from appearing?
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Obstructive lung disease from restrictive lung disease

13. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Saturated with oxygen or unsaturated
Diaphragm and the intercostal muscles

14. FIO2
Dyspnea that awakens the patient several hours after going to sleep
Fraction (%age) of inspired oxygen
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Postero-anterior (PA) and lateral view series

15. Paroxysmal nocturnal dyspnea (PND) is...
Spirometry
Tongue
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Dyspnea that awakens the patient several hours after going to sleep

16. The trachea divides into right and left mainstem bronchi At what level?
Wheezes - high-pitched - musical sounds - distinct whistling quality
T4 or T5 - and just below the manubrio-sternal joint
Altering the respiratory rate and/or the tidal volume
Perfusion

17. 20.95% Atmospheric Composition
The total amount of air that can be exhaled following a maximal inhalation
Oxygen (O2)
Brief - discrete - non-musical sounds with a popping quality
Perfusion

18. Coarse crackles are...
Louder - lower-pitched - and slightly longer in duration
Cough
A reduction in lung capacity - secondary to scarring or extraneous material
50%

19. The external intercostal muscles increase the antero-posterior chest diameter during
5 years - to detect obstruction and determine its reversibility
'adventitious' breath sounds
10 to 11 cm long and about 2 cm in diameter
Inspiration

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

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21. Coarse crackles are heard in
The gas in the conducting airways does not participate in alveolar exchange
80%
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
Pneumonia - obstructive lung disease - and late pulmonary edema

22. The tracheo-bronchial tree is a tubular system that provides a pathway for
Air to move from the upper airway to the farthest alveolar reaches
A tracing of the lung volume against time in seconds
reduced in size - compared with a normal curve - due to lower lung volume
Postero-anterior (PA) and lateral view series

23. Coarse crackles result from
Total lung capacity (TLC)
Increased minute volume ventilation - which results in a lowered carbon dioxide level
release of O2 from Hb - as heat is a by-product of metabolism.
Air bubbles flowing through secretions or slightly closed airways during respiration

24. Which bronchus is wider - shorter - and more vertically placed?
2 - each wavelength is partially absorbed by hemoglobin
80%
Right
Increased work of breathing

25. The best indicator of adequate ventilation is the...
Increased minute volume ventilation - which results in a lowered carbon dioxide level
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
PaCO2
A good effort

26. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Excessive secretions and abnormal airway collapsibility
Cough
Partial pressure of O2 in the arterial blood
Carboxyhemoglobin

27. The vital capacity and the residual volume together constitute the...
Total lung capacity (TLC)
Overcome some of the problems associated with low blood flow to the probe site
Inspiration
results in a lower than normal FEV1%

28. What is the potential space between the visceral and parietal pleurae?
Expiratory volume - and there is a prolonged expiratory time
Pleural space
A good effort
Immediate oxygenation with or without intubation

29. Bronchiovesicular breath sounds
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Fraction (%age) of inspired oxygen
70% occlusion of the airway
Altering the respiratory rate and/or the tidal volume

30. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
Bronchospasm - mucosal edema - or excessive secretions
Partial pressure of O2 in the arterial blood
reduced in size - compared with a normal curve - due to lower lung volume
Perfusion

31. the lingula is analogous to...
The amount of air that can be inhaled after normal inspiration
Interstitial diseases or early pulmonary edema
The right middle lobe
Manubrio-sternal junction (angle of Louis)

32. forced expiratory volume in one second (FEV1)
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
Nitrogen
release of O2 from Hb
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

33. Oxygen moves from the...
Alveoli to the blood
Bronchospasm - mucosal edema - or excessive secretions
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Pulse oximetry

34. vital capacity (VC)
Fraction (%age) of inspired oxygen
Partial pressure of CO2 in the arterial blood
Insufficient oxygenation of hemoglobin in the lungs
The total amount of air that can be exhaled following a maximal inhalation

35. Does lung tissue have pain fibers?
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
No
require supplemental oxygenation and possibly ABG analysis
Hypoventilation or modest changes in the PaO2

36. PACO2
The right middle lobe
'scooped out' or bowl-shaped
Partial pressure of carbon dioxide in the alveoli
A sensor placed over a translucent area of arterial pulsation

37. Factors that influence the oxygen carrying capacity of hemoglobin
There is an inverse relationship between pressure and volume
Increased amounts of unsaturated hemoglobin in capillary blood
Expiration
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

38. Pulse Oximetry does not detect
10 to 11 cm long and about 2 cm in diameter
Hypoventilation or modest changes in the PaO2
Diaphragm and the intercostal muscles
Insufficient oxygenation of hemoglobin in the lungs

39. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
quickly - usually reaching a plateau within 6.0 seconds
Bronchospasm - mucosal edema - or excessive secretions
Pneumonia - obstructive lung disease - and late pulmonary edema
Portable antero-posterior (AP) view

40. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Manubrio-sternal junction (angle of Louis)
Decreased Hb-O2 affinity
Immediate oxygenation with or without intubation
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

41. The acini consist of the...
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Narrowed nearly to the point of closure
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
No respiration for > 20 seconds

42. The visceral pleura lines the...
Diaphragm and the intercostal muscles
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Outer surface of each lung
Alveoli to the blood

43. Continuous lung sounds
Portable antero-posterior (AP) view
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Wheezes - high-pitched - musical sounds - distinct whistling quality
Diaphragm - External Intercostals

44. HCO3
Bicarbonate
Blue or bluish-gray discoloration of the skin or mucous membranes
Louder - lower-pitched - and slightly longer in duration
right & left

45. Fine crackles are...
Soft - high-pitched and crisp
Partial pressure of carbon dioxide in the alveoli
Inspiration
Increased work of breathing

46. 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
Pulse oximetry
A reliable and consistent classification of auditory findings
require supplemental oxygenation and possibly ABG analysis
Air-filled - fluid-filled - or solid

47. terminal respiratory unit
Narrowed nearly to the point of closure
Brief - discrete - non-musical sounds with a popping quality
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
Acinus

48. Continuous lung sounds occur when air flows rapidly through bronchi that are...
Narrowed nearly to the point of closure
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Alveoli to the blood
results in a lower than normal FEV1%

49. Bronchophony
10 to 11 cm long and about 2 cm in diameter
Dyspnea upon assuming a recumbent position
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
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

50. Hyperventilation is defined as
Insufficient oxygenation of hemoglobin in the lungs
Either inspiration or expiration
70% occlusion of the airway
Increased minute volume ventilation - which results in a lowered carbon dioxide level