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Pulmonology

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Answer 50 questions in 15 minutes.
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1. What occurs passively as muscles relax?
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Expiration
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

2. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
respiration
Inflammation of the adjacent parietal pleura
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
Ventilation

3. Spirometry can be used to determine the severity of functional impairment as well as
To assess response to treatment
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
right & left

4. Which bronchus is more susceptible to aspiration of foreign bodies?
Pneumonia - obstructive lung disease - and late pulmonary edema
Right
Upper respiratory obstruction - usually in the trachea or larynx
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

5. Fine crackles are heard in
Interstitial diseases or early pulmonary edema
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
'adventitious' breath sounds
Pneumonia - obstructive lung disease - and late pulmonary edema

6. Spirometry is useful in distinguishing
T4 or T5 - and just below the manubrio-sternal joint
Obstructive lung disease from restrictive lung disease
results in a lower than normal FEV1%
The gas in the conducting airways does not participate in alveolar exchange

7. tidal volume (Vt)
Either continuous or discontinuous
Tongue
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing

8. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
The right middle lobe
respiration
Saturated with oxygen or unsaturated
Excessive secretions and abnormal airway collapsibility

9. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Pulse oximetry
Spirometry
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible

10. Chest Radiography: The most common chest X-ray series is the...
Inflammation of the adjacent parietal pleura
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Postero-anterior (PA) and lateral view series
release of O2 from Hb

11. Continuous lung sounds often audible at the...
reduced in size - compared with a normal curve - due to lower lung volume
Mouth as well as through the chest wall
Observing the pattern of breathing
Tongue

12. The trachea bifurcates into its mainstem bronchi at the level of...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
80%
The negative logarithm of hydrogen ions in the blood
The atmospheric pressure

13. residual volume
Contracts
T4 or T5 - and just below the manubrio-sternal joint
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
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

14. terminal respiratory unit
Interstitial diseases or early pulmonary edema
Blue or bluish-gray discoloration of the skin or mucous membranes
Acinus
Outer surface of each lung

15. Rhonchi are due to...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
quickly - usually reaching a plateau within 6.0 seconds
Diffusion
Excessive secretions and abnormal airway collapsibility

16. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Expiration
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Immediate oxygenation with or without intubation
To assess response to treatment

17. The pattern of breathing refers to...
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Brief - discrete - non-musical sounds with a popping quality
Air to move from the upper airway to the farthest alveolar reaches
Inflammation of the adjacent parietal pleura

18. low CO2 = low acidity =
Sternocleidomastoid - Scalene Muscles
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Binding of O2 to Hb
A tracing of the lung volume against time in seconds

19. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Partial pressure of O2 in the arterial blood
Upper respiratory obstruction - usually in the trachea or larynx
Nitrogen
Ventilation - Diffusion - Perfusion

20. Orthopnea is quantified by
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Acinus
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide

21. Patients with obstructive disease have normal
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Right
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Lung volumes - but find it difficult to exhale rapidly

22. Inspiratory stridor becomes evident at about
The negative logarithm of hydrogen ions in the blood
70% occlusion of the airway
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

23. The normal FEV1 /FVC ratio is...
The amount of air that can be inhaled after normal inspiration
The negative logarithm of hydrogen ions in the blood
70%
require supplemental oxygenation and possibly ABG analysis

24. Continuous lung sounds
The rib above it
Right
Wheezes - high-pitched - musical sounds - distinct whistling quality
Oxygen (O2)

25. Pulse Oximetry does not detect
right & left
A tracing of the lung volume against time in seconds
Nitrogen
Hypoventilation or modest changes in the PaO2

26. 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
Perfusion
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
Insufficient oxygenation of hemoglobin in the lungs

27. Pulse oximetry determines the percent of hemoglobin saturated with oxygen by way of...
A sensor placed over a translucent area of arterial pulsation
'crackles' or 'rales'
Wheezes - high-pitched - musical sounds - distinct whistling quality
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide

28. Spirometry normal range
Overcome some of the problems associated with low blood flow to the probe site
80 to 120% of predicted value
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Tongue

29. The internal intercostals decrease the transverse diameter of the chest during
Oxygen (O2)
'adventitious' breath sounds
Expiration
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

30. normal adult tidal volume
Spirometry
T4 or T5 - and just below the manubrio-sternal joint
Diaphragm and the intercostal muscles
500 to 800 mL

31. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
The atmospheric pressure
The right middle lobe
Ventilation - Diffusion - Perfusion
Diaphragm - External Intercostals

32. The vital capacity and the residual volume together constitute the...
The examiner can clearly distinguish the word that the pt speak or whispers
500 to 800 mL
Mouth as well as through the chest wall
Total lung capacity (TLC)

33. FIO2
Fraction (%age) of inspired oxygen
Diffusion
Narrowed nearly to the point of closure
No

34. Expiratory stridor indicates
respiration
Obstruction below the vocal cords (subglottic or tracheal obstruction)
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Binding of O2 to Hb

35. Bronchial breath sounds
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
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

36. Does lung tissue have pain fibers?
No
Outer surface of each lung
right & left
Postero-anterior (PA) and lateral view series

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

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38. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Increase the intrathoracic space
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Air-filled - fluid-filled - or solid
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

39. The main bronchi are divided into smaller branches that begin to subdivide into
Expiration
Partial pressure of CO2 in the arterial blood
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
Pulse oximetry

40. within limits - increased temperature =
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Louder - lower-pitched - and slightly longer in duration
release of O2 from Hb - as heat is a by-product of metabolism.
Diffusion

41. Carbon dioxide moves from the...
No
Blood to the alveoli
Right
Normal to increased FEV1%

42. Coarse crackles are...
The gas in the conducting airways does not participate in alveolar exchange
Louder - lower-pitched - and slightly longer in duration
Manubrio-sternal junction (angle of Louis)
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

43. Which lobe has an inferior tongue-like projection called the lingula?
Left upper lobe
Increased Hb-O2 affinity
To assess response to treatment
PaCO2

44. Compliance
'scooped out' or bowl-shaped
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
Inspiration
Overcome some of the problems associated with low blood flow to the probe site

45. most important factor that influences the oxygen carrying capacity of hemoglobin
Significant pulmonary impairment
Partial pressure of oxygen (PO2)
35 to 45 mmHg
Obstruction below the vocal cords (subglottic or tracheal obstruction)

46. movement of blood through the capillaries in direct communication with the alveoli
Dyspnea upon assuming a recumbent position
Perfusion
To assess response to treatment
The examiner can clearly distinguish the word that the pt speak or whispers

47. hypocapnia
Lowered carbon dioxide level - results from hyperventilation
Functional residual capacity (FRC)
Diffusion
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval

48. HCO3
The amount of air that can be inhaled after normal inspiration
T4 or T5 - and just below the manubrio-sternal joint
Bicarbonate
Pulse oximetry

49. Continuous lung sounds occur during...
The gas in the conducting airways does not participate in alveolar exchange
Either inspiration or expiration
respiration
Expiratory volume - and there is a prolonged expiratory time

50. normal subjects expel approximately how much of the FVC in the 1st second?
80%
Lung volumes - but find it difficult to exhale rapidly
The rib above it
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

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Pulmonology

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