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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. Which bronchus is more susceptible to aspiration of foreign bodies?
T4 or T5 - and just below the manubrio-sternal joint
Alveoli to the blood
Air to move from the upper airway to the farthest alveolar reaches
Right

2. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Functional residual capacity (FRC)
Blood to the alveoli
Partial pressure of oxygen in the alveoli
Portable antero-posterior (AP) view

3. Chest Radiography: The most common chest X-ray series is the...
Obstructive lung disease from restrictive lung disease
2 - each wavelength is partially absorbed by hemoglobin
Postero-anterior (PA) and lateral view series
Decreased Hb-O2 affinity

4. The muscles of inspiration are the...
Diaphragm - External Intercostals
right & left
Air to move from the upper airway to the farthest alveolar reaches
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

5. The best indicator of adequate ventilation is the...
A tracing of the lung volume against time in seconds
The atmospheric pressure
PaCO2
Carboxyhemoglobin

6. Continuous lung sounds often audible at the...
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Mouth as well as through the chest wall
Alveoli to the blood
The total amount of air in the lungs at the end of a maximal inhalation

7. Compliance
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
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
To assess response to treatment
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

8. Does lung tissue have pain fibers?
The total amount of air that can be exhaled following a maximal inhalation
No
A sensor placed over a translucent area of arterial pulsation
Partial pressure of carbon dioxide in the alveoli

9. The purpose of respiration is to...
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
quickly - usually reaching a plateau within 6.0 seconds
The amount of air that can be inhaled after normal inspiration
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide

10. During inspiration the diaphragm
Contracts
Ventilation - Diffusion - Perfusion
There is an inverse relationship between pressure and volume
Inflammation of the adjacent parietal pleura

11. A normal volume-time curve rises
The rib above it
quickly - usually reaching a plateau within 6.0 seconds
Obstruction below the vocal cords (subglottic or tracheal obstruction)
require supplemental oxygenation and possibly ABG analysis

12. Bohr Effect of pH is graphed as
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Oxygen-Hemoglobin Dissociation Curve
Larger airways
Excessive secretions and abnormal airway collapsibility

13. With restrictive disease - the flow-volume curve is...
Perfusion
80 to 120% of predicted value
reduced in size - compared with a normal curve - due to lower lung volume
Soft - high-pitched and crisp

14. The parietal pleura lines the...
500 to 800 mL
'scooped out' or bowl-shaped
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Spirometry

15. The spirometry printout usually includes

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16. office-based spirometry is recommended for patients as young as
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
5 years - to detect obstruction and determine its reversibility
A sensor placed over a translucent area of arterial pulsation
A reduction in lung capacity - secondary to scarring or extraneous material

17. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Spirometry
Hypoventilation or modest changes in the PaO2
The examiner can clearly distinguish the word that the pt speak or whispers
Inflammation of the adjacent parietal pleura

18. The trachea is how long/wide?
Spirometry
10 to 11 cm long and about 2 cm in diameter
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
Overcome some of the problems associated with low blood flow to the probe site

19. vital capacity (VC)
The total amount of air that can be exhaled following a maximal inhalation
Decreased Hb-O2 affinity
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

20. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Inspiration
Sternocleidomastoid - Scalene Muscles
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Spirometry

21. Which lung has an oblique fissure?
PaCO2
The total amount of air that can be exhaled following a maximal inhalation
right & left
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval

22. Rhonchi
Either inspiration or expiration
Right
Pressure required to drive air through the airways
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

23. Orthopnea is defined as
Partial pressure of oxygen (PO2)
Dyspnea upon assuming a recumbent position
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
No respiration for > 20 seconds

24. within limits - increased temperature =
Diaphragm - External Intercostals
Pulse oximetry
Narrowed nearly to the point of closure
release of O2 from Hb - as heat is a by-product of metabolism.

25. dead space ventilation
Manubrio-sternal junction (angle of Louis)
The gas in the conducting airways does not participate in alveolar exchange
'adventitious' breath sounds
No respiration for > 20 seconds

26. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
PaCO2
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Immediate oxygenation with or without intubation
Air bubbles flowing through secretions or slightly closed airways during respiration

27. Tachypnea is an
Either inspiration or expiration
Bicarbonate
results in a lower than normal FEV1%
Increased rate of breathing and is commonly associated with a decrease in tidal volume

28. Vesicular breath sounds
Dyspnea upon assuming a recumbent position
Inspiration
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
Increased Hb-O2 affinity

29. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
Bronchospasm - mucosal edema - or excessive secretions
50%
right
Saturated with oxygen or unsaturated

30. Spirometry can be used to determine the severity of functional impairment as well as
require supplemental oxygenation and possibly ABG analysis
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
To assess response to treatment
Larger airways

31. Boyle's Gas Law
Pneumonia - obstructive lung disease - and late pulmonary edema
Wheezes - high-pitched - musical sounds - distinct whistling quality
There is an inverse relationship between pressure and volume
Mediastinum

32. Bohr Effect of pH: right shift
release of O2 from Hb - as heat is a by-product of metabolism.
Decreased Hb-O2 affinity
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
The total amount of air in the lungs at the end of a maximal inhalation

33. 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
Diaphragm - External Intercostals
Right
A reduction in lung capacity - secondary to scarring or extraneous material

34. Pulse Oximetry does not detect
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Hypoventilation or modest changes in the PaO2
'crackles' or 'rales'
Mediastinum

35. pH
Right
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
The negative logarithm of hydrogen ions in the blood
Either continuous or discontinuous

36. Examples of obstructive disease
Partial pressure of oxygen (PO2)
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Immediate oxygenation with or without intubation
quickly - usually reaching a plateau within 6.0 seconds

37. Obstructive Disease: Expiratory airflow is reduced more than
Sternocleidomastoid - Scalene Muscles
Normal to increased FEV1%
Expiratory volume - and there is a prolonged expiratory time
Partial pressure of CO2 in the arterial blood

38. An efficient approach to examination of the patient begins with
Binding of O2 to Hb
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Decreased pressure
Observing the pattern of breathing

39. The trachea bifurcates into its mainstem bronchi at the level of...
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Diaphragm and the intercostal muscles
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Air-filled - fluid-filled - or solid

40. Fine crackles are...
Soft - high-pitched and crisp
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
Excessive secretions and abnormal airway collapsibility
Perfusion

41. gas exchange across the alveolar-pulmonary capillary membranes
The right middle lobe
There is an inverse relationship between pressure and volume
Diffusion
Louder - lower-pitched - and slightly longer in duration

42. The primary muscles of respiration are the...
Diaphragm and the intercostal muscles
Overcome some of the problems associated with low blood flow to the probe site
Portable antero-posterior (AP) view
Right

43. The lungs are paired - cone-shaped organs in the thoracic cavity separated By what space?
Inspiration
Increased work of breathing
Mediastinum
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

44. Patients with obstructive disease have normal
70% occlusion of the airway
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Wheezes - high-pitched - musical sounds - distinct whistling quality
Lung volumes - but find it difficult to exhale rapidly

45. FIO2
The amount of air that can be inhaled after normal inspiration
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Partial pressure of O2 in the arterial blood
Fraction (%age) of inspired oxygen

46. The vital capacity and the residual volume together constitute the...
Lowered carbon dioxide level - results from hyperventilation
Total lung capacity (TLC)
80 to 120% of predicted value
Blood to the alveoli

47. Coarse crackles result from
Fraction (%age) of inspired oxygen
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
'adventitious' breath sounds
Air bubbles flowing through secretions or slightly closed airways during respiration

48. Nitroglycerin applied to the probe area has been reported to...
Overcome some of the problems associated with low blood flow to the probe site
Partial pressure of oxygen in the alveoli
Wheezes - high-pitched - musical sounds - distinct whistling quality
Diaphragm and the intercostal muscles

49. Restrictive disease refers to...
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
'crackles' or 'rales'
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
A reduction in lung capacity - secondary to scarring or extraneous material

50. During expiration - thoracic cavity volume decreases - and the intrapulmonary pressure becomes greater than
The atmospheric pressure
results in a lower than normal FEV1%
Wheezes - high-pitched - musical sounds - distinct whistling quality
Air to move from the upper airway to the farthest alveolar reaches