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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. most important factor that influences the oxygen carrying capacity of hemoglobin
A good effort
The right middle lobe
PaCO2
Partial pressure of oxygen (PO2)

2. Patients with obstructive disease have normal
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Right
Partial pressure of oxygen (PO2)
Lung volumes - but find it difficult to exhale rapidly

3. Spirometry plots
Significant pulmonary impairment
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
A tracing of the lung volume against time in seconds
Spirometry

4. Normal range of PaCO2
35 to 45 mmHg
The amount of air that can be exhaled after expiration
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

5. dead space ventilation
Oxygen-Hemoglobin Dissociation Curve
results in a lower than normal FEV1%
The gas in the conducting airways does not participate in alveolar exchange
Acinus

6. Bohr Effect of pH: right shift
Partial pressure of CO2 in the arterial blood
80%
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Decreased Hb-O2 affinity

7. 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
Bicarbonate
quickly - usually reaching a plateau within 6.0 seconds
release of O2 from Hb

8. Auscultation of the chest depends on...
Speed of airflow - the higher the flow - the greater the resistance
Inspiration
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
A reliable and consistent classification of auditory findings

9. What may prevent cyanosis from appearing?
The right middle lobe
The atmospheric pressure
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Brief - discrete - non-musical sounds with a popping quality

10. With restrictive disease - the flow-volume curve is...
Left upper lobe
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Bicarbonate
reduced in size - compared with a normal curve - due to lower lung volume

11. Pectoriloquy
80%
The examiner can clearly distinguish the word that the pt speak or whispers
Inflammation of the adjacent parietal pleura
The amount of air that can be inhaled after normal inspiration

12. Abnormal lung sounds AKA

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13. within limits - increased temperature =
release of O2 from Hb - as heat is a by-product of metabolism.
Interstitial diseases or early pulmonary edema
Ventilation
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

14. Pulse Oximetry is dependent on...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Hypoventilation or modest changes in the PaO2
require supplemental oxygenation and possibly ABG analysis
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

15. Which lung has an oblique fissure?
Significant pulmonary impairment
Pressure required to drive air through the airways
right & left
Oxygen (O2)

16. terminal respiratory unit
35 to 45 mmHg
Acinus
Left upper lobe
The examiner can clearly distinguish the word that the pt speak or whispers

17. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
Decreased Hb-O2 affinity
results in a lower than normal FEV1%
Dullness replaces resonance
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

18. Does lung tissue have pain fibers?
Bronchospasm - mucosal edema - or excessive secretions
No
'scooped out' or bowl-shaped
Diaphragm and the intercostal muscles

19. Compliance
Significant pulmonary impairment
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
Overcome some of the problems associated with low blood flow to the probe site
Alveoli to the blood

20. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
Portable antero-posterior (AP) view
Left upper lobe
Mouth as well as through the chest wall
Difficulty breathing or shortness of breath

21. Cyanosis appears when
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Diaphragm - External Intercostals
Expiratory volume - and there is a prolonged expiratory time
A good effort

22. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
Functional residual capacity (FRC)
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
results in a lower than normal FEV1%

23. Bronchiovesicular breath sounds
The amount of air that can be inhaled after normal inspiration
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Diaphragm and the intercostal muscles
The rib above it

24. Continuous lung sounds occur in the setting of...
Tongue
Bronchospasm - mucosal edema - or excessive secretions
The total amount of air in the lungs at the end of a maximal inhalation
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

25. Rhonchi frequently clear after
Dyspnea upon assuming a recumbent position
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Cough
Bronchospasm - mucosal edema - or excessive secretions

26. Percussion helps you establish whether the underlying tissues are...
Either continuous or discontinuous
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Nitrogen
Air-filled - fluid-filled - or solid

27. The main bronchi are divided into smaller branches that begin to subdivide into
Sternocleidomastoid - Scalene Muscles
2 - each wavelength is partially absorbed by hemoglobin
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus
release of O2 from Hb

28. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
Increased work of breathing
Observing the pattern of breathing
Blue or bluish-gray discoloration of the skin or mucous membranes
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

29. The tracheo-bronchial tree is a tubular system that provides a pathway for
Overcome some of the problems associated with low blood flow to the probe site
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Speed of airflow - the higher the flow - the greater the resistance
Air to move from the upper airway to the farthest alveolar reaches

30. Rhonchi originate in the...
Manubrio-sternal junction (angle of Louis)
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Larger airways
The total amount of air in the lungs at the end of a maximal inhalation

31. Cyanosis is caused by
Increased amounts of unsaturated hemoglobin in capillary blood
A tracing of the lung volume against time in seconds
reduced in size - compared with a normal curve - due to lower lung volume
right

32. The purpose of respiration is to...
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
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
Alveoli to the blood
respiration

33. The normal FEV1 /FVC ratio is...
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
70%
right & left

34. Continuous lung sounds
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Dullness replaces resonance
Wheezes - high-pitched - musical sounds - distinct whistling quality

35. Nitroglycerin applied to the probe area has been reported to...
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Overcome some of the problems associated with low blood flow to the probe site
Altering the respiratory rate and/or the tidal volume
'scooped out' or bowl-shaped

36. The internal intercostals decrease the transverse diameter of the chest during
Postero-anterior (PA) and lateral view series
Right
Spirometry
Expiration

37. Spirometry: The result is stated as
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Diaphragm and the intercostal muscles
2 - each wavelength is partially absorbed by hemoglobin
Blue or bluish-gray discoloration of the skin or mucous membranes

38. normal subjects expel approximately how much of the FVC in the 1st second?
80%
Expiratory volume - and there is a prolonged expiratory time
5 years - to detect obstruction and determine its reversibility
80 to 120% of predicted value

39. The external intercostal muscles increase the antero-posterior chest diameter during
Portable antero-posterior (AP) view
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
'crackles' or 'rales'
Inspiration

40. Factors that influence the oxygen carrying capacity of hemoglobin
release of O2 from Hb - as heat is a by-product of metabolism.
Difficulty breathing or shortness of breath
The amount of air that can be exhaled after expiration
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

41. Continuous lung sounds occur during...
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
Either inspiration or expiration
The negative logarithm of hydrogen ions in the blood
Spirometry

42. The most reliable site for detecting central cyanosis is the...
Sternocleidomastoid - Scalene Muscles
Tongue
Alveoli to the blood
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

43. Pulse oximetry limitations: what may be misinterpreted as oxygenated hemoglobin?
Either continuous or discontinuous
The atmospheric pressure
Carboxyhemoglobin
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

44. Coarse crackles are heard in
Cough
Difficulty breathing or shortness of breath
Insufficient oxygenation of hemoglobin in the lungs
Pneumonia - obstructive lung disease - and late pulmonary edema

45. Tachypnea is an
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Hypoventilation or modest changes in the PaO2
10 to 11 cm long and about 2 cm in diameter
respiration

46. The muscles of expiration are the...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Outer surface of each lung
Lowered carbon dioxide level - results from hyperventilation
Sternocleidomastoid - Scalene Muscles

47. Orthopnea is defined as
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Dyspnea upon assuming a recumbent position
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

48. Restrictive disease refers to...
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Upper respiratory obstruction - usually in the trachea or larynx
A reduction in lung capacity - secondary to scarring or extraneous material
Hypoventilation or modest changes in the PaO2

49. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
'scooped out' or bowl-shaped
quickly - usually reaching a plateau within 6.0 seconds
Saturated with oxygen or unsaturated
Increased rate of breathing and is commonly associated with a decrease in tidal volume

50. Inspiratory stridor becomes evident at about
70% occlusion of the airway
A reduction in lung capacity - secondary to scarring or extraneous material
10 to 11 cm long and about 2 cm in diameter
Brief - discrete - non-musical sounds with a popping quality