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Pulmonology

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Answer 50 questions in 15 minutes.
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1. Spirometry: The result is stated as
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
The total amount of air that can be exhaled following a maximal inhalation
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

2. Vesicular breath sounds
Fraction (%age) of inspired oxygen
Obstruction below the vocal cords (subglottic or tracheal obstruction)
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
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy

3. Hyperventilation is defined as
Increased minute volume ventilation - which results in a lowered carbon dioxide level
5 years - to detect obstruction and determine its reversibility
No
Lung volumes - but find it difficult to exhale rapidly

4. Auscultation of the chest depends on...
2 - each wavelength is partially absorbed by hemoglobin
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
A reliable and consistent classification of auditory findings
The amount of air that can be inhaled after normal inspiration

5. Bohr Effect of pH is graphed as
Expiratory volume - and there is a prolonged expiratory time
Oxygen-Hemoglobin Dissociation Curve
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

6. Central cyanosis results from
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
Insufficient oxygenation of hemoglobin in the lungs
Difficulty breathing or shortness of breath

7. The trachea divides into
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
The amount of air that can be exhaled after expiration
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
right and left mainstem bronchi

8. Pulse Oximetry does not detect
Hypoventilation or modest changes in the PaO2
Pulse oximetry
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

9. Which lung has an oblique fissure?
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Perfusion
Overcome some of the problems associated with low blood flow to the probe site
right & left

10. Percussion helps you establish whether the underlying tissues are...
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Air-filled - fluid-filled - or solid
Air bubbles flowing through secretions or slightly closed airways during respiration
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL

11. Cyanosis is caused by
Increased amounts of unsaturated hemoglobin in capillary blood
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
Diffusion
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

12. The trachea bifurcates into its mainstem bronchi at the level of...
Decreased Hb-O2 affinity
A reduction in lung capacity - secondary to scarring or extraneous material
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds

13. normal adult tidal volume
Ventilation
T4 or T5 - and just below the manubrio-sternal joint
500 to 800 mL
Increase the intrathoracic space

14. high CO2 = high acidity =
A reduction in lung capacity - secondary to scarring or extraneous material
release of O2 from Hb
respiration
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

15. most important factor that influences the oxygen carrying capacity of hemoglobin
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Partial pressure of oxygen (PO2)
Partial pressure of O2 in the arterial blood
Inspiration

16. Carbon dioxide moves from the...
Blood to the alveoli
Outer surface of each lung
Fraction (%age) of inspired oxygen
Portable antero-posterior (AP) view

17. The trachea divides into right and left mainstem bronchi At what level?
T4 or T5 - and just below the manubrio-sternal joint
Inspiration
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
A reliable and consistent classification of auditory findings

18. low CO2 = low acidity =
Binding of O2 to Hb
'scooped out' or bowl-shaped
The examiner can clearly distinguish the word that the pt speak or whispers
70%

19. Rhonchi occur during
There is an inverse relationship between pressure and volume
Expiration
Altering the respiratory rate and/or the tidal volume
Either inspiration or expiration

20. At rest - the use of accessory muscles is a sign of...
Lung volumes - but no difficulty or delay in exhaling what volume they do have
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Significant pulmonary impairment
70% occlusion of the airway

21. The pattern of breathing refers to...
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
70%
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

22. Internationally recognized guidelines for management of asthma and COPD recommend the use of...
Obstructive lung disease from restrictive lung disease
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Wheezes - high-pitched - musical sounds - distinct whistling quality

23. Spirometry is useful in distinguishing
Obstructive lung disease from restrictive lung disease
Pneumonia - obstructive lung disease - and late pulmonary edema
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
There is an inverse relationship between pressure and volume

24. terminal respiratory unit
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Alveoli to the blood
Acinus
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

25. Inspiratory stridor becomes evident at about
70% occlusion of the airway
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
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
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration

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

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27. Boyle's Gas Law
There is an inverse relationship between pressure and volume
Spirometry
10 to 11 cm long and about 2 cm in diameter
Speed of airflow - the higher the flow - the greater the resistance

28. Cyanosis
Diffusion
Bronchospasm - mucosal edema - or excessive secretions
Blue or bluish-gray discoloration of the skin or mucous membranes
Either inspiration or expiration

29. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Increased work of breathing
Inspiration
T4 or T5 - and just below the manubrio-sternal joint
Excessive secretions and abnormal airway collapsibility

30. Bronchiovesicular breath sounds
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Acinus
Functional residual capacity (FRC)
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

31. Pulse Oximetry is dependent on...
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
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
5 years - to detect obstruction and determine its reversibility

32. Pulmonary ventilation is varied by
T4 or T5 - and just below the manubrio-sternal joint
Altering the respiratory rate and/or the tidal volume
Increased work of breathing
The rib above it

33. What may prevent cyanosis from appearing?
Spirometry
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
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Pressure required to drive air through the airways

34. The muscles of inspiration are the...
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Carboxyhemoglobin
Diaphragm - External Intercostals
Excessive secretions and abnormal airway collapsibility

35. 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
The total amount of air in the lungs at the end of a maximal inhalation
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve

36. The interspace between two ribs (intercostal space) is numbered by
The negative logarithm of hydrogen ions in the blood
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Partial pressure of carbon dioxide in the alveoli
The rib above it

37. Examples of obstructive disease
reduced in size - compared with a normal curve - due to lower lung volume
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Alveoli to the blood

38. hypocapnia
To assess response to treatment
Air bubbles flowing through secretions or slightly closed airways during respiration
respiration
Lowered carbon dioxide level - results from hyperventilation

39. Egophony

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40. dead space ventilation
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Tongue
The gas in the conducting airways does not participate in alveolar exchange
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

41. The muscles of expiration are the...
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Either inspiration or expiration
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Blood to the alveoli

42. Respiration involves
Spirometry
Ventilation - Diffusion - Perfusion
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Partial pressure of O2 in the arterial blood

43. Abnormal lung sounds are classified as
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
Either continuous or discontinuous
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Pressure required to drive air through the airways

44. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Air bubbles flowing through secretions or slightly closed airways during respiration
Expiratory volume - and there is a prolonged expiratory time
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Diffusion

45. increased volume results in
A tracing of the lung volume against time in seconds
Graphic representations of the patient's efforts in the form of a flow-volume curve and a volume-time curve
Decreased pressure
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

46. within limits - increased temperature =
Ventilation
release of O2 from Hb - as heat is a by-product of metabolism.
2 - each wavelength is partially absorbed by hemoglobin
70%

47. Coarse crackles result from
Air bubbles flowing through secretions or slightly closed airways during respiration
Postero-anterior (PA) and lateral view series
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Sternocleidomastoid - Scalene Muscles

48. The external intercostal muscles increase the antero-posterior chest diameter during
Inspiration
Either continuous or discontinuous
Contracts
Diffusion

49. Normal range of PaCO2
Portable antero-posterior (AP) view
The atmospheric pressure
reduced in size - compared with a normal curve - due to lower lung volume
35 to 45 mmHg

50. 20.95% Atmospheric Composition
Speed of airflow - the higher the flow - the greater the resistance
Air to move from the upper airway to the farthest alveolar reaches
Oxygen (O2)
The negative logarithm of hydrogen ions in the blood

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Pulmonology

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