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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. The diaphragm contracts and moves downward during inspiration - lowering the abdominal contents to...
Diffusion
The rib above it
Increase the intrathoracic space
Inspiration

2. The acini consist of the...
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
The gas in the conducting airways does not participate in alveolar exchange
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
Either continuous or discontinuous

3. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
Expiratory volume - and there is a prolonged expiratory time
A reliable and consistent classification of auditory findings
50%
respiration

4. Which bronchus is wider - shorter - and more vertically placed?
Obstructive lung disease from restrictive lung disease
Right
Carboxyhemoglobin
There is an inverse relationship between pressure and volume

5. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli
Bicarbonate
Diffusion
require supplemental oxygenation and possibly ABG analysis

6. Oxygen moves from the...
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
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
The gas in the conducting airways does not participate in alveolar exchange

7. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Inspiration
Pressure required to drive air through the airways
Wheezes - high-pitched - musical sounds - distinct whistling quality
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration

8. An efficient approach to examination of the patient begins with
A reliable and consistent classification of auditory findings
Observing the pattern of breathing
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
50%

9. Which lung has an oblique fissure?
Lung volumes - but find it difficult to exhale rapidly
Speed of airflow - the higher the flow - the greater the resistance
right and left mainstem bronchi
right & left

10. inspiratory reserve
Hypoventilation or modest changes in the PaO2
Altering the respiratory rate and/or the tidal volume
500 to 800 mL
The amount of air that can be inhaled after normal inspiration

11. Late inspiratory crackles result from
A reliable and consistent classification of auditory findings
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Altering the respiratory rate and/or the tidal volume
To assess response to treatment

12. The muscles of inspiration are the...
Pneumonia - obstructive lung disease - and late pulmonary edema
Diaphragm - External Intercostals
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
A reduction in lung capacity - secondary to scarring or extraneous material

13. The spirometry printout usually includes

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14. Stridor is a high-pitched - noisy respiration - Which is indicative of...
Upper respiratory obstruction - usually in the trachea or larynx
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Expiratory volume - and there is a prolonged expiratory time
Lung volumes - but find it difficult to exhale rapidly

15. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
Dullness replaces resonance
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 inspiration or expiration
Partial pressure of oxygen (PO2)

16. Obstructive Disease: Expiratory airflow is reduced more than
Louder - lower-pitched - and slightly longer in duration
Blue or bluish-gray discoloration of the skin or mucous membranes
Wheezes - high-pitched - musical sounds - distinct whistling quality
Expiratory volume - and there is a prolonged expiratory time

17. Oximetry readings of < 94%
Perfusion
require supplemental oxygenation and possibly ABG analysis
The gas in the conducting airways does not participate in alveolar exchange
Blood to the alveoli

18. vital capacity (VC)
Increased work of breathing
The total amount of air that can be exhaled following a maximal inhalation
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
results in a lower than normal FEV1%

19. Chest Radiography: The most common chest X-ray series is the...
Larger airways
Postero-anterior (PA) and lateral view series
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
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

20. Obstructive disease refers to...
Inspiration
Spirometry
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
The total amount of air in the lungs at the end of a maximal inhalation

21. Rhonchi are due to...
Partial pressure of O2 in the arterial blood
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
Excessive secretions and abnormal airway collapsibility
A good effort

22. The external intercostal muscles increase the antero-posterior chest diameter during
'crackles' or 'rales'
Inspiration
Total lung capacity (TLC)
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval

23. Continuous lung sounds occur during...
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
require supplemental oxygenation and possibly ABG analysis
Observing the pattern of breathing
Either inspiration or expiration

24. The parietal pleura lines the...
Inside of the thoracic cavity wall and the upper surface of the diaphragm
Normal to increased FEV1%
Air-filled - fluid-filled - or solid
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

25. A normal volume-time curve rises
quickly - usually reaching a plateau within 6.0 seconds
Excessive secretions and abnormal airway collapsibility
A reliable and consistent classification of auditory findings
Increase the intrathoracic space

26. Coarse crackles result from
Spirometry
Expiration
Air bubbles flowing through secretions or slightly closed airways during respiration
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)

27. Orthopnea is quantified by
70%
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
2 - each wavelength is partially absorbed by hemoglobin
The examiner can clearly distinguish the word that the pt speak or whispers

28. Patients with restrictive disease have low
Oxygen (O2)
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Partial pressure of oxygen (PO2)
Partial pressure of carbon dioxide in the alveoli

29. Orthopnea is defined as
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
Altering the respiratory rate and/or the tidal volume
Dyspnea upon assuming a recumbent position
right and left mainstem bronchi

30. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
reduced in size - compared with a normal curve - due to lower lung volume
Air-filled - fluid-filled - or solid
Increased work of breathing
release of O2 from Hb - as heat is a by-product of metabolism.

31. Compliance
Inspiration
Perfusion
Manubrio-sternal junction (angle of Louis)
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

32. Rhonchi frequently clear after
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Left upper lobe
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Cough

33. 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
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Pulse oximetry
PaCO2
Speed of airflow - the higher the flow - the greater the resistance

34. The purpose of respiration is to...
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
70% occlusion of the airway
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

35. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Functional residual capacity (FRC)
Left upper lobe
Portable antero-posterior (AP) view

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

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37. Bohr Effect of pH: right shift
Decreased Hb-O2 affinity
2 - each wavelength is partially absorbed by hemoglobin
Inspiration
Tongue

38. Central cyanosis results from
The total amount of air that can be exhaled following a maximal inhalation
Insufficient oxygenation of hemoglobin in the lungs
Cough
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction

39. Pulse Oximetry is dependent on...
Blood to the alveoli
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Contracts
Mediastinum

40. The normal FEV1 /FVC ratio is...
70%
Diaphragm and the intercostal muscles
'scooped out' or bowl-shaped
No

41. Nitroglycerin applied to the probe area has been reported to...
Either inspiration or expiration
The total amount of air that can be exhaled following a maximal inhalation
Overcome some of the problems associated with low blood flow to the probe site
release of O2 from Hb

42. high CO2 = high acidity =
Larger airways
right & left
release of O2 from Hb
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

43. Egophony

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44. hypocapnia
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Lowered carbon dioxide level - results from hyperventilation
Lung volumes - but no difficulty or delay in exhaling what volume they do have
right & left

45. Abnormal lung sounds are classified as
Increase the intrathoracic space
Cough
Either continuous or discontinuous
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

46. Spirometry plots
Ventilation
Expiratory volume - and there is a prolonged expiratory time
Contracts
A tracing of the lung volume against time in seconds

47. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Spirometry
Dullness replaces resonance
Upper respiratory obstruction - usually in the trachea or larynx
80 to 120% of predicted value

48. FEV1/FVC
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Soft - high-pitched and crisp

49. Cyanosis appears when
Spirometry
Upper respiratory obstruction - usually in the trachea or larynx
Increased minute volume ventilation - which results in a lowered carbon dioxide level
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL

50. Expiratory stridor indicates
release of O2 from Hb
Obstruction below the vocal cords (subglottic or tracheal obstruction)
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Either inspiration or expiration

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Pulmonology

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