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Pulmonology

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Answer 50 questions in 15 minutes.
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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 visceral pleura lines the...
Partial pressure of carbon dioxide in the alveoli
Outer surface of each lung
Mediastinum
release of O2 from Hb - as heat is a by-product of metabolism.

2. During inspiration the diaphragm
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Significant pulmonary impairment
Brief - discrete - non-musical sounds with a popping quality
Contracts

3. The trachea bifurcates into its mainstem bronchi at the level of...
Spirometry
70%
Air bubbles flowing through secretions or slightly closed airways during respiration
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

4. FEV1% in obstructive disease
A reliable and consistent classification of auditory findings
results in a lower than normal FEV1%
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
There is an inverse relationship between pressure and volume

5. Oximetry readings of < 94%
Diffusion
require supplemental oxygenation and possibly ABG analysis
Saturated with oxygen or unsaturated
Partial pressure of carbon dioxide in the alveoli

6. At rest - the use of accessory muscles is a sign of...
Spirometry
Left upper lobe
Total lung capacity (TLC)
Significant pulmonary impairment

7. The vital capacity and the residual volume together constitute the...
Total lung capacity (TLC)
Decreased pressure
The amount of air that can be inhaled after normal inspiration
Contracts

8. 20.95% Atmospheric Composition
50%
Oxygen (O2)
Hypoventilation or modest changes in the PaO2
The right middle lobe

9. Dyspnea is defined as
Dyspnea upon assuming a recumbent position
An area of higher concentration to that of a lower concentration passively - with no expenditure of energy
To assess response to treatment
Difficulty breathing or shortness of breath

10. PaO2
Pressure required to drive air through the airways
Speed of airflow - the higher the flow - the greater the resistance
Partial pressure of O2 in the arterial blood
respiratory bronchioles - alveolar ducts - alveolar sacs - and alveoli

11. The trachea divides into right and left mainstem bronchi At what level?
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
35 to 45 mmHg
Increased minute volume ventilation - which results in a lowered carbon dioxide level
T4 or T5 - and just below the manubrio-sternal joint

12. Obstructive disease refers to...
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Increased work of breathing
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
A good effort

13. Rhonchi originate in the...
Larger airways
Either continuous or discontinuous
The total amount of air that can be exhaled following a maximal inhalation
Terminal - and ultimately into respiratory bronchioles so small that each is associated with one acinus

14. Bohr Effect of pH is graphed as
Oxygen-Hemoglobin Dissociation Curve
Lung volumes - but find it difficult to exhale rapidly
Obstructive lung disease from restrictive lung disease
Spirometry

15. Continuous lung sounds occur when air flows rapidly through bronchi that are...
The total amount of air in the lungs at the end of a maximal inhalation
Expiratory volume - and there is a prolonged expiratory time
Narrowed nearly to the point of closure
A reduction in lung capacity - secondary to scarring or extraneous material

16. Continuous lung sounds often audible at the...
Perfusion
Mouth as well as through the chest wall
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Dyspnea upon assuming a recumbent position

17. Cyanosis is caused by
Either inspiration or expiration
Altering the respiratory rate and/or the tidal volume
Increased amounts of unsaturated hemoglobin in capillary blood
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

18. pH
quickly - usually reaching a plateau within 6.0 seconds
The negative logarithm of hydrogen ions in the blood
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
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

19. An efficient approach to examination of the patient begins with
Blue or bluish-gray discoloration of the skin or mucous membranes
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Observing the pattern of breathing
The total amount of air that can be exhaled following a maximal inhalation

20. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
The examiner can clearly distinguish the word that the pt speak or whispers
Dullness replaces resonance
Obstructive lung disease from restrictive lung disease
Partial pressure of O2 in the arterial blood

21. Restrictive disease refers to...
A reduction in lung capacity - secondary to scarring or extraneous material
Pressure required to drive air through the airways
Hypoventilation or modest changes in the PaO2
Increase the intrathoracic space

22. Egophony

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23. Spirometry is useful in distinguishing
Obstructive lung disease from restrictive lung disease
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
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
Expiratory airflow - the expiratory time is very short - and chest expansion is poor

24. Continuous lung sounds occur during...
Right
Ventilation - Diffusion - Perfusion
Either inspiration or expiration
500 to 800 mL

25. Pectoriloquy
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
The examiner can clearly distinguish the word that the pt speak or whispers
require supplemental oxygenation and possibly ABG analysis
Dyspnea upon assuming a recumbent position

26. Rhonchi occur during
Either inspiration or expiration
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
Blood to the alveoli
release of O2 from Hb

27. gas exchange across the alveolar-pulmonary capillary membranes
Diffusion
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
Inspiration
Mediastinum

28. What occurs passively as muscles relax?
require supplemental oxygenation and possibly ABG analysis
Expiration
Larger airways
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

29. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Diffusion
Left upper lobe
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Functional residual capacity (FRC)

30. Continuous lung sounds occur in the setting of...
reduced in size - compared with a normal curve - due to lower lung volume
Binding of O2 to Hb
500 to 800 mL
Bronchospasm - mucosal edema - or excessive secretions

31. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Alveoli to the blood
A reliable and consistent classification of auditory findings
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
Spirometry

32. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
Binding of O2 to Hb
A tracing of the lung volume against time in seconds
Dullness replaces resonance
Saturated with oxygen or unsaturated

33. Continuous lung sounds
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Wheezes - high-pitched - musical sounds - distinct whistling quality

34. An SaO2 of 90% correlates with a PaO2 as low as 59 and requires
Air-filled - fluid-filled - or solid
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Immediate oxygenation with or without intubation
Left upper lobe

35. Restrictive Disease: Expiratory volume is reduced more than
Partial pressure of CO2 in the arterial blood
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
70% occlusion of the airway
Soft - high-pitched and crisp

36. pain in lung conditions usually arises from
Inflammation of the adjacent parietal pleura
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
Cough
Binding of O2 to Hb

37. The trachea divides into
The total amount of air that can be exhaled following a maximal inhalation
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
The right middle lobe
right and left mainstem bronchi

38. PACO2
10 to 11 cm long and about 2 cm in diameter
The examiner can clearly distinguish the word that the pt speak or whispers
respiration
Partial pressure of carbon dioxide in the alveoli

39. Fine crackles are...
Partial pressure of oxygen (PO2)
The total amount of air that can be exhaled following a maximal inhalation
Soft - high-pitched and crisp
Spirometry

40. Coarse crackles are...
quickly - usually reaching a plateau within 6.0 seconds
Diffusion
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Louder - lower-pitched - and slightly longer in duration

41. Bronchial breath sounds
Diaphragm and the intercostal muscles
Air bubbles flowing through secretions or slightly closed airways during respiration
Inspiratory and expiratory sounds - about equal in length - sometimes separated by a silent interval
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

42. Auscultation of the chest depends on...
The amount of air that can be inhaled after normal inspiration
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Ventilation
A reliable and consistent classification of auditory findings

43. Examples of restrictive disease
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
To assess response to treatment
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
Inspiration

44. Spirometry normal range
80 to 120% of predicted value
Increased amounts of unsaturated hemoglobin in capillary blood
Normal to increased FEV1%
Pulse oximetry

45. Abnormal lung sounds AKA

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46. Orthopnea is quantified by
Immediate oxygenation with or without intubation
Air bubbles flowing through secretions or slightly closed airways during respiration
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Upper respiratory obstruction - usually in the trachea or larynx

47. FEV1% in restrictive disease
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
35 to 45 mmHg
Normal to increased FEV1%
5 years - to detect obstruction and determine its reversibility

48. With restrictive disease - the flow-volume curve is...
Partial pressure of CO2 in the arterial blood
Expiratory volume - and there is a prolonged expiratory time
Expiratory airflow - the expiratory time is very short - and chest expansion is poor
reduced in size - compared with a normal curve - due to lower lung volume

49. a visible and palpable angulation of the sternum - and the point at which the second rib articulates with the sternum
Manubrio-sternal junction (angle of Louis)
5 years - to detect obstruction and determine its reversibility
Oxygen (O2)
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

50. Coarse crackles are heard in
Binding of O2 to Hb
Cough
Pneumonia - obstructive lung disease - and late pulmonary edema
right & left

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Pulmonology

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