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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. Spirometry plots
2 - each wavelength is partially absorbed by hemoglobin
quickly - usually reaching a plateau within 6.0 seconds
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
A tracing of the lung volume against time in seconds

2. Rhonchi originate in the...
Larger airways
'adventitious' breath sounds
respiration
Blood to the alveoli

3. dead space ventilation
Soft - high-pitched and crisp
Brief - discrete - non-musical sounds with a popping quality
Immediate oxygenation with or without intubation
The gas in the conducting airways does not participate in alveolar exchange

4. Examples of obstructive disease
Insufficient oxygenation of hemoglobin in the lungs
Upper respiratory obstruction - usually in the trachea or larynx
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly

5. Expiratory stridor indicates
Mouth as well as through the chest wall
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Blue or bluish-gray discoloration of the skin or mucous membranes
Obstruction below the vocal cords (subglottic or tracheal obstruction)

6. Cyanosis is caused by
Expiratory volume - and there is a prolonged expiratory time
Perfusion
Increased amounts of unsaturated hemoglobin in capillary blood
Dullness replaces resonance

7. Peripheral cyanosis results from
release of O2 from Hb
right and left mainstem bronchi
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma

8. Pulmonary ventilation is varied by
Altering the respiratory rate and/or the tidal volume
The total amount of air in the lungs at the end of a maximal inhalation
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

9. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Functional residual capacity (FRC)
A site of obstruction above the vocal cords (supraglottic or glottic obstruction)
No
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'

10. The movement of air back and forth from the deepest reaches of the alveoli to the outside environment
70%
The atmospheric pressure
respiration
Oxygen-Hemoglobin Dissociation Curve

11. Chest Radiography: The most common chest X-ray series is the...
Postero-anterior (PA) and lateral view series
The gas in the conducting airways does not participate in alveolar exchange
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
Perfusion

12. Stridor is a high-pitched - noisy respiration - Which is indicative of...
right and left mainstem bronchi
Blood to the alveoli
Upper respiratory obstruction - usually in the trachea or larynx
PaCO2

13. The accessory muscles are the...
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Either continuous or discontinuous
Nitrogen
Sternocleidomastoid - Scalene Muscles

14. PaCO2
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
No respiration for > 20 seconds
Partial pressure of CO2 in the arterial 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

15. Simple - objective - noninvasive diagnostic test can be performed with relative ease on patients who present with respiratory-related symptoms
Spirometry
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)
Fraction (%age) of inspired oxygen

16. FEV1/FVC
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
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
Dullness replaces resonance
Insufficient oxygenation of hemoglobin in the lungs

17. The circulatory system transport of oxygen to - and carbon dioxide from - the peripheral tissues
Perfusion
Expiration
The total amount of air in the lungs at the end of a maximal inhalation
T4 or T5 - and just below the manubrio-sternal joint

18. Continuous lung sounds occur during...
Expiration
Cough
Immediate oxygenation with or without intubation
Either inspiration or expiration

19. expiratory reserve
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 amount of air that can be exhaled after expiration
Air to move from the upper airway to the farthest alveolar reaches
Postero-anterior (PA) and lateral view series

20. Which lung has a horizontal fissure?
right
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Carboxyhemoglobin
Saturated with oxygen or unsaturated

21. The most reliable site for detecting central cyanosis is the...
right and left mainstem bronchi
quickly - usually reaching a plateau within 6.0 seconds
Tongue
Carboxyhemoglobin

22. Bronchial breath sounds
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Altering the respiratory rate and/or the tidal volume
Obstruction below the vocal cords (subglottic or tracheal obstruction)

23. pH
Upper respiratory obstruction - usually in the trachea or larynx
Significant pulmonary impairment
The negative logarithm of hydrogen ions in the blood
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature

24. residual volume
Pressure required to drive air through the airways
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
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
Partial pressure of oxygen (PO2)

25. Which bronchus is more susceptible to aspiration of foreign bodies?
Right
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
right and left mainstem bronchi
35 to 45 mmHg

26. The muscles of inspiration are the...
Observing the pattern of breathing
Diaphragm - External Intercostals
respiration
Functional residual capacity (FRC)

27. Bohr Effect of pH: left shift
Increased Hb-O2 affinity
There is an inverse relationship between pressure and volume
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
The examiner can clearly distinguish the word that the pt speak or whispers

28. Orthopnea is quantified by
The ratio of the FEV1 to the forced vital capacity - and it is expressed as a percentage (FEV1%)
Tongue
The negative logarithm of hydrogen ions in the blood
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

29. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
Interstitial diseases or early pulmonary edema
A good effort
'adventitious' breath sounds
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

30. What is the potential space between the visceral and parietal pleurae?
Nitrogen
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
Sternocleidomastoid - Scalene Muscles
Pleural space

31. Cyanosis appears when
Lung volumes - but find it difficult to exhale rapidly
Increased Hb-O2 affinity
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature

32. The trachea bifurcates into its mainstem bronchi at the level of...
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
Overcome some of the problems associated with low blood flow to the probe site
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Dullness replaces resonance

33. Rhonchi
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality
Pneumonia - obstructive lung disease - and late pulmonary edema
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Pleural space

34. office-based spirometry is recommended for patients as young as
Manubrio-sternal junction (angle of Louis)
Increased work of breathing
5 years - to detect obstruction and determine its reversibility
Partial pressure of O2 in the arterial blood

35. What occurs passively as muscles relax?
Pleural space
Expiration
80%
Either continuous or discontinuous

36. increased volume results in
Wheezes - high-pitched - musical sounds - distinct whistling quality
Decreased pressure
Partial pressure of oxygen in the alveoli
Dyspnea upon assuming a recumbent position

37. The trachea divides into
Saturated with oxygen or unsaturated
right and left mainstem bronchi
Pressure required to drive air through the airways
Sternocleidomastoid - Scalene Muscles

38. A means of measuring the movement of air into and out of the lungs during various breathing maneuvers
Spirometry
Inflammation of the adjacent parietal pleura
Increased work of breathing
5 years - to detect obstruction and determine its reversibility

39. Coarse crackles are heard in
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
reduced in size - compared with a normal curve - due to lower lung volume
2 - each wavelength is partially absorbed by hemoglobin
Pneumonia - obstructive lung disease - and late pulmonary edema

40. Airway resistance refers to...
Pressure required to drive air through the airways
Manubrio-sternal junction (angle of Louis)
Saturated with oxygen or unsaturated
Partial pressure of CO2 in the arterial blood

41. During inspiration the diaphragm
Contracts
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Functional residual capacity (FRC)
Oxygen-Hemoglobin Dissociation Curve

42. pain in lung conditions usually arises from
No respiration for > 20 seconds
release of O2 from Hb - as heat is a by-product of metabolism.
Inflammation of the adjacent parietal pleura
Lung volumes - but no difficulty or delay in exhaling what volume they do have

43. inspiratory reserve
Contracts
The amount of air that can be inhaled after normal inspiration
The maximum volume of air that can be expelled from the lungs following a maximal inspiration - performed as rapidly and forcefully as possible
Mediastinum

44. Spirometry: The result is stated as
Either inspiration or expiration
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height
Blue or bluish-gray discoloration of the skin or mucous membranes

45. Bronchophony
'adventitious' breath sounds
70%
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
'scooped out' or bowl-shaped

46. The visceral pleura lines the...
Sternocleidomastoid - Scalene Muscles
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Soft - high-pitched and crisp
Outer surface of each lung

47. The purpose of respiration is to...
reduced in size - compared with a normal curve - due to lower lung volume
No respiration for > 20 seconds
Keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide
A reliable and consistent classification of auditory findings

48. At rest - the use of accessory muscles is a sign of...
Significant pulmonary impairment
'crackles' or 'rales'
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
respiration

49. total lung capacity (TLC)
Spirometry in the diagnosis - severity staging - and monitoring of these conditions
The total amount of air in the lungs at the end of a maximal inhalation
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Outer surface of each lung

50. normal subjects expel approximately how much of the FVC in the 1st second?
Outer surface of each lung
Partial pressure of O2 in the arterial blood
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase
80%