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Pulmonology

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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. Hyperventilation is defined as
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Lung volumes - but find it difficult to exhale rapidly
Tongue
Partial pressure of carbon dioxide in the alveoli

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

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3. What may prevent cyanosis from appearing?
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
Perfusion
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Sternocleidomastoid - Scalene Muscles

4. What chest radiography is used for unstable patients or those unable to stand during the X-ray?
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
'adventitious' breath sounds
Portable antero-posterior (AP) view
Increased work of breathing

5. Abnormal lung sounds are classified as
Diffusion
5 years - to detect obstruction and determine its reversibility
Either continuous or discontinuous
Expiration

6. What is the potential space between the visceral and parietal pleurae?
Cough
Pleural space
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Either continuous or discontinuous

7. Cyanosis appears when
PaO2 is less than 40 mm Hg - and the unsaturated hemoglobin is 5 grams/dL
Partial pressure of oxygen (PO2)
Speed of airflow - the higher the flow - the greater the resistance
Increase the intrathoracic space

8. The use of accessory muscles (contraction of the sternocleidomastoid or supraclavicular muscles during inspiration) indicates
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up
Either inspiration or expiration
Expiration
Increased work of breathing

9. FIO2
80 to 120% of predicted value
Partial pressure of carbon dioxide in the alveoli
Fraction (%age) of inspired oxygen
Soft - high-pitched and crisp

10. The volume of gas remaining in the lungs at the end of normal expiration is called the...
Functional residual capacity (FRC)
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
Expiratory volume - and there is a prolonged expiratory time
Oxygen (O2)

11. Compliance
The sternal angle of Louis anteriorly - and the T4 spinous process posteriorly
Functional residual capacity (FRC)
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
The total amount of air that can be exhaled following a maximal inhalation

12. Pulse Oximetry: The amount of absorption differs depending on whether the hemoglobin is...
Anemia - since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration
80 to 120% of predicted value
Saturated with oxygen or unsaturated
Bronchospasm - mucosal edema - or excessive secretions

13. The trachea divides into right and left mainstem bronchi At what level?
Left upper lobe
T4 or T5 - and just below the manubrio-sternal joint
Partial pressure of carbon dioxide in the alveoli
The rib above it

14. Tachypnea is an
There is an inverse relationship between pressure and volume
Increased rate of breathing and is commonly associated with a decrease in tidal volume
Blood to the alveoli
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

15. The best indicator of adequate ventilation is the...
Wheezes - high-pitched - musical sounds - distinct whistling quality
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
Portable antero-posterior (AP) view
PaCO2

16. Spirometry is useful in distinguishing
Insufficient oxygenation of hemoglobin in the lungs
No respiration for > 20 seconds
Speed of airflow - the higher the flow - the greater the resistance
Obstructive lung disease from restrictive lung disease

17. Spirometry: The result is stated as
Inflammation of the adjacent parietal pleura
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
Expiration
A percentage of predicted values - which are derived from normal individuals grouped by gender - age - and height

18. Flow-Volume Curve: On a normal graph - the flow-volume curve is...
Carboxyhemoglobin
Dyspnea that awakens the patient several hours after going to sleep
Shaped like a sail - rising rapidly to a sharp peak - then descending in a straight line at about a 45˚ angle
reduced in size - compared with a normal curve - due to lower lung volume

19. increased volume results in
Internal Intercostals - Internal and External Obliques - Transversus Abdominis
Bicarbonate
500 to 800 mL
Decreased pressure

20. Oxygen moves from the...
Excessive secretions and abnormal airway collapsibility
Dyspnea that awakens the patient several hours after going to sleep
Alveoli to the blood
Partial pressure of CO2 in the arterial blood

21. Rhonchi frequently clear after
Partial pressure of carbon dioxide in the alveoli
Nitrogen
Cough
The right middle lobe

22. Restrictive disease refers to...
'adventitious' breath sounds
Increase the intrathoracic space
A reduction in lung capacity - secondary to scarring or extraneous material
The total amount of air that can be exhaled following a maximal inhalation

23. expiratory reserve
Bronchospasm - mucosal edema - or excessive secretions
The amount of air that can be exhaled after expiration
Significant pulmonary impairment
Difficulty breathing or shortness of breath

24. Rhonchi
An increase in airway resistance as a result of a reduction of elastic recoil and /or compromise of the air passage
Mouth as well as through the chest wall
right and left mainstem bronchi
Continuous lung sound - lower-pitched - snoring sounds - may have a gurgling quality

25. Continuous lung sounds occur when air flows rapidly through bronchi that are...
Narrowed nearly to the point of closure
The volume of air inhaled and exhaled with each resting breath during normal - quiet breathing
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
Spirometry in the diagnosis - severity staging - and monitoring of these conditions

26. pH
The negative logarithm of hydrogen ions in the blood
Diffusion
Pulse oximetry
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

27. Spirometry can be used to determine the severity of functional impairment as well as
Upper respiratory obstruction - usually in the trachea or larynx
Either continuous or discontinuous
To assess response to treatment
Expiratory volume - and there is a prolonged expiratory time

28. The tracheo-bronchial tree is a tubular system that provides a pathway for
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax
Immediate oxygenation with or without intubation
Air to move from the upper airway to the farthest alveolar reaches
Air bubbles flowing through secretions or slightly closed airways during respiration

29. Sharp peaks and smooth descents on the flow-volume curves - and a flat plateau at the end of the volume-time curve suggests
right & left
A good effort
Larger airways
Diffusion

30. What change occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers?
Lung volumes - but no difficulty or delay in exhaling what volume they do have
Bicarbonate
Increased work of breathing
Dullness replaces resonance

31. The muscles of expiration are the...
Carboxyhemoglobin
The examiner can clearly distinguish the word that the pt speak or whispers
Diaphragm - External Intercostals
Internal Intercostals - Internal and External Obliques - Transversus Abdominis

32. low CO2 = low acidity =
right and left mainstem bronchi
Binding of O2 to Hb
Spirometry
results in a lower than normal FEV1%

33. normal adult tidal volume
500 to 800 mL
Interstitial diseases or early pulmonary edema
Dyspnea upon assuming a recumbent position
Lung volumes - but no difficulty or delay in exhaling what volume they do have

34. Factors that influence the oxygen carrying capacity of hemoglobin
Expiratory volume - and there is a prolonged expiratory time
Partial pressure of oxygen (PO2) - Bohr effect of pH - Temperature
70%
80 to 120% of predicted value

35. The pattern of breathing refers to...
The total amount of air that can be exhaled following a maximal inhalation
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
80 to 120% of predicted value
Inside of the thoracic cavity wall and the upper surface of the diaphragm

36. Rhonchi occur during
Either inspiration or expiration
'scooped out' or bowl-shaped
Ventilation - Diffusion - Perfusion
Number of pillows the patient uses for sleeping - or by the fact that the patient needs to sleep sitting up

37. Vesicular breath sounds
No respiration for > 20 seconds
Sternocleidomastoid - Scalene Muscles
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
Louder and higher in pitch - with a short silence between inspiratory and expiratory sounds - the expiratory phase lasting longer than inspiratory phase

38. high CO2 = high acidity =
release of O2 from Hb - as heat is a by-product of metabolism.
From insufficient cardiac output - obstruction of blood flow - or vasoconstriction due to cold temperature
Normal to increased FEV1%
release of O2 from Hb

39. Examples of obstructive disease
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Increase the intrathoracic space
'crackles' or 'rales'
Saturated with oxygen or unsaturated

40. increasing the volume of the thoracic cavity by flattening the diaphragm and elevating the ribs
Soft - high-pitched and crisp
Brief - discrete - non-musical sounds with a popping quality
Inspiration
Expiration

41. 20.95% Atmospheric Composition
A pulsatile blood flow - therefore it may be inaccurate in situations that result in peripheral vasoconstriction
Lung volumes - but find it difficult to exhale rapidly
Oxygen (O2)
Alveolar and interstitial processes such as edema - fibrosis - and infection; large - space-occupying lesions; atelectasis; pleural effusion; and pneumothorax

42. Coarse crackles are...
respiratory rate and rhythm - the depth of breathing - and the relative amount of time spent in inspiration and expiration
Louder - lower-pitched - and slightly longer in duration
The examiner can clearly distinguish the word that the pt speak or whispers
Narrowed nearly to the point of closure

43. Late inspiratory crackles result from
Speed of airflow - the higher the flow - the greater the resistance
The spoken sound 'ee' as in 'bee' is heard by the ascultator as the 'a' in 'bay'
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
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

44. Carbon dioxide moves from the...
Pneumonia - obstructive lung disease - and late pulmonary edema
Increased minute volume ventilation - which results in a lowered carbon dioxide level
Partial pressure of oxygen (PO2)
Blood to the alveoli

45. hypocapnia
Obstruction below the vocal cords (subglottic or tracheal obstruction)
Perfusion
Lowered carbon dioxide level - results from hyperventilation
Normal to increased FEV1%

46. Abnormal lung sounds AKA

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47. Normal range of PaCO2
Increased rate of breathing and is commonly associated with a decrease in tidal volume
35 to 45 mmHg
A series of tiny explosions when small airways - deflated during expiration - pop open during inspiration
respiration

48. Auscultation of the chest depends on...
A reliable and consistent classification of auditory findings
Either inspiration or expiration
Chronic obstructive pulmonary disease (COPD) - chronic bronchitis - emphysema - and asthma
Significant pulmonary impairment

49. Nitroglycerin applied to the probe area has been reported to...
Overcome some of the problems associated with low blood flow to the probe site
Blue or bluish-gray discoloration of the skin or mucous membranes
No
Wheezes - high-pitched - musical sounds - distinct whistling quality

50. the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane
Diffusion
Vesicular breath sounds - Bronchiovesicular breath sounds - Bronchial breath sounds
'adventitious' breath sounds
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