Pulmonary Pathophysiology
Pulmonary pathophysiology - directly from west book
- 1.
The one-second forced expiratory volume test:
- A.
Is difficult to perform.
- B.
Can be used to assess the efficacy of bronchodilators.
- C.
Is unaffected by dynamic compression of the airways.
- D.
Is reduced in patients with fibrosis but not COPD.
- E.
Increases with age.
Correct Answer
B. Can be used to assess the efficacy of bronchodilators. -
- 2.
Maximum flow rate during most of a forced expiration is limited by:
- A.
Turbulence in the trachea.
- B.
Action of the diaphragm.
- C.
Contraction of the intercostal muscles.
- D.
Power of the abdominal muscles.
- E.
Compression of the airways.
Correct Answer
E. Compression of the airways. -
- 3.
The FEV1 and FVC are measured in a patient with interstitial fibrosis of the lung. We expect:
- A.
Increased FEV1.
- B.
Increased FVC.
- C.
Increased FEV1/FVC.
- D.
Decreased expiratory flow rate when related to lung volume.
- E.
Abnormally high flow rate early in expiration.
Correct Answer
C. Increased FEV1/FVC. -
- 4.
The inspiratory flow-volume curve is most valuable for:
- A.
Detecting fixed upper airway obstruction.
- B.
Measuring the response to bronchodilator drugs.
- C.
Differentiating between chronic bronchitis and emphysema.
- D.
Detecting resistance in small peripheral airways.
- E.
Detecting fatigue of the diaphragm.
Correct Answer
A. Detecting fixed upper airway obstruction. -
- 5.
Concerning the single-breath nitrogen test:
- A.
It is usually normal in mild COPD.
- B.
The slope of phase 3 is increased in chronic bronchitis.
- C.
In phase 3, well-ventilated units empty last.
- D.
In normal subjects the last expired gas comes from the base of the lung.
- E.
The expiratory flow rate should be as fast as possible.
Correct Answer
B. The slope of phase 3 is increased in chronic bronchitis. -
- 6.
The FEV1 in a patient with COPD is reduced by:
- A.
Increased lung compliance.
- B.
Increase in the number of small airways.
- C.
Increased radial traction on the airways.
- D.
Increased elastic recoil of the lung.
- E.
Hypertrophy of the diaphragm
Correct Answer
A. Increased lung compliance. -
- 7.
The closing volume as measured from the single-breath N2 test:
- A.
A. Decreases with age.
- B.
B. Is highly reproducible.
- C.
C. Is affected by the small, peripheral airways.
- D.
D. Is most informative in patients with severe lung disease.
- E.
E. Is normal in mild COPD.
Correct Answer
C. C. Is affected by the small, peripheral airways. -
- 8.
In peripheral capillaries, more oxygen can be unloaded from the blood to the tissues at a given PO2 when:
- A.
Blood temperature is reduced.
- B.
PCO2 is reduced.
- C.
Blood pH is raised.
- D.
Concentration of 2,3-DPG in the red cell is raised.
- E.
Hydrogen ion concentration is reduced.
Correct Answer
D. Concentration of 2,3-DPG in the red cell is raised. -
- 9.
A young man with normal lungs takes an overdose of barbiturate, which causes him to hypoventilate. Which of the following will probably reach the value of 50 first (assume usual units)?
- A.
Arterial PO2.
- B.
Arterial oxygen saturation.
- C.
Arterial PCO2.
- D.
Plasma bicarbonate concentration.
- E.
Base excess.
Correct Answer
C. Arterial PCO2. -
- 10.
A previously well patient takes an overdose of a narcotic drug and is brought to the emergency room within an hour. The arterial PCO2 is found to be 80 mm Hg. What is the most likely value for the arterial pH?
- A.
6.8
- B.
7.0
- C.
7.2
- D.
7.4
- E.
7.6
Correct Answer
C. 7.2 -
- 11.
A patient with chronic pulmonary disease undergoes emergency surgery. Postoperatively, the arterial PO2, PCO2, and pH are 50 mm Hg, 50 mm Hg, and 7.20, respectively. How would the acid-base status be best described?
- A.
Mixed respiratory and metabolic acidosis.
- B.
Uncompensated respiratory acidosis.
- C.
Fully compensated respiratory acidosis.
- D.
Uncompensated metabolic acidosis.
- E.
Fully compensated metabolic acidosis.
Correct Answer
A. Mixed respiratory and metabolic acidosis. -
- 12.
Which of the following mechanisms of hypoxemia will prevent the arterial PO2 reaching the expected level if the subject is given 100% oxygen to breathe?
- A.
Hypoventilation.
- B.
Diffusion impairment.
- C.
Ventilation–perfusion inequality.
- D.
Shunt.
- E.
Residence at high altitude.
Correct Answer
D. Shunt. -
- 13.
Concerning obstructive sleep apnea:
- A.
The condition is rare.
- B.
Most patients are lean.
- C.
Treatment by continuous positive airway pressure (CPAP) is often effective.
- D.
Treatment by CPAP tends to cause systemic hypertension.
- E.
Snoring is uncommon.
Correct Answer
C. Treatment by continuous positive airway pressure (CPAP) is often effective. -
- 14.
In a normal person, doubling the diffusing capacity would be expected to:
- A.
Increase arterial PO2 during moderate exercise.
- B.
Increase the uptake of halothane given during anesthesia.
- C.
Decrease arterial PCO2 during resting breathing.
- D.
Increase resting oxygen uptake when the subject breathes air.
- E.
Increase maximal oxygen uptake at extreme altitude.
Correct Answer
E. Increase maximal oxygen uptake at extreme altitude. -
- 15.
The laboratory provides the following report on a patient's arterial blood: pH, 7.25; PCO2, 32 mm Hg; and HCO3- concentration, 25 mmol · l–1. You conclude that there is:
- A.
Respiratory alkalosis with metabolic compensation.
- B.
Acute respiratory acidosis.
- C.
Metabolic acidosis with respiratory compensation.
- D.
Metabolic alkalosis with respiratory compensation.
- E.
A laboratory error.
Correct Answer
E. A laboratory error. -
- 16.
An arterial blood sample is taken from a patient with acute shortness of breath breathing air at sea level. Assume the respiratory exchange ratio is 0.8. PO2 = 70 torr, PCO2 = 32 torr, pH = 7.30. These data indicate:
- A.
A primary respiratory alkalosis with metabolic compensation.
- B.
A normal alveolar–arterial PO2 difference.
- C.
An arterial O2 saturation of less than 70%.
- D.
The sample was mistakenly drawn from a vein.
- E.
A partially compensated metabolic acidosis.
Correct Answer
E. A partially compensated metabolic acidosis. -
- 17.
The functional residual capacity:
- A.
Can be measured with a single spirometer.
- B.
Is often larger when measured by helium dilution than with a body plethysmograph.
- C.
Is reduced during an attack of asthma.
- D.
Is determined by a balance between the elastic recoil of the lung and chest wall.
- E.
Falls with increasing age.
Correct Answer
D. Is determined by a balance between the elastic recoil of the lung and chest wall. -
- 18.
Airway resistance in a patient with asthma:
- A.
Is raised by increasing lung volume.
- B.
Is reduced by inhaling β2 agonists.
- C.
Is increased by destruction of alveolar walls.
- D.
Is unaffected by secretions in the airways.
- E.
Is increased by atrophy of bronchial smooth muscle.
Correct Answer
B. Is reduced by inhaling β2 agonists. -
- 19.
During an exercise test on a patient with mitral stenosis, it was found that the respiratory exchange ratio of expired gas rapidly rose above 1 at a low level of exercise. A likely reason is:
- A.
Abnormally high levels of lactate in the blood.
- B.
Abnormally low ventilation.
- C.
Abnormally high cardiac output.
- D.
Increased lung compliance.
- E.
Reduced diffusing capacity of the lung.
Correct Answer
A. Abnormally high levels of lactate in the blood. -
- 20.
In the upright human lung, which of the following is greater at the apex than the base?
- A.
Blood flow.
- B.
Ventilation.
- C.
Alveolar PCO2.
- D.
Alveolar size.
- E.
Capillary blood volume.
Correct Answer
D. Alveolar size. -
- 21.
Which of the following increases by the largest percentage at maximal exercise compared with rest?
- A.
PCO2 of mixed venous blood.
- B.
Alveolar ventilation.
- C.
Tidal volume.
- D.
Heart rate.
- E.
Cardiac output.
Correct Answer
B. Alveolar ventilation. -
- 22.
A current hypothesis for the pathogenesis of emphysema is:
- A.
Damage to pulmonary capillaries by increased alveolar pressure.
- B.
Chronic stimulation of bronchial mucous glands by cigarette smoking.
- C.
Destruction of lung elastin by excessive action of neutrophil elastase.
- D.
Excessive amounts of exercise.
- E.
Hyperventilation at high altitude.
Correct Answer
C. Destruction of lung elastin by excessive action of neutrophil elastase. -
- 23.
Alpha 1-antitrypsin deficiency:
- A.
Causes severe bronchitis with emphysema.
- B.
Results in emphysema at a relatively early age.
- C.
Is caused by infections in early childhood.
- D.
Is common in heterozygotes for the Z gene.
- E.
Tends to be most marked in the upper regions of the lung.
Correct Answer
B. Results in emphysema at a relatively early age. -
- 24.
Patients with COPD with the type A presentation (as opposed to type B) tend to have:
- A.
More cough productive of sputum.
- B.
Smaller lung volumes.
- C.
Decreased lung elastic recoil.
- D.
More hypoxemia.
- E.
Greater tendency to develop cor pulmonale.
Correct Answer
C. Decreased lung elastic recoil. -
- 25.
In a patient with severe bronchitis and emphysema, which of the following is likely to be normal?
- A.
FEV1.
- B.
FVC.
- C.
FEV1/FVC.
- D.
FEF25–75%.
- E.
None of the above.
Correct Answer
E. None of the above. -
- 26.
When a bronchodilator is administered to a patient during an asthma attack, which of the following typically decrease?
- A.
FEV1
- B.
FEV/FVC %
- C.
FVC
- D.
FEF25–75%
- E.
FRC
Correct Answer
E. FRC -
- 27.
Concerning the use of β-adrenergic agonists in asthma:
- A.
β1-selective agonists are preferred to β2 agonists.
- B.
They relax airway smooth muscle by decreasing the concentration of adenyl cyclase.
- C.
They reduce the concentration of intracellular cAMP.
- D.
They reduce airway inflammation.
- E.
They are usually given as tablets by mouth.
Correct Answer
D. They reduce airway inflammation. -
- 28.
The type II alveolar epithelial cell:
- A.
Provides most of the structural SPport for the normal alveolar wall.
- B.
Cannot multiply.
- C.
Is formed when a type I epithelial cell divides.
- D.
Secretes surfactant.
- E.
Is metabolically inactive.
Correct Answer
D. Secretes surfactant. -
- 29.
Histologic changes in diffuse interstitial pulmonary fibrosis typically include:
- A.
Infiltration of the alveolar wall with lymphocytes and plasma cells.
- B.
Breakdown of many alveolar walls.
- C.
Mucous gland hypertrophy in the bronchi.
- D.
Mucous plugging of airways.
- E.
Increased volume of the pulmonary capillary bed.
Correct Answer
A. Infiltration of the alveolar wall with lymphocytes and plasma cells. -
- 30.
Features of diffuse interstitial pulmonary fibrosis include:
- A.
Cough productive of copious sputum.
- B.
Hemoptysis.
- C.
Rhonchi in both lungs.
- D.
Dyspnea especially on exercise.
- E.
Depressed diaphragms on the radiograph.
Correct Answer
D. Dyspnea especially on exercise. -
- 31.
Pulmonary function tests in diffuse interstitial pulmonary fibrosis typically show:
- A.
Increased FEV1.
- B.
Increased FVC.
- C.
Increased FEV1/FVC %.
- D.
Increased TLC.
- E.
Increased airway resistance when related to lung volume.
Correct Answer
C. Increased FEV1/FVC %. -
- 32.
The arterial hypoxemia of a patient with diffuse interstitial pulmonary fibrosis:
- A.
Typically worsens on exercise.
- B.
Is chiefly caused by diffusion impairment.
- C.
Is associated with a large increase in diffusing capacity during exercise.
- D.
Is usually associated with carbon dioxide retention.
- E.
Is improved during exercise because of the abnormally large increase in cardiac output.
Correct Answer
A. Typically worsens on exercise. -
- 33.
In a patient with diffuse interstitial fibrosis of the lung, the maximal expiratory flow rate at a given lung volume may be higher than in a normal SBject because:
- A.
Expiratory muscles have a large mechanical advantage.
- B.
Airways have a small diameter.
- C.
Dynamic compression of the airways is more likely than in a normal subject.
- D.
Radial traction on the airways is increased.
- E.
Airway resistance is increased.
Correct Answer
D. Radial traction on the airways is increased. -
- 34.
The diffusing capacity for carbon monoxide in a patient with diffuse interstitial lung disease:
- A.
Is typically substantially increased.
- B.
Shows an abnormally large increase during exercise.
- C.
Is unaffected by thickening of the blood-gas barrier.
- D.
Is reduced in part because of obliteration of pulmonary capillaries.
- E.
Falls only late in the disease.
Correct Answer
D. Is reduced in part because of obliteration of pulmonary capillaries. -
- 35.
Features of pneumothorax include:
- A.
It reduces the volume of the chest wall on the affected side.
- B.
It causes an increased blood flow in the affected lung.
- C.
When present in the tension form it is a medical emergency.
- D.
Spontaneous pneumothorax is mainly seen in older women.
- E.
The FVC is increased
Correct Answer
C. When present in the tension form it is a medical emergency. -
- 36.
Increased movement of fluid from the lumen of pulmonary capillaries into the interstitium can be caused by:
- A.
Increased permeability of the alveolar epithelial cells.
- B.
Reduced capillary hydrostatic pressure.
- C.
Reduced colloid osmotic pressure of the blood.
- D.
Increased hydrostatic pressure in the interstitial space.
- E.
Reduced colloid osmotic pressure of the interstitial fluid.
Correct Answer
C. Reduced colloid osmotic pressure of the blood. -
- 37.
Concerning the blood-gas barrier in the normal lung:
- A.
Fluid can drain through the interstitium of the thick side of the blood-gas barrier.
- B.
The alveolar epithelium has a high permeability for water.
- C.
The strength of the barrier on the thin side is mainly attributable to the endothelial cells.
- D.
No protein normally crosses the capillary endothelium.
- E.
Water is actively transported into the alveolar spaces by alveolar epithelial cells.
Correct Answer
A. Fluid can drain through the interstitium of the thick side of the blood-gas barrier. -
- 38.
In the earliest stages of pulmonary edema all of the following are true except:
- A.
Fluid tracks through the interstitium of the thin side of the blood-gas barrier to the perivascular and peribronchial spaces.
- B.
There is no increase in lung lymph flow.
- C.
Fluid floods the alveoli one by one.
- D.
The hydrostatic pressure in the interstitium probably falls.
- E.
Cuffs of fluid collect around the small arteries and veins.
Correct Answer
E. Cuffs of fluid collect around the small arteries and veins. -
- 39.
Interstitial pulmonary edema (in the absence of alveolar edema) typically results in:
- A.
Septal lines on the chest radiograph.
- B.
Increased lung compliance.
- C.
Reduced lymph flow from the lungs.
- D.
Severe hypoxemia.
- E.
Fluffy shadowing on the chest radiograph.
Correct Answer
A. Septal lines on the chest radiograph. -
- 40.
When edema fluid is present in the airways and alveoli:
- A.
Carbon dioxide retention typically occurs.
- B.
The alveoli that contain fluid become overexpanded.
- C.
The fluid is free of red blood cells.
- D.
During positive pressure ventilation the fluid is moved peripherally.
- E.
No changes are seen on the chest radiograph.
Correct Answer
D. During positive pressure ventilation the fluid is moved peripherally. -
- 41.
Concerning high-altitude pulmonary edema:
- A.
The hypoxia directly increases capillary permeability.
- B.
Pulmonary venous pressure is increased.
- C.
The best treatment is to give diuretics.
- D.
Dyspnea is not a feature
- E.
It is related to the high pulmonary artery pressures caused by hypoxic vasoconstriction.
Correct Answer
E. It is related to the high pulmonary artery pressures caused by hypoxic vasoconstriction. -
- 42.
Concerning severe pulmonary edema with alveolar filling:
- A.
Lung compliance is increased.
- B.
Airway resistance is not affected.
- C.
The arterial hypoxemia cannot be abolished by breathing 100% oxygen.
- D.
Respiration is deep and labored.
- E.
The alveolar edema causes chest pain.
Correct Answer
C. The arterial hypoxemia cannot be abolished by breathing 100% oxygen. -
- 43.
The formation of venous thrombi is favored by:
- A.
Overtransfusion.
- B.
Walking.
- C.
Anemia.
- D.
Use of oral contraceptives.
- E.
Leg exercises.
Correct Answer
D. Use of oral contraceptives. -
- 44.
Moderately large pulmonary emboli often cause:
- A.
CO2 retention.
- B.
Increased physiologic dead space.
- C.
Pulmonary hypotension.
- D.
Decreased lung elastic recoil.
- E.
Reduced airway resistance.
Correct Answer
B. Increased physiologic dead space. -
- 45.
Cor pulmonale:
- A.
May complicate long-standing COPD.
- B.
Always causes a reduced cardiac output.
- C.
Does not occur in diffuse interstitial pulmonary fibrosis.
- D.
Cannot cause neck vein engorgement.
- E.
Cannot cause ankle edema.
Correct Answer
A. May complicate long-standing COPD. -
- 46.
Which of the following atmospheric pollutants is present in the highest concentration (by weight) in the United States?
- A.
Hydrocarbons.
- B.
Sulfur oxides.
- C.
Nitrogen oxides.
- D.
Carbon monoxide.
- E.
Ozone.
Correct Answer
D. Carbon monoxide. -
- 47.
Concerning smog:
- A.
Ozone is mainly produced in automobile engines.
- B.
A temperature inversion occurs when the air near the ground is hotter than the air above.
- C.
The main source of sulfur oxides is the automobile.
- D.
Nitrogen oxides can cause inflammation of the upper respiratory tract.
- E.
Scrubbing flue gases is ineffective in removing particulates
Correct Answer
D. Nitrogen oxides can cause inflammation of the upper respiratory tract. -
- 48.
Concerning cigarette smoke:
- A.
Inhaled smoke contains negligible amounts of carbon monoxide.
- B.
Cigarette smokers can have enough carboxyhemoglobin level in their blood to impair mental skills.
- C.
Nicotine is not addictive.
- D.
The risk of coronary heart disease is not affected by smoking.
- E.
The concentration of pollutants in cigarette smoke is less than in the air of a large city on a smoggy day.
Correct Answer
B. Cigarette smokers can have enough carboxyhemoglobin level in their blood to impair mental skills. -
- 49.
Concerning the deposition of aerosol in the lung:
- A.
Most particles less than 5 µm in diameter are filtered by the nose during resting breathing.
- B.
Many inhaled particles are deposited in the region of the terminal and respiratory bronchioles.
- C.
Astronauts who are weightless have the same particle deposition as when they are on earth.
- D.
Particles 0.5 µm wide diffuse almost as fast as gas molecules.
- E.
Many particles larger than 10 µm wide are not deposited in the lung but are exhaled with the next breath.
Correct Answer
B. Many inhaled particles are deposited in the region of the terminal and respiratory bronchioles. -
- 50.
In a coal miner, the deposition of coal dust in the lung will be reduced by:
- A.
Frequent coughing.
- B.
Exercise.
- C.
Mining operations that produce very small dust particles.
- D.
Rapid deep breathing.
- E.
Nose breathing, as opposed to mouth breathing.
Correct Answer
E. Nose breathing, as opposed to mouth breathing. -
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