Pulmonary Pathophysiology
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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.
- 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.
- 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.
- 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.
- 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.
- 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
- 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.
- 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.
- 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.
- 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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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