Pathophysiology: Chapter 36: Alterations of Pulmonary Function

Question 1

Besides dyspnea, what is the most common characteristic associated with pulmonary
disease?
a. Chest pain 
b. Digit clubbing
c. Cough 
d. Hemoptysis

Answer 1

ANS: C
Pulmonary disease is associated with many signs and symptoms, and their specific
characteristics often help in identifying the underlying disorder. The most common
characteristics are dyspnea and cough. Others include abnormal sputum, hemoptysis,
altered breathing patterns, hypoventilation and hyperventilation, cyanosis, clubbing of the
digits, and chest pain.

Question 2

Sitting up in a forward-leaning position generally relieves which breathing disorder?

a. Hyperpnea c. Apnea
b. Orthopnea d. Dyspnea on exertion

Answer 2

ANS: B
Of the options available, only orthopnea is generally relieved by sitting up in a
forward-leaning posture or supporting the upper body on several pillows.

Question 3

Kussmaul respirations as a respiratory pattern may be associated with which
characteristic(s)?
a. Alternating periods of deep and shallow breathing
b. Pulmonary fibrosis
c. Chronic obstructive pulmonary disease
d. Slightly increased ventilatory rate, large tidal volumes, and no expiratory pause

Answer 3

ANS: D
Kussmaul respirations are characterized by a slightly increased ventilatory rate, very large
tidal volume, and no expiratory pause. Kussmaul respirations are not associated with any
of the other options.

Question 4

Respirations that are characterized by alternating periods of deep and shallow breathing
are a result of which respiratory mechanism?
a. Decreased blood flow to the medulla oblongata
b. Increased partial pressure of arterial carbon dioxide (PaCO2), decreased pH, and
decreased partial pressure of arterial oxygen (PaO2)
c. Stimulation of stretch or J-receptors
d. Fatigue of the intercostal muscles and diaphragm

Answer 4

ANS: A
Alternating periods of deep and shallow breathing are characteristic of Cheyne-Stokes
respirations and are the result of any condition that slows the blood flow to the brainstem,
which in turn slows impulses that send information to the respiratory centers of the
brainstem. None of the remaining options are responsible for the described breathing
pattern.

Question 5

With a total hemoglobin of 9 g/dl, how many grams per deciliter of hemoglobin must
become desaturated for cyanosis to occur?
a. 3 c. 7
b. 5 d. 9

Answer 5

ANS: B
Cyanosis generally develops when 5 g/dl of hemoglobin is desaturated, regardless of
hemoglobin concentration.

Question 6

Which statement is true regarding ventilation?
a. Hypoventilation causes hypocapnia.
b. Hyperventilation causes hypercapnia.
c. Hyperventilation causes hypocapnia.
d. Hyperventilation results in an increased partial pressure of arterial carbon dioxide
(PaCO2).

Answer 6

ANS: C
Hyperventilation is alveolar ventilation that exceeds metabolic demands. The lungs
remove carbon dioxide at a faster rate than produced by cellular metabolism, resulting in
decreased PaCO2 or hypocapnia. None of the remaining options are accurate statements.

Question 7

What term is used to describe the selective bulbous enlargement of the distal segment of a
digit that is commonly associated with diseases that interfere with oxygenation of the
blood?
a. Edema c. Angling
b. Clubbing d. Osteoarthropathy

Answer 7

ANS: B
Clubbing is the selective bulbous enlargement of the end (distal segment) of a digit (finger
or toe) (see Figure 35-1) and is commonly associated with diseases that interfere with
oxygenation, such as bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, and
congenital heart disease. None of the remaining options are terms used to identify the
condition described.

Question 8

Pulmonary edema and pulmonary fibrosis cause hypoxemia by which mechanism?

a. Creating alveolar dead space
b. Decreasing the oxygen in inspired gas
c. Creating a right-to-left shunt
d. Impairing alveolocapillary membrane diffusion

Answer 8

ANS: D
Diffusion of oxygen through the alveolocapillary membrane is impaired if the
alveolocapillary membrane is thickened or if the surface area available for diffusion is
decreased. Abnormal thickness, as occurs with edema (tissue swelling) and fibrosis
(formation of fibrous lesions), increases the time required for diffusion across the
alveolocapillary membrane. None of the remaining options accurately describes the
mechanism that triggers hypoxemia as a result of pulmonary edema or pulmonary fibrosis.

Question 9

High altitudes may produce hypoxemia through which mechanism?

a. Shunting c. Decreased inspired oxygen
b. Hypoventilation d. Diffusion abnormalities

Answer 9

ANS: C
The presence of adequate oxygen content of the inspired air is the first factor. Oxygen
content is lessened at high altitudes. At high altitudes none of the remaining options would
be the cause of hypoxemia.

Question 10

Which condition is capable of producing alveolar dead space?

a. Pulmonary edema c. Atelectasis
b. Pulmonary emboli d. Pneumonia

Answer 10

ANS: B
A pulmonary embolus that impairs blood flow to a segment of the lung results in an area
where alveoli are ventilated but not perfused, which causes alveolar dead space. Alveolar
dead space is not the result of any of the remaining options.

Question 11

What is the most common cause of pulmonary edema?

a. Right-sided heart failure c. Mitral valve prolapse
b. Left-sided heart failure d. Aortic stenosis

Answer 11

ANS: B
The most common cause of pulmonary edema is heart disease. When the left ventricle
fails, filling pressures on the left side of the heart increase and cause a concomitant
increase in pulmonary capillary hydrostatic pressure. The remaining options are not
common triggers for pulmonary edema.

Question 12

Pulmonary edema usually begins to develop at a pulmonary capillary wedge pressure or
left atrial pressure of how many millimeters of mercury (mm Hg)?
a. 10 c. 30
b. 20 d. 40

Answer 12

ANS: B
Pulmonary edema usually begins to develop at a pulmonary capillary wedge pressure or
left atrial pressure of 20 mm Hg.

Question 13

The collapse of lung tissue caused by the lack of collateral ventilation through the pores of
Kohn is referred to as what type of atelectasis?
a. Compression c. Absorption
b. Perfusion d. Hypoventilation

Answer 13

ANS: C
Absorption atelectasis is a result of the gradual absorption of air from obstructed or
hypoventilated alveoli or from inhalation of concentrated oxygen or anesthetic agents. The
other forms of atelectasis are not a result of the described mechanism.

Question 14

In what form of bronchiectasis do both constrictions and dilations deform the bronchi?

a. Varicose c. Cylindric
b. Symmetric d. Saccular

Answer 14

ANS: A
Varicose bronchiectasis exists when both constrictions and dilations deform the bronchi.
None of the other options involve both constriction and dilation, resulting in bronchi
deformity.

Question 15

Which pleural abnormality involves a site of pleural rupture that acts as a one-way valve,
permitting air to enter on inspiration but preventing its escape by closing during
expiration?
a. Spontaneous pneumothorax c. Open pneumothorax
b. Tension pneumothorax d. Secondary pneumothorax

Answer 15

ANS: B
In tension pneumothorax, the site of pleural rupture acts as a one-way valve, permitting air
to enter on inspiration but preventing its escape by closing up during expiration. As more
and more air enters the pleural space, air pressure in the pneumothorax begins to exceed
barometric pressure. None of the other options result from the pathologic condition
described.

Question 16

In which type of pleural effusion does the fluid become watery and diffuse out of the
capillaries as a result of increased blood pressure or decreased capillary oncotic pressure?
a. Exudative c. Transudative
b. Purulent d. Large

Answer 16

ANS: C
In transudative pleural effusion, the fluid, or transudate, is watery and diffuses out of the
capillaries as a result of disorders that increase intravascular hydrostatic pressure or
decrease capillary oncotic pressure. The described mechanism is not associated with the
other forms of pleural effusion.

Question 17

Which condition involves an abnormally enlarged gas-exchange system and the
destruction of the lung’s alveolar walls?
a. Transudative effusion c. Exudative effusion
b. Emphysema d. Abscess

Answer 17

ANS: B
Emphysema is abnormal permanent enlargement of gas-exchange airways (acini)
accompanied by the destruction of alveolar walls without obvious fibrosis. The described
mechanism is not associated with the other options.

Question 18

Which term is used to identify a circumscribed area of suppuration and destruction of lung
parenchyma?
a. Consolidation c. Empyema
b. Cavitation d. Abscess

Answer 18

ANS: D
An abscess is a circumscribed area of suppuration and destruction of lung parenchyma.
The described pathologic abnormality is not associated with the other options.

Question 19

Which condition is not a cause of chest wall restriction?

a. Pneumothorax c. Gross obesity
b. Severe kyphoscoliosis d. Neuromuscular disease

Answer 19

ANS: A
Unlike the other options that result in chest wall restriction, a pneumothorax is the
presence of air or gas in the pleural space caused by a rupture in the visceral pleura (which
surrounds the lungs) or the parietal pleura and chest wall.

Question 20

What causes pneumoconiosis?

a. Pneumococci bacteria c. Exposure to asbestos
b. Inhalation of inorganic dust particles d. Inhalation of cigarette smoke

Answer 20

ANS: B
Pneumoconiosis represents any change in the lung caused by the inhalation of inorganic
dust particles, which usually occurs in the workplace. Pneumoconiosis is not a result of
any of the other options.

Question 21

Which condition is a fulminant form of respiratory failure characterized by acute lung
inflammation and diffuse alveolocapillary injury?
a. Acute respiratory distress syndrome (ARDS)
b. Pneumonia
c. Pulmonary emboli
d. Acute pulmonary edema

Answer 21

ANS: A
ARDS is a fulminant form of respiratory failure characterized by acute lung inflammation
and diffuse alveolocapillary injury. The described pathologic characteristics are not
associated with the other options.

Question 22

Which structure(s) in acute respiratory distress syndrome (ARDS) release inflammatory
mediators such as proteolytic enzymes, oxygen-free radicals, prostaglandins, leukotrienes,
and platelet-activating factor?
a. Complement cascade c. Macrophages
b. Mast cells d. Neutrophils

Answer 22

ANS: D
The role of neutrophils is central to the development of ARDS. Activated neutrophils
release a battery of inflammatory mediators, among them proteolytic enzymes,
oxygen-free radicals (superoxide radicals, hydrogen peroxide, hydroxyl radicals),
arachidonic acid metabolites (prostaglandins, thromboxanes, leukotrienes), and
platelet-activating factor. These mediators cause extensive damage to the alveolocapillary
membrane and greatly increase capillary membrane permeability. The described responses
are not associated with the other options.

Question 23

Pulmonary edema in acute respiratory distress syndrome (ARDS) is the result of an
increase in:
a. Levels of serum sodium and water c. Capillary hydrostatic pressure
b. Capillary permeability d. Oncotic pressure

Answer 23

ANS: B
Increased capillary permeability, a hallmark of ARDS, allows fluids, proteins, and blood
cells to leak from the capillary bed into the pulmonary interstitium and alveoli. The
resulting pulmonary edema and hemorrhage severely reduce lung compliance and impair
alveolar ventilation. The other options would not trigger ARDS-associated pulmonary
edema.

Question 24

In acute respiratory distress syndrome (ARDS), alveoli and respiratory bronchioles fill
with fluid as a result of which mechanism?
a. Compression on the pores of Kohn, thus preventing collateral ventilation
b. Increased capillary permeability, which causes alveoli and respiratory bronchioles
to fill with fluid
c. Inactivation of surfactant and the impairment of type II alveolar cells
d. Increased capillary hydrostatic pressure that forces fluid into the alveoli and
respiratory bronchioles

Answer 24

ANS: C
Lung inflammation and injury damage the alveolar epithelium and the vascular
endothelium. Surfactant is inactivated, and its production by type II alveolar cells is
impaired as alveoli and respiratory bronchioles fill with fluid or collapse. The other
options would not trigger the described response.

Question 25

Which type of pulmonary disease requires more force to expire a volume of air?

a. Restrictive c. Acute
b. Obstructive d. Communicable

Answer 25

ANS: B
Obstructive pulmonary disease is characterized by airway obstruction that is worse with
expiration. Either more force (i.e., the use of accessory muscles of expiration) or more
time is required to expire a given volume of air. The other options are not associated with
a need for an increase of force to expire air.

Question 26

Which immunoglobulin (Ig) may contribute to the pathophysiologic characteristics of
asthma?
a. IgA c. IgG
b. IgE d. IgM

Answer 26

ANS: B
Asthma is a familial disorder, and more than 100 genes have been identified that may play
a role in the susceptibility of and the pathogenetic mechanisms that cause asthma,
including those that influence the production of interleukin (IL)–4, IL-5, and IL-13; IgE;
eosinophils; mast cells; adrenergic receptors; and leukotrienes. The pathophysiologic
characteristics of asthma are not associated with the other immunoglobulins.

Question 27

Which statement about the late asthmatic response is true?
a. Norepinephrine causes bronchial smooth muscle contraction and mucus secretion.
b. The release of toxic neuropeptides contributes to increased bronchial
hyperresponsiveness.
c. The release of epinephrine causes bronchial smooth muscle contraction and
increases capillary permeability.
d. Immunoglobulin G initiates the complement cascade and causes smooth muscle
contraction and increased capillary permeability.

Answer 27

ANS: B
The late asthmatic response begins 4 to 8 hours after the early response when the release
of toxic neuropeptides contributes to increased bronchial hyperresponsiveness. This
selection is the only option associated with the late asthmatic response.

Question 28

Clinical manifestations of inspiratory and expiratory wheezing, dyspnea, nonproductive
cough, and tachypnea are indicative of which condition?
a. Chronic bronchitis c. Pneumonia
b. Emphysema d. Asthma

Answer 28

ANS: D
At the beginning of an attack, the individual experiences chest constriction, expiratory
wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, and
tachypnea. Severe attacks involve the use of accessory muscles of respiration, and
wheezing is heard during both inspiration and expiration. The presentations of none of the
other options are consistent with the described symptoms.

Question 29

The most successful treatment for chronic asthma begins with which action?

a. Avoidance of the causative agent
b. Administration of broad-spectrum antibiotics
c. Administration of drugs that reduce bronchospasm
d. Administration of drugs that decrease airway inflammation

Answer 29

ANS: A
Chronic management of asthma begins with the avoidance of allergens and other triggers.
The effectiveness of the other options is reliant on the avoidance of triggers.

Question 30

Which factor contributes to the production of mucus associated with chronic bronchitis?

a. Airway injury c. Increased Goblet cell size
b. Pulmonary infection d. Bronchospasms

Answer 30

ANS: C
Continual bronchial inflammation causes bronchial edema and increases the size and
number of mucous glands and goblet cells in the airway epithelium. Thick, tenacious
mucus is produced and cannot be cleared because of impaired ciliary function (see Figure
35-13). The lung’s defense mechanisms are therefore compromised, increasing a
susceptibility to pulmonary infection, which contributes to airway injury. Frequent
infectious exacerbations are complicated by bronchospasm with dyspnea and productive
cough.

Question 31

Clinical manifestations of decreased exercise tolerance, wheezing, shortness of breath, and
productive cough are indicative of which respiratory disorder?
a. Chronic bronchitis c. Pneumonia
b. Emphysema d. Asthma

Answer 31

ANS: A
The symptoms that lead individuals with chronic bronchitis to seek medical care include
decreased exercise tolerance, wheezing, and shortness of breath. Individuals usually have a
productive cough (“smoker’s cough”). The described symptoms are not associated with
any of the other options.

Question 32

Clinical manifestations that include unexplained weight loss, dyspnea on exertion, use of
accessory muscles, and tachypnea with prolonged expiration are indicative of which
respiratory disorder?
a. Chronic bronchitis c. Pneumonia
b. Emphysema d. Asthma

Answer 32

ANS: B
Individuals with emphysema usually have dyspnea on exertion that later progresses to
significant dyspnea, even at rest (see Table 35-3). Little coughing and very little sputum
are produced. The individual is often thin, has tachypnea with prolonged expiration, and
must use accessory muscles for ventilation. The anteroposterior diameter of the chest is
increased (barrel chest), and the chest has a hyperresonant sound with percussion. The
described symptoms are not associated with any of the other options.

Question 33

Which of the following is the most common route of lower respiratory tract infection?

a. Aspiration of oropharyngeal secretions
b. Inhalation of microorganisms
c. Microorganisms spread to the lung via blood
d. Poor mucous membrane protection

Answer 33

ANS: A
Aspiration of oropharyngeal secretions is the most common route of lower respiratory tract
infection; thus the nasopharynx and oropharynx constitute the first line of defense for most
infectious agents. The other options are not common routes of lower respiratory tract
infections.

Question 34

What is the initial step in the management of emphysema?

a. Inhaled anticholinergic agents c. Cessation of smoking
b. Beta agonists d. Surgical reduction of lung volume

Answer 34

ANS: C
Chronic management of emphysema begins with smoking cessation. Pharmacologic
management includes inhaled anticholinergic agents, and beta agonists should be
prescribed. Pulmonary rehabilitation, improved nutrition, and breathing techniques all can
improve symptoms. Oxygen therapy is indicated in chronic hypoxemia but must be
administered with care. In selected patients, lung volume reduction surgery or
transplantation can be considered.

Question 35

In tuberculosis, the body walls off the bacilli in a tubercle by stimulating which action?

a. Macrophages that release tumor necrosis factor–alpha (TNF-)
b. Phagocytosis by neutrophils and eosinophils
c. Formation of immunoglobulin G to initiate the complement cascade
d. Apoptotic infected macrophages that activate cytotoxic T cells

Answer 35

ANS: D
In defense, macrophages and lymphocytes release interferon, which inhibits the replication
of the microorganism and stimulates more macrophages to attack the bacterium. Apoptotic
infected macrophages can also activate cytotoxic T cells (cluster of differentiation [CD] 8).
Tuberculosis does not trigger the mechanisms described by the other options.

Question 36

The progression of chronic bronchitis is best halted by which intervention?

a. Regular use of bronchodilators
b. Smoking cessation
c. Postural chest drainage techniques
d. Identification of early signs of infection

Answer 36

ANS: B
By the time an individual seeks medical care for symptoms, considerable airway damage
is present. If the individual stops smoking, then disease progression can be halted. If
smoking is stopped before symptoms occur, then the risk of chronic bronchitis decreases
considerably and eventually reaches that of nonsmokers. The other interventions, although
appropriate, are not directed toward halting the progression of the disease process.

Question 37

Clinical manifestations of inspiratory crackles, increased tactile fremitus, egophony, and
whispered pectoriloquy are indicative of which respiratory condition?
a. Chronic bronchitis c. Pneumonia
b. Emphysema d. Asthma

Answer 37

ANS: C
Physical examination may reveal signs of pulmonary consolidation, such as inspiratory
crackles, increased tactile fremitus, egophony, and whispered pectoriloquy, which support
a diagnosis of pneumonia. The presentations of the other options are not consistent with
the described symptoms.

Question 38

Pulmonary artery hypertension (PAH) results from which alteration?

a. Narrowed pulmonary capillaries c. Destruction of alveoli
b. Narrowed bronchi and bronchioles d. Ischemia of the myocardium

Answer 38

ANS: A
PAH is characterized by endothelial dysfunction with an overproduction of
vasoconstrictors (e.g., thromboxane, endothelin) and decreased production of vasodilators
(e.g., nitric oxide, prostacyclin), resulting in narrowed pulmonary capillaries. None of the
remaining options result in pulmonary hypertension.

Question 39

Squamous cell carcinoma of the lung is best described as a tumor that causes which
alterations?
a. Abscesses and ectopic hormone production
b. Airway obstruction and atelectasis
c. Pleural effusion and shortness of breath
d. Chest wall pain and early metastasis

Answer 39

ANS: B
Typically, the tumors are centrally located near the hila and project into bronchi. Because
of this central location, nonproductive cough or hemoptysis is common. Pneumonia and
atelectasis are often associated with squamous cell carcinoma. Chest pain is a late
symptom associated with large tumors. These tumors can remain fairly well localized and
tend not to metastasize until late in the course of the disease. Squamous cell carcinomas
are not associated with any of the other options.

Question 40

What medical term is used to identify the accumulation of air in the pleural space?

a. Flail chest c. Pleural effusion
b. Pneumothorax d. Exudate effusion

Answer 40

ANS: B
Pneumothorax is the presence of air or gas in the pleural space caused by a rupture in the
visceral pleura (which surrounds the lungs) or the parietal pleura and chest wall. The
condition is not identified by any of the other options.

Question 41

What medical term is used to identify the presence of pus in the pleural space?

a. Plural effusion c. Empyema
b. Asthma d. Pneumonia

Answer 41

ANS: C
Empyema is the presence of pus in the pleural space. This condition is not identified by
any of the other options.

Question 42

Fluid in the pleural space characterizes which condition?

a. Pleural effusion c. Bronchiectasis
b. Atelectasis d. Ischemia

Answer 42

ANS: A
Pleural effusion is the presence of fluid in the pleural space. This condition is not
identified by any of the other options.

Question 43

Which statement is true regarding hypoxemia?

a. Hypoxemia results in the increased oxygenation of arterial blood.
b. Respiratory alterations cause hypoxemia.
c. Hypoxemia results in the decreased oxygenation of tissue cells.
d. Various system changes cause hypoxemia.

Answer 43

ANS: B
Hypoxemia, or reduced oxygenation of arterial blood (PaO2), is caused by respiratory
alterations, whereas hypoxia, or reduced oxygenation of cells in tissues, may be caused by
alterations of other systems as well.

Question 44

Which medication classification is generally included in the treatment of silicosis?

a. Corticosteroids c. Bronchodilators
b. Antibiotics d. Expectorants

Answer 44

ANS: A
No specific treatment exists for silicosis, although corticosteroids may produce some
improvement in the early, more acute stages. The other options are not generally
prescribed.

Question 45

What medical term is used for a condition that results from pulmonary hypertension,
creating chronic pressure overload in the right ventricle?
a. Hypoxemia c. Bronchiectasis
b. Hypoxia d. Cor pulmonale

Answer 45

ANS: D
Cor pulmonale develops as pulmonary hypertension and creates chronic pressure overload
in the right ventricle similar to that created in the left ventricle by systemic hypertension.
None of the other options identify the condition.