Respiratory Physiology Flashcards

1
Q
  1. Which of the following lung volumes or capacities can be measured by spirometry?

(a) Functional residual capacity (FRC)
(b) Physiologic dead space
(c) Residual volume (RV)
(d) Total lung capacity (TLC)
(e) Vital capacity (Vc)

A

The answer is E [I A 4, 5, B 2, 3, 5].

Residual volume (RV) cannot be measured by spirometry. Therefore, any lung volume or capacity that includes the RV cannot be measured by spirometry. Measurements that include RV are functional residual capacity (FRC) and total lung capacity (TLC). Vital capacity (Vc) does not include RV and is, therefore, measurable by spirometry. Physiologic dead space is not measurable by spirometry and requires sampling of arterial Pco2 and expired CO2.

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2
Q

An infant born prematurely in gestational week 25 has neonatal respiratory distress syndrome. Which of the following would be expected in this infant?

(a) Arterial Po2 of 100 mm Hg
(b) Collapse of the small alveoli
(c) Increased lung compliance
(d) Normal breathing rate
(e) Lecithin:sphingomyelin ratio of greater than 2:1 in amniotic fluid

A

The answer is B [II D 2].

Neonatal respiratory distress syndrome is caused by lack of adequate surfactant in the immature lung. Surfactant appears between the 24th and the 35th gestational week. In the absence of surfactant, the surface tension of the small alveoli is too high. When the pressure on the small alveoli is too high (P = 2T/r), the small alveoli collapse into larger alveoli. There is decreased gas exchange with the larger, collapsed alveoli, and ventilation/perfusion (V/Q) mismatch, hypoxemia, and cyanosis occur. The lack of surfactant also decreases lung compliance, making it harder to inflate the lungs, increasing the work of breathing, and producing dyspnea (shortness of breath). Generally, lecithin:sphingomyelin ratios greater than 2:1 signify mature levels of surfactant.

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3
Q

In which vascular bed does hypoxia cause vasoconstriction?

(a) Coronary
(b) Pulmonary
(c) Cerebral
(d) Muscle
(e) Skin

A

The answer is B [VI C].

Pulmonary blood flow is controlled locally by the Po2 of alveolar air. Hypoxia causes pulmonary vasoconstriction and thereby shunts blood away from unventilated areas of the lung, where it would be wasted. In the coronary circulation, hypoxemia causes vasodilation. The cerebral, muscle, and skin circulations are not controlled directly by Po2.

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4
Q

A 12-year-old boy has a severe asthmatic attack with wheezing. He experiences rapid breathing and becomes cyanotic. His arterial Po2 is 60 mm Hg and his Pco2 is 30 mm Hg.

Which of the following statements about this patient is most likely to be true?

(a) Forced expiratory volume1/forced vital capacity (FEV1/FVC) is increased
(b) Ventilation/perfusion (V/Q) ratio is increased in the affected areas of his lungs
(c) His arterial Pco2 is higher than normal because of inadequate gas exchange
(d) His arterial Pco2 is lower than normal because hypoxemia is causing him to hyperventilate
(e) His residual volume (RV) is decreased

A

The answer is D [VIII B 2 a].

The patient’s arterial Pco2 is lower than the normal value of 40 mm Hg because hypoxemia has stimulated peripheral chemoreceptors to increase his breathing rate; hyperventilation causes the patient to blow off extra CO2 and results in respiratory alkalosis. In an obstructive disease, such as asthma, both forced expiratory volume (FEV1) and forced vital capacity (FVC) are decreased, with the larger decrease occurring in FEV1. Therefore, the FEV1/FVC ratio is decreased. Poor ventilation of the affected areas decreases the ventilation/perfusion (V/Q) ratio and causes hypoxemia. The patient’s residual volume (RV) is increased because he is breathing at a higher lung volume to offset the increased resistance of his airways.

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5
Q

A 12-year-old boy has a severe asthmatic attack with wheezing. He experiences rapid breathing and becomes cyanotic. His arterial Po2 is 60 mm Hg and his Pco2 is 30 mm Hg.

To treat this patient, the physician should administer

(a) an α1-adrenergic antagonist
(b) a β1-adrenergic antagonist
(c) a β2-adrenergic agonist
(d) a muscarinic agonist
(e) a nicotinic agonist

A

The answer is C [II E 3 a (2)].

A cause of airway obstruction in asthma is bronchiolar constriction. β2-adrenergic stimulation (β2-adrenergic agonists) produces relaxation of the bronchioles.

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6
Q

Which of the following is true during inspiration?

(a) Intrapleural pressure is positive
(b) The volume in the lungs is less than the functional residual capacity (FRC)
(c) Alveolar pressure equals atmospheric pressure (d) Alveolar pressure is higher than atmospheric pressure
(e) Intrapleural pressure is more negative than it is during expiration

A

The answer is E [II F 2].

During inspiration, intrapleural pressure becomes more negative than it is at rest or during expiration (when it returns to its less negative resting value). During inspiration, air flows into the lungs when alveolar pressure becomes lower (due to contraction of the diaphragm) than atmospheric pressure; if alveolar pressure were not lower than atmospheric pressure, air would not flow inward. The volume in the lungs during inspiration is the functional residual capacity (FRC) plus one tidal volume (Vt).

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7
Q

Which volume remains in the lungs after a tidal volume (Vt) is expired?

(a) Tidal volume (Vt)
(b) Vital capacity (Vc)
(c) Expiratory reserve volume (ERV)
(d) Residual volume (RV)
(e) Functional residual capacity (FRC)
(f) Inspiratory capacity
(g) Total lung capacity

A

The answer is E [I B 2].

During normal breathing, the volume inspired and then expired is a tidal volume (Vt). The volume remaining in the lungs after expiration of a Vt is the functional residual capacity (FRC).

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8
Q

A 35-year-old man has a vital capacity (Vc) of 5 L, a tidal volume (Vt) of 0.5 L, an inspiratory capacity of 3.5 L, and a functional residual capacity (FRC) of 2.5 L. What is his expiratory reserve volume (ERV)?

(a) 4.5 L
(b) 3.9 L
(c) 3.6 L
(d) 3.0 L
(e) 2.5 L
(f) 2.0 L
(g) 1.5 L

A

The answer is G [I A 3; Figure 4.1].

Expiratory reserve volume (ERV) equals vital capacity (Vc) minus inspiratory capacity [Inspiratory capacity includes tidal volume (Vt) and inspiratory reserve volume (IRV)].

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9
Q

When a person is standing, blood flow in the lungs is

(a) equal at the apex and the base
(b) highest at the apex owing to the effects of gravity on arterial pressure
(c) highest at the base because that is where the difference between arterial and venous pressure is greatest
(d) lowest at the base because that is where alveolar pressure is greater than arterial pressure

A

The answer is C [VI B].

The distribution of blood flow in the lungs is affected by gravitational effects on arterial hydrostatic pressure. Thus, blood flow is highest at the base, where arterial hydrostatic pressure is greatest and the difference between arterial and venous pressure is also greatest. This pressure difference drives the blood flow.

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10
Q

Which of the following is the site of highest airway resistance?

(a) Trachea
(b) Largest bronchi
(c) Medium-sized bronchi
(d) Smallest bronchi
(e) Alveoli

A

The answer is C [II E 4].

The medium-sized bronchi actually constitute the site of highest resistance along the bronchial tree. Although the small radii of the alveoli might predict that they would have the highest resistance, they do not because of their parallel arrangement. In fact, early changes in resistance in the small airways may be “silent” and go undetected because of their small overall contribution to resistance.

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11
Q

A 49-year-old man has a pulmonary embolism that completely blocks blood flow to his left lung. As a result, which of the following will occur?

(a) Ventilation/perfusion (V/Q) ratio in the left lung will be zero
(b) Systemic arterial Po2 will be elevated
(c) V/Q ratio in the left lung will be lower than in the right lung
(d) Alveolar Po2 in the left lung will be approximately equal to the Po2 in inspired air
(e) Alveolar Po2 in the right lung will be approximately equal to the Po2 in venous blood

A

The answer is D [VII B 2].

Alveolar Po2 in the left lung will equal the Po2 in inspired air. Because there is no blood flow to the left lung, there can be no gas exchange between the alveolar air and the pulmonary capillary blood. Consequently, O2 is not added to the capillary blood. The ventilation/perfusion (V/Q) ratio in the left lung will be infinite (not zero or lower than that in the normal right lung) because Q (the denominator) is zero. Systemic arterial Po2 will, of course, be decreased because the left lung has no gas exchange. Alveolar Po2 in the right lung is unaffected.

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12
Q

Which volume remains in the lungs after a maximal expiration?

(a) Tidal volume (Vt)
(b) Vital capacity (Vc)
(c) Expiratory reserve volume (ERV)
(d) Residual volume (RV)
(e) Functional residual capacity (FRC)
(F) Inspiratory capacity
(g) Total lung capacity

A

The answer is D [I A 3].

During a forced maximal expiration, the volume expired is a tidal volume (Vt) plus the expiratory reserve volume (ERV). The volume remaining in the lungs is the residual volume (RV).

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13
Q

Compared with the systemic circulation, the pulmonary circulation has a

(a) higher blood flow
(b) lower resistance
(c) higher arterial pressure
(d) higher capillary pressure
(e) higher cardiac output

A

The answer is B [VI A].

Blood flow (or cardiac output) in the systemic and pulmonary circulations is nearly equal; pulmonary flow is slightly less than systemic flow because about 2% of the systemic cardiac output bypasses the lungs. The pulmonary circulation is characterized by both lower pressure and lower resistance than the systemic circulation, so flows through the two circulations are approximately equal (flow = pressure/resistance).

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14
Q

A healthy 65-year-old man with a tidal volume (Vt) of 0.45 L has a breathing frequency of 16 breaths/min. His arterial Pco2 is 41 mm Hg, and the Pco2 of his expired air is 35 mm Hg. What is his alveolar ventilation?

(a) 0.066 L/min
(b) 0.38 L/min
(c) 5.0 L/min
(d) 6.14 L/min
(e) 8.25 L/min

A

The answer is D [I A 5 b, 6 b].

Alveolar ventilation is the difference between tidal volume (Vt) and dead space multiplied by breathing frequency. Vt and breathing frequency are given, but dead space must be calculated. Dead space is Vt multiplied by the difference between arterial Pco2 and expired Pco2 divided by arterial Pco2. Thus: dead space = 0.45 × (41 - 35/41) = 0.066 L. Alveolar ventilation is then calculated as: (0.45 L - 0.066 L) × 16 breaths/min = 6.14 L/min.

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15
Q

Compared with the apex of the lung, the base of the lung has

(a) a higher pulmonary capillary Po2
(b) a higher pulmonary capillary Pco2
(c) a higher ventilation/perfusion (V/Q) ratio
(d) the same V/Q ratio

A

The answer is B [VII C; Figure 4.10; Table 4.5].

Ventilation and perfusion of the lung are not distributed uniformly. Both are lowest at the apex and highest at the base. However, the differences for ventilation are not as great as for perfusion, making the ventilation/ perfusion (V/Q) ratios higher at the apex and lower at the base. As a result, gas exchange is more efficient at the apex and less efficient at the base. Therefore, blood leaving the apex will have a higher Po2 and a lower Pco2.

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16
Q

Hypoxemia produces hyperventilation by a direct effect on the

(a) phrenic nerve
(b) J receptors
(c) lung stretch receptors
(d) medullary chemoreceptors
(e) carotid and aortic body chemoreceptors

A

The answer is E [VIII B 2].

Hypoxemia stimulates breathing by a direct effect on the peripheral chemoreceptors in the carotid and aortic bodies. Central (medullary) chemoreceptors are stimulated by CO2 (or H+). The J receptors and lung stretch receptors are not chemoreceptors. The phrenic nerve innervates the diaphragm, and its activity is determined by the output of the brain stem breathing center.

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17
Q

Which of the following changes occurs during strenuous exercise?

(a) Ventilation rate and O2 consumption increase to the same extent
(b) Systemic arterial Po2 decreases to about 70 mm Hg
(c) Systemic arterial Pco2 increases to about 60 mm Hg
(d) Systemic venous Pco2 decreases to about 20 mm Hg
(e) Pulmonary blood flow decreases at the expense of systemic blood flow

A

The answer is A [IX A].

During exercise, the ventilation rate increases to match the increased O2 consumption and CO2 production. This matching is accomplished without a change in mean arterial Po2 or Pco2. Venous Pco2 increases because extra CO2 is being produced by the exercising muscle. Because this CO2 will be blown off by the hyperventilating lungs, it does not increase the arterial Pco2. Pulmonary blood flow (cardiac output) increases manifold during strenuous exercise.

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18
Q

If an area of the lung is not ventilated because of bronchial obstruction, the pulmonary capillary blood serving that area will have a Po2 that is

(a) equal to atmospheric Po2
(b) equal to mixed venous Po2
(c) equal to normal systemic arterial Po2
(d) higher than inspired Po2
(e) lower than mixed venous Po2

A

The answer is B [VII B 1].

If an area of lung is not ventilated, there can be no gas exchange in that region. The pulmonary capillary blood serving that region will not equilibrate with alveolar Po2 but will have a Po2 equal to that of mixed venous blood.

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19
Q

In the transport of CO2 from the tissues to the lungs, which of the following occurs in venous blood?

(a) Conversion of CO2 and H2O to H+ and HCO3 - in the red blood cells (RBCs)
(b) Buffering of H+ by oxyhemoglobin
(c) Shifting of HCO3 - into the RBCs from plasma in exchange for Cl-
(d) Binding of HCO3 - to hemoglobin
(e) Alkalinization of the RBCs

A

The answer is A [V B; Figure 4.9].

CO2 generated in the tissues is hydrated to form H+ and HCO3 - in red blood cells (RBCs). H+ is buffered inside the RBCs by deoxyhemoglobin, which acidifies the RBCs. HCO3 - leaves the RBCs in exchange for Cl- and is carried to the lungs in the plasma. A small amount of CO2 (not HCO3 -) binds directly to hemoglobin (carbaminohemoglobin).

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20
Q

Which of the following causes of hypoxia is characterized by a decreased arterial Po2 and an increased A–a gradient?

(a) Hypoventilation
(b) Right-to-left cardiac shunt
(c) Anemia
(d) Carbon monoxide poisoning
(e) Ascent to high altitude

A

The answer is B [IV A 4; IV D; Table 4.4; Table 4.5].

Hypoxia is defined as decreased O2 delivery to the tissues. It occurs as a result of decreased blood flow or decreased O2 content of the blood. Decreased O2 content of the blood is caused by decreased hemoglobin concentration (anemia), decreased O2-binding capacity of hemoglobin (carbon monoxide poisoning), or decreased arterial Po2 (hypoxemia). Hypoventilation, right-to-left cardiac shunt, and ascent to high altitude all cause hypoxia by decreasing arterial Po2. Of these, only right-to-left cardiac shunt is associated with an increased A–a gradient, reflecting a lack of O2 equilibration between alveolar gas and systemic arterial blood. In right-to-left shunt, a portion of the right heart output, or pulmonary blood flow, is not oxygenated in the lungs and thereby “dilutes” the Po2 of the normally oxygenated blood. With hypoventilation and ascent to high altitude, both alveolar and arterial Po2 are decreased, but the A–a gradient is normal.

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21
Q

A 42-year-old woman with severe pulmonary fibrosis is evaluated by her physician and has the following arterial blood gases: pH = 7.48, PaO2 = 55 mm Hg, and PaCO2 = 32 mm Hg. Which statement best explains the observed value of PaCO2 ?

(a) The increased pH stimulates breathing via peripheral chemoreceptors
(b) The increased pH stimulates breathing via central chemoreceptors
(c) The decreased PaO2 inhibits breathing via peripheral chemoreceptors
(d) The decreased PaO2 stimulates breathing via peripheral chemoreceptors
(e) The decreased PaO2 stimulates breathing via central chemoreceptors

A

The answer is D [VIII B; Table 4.7].

The patient’s arterial blood gases show increased pH, decreased PaO2, and decreased PaCO2. The decreased PaO2 causes hyperventilation (stimulates breathing) via the peripheral chemoreceptors, but not via the central chemoreceptors. The decreased PaCO2 results from hyperventilation (increased breathing) and causes increased pH, which inhibits breathing via the peripheral and central chemoreceptors.

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22
Q

A 38-year-old woman moves with her family from New York City (sea level) to Leadville Colorado (10,200 feet above sea level). Which of the following will occur as a result of residing at high altitude?

(a) Hypoventilation
(b) Arterial Po2 greater than 100 mm Hg
(c) Decreased 2,3-diphosphoglycerate (DPG) concentration
(d) Shift to the right of the hemoglobin–O2 dissociation curve
(e) Pulmonary vasodilation
(f) Hypertrophy of the left ventricle
(g) Respiratory acidosis

A

The answer is D [IX B; Table 4.9].

At high altitudes, the Po2 of alveolar air is decreased because barometric pressure is decreased. As a result, arterial Po2 is decreased (

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23
Q

The pH of venous blood is only slightly more acidic than the pH of arterial blood because

(a) CO2 is a weak base
(b) there is no carbonic anhydrase in venous blood
(c) the H+ generated from CO2 and H2O is buffered by HCO3 – in venous blood
(d) the H+ generated from CO2 and H2O is buffered by deoxyhemoglobin in venous blood
(e) oxyhemoglobin is a better buffer for H+

than is deoxyhemoglobin

A

The answer is D [V B].

In venous blood, CO2 combines with H2O and produces the weak acid H2CO3, catalyzed by carbonic anhydrase. The resulting H+ is buffered by deoxyhemoglobin, which is such an effective buffer for H+ (meaning that the pK is within 1.0 unit of the pH of blood) that the pH of venous blood is only slightly more acid than the pH of arterial blood. Oxyhemoglobin is a less effective buffer than is deoxyhemoglobin.

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24
Q

In a maximal expiration, the total volume expired is

(a) tidal volume (Vt)
(b) vital capacity (Vc)
(c) expiratory reserve volume (ERV)
(d) residual volume (RV)
(e) functional residual capacity (FRC)
(f) inspiratory capacity
(g) total lung capacity

A

The answer is B [I B 3].

The volume expired in a forced maximal expiration is forced vital capacity, or vital capacity (Vc).

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25
Q

A person with a ventilation/perfusion (V/Q) defect has hypoxemia and is treated with supplemental O2. The supplemental O2 will be most helpful if the person’s predominant V/Q defect is

(a) dead space
(b) shunt
(c) high V/Q
(d) low V/Q
(e) V/Q = 0
(f) V/Q = ∞

A

The answer is D [VII].

Supplemental O2 (breathing inspired air with a high Po2) is most helpful in treating hypoxemia associated with a ventilation/perfusion (V/Q) defect if the predominant defect is low V/Q. Regions of low V/Q have the highest blood flow. Thus, breathing high Po2 air will raise the Po2 of a large volume of blood and have the greatest influence on the total blood flow leaving the lungs (which becomes systemic arterial blood). Dead space (i.e., V/Q = ∞) has no blood flow, so supplemental O2 has no effect on these regions. Shunt (i.e., V/Q = 0) has no ventilation, so supplemental O2 has no effect. Regions of high V/Q have little blood flow, thus raising the Po2 of a small volume of blood will have little overall effect on systemic arterial blood.

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26
Q

Which person would be expected to have the largest A–a gradient?

(a) Person with pulmonary fibrosis
(b) Person who is hypoventilating due to morphine overdose
(c) Person at 12,000 feet above sea level
(d) Person with normal lungs breathing 50% O2
(e) Person with normal lungs breathing 100% O2

A

The answer is A [IV D].

Increased A–a gradient signifies lack of O2 equilibration between alveolar gas (A) and systemic arterial blood (a). In pulmonary fibrosis, there is thickening of the alveolar/pulmonary capillary barrier and increased diffusion distance for O2, which results in lack of equilibration of O2, hypoxemia, and increased A–a gradient. Hypoventilation and ascent to 12,000 feet also cause hypoxemia, because systemic arterial blood is equilibrated with a lower alveolar Po2 (normal A–a gradient). Persons breathing 50% or 100% O2 will have elevated alveolar Po2, and their arterial Po2 will equilibrate with this higher value (normal A–a gradient).

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27
Q

Which of the following sets of data would have the highest rate of O2 transfer between alveolar gas and pulmonary capillary blood?

(a) PIO2 (mmHg) 150 PVO2 (mmHg) 40 Surface Area (Relative) 1 Thickness (Relative) 1
(b) PIO2 (mmHg) 150 PVO2 (mmHg) 40 Surface Area (Relative) 2 Thickness (Relative) 2
(c) PIO2 (mmHg) 300 PVO2 (mmHg) 40 Surface Area (Relative) 1 Thickness (Relative) 2
(d) PIO2 (mmHg) 150 PVO2 (mmHg) 80 Surface Area (Relative) 1 Thickness (Relative) 1
(e) PIO2 (mmHg) 190 PVO2 (mmHg) 80 Surface Area (Relative) 2 Thickness (Relative) 2

A

The answer is C [III D).

The diffusion of O2 from alveolar gas to pulmonary capillary blood is proportional to the partial pressure difference for O2 between inspired air and mixed venous blood entering the pulmonary capillaries, proportional to the surface area for diffusion, and inversely proportional to diffusion distance, or thickness of the barrier.

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28
Q

A patient has a dead space of 150 ml, functional residual capacity of 3 L, tidal volume of 650 ml, expiratory reserve volume of 1.5 L, a total lung capacity of 8 L, respiratory rate of 15 breaths/min. What is the alveolar ventilation?

A) 5 L/min
B) 7.5 L/min
C) 6.0 L/min
D) 9.0 L/min

A

Alveolar ventilation = Respiratory rate (Tidal volume- Dead space)
= 15(650-150)

B) 7.5 L/min

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29
Q

A person with normal lungs at sea level (760 mm Hg) is breathing 50% oxygen. What is the approximate alveolar Po2?

A

PAo2 = PiO2 - (Pco2/R)
PiO2 = FiO2 (Patm – 47)

PAo2 = PiO2 - (Pco2/R) = 0.5(760 – 47) – 40/0.8 = 356.5 - 50
= 306.5 mm Hg

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30
Q

Which of the following elicits a left shift in the oxygen-Hb dissociation curve?

A. Increased acidity
B. Increase temperature
C. High PCO2
D. Carbon monoxide

A

D. Carbon monoxide

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31
Q

A 34-year-old male sustains a bullet wound to the chest that causes a pneumothorax. Which of the following best describes the changes in lung volume and thoracic volume in this man, compared to normal?
Lung volume Thoracic Volume
A) decreased decreased
B) decreased increased
C) decreased no change
D) increased decreased
E) increased increaseed
F) no change decreased

A

B) Lung volume: decreased
Thoracic volume: increased

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32
Q

A liquid-ventilated lung compared to a gas- ventilated lung
A) has a reduced airway resistance
B) has increased residual volume
C) has a more pronounced hysteresis
D) is more compliant
E) requires greater pressure to inflate

A

D) is more compliant

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33
Q

In which of the following conditions is alveolar Po2 increased and alveolar Pco2 decreased?
A) Increased alveolar ventilation and unchanged metabolism
B) Decreased alveolar ventilation and unchanged metabolism
C) Increased metabolism and unchanged alveolar ventilation
D) Proportional increase in metabolism and alveolar ventilation

A

A) Increased alveolar ventilation and unchanged metabolism

34
Q

The diffusing capacity of a gas is the volume of gas that will diffuse through a membrane each minute for a pressure difference of 1 mm Hg. Which of the following gases is often used to estimate the oxygen diffusing capacity of the lungs?

A) Carbon dioxide
B) Carbon monoxide
C) Cyanide gas
D) Nitrogen
E) Oxygen

A

B) Carbon monoxide

35
Q

At the end of inhalation, with an open glottis, the pleural pressure is
A) greater than atmospheric pressure
B) equal to atmospheric pressure
C) less than alveolar pressure
D) equal to alveolar pressure
E) greater than alveolar pressure

A

C) less than alveolar pressure

36
Q

A person’s normal tidal volume is 400 ml with a dead space of 100 ml. The respiratory rate is 12 breaths/min. The person is placed on ventilator for surgery and the tidal volume is 700 with a rate of 12. What is the approximate alveolar Pco2 for this person?
A) 5
B) 20
C) 40
D) 50

A

B) 20
Normal alveolar Pco2 is 40 mm Hg. Normal alveolar ventilation for this person is 3.6 L/min. On the ventilator the alveolar ventilation is 7.2 L/min. A doubling of alveolar ventilation results in a decrease in alveolar Pco2 by one- half. Thus alveolar Pco2 would be 20.

37
Q

Which of the following is normally associated with a restrictive pulmonary disease?
A. Increased FRC
B. Increased FEV1
C. Reduced DLCO
D. Reduced lung elastance

A

C. Reduced DLCO

38
Q

The respiratory passageways have smooth muscle in their walls. Which of the following best describes the effect of acetylcholine and epinephrine on the respiratory passage ways?
acetylcholine epinephrine
A) constrict constrict
B) constrict dilate
C) constrict no effect
D) dilate constrict
E) dilate dilate
F) dilate no effect
G) no effect constrict
H) no effect dilate

A

B) acetylcholine : constrict
epinephrine : dilate

39
Q

A healthy, 45-year-old man is reading the newspaper.
Which of the following muscles are used for quiet
breathing?
A) Diaphragm and external intercostals
B) Diaphragm and internal intercostals
C) Diaphragm only
D) Internal intercostals and abdominal recti
E) Scaleni
F) Sternocleidomastoid muscles

A

C) diaphragm only

40
Q

A man inspires 1000 ml from a spirometer. The intrapleural pressure was -4 cm H2O before inspiration and - 12 cm H2O the end of inspiration. What is the compliance of the lungs?
A) 50 ml/cm H20
B) 100 ml/cm H2O
C) 125 ml/cm H2O
D) 150 ml/cm H20
E) 250 ml/cm H2O

A

Compliance = V/P
C) 125 ml/cm H2O

41
Q

The diagram above shows three different compliance curves (S, T, and U) for isolated lungs subjected to various transpulmonary pressures. Which of the following best describe the relative compliances for the three curves?

A

S > T >U

42
Q

A patient has a dead space of 150 ml, functional
residual capacity of 3 L, tidal volume of 650 ml, expiratory reserve volume of 1.5 L, a total lung capacity of 8L, respiratory rate of 15 breaths/min. What is the alveolar ventilation?
A) 5 L/min
B) 7.5 L/min
C) 6.0 L/min
D) 9.0 L/min

A

Alveolar Ventilation = Breathing Rate (VT – VD)
B) 7.5 L/min

43
Q

A child has been eating round candies approximately 1 and 1.5 cm in diameter and inhaled one down his air-way blocking his left bronchiole. Which of the following will describe the changes that occur?

A

Answer = E

44
Q

Which diagram best describes the relationship between alveolar ventilation (VA) and arterial carbon dioxide tension (Pc0,) when the Pco, is changed acutely over a range of 35 to 75 mmHg?

A
45
Q

Which of the following oxygen-hemoglobin dissociation curves corresponds to normal blood (red line) and blood containing carbon monoxide (green line)?

A
46
Q

The forces governing the diffusion of a gas through a biological membrane include the pressure difference across the membrane (AP), the cross-sectional area of the membrane (A), the solubility of the gas (S), the distance of diffusion (d), and the molecular weight of the gas (MW). Which of the following changes increases the diffusion of a gas through a biological membrane?

A
47
Q

A patient has a dead space of 150 ml, functional residual capacity of 3 L, tidal volume of 650 ml, expiratory reserve volume of 1.5 L, total lung capacity of 8 L, and respiratory rate of 15 breaths/min. What is the residual volume?
A) 500 ml
B) 1000 ml
C) 1500 ml
D) 2500 ml
E) 6500 ml

A

RV = FRC−ERV, or RV = TLC−IVC.
C) 1500ml

48
Q

By the time inspired air reaches the respiratory exchange surfaces, the partial pressure of water (water vapor pressure) in this gas mixture is __________. Assume normal body temperature (37 °C).
(A) 10 mm Hg
(B) 37 mm Hg
(C) 47 mm Hg
(D) 100 mm Hg
(E) 760 mm Hg

A

(C) 47 mm Hg

49
Q

Which of the following is (are) responsible for the release of surfactant molecules into the air-filled lumen of the alveoli?
(A) Type I alveolar cell
(B) Type II alveolar cell
(C) Lung macrophages
(D) A and B only
(E) A, B, and C

A

(B) Type II alveolar cell

50
Q

In the lungs, which one of the following is NOT a barrier to gas exchange between red blood cells and the alveolar space?
(A) A fluid layer of water and surfactants covering the luminal surface of alveolar cells
(B) Basement membranes of endothelial and alveolar cells
(C) Alveolar cells
(D) Smooth muscle cells surrounding the endothelial cells
(E) The plasma membrane of the endothelial cells

A

(D) Smooth muscle cells surrounding the endothelial cells

51
Q

The maximum amount of air that can be expired after a maximum inspiration is:
(A) Tidal volume
(B) Vital capacity
(C) Expiratory reserve volume
(D) Inspiratory reserve volume
(E) Total lung volume

A

(B) Vital capacity

52
Q

This volume of air cannot be exhaled from the lungs regardless of the magnitude of expiration:
(A) Vital capacity
(B) Inspiratory reserve volume
(C) Residual volume
(D) Expiratory reserve volume
(E) Tidal volume

A

(C) Residual volume

53
Q

If tidal volume is 150 mL and breathing rate is 25 breaths/min, what is the alveolar minute volume?
(A) 0 mL/min
(B) 20 mL/min
(C) 150 mL/min
(D) 3,000 mL/min
(E) 3,750 mL/min

A

(A) 0 mL/min

54
Q

If tidal volume is 500 mL and breathing rate is 12 breaths/min, what is the minute volume?
(A) 0 mL/min
(B) 12 mL/min
(C) 500 mL/min
(D) 4,200 mL/min
(E) 6,000 mL/min

A

(E) 6,000 mL/min

55
Q

If tidal volume is 500 mL and breathing rate is 12 breaths/min, what is the alveolar minute volume?
(A) 0 mL/min
(B) 12 mL/min
(C) 500 mL/min
(D) 4,200 mL/min
(E) 6,000 mL/min

A

(D) 4,200 mL/min

56
Q

Given normal and resting ventilation and metabolic rates, what is the partial pressure of oxygen (PO2) in the systemic arteries?
(A) 0 mm Hg
(B) 40 mm Hg
(C) 46 mm Hg
(D) 100 mm Hg
(E) 150 mm Hg

A

(D) 100 mm Hg

57
Q

Given normal and resting ventilation and metabolic rates, what is the partial pressure of oxygen (PO2) in the systemic veins?
(A) 0 mm Hg
(B) 40 mm Hg
(C) 46 mm Hg
(D) 100 mm Hg
(E) 150 mm Hg

A

(B) 40 mm Hg

58
Q

Given normal and resting ventilation and metabolic rates, what is the partial pressure of carbon dioxide (PCO2) in the systemic arteries?
(A) 0 mm Hg
(B) 40 mm Hg
(C) 46 mm Hg
(D) 100 mm Hg
(E) 150 mm Hg

A

(B) 40 mm Hg

59
Q

Given normal and resting ventilation and metabolic rates, what is the partial pressure of carbon dioxide (PCO2) in the systemic veins?
(A) 0 mm Hg
(B) 40 mm Hg
(C) 46 mm Hg
(D) 100 mm Hg
(E) 150 mm Hg

A

(C) 46 mm Hg

60
Q

Bronchodilators are a class of drug often used in the treatment of asthma and COPD, which act on β-adrenergic receptors of the airways to induce smooth muscle relaxation. The anatomic distribution of these receptors is closely correlated to the function of each structural component of the lungs. What structural component(s) of the airway would be most affected by the use of a bronchodilator, and in what functional zone(s) are they found?

A) Lobar bronchi and alveoli would be affected equally, and they are both found in the respiratory zone
B) Lobar bronchi and alveoli would be affected equally, and they are found in the conducting and respiratory zones respectively
C) Lobar bronchi, which are found in the conducting zone
D) Alveoli, which are found in the respiratory zone

A

Lobar bronchi, which are found in the conducting zone

61
Q

What produces the force which drives normal exhalation, and is the process active or passive?
Choose 1 answer:

A)Diaphragm, active
B)Intercostal muscles, active
C) Elastic force, passive
D) Reflex arcs, passive

A

Elastic force, passive

62
Q

In a situation where the respiratory bronchioles become inflamed and narrowed, such as is seen in asthma, which aspect of respiration would be most mechanically impaired?

A) Normal expiration
B) Forced inhalation
C) Normal inhalation
D) Forced expiration

A

Forced expiration

63
Q

What is the pressure of gas within the alveoli at the peak of inspiration, just before expiration, relative to that of atmospheric air?

A) less than atmospheric air
B) greater than atmospheric air
C) cannot be predicted without more information
D) the same as atmospheric air

A

D) same as atmospheric air

64
Q

The partial pressures of carbon dioxide (pCO2) and oxygen (pO2) in the atmosphere at sea level are 0.3 mmHg and 160 mmHg respectively, but the partial pressures of these gases in blood leaving the lungs are 40 mmHg
(pCO2)and 95 mmHg (pO2). What factor most likely accounts for this difference?

A)CO2, penetrates more deeply into small airways than O2
B) CO2, is less soluble in the blood than O2
C) O2 penetrates more deeply into small airways than CO2
D) CO2, is more soluble in the blood than O2

A

D) CO2, is more soluble in the blood than O2

65
Q

Interstitial lung disease (ILD) refers to a set of conditions which affect the
pulmonary interstitium- the area of tissue and space which lies between the
alveoli and alveolar capillaries. What factor in the setting of severe ILD, would
NOT decrease the extent to which oxygen passes from the air sacs of the lungs
into the blood?
Choose 1 answer:
A)Decreased interstitial thickness
B) Increased lung elastic recoil
C)Decreased lung capacity
D) Increased alveolar surface tension

A

A)Decreased interstitial thickness

66
Q

Septic shock is a serious condition resulting from the body’s response to systemic
bacterial infections, which may impair oxygen uptake and delivery. What
physiological change may result from septic shock which would decrease the
ability of hemoglobin in the alveolar capillaries to become fully saturated with
oxygen?
Choose 1 answer:
A)Increased blood pH
B)Decreased afferent capillary pO?
C)Increased capillary blood flow
D)Decreased alveolar wall thickness

A

C)Increased capillary blood flow

67
Q

How might central and peripheral chemoreceptors compare with regard to their
role in the detection of respiratory gases resulting from a prolonged period of
hypoventilation?
Choose 1 answer:
A) Central chemoreceptors and peripheral chemoreceptors may both respond
to the resultant decrease in pO2, but only peripheral chemoreceptors could respond to the increase in pCO2
B) Central chemoreceptors and peripheral chemoreceptors may both respond
to the resultant decrease in pCO2, but only peripheral chemoreceptors could respond to the increase in pO2
C) Central chemoreceptors and peripheral chemoreceptors may both respond
to the resultant increase in pCO2, but only peripheral chemoreceptors could respond to the decrease in pO2
D) Central chemoreceptors and peripheral chemoreceptors may both respond
to the resultant increase in pO2, but only peripheral chemoreceptors could
respond to the decrease in pCO2

A

C) Central chemoreceptors and peripheral chemoreceptors may both respond
to the resultant increase in pCO2, but only peripheral chemoreceptors could respond to the decrease in pO2

68
Q

Many respiratory diseases affect pulmonary function by altering the ability of
alveoli to participate in gas exchange. What physical change would most greatly
reduce the degree to which a particular alveolus is ventilated?
Choose 1 answer:
A) Increased alveolar elastic recoil
B) Decreased capillary flow
C) Increased alveolar volume
D) Decreased temperature

A

A) Increased alveolar elastic recoil

69
Q

If the mouth and nose are closed at the peak of a complete inspiration, but before
expiration, and the breath is held, what is the pressure of gases within the alveoli
relative to the pressure of atmospheric air?
Choose 1 answer:
A) Alveolar pressure is greater than the pressure of atmospheric air
B) Alveolar pressure is equal to the pressure of atmospheric air
C) Alveolar pressure is less than the pressure of atmospheric air
D) Cannot be predicted without more information

A

A) Alveolar pressure is greater than the pressure of atmospheric air

70
Q

Which of the following statements is correct?

A) Right-to-left shunts represent an extremely high V/Q ratio
B) Right-to-left shunts are not a cause of elevated alveolar-arterial oxygen difference
C) An increase in the alveolar dead-space can result from an increase in the number of high V/Q units in the lung
D) The shape of the oxyhemoglobin dissociation curve means that low V/Q units in the lung are not a cause of hypoxemia (low PaO2)

Totally occluding the right pulmonary artery increases the right-to-left shunt fraction by 50%

A

C) An increase in the alveolar dead-space can result from an increase in the number of high V/Q units in the lung

71
Q

An increase in the pH of blood will:

A) Shift the oxyhemoglobin dissociation curve to the right
B) Decrease P50
C) Decrease the affinity of hemoglobin for oxygen
D) Decrease the oxygen capacity of the blood
E) Do all of the above

A

B) Decrease P50

72
Q

Which of the following decreases oxygen content but does not alter PaO2 or percentage saturation of hemoglobin?

A) Ascent to an altitude of 3500 m
B) Polycythemia
C) Breathing 50% oxygen
D) Anemia
E) Development of a large right-to-left shunt

A

D) Anemia

73
Q

Using the equation PV = constant; if the volume of the thoracic cavity increases (in other words, the size of the thoracic cavity increases), the pressure inside the thoracic cavity will __________.
increase
decrease
stay the same

A

decrease

74
Q

When the pressure within the thoracic cavity increases compared to atmospheric pressure, air will __________ the lungs.
exit
enter
not enter or exit

A

exit

75
Q

Using the equation PV = constant; if the volume of the thoracic cavity decreases (in other words, the size of the thoracic cavity decreases), the pressure inside the thoracic cavity will __________.
increase
decrease
stay the same

A

increase

76
Q

When the pressure within the thoracic cavity decreases (compared to atmospheric pressure) air will __________ the lungs.
exit
enter
not enter or exit

A

enter

77
Q

In order to inhale, the size of the thoracic cavity has to increase in order to decrease the internal pressure (compared to atmospheric pressure). In order to accomplish this task, which of the following must occur?
A) the diaphragm muscle and external intercostals contract
B) the diaphragm muscle and external intercostals relax
C) the diaphragm muscle contracts and the external intercostals relax

A

A) the diaphragm muscle and external intercostals contract

78
Q

What is the volume that remains in the lungs even after a forceful exhale
A) expiratory reserve
B) residual volume
C) inspiratory reserve
D) total lung capacity

A

B) residual volume

79
Q

What muscles are used in breathing in and breathing out?
answer choices
A) diaphragm and intercostals
B) diaphragm and lungs
C) lungs and ribs
D) lungs and diaphragm

A

A) diaphragm and intercostals

80
Q

The volume of a normal breath
answer choices
A) 3000mL
B) 2400mL
C) 1200mL
D) 500mL

A

D) 500mL

81
Q

What is the volume of one breath called?
A) minute ventilation
B) inspiratory capacity
C) tidal volume
D) vital capacity

A

C) tidal volume

82
Q

You exhale normally and then start to breathe into a spirometer containing 6-L of helium. After several minutes, the helium concentration in the spirometer falls to 4%. Your FRC is approximately:
A) 1.8L
B) 2.4L
C) 3.0L
D) 4.5L

A

The correct answer is 3 L

from the law of the conservation of matter:
F1 x V1 = F2 x (V1+ V2)
(.06)(6) = (.04)(6+V2)
(.36/.04) = (6+V2)
(9-6)=V2
V2=3