Week 1 Flashcards
A 64-year-old man with a history of smoking comes to the physician because of shortness of breath. Pulmonary function tests are performed using simple spirometry. Which of the following lung volumes or lung capacities cannot be measured directly using this technique?
A.Expiratory reserve volume
B.Functional residual capacity
C.Inspiratory reserve volume
D.Tidal volume
E.Vital capacity
SM 157: Mechanics
learning objective: 154: list adult values for normal lung volume and capacities, 158 – 2.how do changes in lung and chest wall compliances affect FRC and intrapleural pressure
A 64-year-old man with a history of smoking comes to the physician because of shortness of breath. Pulmonary function tests are performed using simple spirometry. Which of the following lung volumes or lung capacities cannot be measured directly using this technique?
A.Expiratory reserve volume
B.Functional residual capacity
C.Inspiratory reserve volume
D.Tidal volume
E.Vital capacity
A 56-yr-old woman comes to the physician because of a 6-month history of hoarseness of her voice. The patient also reports appetite and weight loss during the same period. She has smoke 2 packs of cigarettes daily for 20 years. Laryngoscopy shows an absence of movement of the left vocal cord. Further evaluation confirms a diagnosis of stage 4 lung cancer. Lymph node involvement in which of the following labeled locations is most likely responsible for her symptoms?
learning objective: 173 - 5. Identify some abnormalities on chest x-ray based on alteration of the normal anatomy.
•Damage to the left recurrent laryngeal nerve – branch of left vagus nerve and arises as the left vagus nerve crosses in front of the arch of the aorta
The pressure-volume curves shown (TLC = total lung capacity) were obtained from a normal subject and from a 56-year-old patient who presented to his primary care physician with shortness of breath and a cough. Physical exam shows diffuse crackles at the lung bases. Which of the following conditions best accounts for the differences observed in the patient curve compared with the normal curve?
A.alpha-1-antitrypsin deficiency
B.Asthma
C.Bronchospasm
D.Idiopathic pulmonary fibrosis
E.Old age
learning objective: 159a - 2. How do changes in lung and chest wall compliances affect FRC and intrapleural pressure?
The pressure-volume curves shown (TLC = total lung capacity) were obtained from a normal subject and from a 56-year-old patient who presented to his primary care physician with shortness of breath and a cough. Physical exam shows diffuse crackles at the lung bases. Which of the following conditions best accounts for the differences observed in the patient curve compared with the normal curve?
A.alpha-1-antitrypsin deficiency
B.Asthma
C.Bronchospasm
D.Idiopathic pulmonary fibrosis
E.Old age
•Only IPF is restrictive. The rest are obstructive except for old age which results in decreased elastic recoil.
After a lung thoracotomy is done photomicrographs are done on a section of the lung. Which of the following products is secreted by the cells indicated by the arrow?
A.Alkaline phosphatase
B.Angiotensin-converting enzyme
C.Immunoglobulin
D.Major basic protein
E.Mucus
F.Surfactant
G.Tubular Myelin
learning objective: 157 – 3. Describe the histological components of lung stroma and pulmonary lobules and how they relate to lung function.
After a lung thoracotomy is done photomicrographs are done on a section of the lung. Which of the following products is secreted by the cells indicated by the arrow?
- A – osteoblasts produce alkaline phosphatase
- B – pulmonary endothelial cells produce ACE
- C – Ig is secreted by plasma cells. Micrograph cells are attached to the basal lamina so cannot be plasma cells
- D – major basic protein is produced by eosinophils
- E – mucus cells have a similar cytoplasmic appearance but their nuclei are typically flattened and pushed to the side next to the basement membrane
•F – type II pneumocytes are cuboidal with round nuclei and a foamy cytoplasm. They contain lamellar bodies (granules) of surfactant
•G – tubular myelin is not produced by lamellar bodies (highly ordered lattice that forms within the alveolar airspace
A healthy 25-year-old man lives at the beach on the Pacific coast of the US. His twin brother has been living in a mountain cabin for the past 2 years. Which of the following indices is likely to be greater in the man living at sea level?
A.Diameter of pulmonary arterioles
B.EPO production
C.Muscle capillary density
D.Renal bicarbonate excretion
E.Respiratory rate
learning objective: 159a - 5. Explain how the resistance to airflow contributes to alveolar and intrapleural pressures
A healthy 25-year-old man lives at the beach on the Pacific coast of the US. His twin brother has been living in a mountain cabin for the past 2 years. Which of the following indices is likely to be greater in the man living at sea level?
A.Diameter of pulmonary arterioles
B.EPO production
C.Muscle capillary density
D.Renal bicarbonate excretion
E.Respiratory rate
- Hypoxic pulmonary vasoconstriction
- In the lungs decreased PO2 causes a reflexive decrease in arteriolar diameter (normally, this response shunts blood away from non-ventilated regions).
- Decreased arteriolar diameter – increased PVR – increased right ventricular afterload and pulmonary hypertension
- Pulmonary vascular remodeling – increased wall thickness and decreased internal diameter
A 23 y/o man participates in a clinical study in which is lung volumes and capacities are determined. He is connected to a spirometer containing a known concentration of helium. He breathes several times until the helium has equilibrated between the spirometer and his lungs. Calculations are made to determine the amount of air remaining in his lungs at specific points during maximal inspiration, maximal expiration, and quiet breathing. Determination of which of the following lung volumes requires this technique.
A.Expiratory reserve volume
B.Inspiratory capacity
C.Inspiratory reserve volume
D.Residual volume
E.Tidal volume
F.Vital capacity
learning objective: 159 – 1. Understand how the interaction of the lung and chest wall gives rise to intrapleural pressure and determines the FRC
A 23 y/o man participates in a clinical study in which is lung volumes and capacities are determined. He is connected to a spirometer containing a known concentration of helium. He breathes several times until the helium has equilibrated between the spirometer and his lungs. Calculations are made to determine the amount of air remaining in his lungs at specific points during maximal inspiration, maximal expiration, and quiet breathing. Determination of which of the following lung volumes requires this technique.
A.Expiratory reserve volume
B.Inspiratory capacity
C.Inspiratory reserve volume
D.Residual volume
E.Tidal volume
F.Vital capacity
A 46 y/o man comes to the physician for an examination prior to beginning an exercise program. The diagram shows an expiratory flow-volume (EFV) curve obtained during pulmonary function testing. Which of the following points or segments of the curve indicate a time during which airway collapse is most likely maximum expiratory airflow?
learning objective: 159 – 6. Be able to explain the factors giving rise to dynamic compression of the airways and why expiratory flow limitation changes with lung volume. Be able to draw a maximal flow-volume curve and explain the factors giving rise to the effort-dependent and effort-independent regions
D is when the lung is exhaling, during exhalation the radial traction is lost as volume in the airways decreases and there is dynamic collapse/compression
A 68 y/o man with emphysema comes to the physician for follow-up. The patient has a long history of heavy cigarette smoking, and pulmonary function tests show a typical obstructive pattern. He has recently developed chronic hypoxemia. Which of the following patterns of results is most likely to occur when supplemental oxygen is given to this patient, assuming that respiration rate initially remains unchanged?
learning objective: 160 – 2. Explain the pathology and pathogenesis of COPD, including emphysema and chronic bronchitis
Answer choice C:
Supplemental oxygen will always increase alveolar PO2 and while arteriolar PO2 will increase, it cannot increase as much as in the alveoli. Lung diffusing capacity is a property of the lung and won’t change based on supplemental oxygen
During an investigational study, a healthy 34 y/o man inhales as much air as possible and then expires with maximal effort until no more air can be expired. Results of the expiratory flow-volume curve are shown. Which of the following best represents forced vital capacity (VC) of this volunteer?
A.1.5 L
B.2.5 L
C.3.5 L
D.4.5 L
E.6.0 L
learning objective: 1. Describe the relationship amongst minute ventilation, alveolar ventilation and dead space
During an investigational study, a healthy 34 y/o man inhales as much air as possible and then expires with maximal effort until no more air can be expired. Results of the expiratory flow-volume curve are shown. Which of the following best represents forced vital capacity (VC) of this volunteer?
A.1.5 L
B.2.5 L
C.3.5 L
D.4.5 L
6.0 L
•6 – 1.5 = 4.5 L
A patient’s arterial blood gas sample showed that O2 saturation was reduced compared with a sample taken from a normal, healthy individual despite a normal PaO2. Which of the following most likely accounts for this shift of the patient’s O2-hemoglobin dissociation curve?
A.Decreased 2, 3-bisphosphoglycerate
B.Decrease PCO2
C.Decreased pH
D.Decreased temperature
E.Hereditary presence of fetal hemoglobin
learning objective: 161 – 5. Explain the implications for gas transport of the shapes of the O2 and CO2 dissociation curves.
A patient’s arterial blood gas sample showed that O2 saturation was reduced compared with a sample taken from a normal, healthy individual despite a normal PaO2. Which of the following most likely accounts for this shift of the patient’s O2-hemoglobin dissociation curve?
A.Decreased 2, 3-bisphosphoglycerate
B.Decrease PCO2
C.Decreased pH
D.Decreased temperature
Hereditary presence of fetal hemoglobin
•All the others would cause a shift to the left
A 27 y/o woman with breast cancer undergoes bilateral mastectomy and radiation therapy. One year later, she returns to the physician because of pain in her neck and anterior thorax. The physician explains that radiation therapy can cause adhesions of muscles and nerves. The patient undergoes surgery to remove the scar tissue of the supraclavicular region but the phrenic nerves are accidentally damaged. The patient suddenly develops dyspnea and cyanosis and the abdominal wall paradoxically moves inward during inspiration. Which of the following is the best explanation for this observation in this patient?
A.Contraction of the diaphragm during inspiration causes the abdominal wall to move inward
B.Contraction of the intercostal muscles during inspiration causes the diaphragm to be drawn upward and the abdominal wall to be drawn inward
C.Contraction of the rectus abdominus muscles during inspiration causes inward motion of the abdomen
D.In the horizontal position, the reduction in thoracic volume required for inspiration is caused by upward movement of the abdominal viscera
E.Relaxation of the muscles of the thoracic wall during inspiration causes the abdominal wall to be drawn inward
learning objective – 163, 2. Describe the major respiratory afferent systems and the reflex responses they elicit
A 27 y/o woman with breast cancer undergoes bilateral mastectomy and radiation therapy. One year later, she returns to the physician because of pain in her neck and anterior thorax. The physician explains that radiation therapy can cause adhesions of muscles and nerves. The patient undergoes surgery to remove the scar tissue of the supraclavicular region but the phrenic nerves are accidentally damaged. The patient suddenly develops dyspnea and cyanosis and the abdominal wall paradoxically moves inward during inspiration. Which of the following is the best explanation for this observation in this patient?
A.Contraction of the diaphragm during inspiration causes the abdominal wall to move inward
B.Contraction of the intercostal muscles during inspiration causes the diaphragm to be drawn upward and the abdominal wall to be drawn inward
C.Contraction of the rectus abdominus muscles during inspiration causes inward motion of the abdomen
D.In the horizontal position, the reduction in thoracic volume required for inspiration is caused by upward movement of the abdominal viscera
E.Relaxation of the muscles of the thoracic wall during inspiration causes the abdominal wall to be drawn inward
- Normally inspiration is produced simultaneously by contraction of the diaphragm and the external intercostal muscles. A paralyzed or weak diaphragm is due to damaged phrenic nerves. Contraction of the intercostals causes the pressure in the pleural space to become more negative and the diaphragm to be sucked upward toward the thorax. Typically the diaphgram flattens downward toward the abdomen pressing the viscera and pushing the abdominal wall outward. But in the damaged state the paradoxical movement of the diaphragm induces the abdominal viscera to move upward toward the thorax and the abdominal wall to move inward.
- A – diaphragm does not contract in this patient
- C – rectus abdominus muscles do not contract during inhalation
- D – inspiration requires expansion of the thoracic volume
E – Inspiration involves active contraction of the muscles
The graph above shows the effects of increasing the partial pressure of O2 in arterial blood (PaO2) on blood O2 content. Point “X” represents data obtained from a normal volunteer breathing room air at sea level. Point “Z” represents data from the same volunteer after having breathed 100% oxygen for 30 mins. Point “Y” represents data obtained from a patient who has also been breathing 100% oxygen for 30 minutes. Datum point “Y” is most likely to have been obtained from which of the following individuals?
A.A patient with carbon monoxide poisoning
B.A patient with LV failure
C.A patient with significant anemia
D.An infant with a VSD and pulmonic valve stenosis
E.A child whose respiration is significantly depressed due to severe head trauma
learning objective: 164 – 1. List the major causes of hypoxemia and be able to explain why they produce hypoxemia
The graph above shows the effects of increasing the partial pressure of O2 in arterial blood (PaO2) on blood O2 content. Point “X” represents data obtained from a normal volunteer breathing room air at sea level. Point “Z” represents data from the same volunteer after having breathed 100% oxygen for 30 mins. Point “Y” represents data obtained from a patient who has also been breathing 100% oxygen for 30 minutes. Datum point “Y” is most likely to have been obtained from which of the following individuals?
A.A patient with carbon monoxide poisoning
B.A patient with LV failure
C.A patient with significant anemia
D.An infant with a VSD and pulmonic valve stenosis
E.A child whose respiration is significantly depressed due to severe head trauma
- Right-to-left shunt = hypoxemia due to an increase in the A-a gradient
- Cannot be corrected by breathing 100% O2
- Healthy individuals reach about 600 mmHg on 100% oxygen
- P02 means a problem with dissolved oxygen
- Blood O2 content is Hb + dissolved
- A – CO messes with Hb binding
- B – LV failure will not have a pO2 problem
- C – Anemia reduces Hb content
E – would have a more mild decrease in pO2 still above >600
A 48 y/o quadriplegic man is admitted to the intensive care unit because of urosepsis. While trying to get a blood sample for arterial blood gas from the femoral artery, it is accidentally drawn from the femoral vein. When compared to the arterial blood sample, the venous sample will most likely show which of the following differences?
learning objective – 180: Describe the relationship between PaCO 2, serum bicarbonate and pH
•B – venous blood so O2 is down, CO2 is up, and blood is more acidic
