Egan's Chapter 9 - The Respiratory System

b. 10 to 12 cm

Approximately how long is the trachea of an adult? a. 5 to 8 cm b. 10 to 12 cm c. 16 to 18 cm d. 20 to 24 cm

d. 75

Approximately what percent of the normal changes in thoracic volume during quiet inspiration is due to the action of the diaphragm? a. 15 b. 25 c. 50 d. 75

a. They elevate the upper chest, increasing chest anteroposterior diameter.

As ventilatory muscles, the sternocleidomastoids do which of the following? a. They elevate the upper chest, increasing chest anteroposterior diameter. b. They elevate the ribs and decrease chest anteroposterior diameter. c. They increase lateral chest movement during inspiration. d. They lower the sternum, thus increasing chest anteroposterior diameter.

a. Carina

At what point does the trachea branch into two main stem bronchi? a. Carina b. Cricoid cartilage c. Glottis d. Manubrium

d. Simple diffusion

By what mechanism does gas exchange across the lung occur? a. Active transport b. Facilitated diffusion c. Facilitated transport d. Simple diffusion

d. Reduces friction.

What is the function of the very small amount of pleural fluid that is found in the pleural space? a. Composes part of anatomic shunt. b. Liquid barrier for pathogens. c. Part of pulmonary blood flow. d. Reduces friction.

d. Structure separating the right and left thoracic cavities

What is the mediastinum? a. Membranous sac surrounding the heart and great vessels b. Middle layer of muscle fibers constituting the heart c. Point of division of the trachea into the bronchi d. Structure separating the right and left thoracic cavities

a. Pseudostratified ciliated columnar epithelium

What is the most common cell type found in the mucosa of the larger airways? a. Pseudostratified ciliated columnar epithelium b. Pseudostratified ciliated cuboidal epithelium c. Stratified ciliated squamous epithelium d. Stratified unciliated serous endothelium

b. Mucociliary escalator

What is the name given to the action produced by the forward stroking of millions of cilia? a. Coughing b. Mucociliary escalator c. Mucus stroking d. The wave

b. Costophrenic angle

What is the name given to the acute angle formed by the costal pleura joining the diaphragmatic pleura? a. Angle of Louis b. Costophrenic angle c. Diaphragmatic groove d. Oblique fissure

a. Sternal angle

What is the name of the external landmark that identifies the point at which the trachea branches into the right and left main stem bronchi? a. Sternal angle b. Cricoid cartilage c. Suprasternal notch d. Xiphoid process

c. Parietal pleura

What is the name of the thin serous membrane that covers the inner layer of the thoracic wall? a. Cupula b. Mesothelioma c. Parietal pleura d. Visceral pleura

b. Manubrium

What is the name of the upper portion of the sternum? a. Angle of Louis b. Manubrium c. Vertebral process d. Xiphoid process

c. Cricoid

What is the only complete circular cartilage of the larynx? a. Arytenoid b. Corniculate c. Cricoid d. Thyroid

c. Protect airway during eating or drinking.

What is the primary function of the larynx? a. Cover the glottic opening during forced expiration. b. House Waldeyer's ring of tonsilar material for airway defense. c. Protect airway during eating or drinking. d. Provide a common passageway for food and gas.

d. There is an equal opposing tendency of the chest wall to expand.

What is the primary mechanism that stops the lungs from collapsing at the end of exhalation? a. Radial tethers, stretched to their maximum length, then halt lung collapse. b. Surfactant neutralizes the tendency of the lung to collapse. c. There is a tendency of the chest wall to lock at the level of FRC. d. There is an equal opposing tendency of the chest wall to expand.

a. Continuous absorption of oxygen (O2) and excretion of carbon dioxide

What is the primary purpose of the respiratory system? a. Continuous absorption of oxygen (O2) and excretion of carbon dioxide b. Filtering to prevent allergens and microbes from reaching the lungs c. Transport oxygenated blood to the tissues d. Warm and humidify inspired gas

a. It receives blood from right and left ventricles.

What is unique regarding the blood supply to the lung? a. It receives blood from right and left ventricles. b. It requires no dedicated blood supply as it exists in a gas environment. c. Pulmonary venous drainage contributes to the normal anatomic shunt. d. The pulmonary arteries are the primary source of O2 for lung structures.

a. Fear of aspiration of bacteria or food

What is your primary concern if you discover that a patient does not have a gag reflex? a. Fear of aspiration of bacteria or food b. That their tonsilar tissues are grossly swollen c. That they will not be able to breathe adequately d. Tracheal collapse

b. Lingula

What portion of the left lung corresponds anatomically to the middle lobe of the right lung? a. Cardiac notch b. Lingula c. Medial segment d. Superior segment

b. Asthma

What pulmonary disorder could lead to acute flattening of the diaphragm? a. Adult respiratory distress syndrome b. Asthma c. Atelectasis d. Pneumonia

c. Type I cells

What type of alveolar cells cover over 90% of the surface area of the alveolar- capillary membrane? a. Alveolar macrophages b. Granular pneumocytes c. Type I cells d. Type II cells

a. Laminar

What type of flow is seen in and beyond the terminal bronchioles? a. Laminar b. Transitional c. Turbulent d. Varies among individuals

b. The lung will collapse.

What will happen when the lung is surgically removed from the thorax? a. The lung will appear to undergo no change. b. The lung will collapse. c. The lung will expand. d. The response of the lung will depend on its age and pathology.

c. Excess fluids

What will most commonly blunt the costophrenic angle as seen on chest radiograph in an upright individual? a. Air b. Bile c. Excess fluids d. Liver on the right, intestines on the left

b. Pectoralis

When a COPD patient leans forward braced in a tripod position, this lends particular advantage to which accessory muscles of inspiration? a. External intercostals b. Pectoralis c. Scalenes d. Sternocleidomastoids

b. They are the smallest of the purely conducting airways.

Which of the following statements about the terminal bronchioles is true? a. They are generally five divisions below the segmental bronchi. b. They are the smallest of the purely conducting airways. c. They average 3 to 4 mm in diameter. d. They have well-defined and predictable amounts of cartilage.

d. The right lung has three lobes and two fissures.

Which of the following statements describes a normal adult lung? a. The left lung is bisected by two fissures. b. The left lung has an upper, a middle, and a lower lobe. c. The right lung has only an upper and a lower lobe. d. The right lung has three lobes and two fissures.

c. Toward the top of the upright lung, blood flow is high.

Which of the following statements is false regarding the pulmonary circulation? a. Pulmonary blood flow is highly dependent on gravity. b. The pulmonary circulation is a low-pressure system. c. Toward the top of the upright lung, blood flow is high. d. Toward the top of the upright lung, blood flow is low.

d. 1, 2, 3, and 4

Which of the following statements is/are true of the pulmonary lymphatic system? 1. It consists of both superficial and deep vessels. 2. It drains into the right lymphatic or thoracic duct. 3. Vessels begin as dead-end lymphatic channels in the lung. 4. With phagocytes, it defends against foreign material. a. 1, 3, and 4 only b. 2, 3, and 4 only c. 2 only d. 1, 2, 3, and 4

c. 2, 3, and 4 only

Which of the muscles below when stimulated will contract and push up on the diaphragm? 1. External intercostals 2. External obliques 3. Internal obliques 4. Rectus abdominous a. 1, 2, and 3 only b. 1 and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4

c. Type II pneumocytes

Which type of lung cells secretes pulmonary surfactant? a. Alveolar macrophages b. Type I cells (pneumocytes) c. Type II pneumocytes d. Type III pneumocytes

d. The right bronchus is more in-line with the trachea.

Why do most aspirated objects and fluids end up in the right main stem bronchus instead of the left main stem bronchus? a. The left bronchus is more in-line with the trachea. b. The left bronchus is shorter than the right. c. The right bronchus is larger than the left. d. The right bronchus is more in-line with the trachea.

d. It promotes lung stability.

Why is pulmonary surfactant such an important biologic substance? a. It clears out cellular debris. b. It is an alveolar macrophage. c. It promotes lung contraction aiding exhalation. d. It promotes lung stability.

b. Mediastinal organs push laterally into the left hemithorax.

Why is the left lung narrower than the right lung? a. Liver compresses the left lung. b. Mediastinal organs push laterally into the left hemithorax. c. There is poorer blood flow during fetal development. d. There is upward pressure of the abdominal contents.

d. Thyroid

What is the cartilage that is commonly referred to as the Adam's apple? a. Arytenoid b. Cricoid c. Cuneiform d. Thyroid

a. Compression of the thoracic cavity

Compared to a normal diaphragm, contraction of a diaphragm that is low and flat may result in which of the following? a. Compression of the thoracic cavity b. Enhanced venous return and thus cardiac output c. Greater diaphragmatic efficiency d. Larger than normal change in thoracic volume

b. lower.

Compared with the systemic circulation under normal conditions, pressure in the pulmonary circulation is: a. higher. b. lower. c. the same. d. not connected.

d. 1, 2, and 3

Fluid transport to and from the lungs is provided by which of the following? 1. Bronchial circulation 2. Lymphatic system 3. Pulmonary circulation a. 2 and 3 only b. 1 and 3 only c. 2 only d. 1, 2, and 3

c. Protect the vital organs.

What is the function of the thorax? a. Facilitate digestion. b. Heat, humidify, and filter gases. c. Protect the vital organs. d. Vocalization.

a. Increased bronchial arterial flow to the area

How does the body compensate for a pulmonary embolus that occludes a branch of the pulmonary artery? a. Increased bronchial arterial flow to the area b. Increased cardiac output c. Pulmonary arteriole and metarteriole vasodilation d. Release of prostaglandins to fight inflammation

a. From the alveolar gases

How does the lung parenchyma receive most of its O2? a. From the alveolar gases b. From the bronchial arteries/capillaries c. From the pulmonary arteries/capillaries d. From the pulmonary lymphatic system

a. 1 to 2 cm

How far is the diaphragm pulled down during tidal breathing? a. 1 to 2 cm b. 3 to 5 cm c. 6 to 8 cm d. 8 to 10 cm

a. Filter out inhaled contaminants, various chemicals, and small blood clots.

Identify the nonprimary function of the respiratory system. a. Filter out inhaled contaminants, various chemicals, and small blood clots. b. Exchange of gases between blood and tissues. c. Continuous absorption of O2 and excretion of carbon dioxide. d. Transport oxygenated blood to the tissues.

b. accessory muscle use

Limited, short-term spontaneous ventilation is possible in a patient with a paralyzed diaphragm because of_____________________. a. reflex diaphragm activity b. accessory muscle use c. active exhalation d. high intraabdominal pressures

b. 2 and 4 only

The pulmonary arterial circulation does which of the following? 1. Delivers oxygenated blood back to the heart. 2. Delivers deoxygenated blood to the lungs. 3. Originates on the left side of the heart. 4. Originates on the right side of the heart. a. 1 and 4 only b. 2 and 4 only c. 1 and 3 only d. 2 and 3 only

c. Lower resistance than the systemic circulation

Pressures in the pulmonary circulation are lower than those in the systemic circulation because of what characteristic of the pulmonary circulation? a. Higher resistance than the systemic circulation b. Less blood flow than the systemic circulation c. Lower resistance than the systemic circulation d. More blood flow than the systemic circulation

d. 1 and 3 only

The pulmonary venous circulation does which of the following? 1. Delivers oxygenated blood back to the heart. 2. Delivers deoxygenated blood to the lungs. 3. Empties into the left atrium. 4. Empties into the right atrium. a. 2 and 3 only b. 1 and 4 only c. 2 and 4 only d. 1 and 3 only

a. Conducting airways

What is the common name given to classify the airway from the nares to the terminal bronchioles? a. Conducting airways b. Respiratory airways c. Transitional airways d. Upper airway

a. contracting at end-exhalation.

The abdominal muscles can actually contribute to inspiration by: a. contracting at end-exhalation. b. contracting at end-inhalation. c. causing a cough. d. increasing end-inspiratory lung volume.

d. Vocal cord impairment or paralysis

What is the effect of damage to the recurrent laryngeal nerves? a. Diaphragmatic paralysis b. Pulmonary circulatory failure c. Inactivation of pulmonary surfactant production d. Vocal cord impairment or paralysis

b. Costal groove on the bottom of each rib

The intercostal arteries, veins, and nerves run through which of the following? a. Costal groove on the top of each rib b. Costal groove on the bottom of each rib c. Fibers of the intercostal musculature d. Surface of the parietal pleura

c. Inferior border of the larynx

The upper respiratory tract traditionally ends at what point? a. Branching of the trachea into right and left main stem bronchi b. Hypopharynx c. Inferior border of the larynx d. The end of the conducting airways

d. Vallecula

Three-folds of tissue between the posterior base of the tongue and the epiglottis form a small space that is a key landmark in oral intubation. What is this called? a. False vocal cords b. Palatine fold c. Taurus tubularus d. Vallecula

d. Mediastinum

To what structures do the parietal pleural membranes adhere? a. Fissures b. Intrapulmonary bronchi c. Lung d. Mediastinum

b. 2 ml/kg predicted body weight

What is normal amount of anatomic dead space found in a healthy lung? a. 1 ml/kg predicted body weight b. 2 ml/kg predicted body weight c. 3 ml/kg predicted body weight d. 4 ml/kg predicted body weight

b. Bronchopulmonary veins emptying into pulmonary veins

Via what pathway does much of the bronchial venous drainage occur? a. Bronchial veins emptying into the inferior vena cava b. Bronchopulmonary veins emptying into pulmonary veins c. Direct connections between bronchial and pulmonary arteries d. Thebesian venous drainage into the heart chambers

c. Floating ribs

What are rib pairs 11 and 12 known as? a. False ribs b. Faux ribs c. Floating ribs d. True ribs

a. Alveolar macrophages

What are the free-wandering phagocytic cells that ingest foreign material in the respiratory zone of the lungs? a. Alveolar macrophages b. Granular pneumocytes c. Type I cells d. Type II cells

d. Turbinates

What are the three bony projections that arise from the lateral walls of the nasal cavity that enhance filtration and humidification? a. Alar nasi b. Frontal sinuses c. Palatine tonsils d. Turbinates

b. Palatine tonsils

What are the vascularized lymphoidal tissues that have a particularly active immunological role in children? a. Lingual tonsils b. Palatine tonsils c. Pharyngeal tonsils d. Superior turbinates

d. 1 and 4 only

What can the release of histamine and other chemical mediators from the mast cells in the airways cause? 1. Bronchoconstriction 2. Bronchodilation 3. Vasoconstriction 4. Vasodilation a. 2 and 4 only b. 1 and 3 only c. 2 and 3 only d. 1 and 4 only

a. Balance between sympathetic and parasympathetic tone

What determines the airway diameter in the normal lung? a. Balance between sympathetic and parasympathetic tone b. In large part, the amount of patient effort c. Activity level of the submucosal glands d. Amount of dopamine present in the airway walls

c. Equal opposing tendency of the chest wall to expand and lung to collapse

What forces establish the sub-atmospheric pressure found in the pleural space? a. Contraction of accessory muscles of inspiration b. Contraction of expiratory muscles c. Equal opposing tendency of the chest wall to expand and lung to collapse d. Effect of gravity, particularly at the base of the lungs

c. 2 and 3 only

What intercommunicating channels permit collateral ventilation between adjacent alveoli and primary lobules? 1. Bronchial anastomoses 2. Canals of Lambert 3. Pores of Kohn 4. Terminal bronchioles a. 1, 2, and 3 only b. 1 and 4 only c. 2 and 3 only d. 1, 2, 3, and 4

b. Acinus

What is called the "functional unit of the lungs"? a. Only the alveoli b. Acinus c. Alveolar-capillary membranes d. Terminal bronchioles

d. Exchange of gases between the blood and the tissue

What is meant by "internal respiration"? a. Any gas exchange that occurs inside the body b. Consumption of O2 in the mitochondria c. Continuous absorption of O2 and excretion of carbon dioxide d. Exchange of gases between the blood and the tissue

b. At the join between the manubrium and sternal body

Where does the sternal angle lie? a. At the depression in the body of the sternum to which the clavicles attach b. At the join between the manubrium and sternal body c. At the superior edge of the sternum d. Where the xiphoid process connects to the sternum

a. External intercostals

Which accessory muscles are active during resting and active inspiration and pull up on all the ribs expanding the thorax? a. External intercostals b. Internal intercostals c. Scalenes d. Sternocleidomastoids

b. Internal intercostals

Which accessory muscles of ventilation work to pull the ribs closer together? a. External intercostals b. Internal intercostals c. Scalenes d. Sternocleidomastoids

b. 1 through 7

Which of rib pairs connect directly to the sternum? a. 1 through 4 b. 1 through 7 c. 1 through 12 d. 11 through 12

d. 1, 2, and 4 only

Which of the following are the primary functions of the nasal cavity? 1. Conduction of gases 2. Filtration and defense 3. Gas exchange 4. Heat and humidify a. 1 and 2 only b. 2 and 3 only c. 2, 3, and 4 only d. 1, 2, and 4 only

c. 1, 2, and 3

Which of the following can impair or inhibit ciliary activity? 1. Drying of the respiratory tract mucosa 2. Exposure to smoke 3. Parasympatholytic drugs a. 1 and 2 only b. 1 only c. 1, 2, and 3 d. 2 and 3 only

b. Filtering of blood clots

Which of the following describes a function of pulmonary circulation? a. Breakdown of angiotensin II b. Filtering of blood clots c. Production of erythropoietin d. Regulation of breathing

b. It consists of all structures distal to a terminal bronchiole.

Which of the following describes an acinus? a. Each acinus is comprised of five terminal respiratory units. b. It consists of all structures distal to a terminal bronchiole. c. It is composed of the smaller conducting airways. d. It is the transitional portion of the lung between conduction and respiration.

a. 1, 2, and 3 only

Which of the following help(s) comprise the defense system of the nose? 1. Clearance of foreign matter by ciliary action 2. Gross filtration by the large hairs of the nasal vestibule 3. Impaction of particulate foreign matter on the nasal mucosa 4. Laminar flow through the concha a. 1, 2, and 3 only b. 2 and 4 only c. 3 only d. 1, 2, 3, and 4

c. Lift upper chest particularly during times of high ventilatory demand.

Which of the following is the most important ventilatory function of the scalene muscles? a. Activate if intrathoracic pressure falls to -40 cm H2O. b. Elevate and fix the first seven ribs. c. Lift upper chest particularly during times of high ventilatory demand. d. Support the trachea within the thorax during heavy exercise.

b. 1 and 2

Which of the following muscles are considered primary muscles of ventilation? 1. Diaphragm 2. Intercostals 3. Scalenes 4. Sternomastoid a. 1, 3, and 4 b. 1 and 2 c. 3 only d. 1, 2, 3, and 4

b. Phrenic

Which of the following nerves innervates the diaphragm? a. Glossopharyngeal b. Phrenic c. Seventh cranial d. Vagus