Chapter 35: Alterations of Pulmonary Function

In what form of bronchiectasis do both constrictions and dilations deform the bronchi? a. Varicose b. Symmetric c. Cylindric d. Saccular

ANS: A Varicose bronchiectasis exists when both constrictions and dilations deform the bronchi.

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

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.

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

ANS: A ARDS is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury

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

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 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

ANS: A Chronic management of asthma begins with the avoidance of allergens and other triggers.

Which medication classification is generally included in the treatment of silicosis? a. Corticosteroids b. Antibiotics c. Bronchodilators d. Expectorants

ANS: A No specific treatment exists for silicosis, although corticosteroids may produce some improvement in the early, more acute stages.

Pulmonary artery hypertension (PAH) results from which alteration? a. Narrowed pulmonary capillaries b. Narrowed bronchi and bronchioles c. Destruction of alveoli d. Ischemia of the myocardium

ANS: A PAH is characterized by endothelial dysfunction with an overproduction of vasoconstrictors and decreased production of vasodilators, resulting in narrowed pulmonary capillaries.

Fluid in the pleural space characterizes which condition? a. Pleural effusion b. Atelectasis c. Bronchiectasis d. Ischemia

ANS: A Pleural effusion is the presence of fluid in the pleural space.

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

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").

Which condition is not a cause of chest wall restriction? a. Pneumothorax b. Severe kyphoscoliosis c. Gross obesity d. Neuromuscular disease

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.

Which characteristics are symptomatic of a flail chest? (Select all that apply.) a. Involves the fracture of several consecutive ribs. b. Involves multiple fractures to individual ribs. c. Can involve the fracture of the sternum. d. Is generally a result of the inflammatory process. e. Is more common among the older adult population.

ANS: A, B, C A flail chest results from the fracture of several consecutive ribs in more than one place or the fracture of the sternum and several consecutive ribs.

Which inflammatory mediators are produced in asthma? (Select all that apply.) a. Histamine b. Bradykinin c. Leukotrienes d. Prostaglandins e. Neutrophil proteases

ANS: A, B, C, D

What are the causes of dyspnea? (Select all that apply.) a. Decreased pH, increased partial pressure of arterial carbon dioxide (PaCO2) and decreased partial pressure of arterial oxygen (PaO2) b. Decreased blood flow to the medulla oblongata c. Stimulation of stretch or J-receptors d. Presence of anxiety e. Presence of pain

ANS: A, C, D Dyspnea can be triggered by decreased pH, increased PaCO2, and decreased PaO2. Stimulation of either stretch or J-receptors is also known as a cause of dyspnea. Dyspnea may be the result of pulmonary disease or many other conditions, such as pain, heart disease, trauma, and anxiety.

. Which statements regarding Mycobacterium tuberculosis are true regarding the bacilli's ability to go into dormancy? (Select all that apply.) a. Neutrophils and macrophages all play a role in its dormancy. b. Mycobacterium tuberculosis is capable of dormancy but for only a short period. c. The immune system is the controlling factor regarding its length of dormancy. d. The bacilli are sealed off in tubercles to allow for dormancy. e. An attack by lymphocytes brings the bacilli out of their dormant state

ANS: A, C, D Neutrophils, lymphocytes, and macrophages seal off the colonies of bacilli, forming a granulomatous lesion called a tubercle. Once the bacilli are isolated in tubercles and immunity develops, tuberculosis may remain dormant for life. If the immune system is impaired, however, or if live bacilli escape into the bronchi, active disease occurs and may spread through the blood and lymphatic system to other organs. This microorganism can remain dormant for extended periods.

Which statements are true regarding exudative effusion? (Select all that apply.) a. Exudative effusion contains high concentrations of white blood cells. b. Exudative effusion produces a very thick exudate. c. Exudative effusion may occur in response to an inflammatory process. d. The presence of a malignant cancer can trigger exudative effusion. e. Exudative effusion is a result of increased capillary permeability.

ANS: A, C, D, E Exudative effusion is less watery and contains high concentrations of white blood cells and plasma proteins. Exudative effusion occurs in response to inflammation, infection, or malignancy and involves inflammatory processes that increase capillary permeability.

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

ANS: B

Which condition is capable of producing alveolar dead space? a. Pulmonary edema b. Pulmonary emboli c. Atelectasis d. Pneumonia

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.

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

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.

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 b. Clubbing c. Angling d. Osteoarthropathy

ANS: B Clubbing is the selective bulbous enlargement of the end (distal segment) of a digit (finger or toe) and is commonly associated with diseases that interfere with oxygenation, such as bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, and congenital heart disease.

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

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

. 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 b. Tension pneumothorax c. Open pneumothorax d. Secondary pneumothorax

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.

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

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.

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 b. Emphysema c. Pneumonia d. Asthma

ANS: B Individuals with emphysema usually have dyspnea on exertion that later progresses to significant dyspnea, even at rest (see Table 35-3)

Sitting up in a forward-leaning position generally relieves which breathing disorder? a. Hyperpnea b. Orthopnea c. Apnea d. Dyspnea on exertion

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.

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 b. 20 c. 30 d. 40

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

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.

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.

What is the most common cause of pulmonary edema? a. Right-sided heart failure b. Left-sided heart failure c. Mitral valve prolapse d. Aortic stenosis

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.

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

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

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

ANS: B Emphysema is abnormal permanent enlargement of gas-exchange airways (acini) accompanied by the destruction of alveolar walls without obvious fibrosis.

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.

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.

Which type of pulmonary disease requires more force to expire a volume of air? a. Restrictive b. Obstructive c. Acute d. Communicable

ANS: B Obstructive pulmonary disease is characterized by airway obstruction that is worse with expiration.

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

ANS: B Pneumoconiosis represents any change in the lung caused by the inhalation of inorganic dust particles, which usually occurs in the workplace.

What medical term is used to identify the accumulation of air in the pleural space? a. Flail chest b. Pneumothorax c. Pleural effusion d. Exudate effusion

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.

What is the initial step in the management of emphysema? a. Inhaled anticholinergic agents b. Beta agonists c. Cessation of smoking d. Surgical reduction of lung volume

ANS: C Chronic management of emphysema begins with smoking cessation.

Which factor contributes to the production of mucus associated with chronic bronchitis? a. Airway injury b. Pulmonary infection c. Increased Goblet cell size d. Bronchospasms

ANS: C Continual bronchial inflammation causes bronchial edema and increases the size and number of mucous glands and goblet cells in the airway epithelium.

What medical term is used to identify the presence of pus in the pleural space? a. Plural effusion b. Asthma c. Empyema d. Pneumonia

ANS: C Empyema is the presence of pus in the pleural space.

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 b. Purulent c. Transudative d. Large

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.

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

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.

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

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.

High altitudes may produce hypoxemia through which mechanism? a. Shunting b. Hypoventilation c. Decreased inspired oxygen d. Diffusion abnormalities

ANS: C The presence of adequate oxygen content of the inspired air is the first factor. Oxygen content is lessened at high altitudes.

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 b. Perfusion c. Absorption d. Hypoventilation

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.

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).

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.

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

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.

Which clinical manifestation is associated with pulmonary hypertension? (Select all that apply.) a. Systemic blood pressure greater than 130/90 mm Hg b. Rhonchi bilaterally c. Dyspnea on exertion d. Peripheral edema e. Jugular venous distention

ANS: C, D, E Symptoms of fatigue, chest discomfort, tachypnea, and dyspnea on exertion, palpitations, and cough are common. Examination may reveal peripheral edema, jugular venous distention, a precordial heave, and accentuation of the pulmonary compartment of the second heart sound.

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

ANS: D An abscess is a circumscribed area of suppuration and destruction of lung parenchyma.

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

ANS: D At the beginning of an attack, the individual experiences chest constriction, expiratory wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, and tachypnea

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

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.

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

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.

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

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).

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

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.

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 b. Mast cells c. Macrophages d. Neutrophils

ANS: D The role of neutrophils is central to the development of ARDS. Activated neutrophils release a battery of inflammatory mediators. These mediators cause extensive damage to the alveolocapillary membrane and greatly increase capillary membrane permeability.