cpulm final
What is the first-line treatment for carbon monoxide poisoning?
100% oxygen via mask or ETT
A 72-year-old woman is admitted to the hospital for treatment of unstable angina. Cardiac catheterization shows occlusion that has caused a 50% reduction in the diameter of the left circumflex artery. Resistance to blood flow in this vessel has increased by what factor relative to a vessel with no occlusion?
16
The alveolar PO2 of an individual breathing 30% O2 at an atmospheric pressure of 747 mm Hg will be (in mm Hg): (assume R = 1.0 and PACO2 = 40 mm Hg)
170
A 25-year-old man is seen by a pulmonologist for exercise-related shortness of breath. The patient states that after 10 minutes of intense workout, he has to stop for at least 40 seconds to catch his breath. The patient has not had any episodes of fever, cough, or weight changes. A pulmonary function test is ordered and partial results are shown below. What is the functional residual capacity of this patient? Residual volume1200 mL Expiratory reserve volume 1500 mL
2700
Which of the following areas can reveal the murmur of aortic stenosis?
2nd intercostal space at the right upper sternal border
What is the normal range for CO2 one might expect to see on a healthy patient without any distress or respiratory diseases?
35-45 mmHg
A patient has an expiratory reserve volume = 1.25 L, inspiratory reserve volume = 2.75 L, and tidal volume = 0.75 L. What is the vital capacity?
4.75 L
What is the normal value of PCO₂?
40 mmHg
Which of the following PaCO2 levels correspond with decreased alveolar ventilation?
50 mmHg
What is considered a normal ejection fraction in a healthy adult?
55% - 60%
A group of PA students accompanied a medical mission team to Peru. After arriving at the airport in Bolivia, they hiked to a remote mountain village in the Andes. At this elevation of 18,000 ft, the barometric pressure was 380 mmHg. Ignoring the fact that air at higher altitudes is actually dryer, the theoretical resulting PO2 of humid inspired air is approcimately...
70 mmHg
What percentage of forced expiratory volume (FEV1) can healthy individuals expel in the first second?
80%
In asthma the FEV1 is:
A smaller volume than normal
Which of the following should increase the P50 of the oxyhemoglobin dissociation curve?
Acidosis
An investigator is studying the clearance of respiratory particles in healthy non-smokers. An aerosol containing radio-labeled particles that are small enough to reach the alveoli is administered to the subjects via a non-rebreather mask. A gamma scanner is then used to evaluate the rate of particle clearance from the lungs. The primary mechanism of particle clearance most likely involves which of the following cell types?
Alveolar macrophages
An investigator is studying the transport mechanisms of carbon dioxide (CO2) from peripheral tissues to the lungs via the bloodstream. According to his studies, there are multiple ways by which CO2 is carried to the lungs. Which mechanisms are responsible for transporting most carbon dioxide from the tissues to the lungs via the bloodstream?
CO2 in the form of HCO3-
Which receptors respond most to CO2 levels?
Central chemoreceptors
An investigator is studying the effects of tissue hypoxia on skeletal muscles. Skeletal muscle hypoxia is induced by decreasing oxygen delivery to peripheral tissues. Which of the following is most likely to achieve this desired effect?
Decrease the serum 2,3-bisphosphoglycerate concentration
Which of the following best describes a restrictive pattern of lung disease (total lung capacity = TLC, FEV1 = forced expiratory volume in 1 s, FVC = forced vital capacity)?
Decreased TLC, FEV1/FVC ratio normal, or increased.
A researcher is studying pulmonary physiology. He identifies a substance secreted by type II pneumocytes that is composed primarily of lipoproteins. This substance will likely have which of the following effects on pulmonary physiology?
Decreased alveolar surface tension
A 34-year-old woman presents to a family medicine clinic with her partner due to excessive day-time fatigue. She feels tired throughout the day despite sleeping for over eight hours nightly. The patient's partner states that she goes through a pattern of breathing at night, during which she stops breathing, then rapidly hyperventilates. During these episodes, the period of apnea is longer than the period of hyperventilation. The patient currently smokes one pack of cigarettes per day. Her BMI is 26 kg/m2. Vitals are within normal limits. Physical exam is unremarkable. In laboratory polysomnography testing demonstrates six episodes of central apneas per hour of sleep. Which of the following best describes the underlying pathophysiology of this patient's clinical condition?
Decreased chemosensitivity to PCO2 // tidal vol
A 5-year-old boy is brought to the emergency room after accidentally ingesting a small plastic bead. Chest radiography reveals a radiopaque object in the right lower lobe. The bead is suspected to be causing near complete occlusion of one of the right lower lobe bronchioles. Which of the following physiological changes will most likely take place in the affected portions of the lung?
Decreased perfusion
A 19-year-old male soccer player undergoes an exercise tolerance test to measure his maximal oxygen uptake during exercise. Which of the following changes are most likely to occur during exercise?
Decreased physiologic dead space
Two days after undergoing left hemicolectomy for a colonic mass, a 60-year-old man develops shortness of breath. His temperature is 38.1°C (100.6°F), pulse is 80/min, respirations are 22/min, and blood pressure is 120/78 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Cardiopulmonary examination shows decreased breath sounds and decreased fremitus at both lung bases. Arterial blood gas analysis on room air shows: pH7.35PaO270 mm HgPCO240 mm Hg An x-ray of the chest shows collapse of the bases of both lungs. Which of the following is the most likely mechanism of this patient's hypoxemia?
Decreased ratio of ventilated alveoli
A child accidentally aspirates a small pebble that lodges in the lower portion of the right inferior lobe. A radiograph is shown below. What changes are expected to occur in the arterial blood supply for this portion of the lung?
Decreased, secondary to arterial vasoconstriction
A 21-year-old man is admitted to the intensive care unit for respiratory failure requiring mechanical ventilation. His minute ventilation is calculated to be 7.0 L/min, and his alveolar ventilation is calculated to be 5.1 L/min. Which of the following is most likely to decrease the difference between minute ventilation and alveolar ventilation?
Decreasing the physiologic dead space
A healthy, 30-year-old woman is referred for a life insurance physical. She has never smoked, and her breath sounds are normal. Her expiratory reserve volume, as depicted in the spirometry tracing below, equals which of the following?
E-D
A 6-year-old boy is brought to the physician by his mother because of a 3-month history of episodic chest pain and shortness of breath on exertion. He is at the 99th percentile for height and 40th percentile for weight. Examination shows a high-arched palate, long and slender upper extremities, and elbows and knees that can be hyperextended. Cardiac examination shows a grade 2/6 late systolic, crescendo murmur with a midsystolic click. The murmur is most likely to be heard best over which of the following labeled areas?
F
Which of the following describes pulsus paradoxus?
Fall in systolic blood pressure during inspiration
Which of the following sums of volumes equals total lung capacity (TLC)?
Forced vital capacity (FVC) and residual volume (RV)
A study is done to determine how carbon dioxide is transported through the bloodstream to the lungs. Two blood samples are examined, one in the peripheral tissues and one in the lungs. Which of the following findings is expected to be seen?
Hemoglobin has a lower affinity for CO2 in the lungs
Stimulation of which receptors of the following should result in decreased ventilation?
Hering-Breuer inflation (stretch) receptors
Which of the following causes an increase in alveolar ventilation?
Increase in PaCo2
Which of the following is NOT a normal response to exercise?
Increased arterial PCO2
According to Fick's law, what will increase passive diffusion into a cell?
Increased surface area
A researcher is studying the structure and function of hemoglobin. He discovers that certain conditions favor the unloading of oxygen to tissues, as demonstrated in the graph below. Which of the following conditions favors this effect? - curve picture
Increasing temperature
How does the Valsalva maneuver increase the intensity of the murmur that is heard on an exam?
It decreases preload.
Pulmonary surfactant increases
Lung compliance.
Which of the following is indicated by pursed-lip breathing?
Obstructive pulmonary disease
An 8 year-old boy is brought to a health care provider complaining of dyspnea and fatigue. On physical examination, a continuous machinery murmur is heard best in the second left intercostal space and is widely transmitted over the precordium. The most likely diagnosis is
PDA
The response to 100% O2 reveals that the patient has which of the following?
R-L shunting
Which of the following processes occurs in high altitude sickness?
Respiratory alkalosis
A 2-year-old boy is brought to the physician because of coughing and difficulty breathing that started shortly after his mother found him in the living room playing with his older brother's toys. He appears anxious. Respirations are 33/min and pulse oximetry on room air shows an oxygen saturation of 88%. Physical examination shows nasal flaring and intercostal retractions. Auscultation of the lungs shows a high-pitched inspiratory wheeze and absent breath sounds on the right side. There is no improvement in his oxygen saturation after applying a non-rebreather mask with 100% FiO2. Which of the following terms best describes the most likely underlying mechanism of this patient's hypoxemia?
Right-to-left shunt
An investigator is studying the affinity of hemoglobin for oxygen in different clinical settings. An illustration of an oxygen-hemoglobin dissociation curve is shown. Curve A shows the test results of one of the research participants and curve B shows a normal oxygen-hemoglobin dissociation curve. Which of the following is most likely present in this research participant? (pink + blue curve)
Secondary polycythemia
Why does the Valsalva maneuver initially decrease blood pressure?
The increased intrathoracic pressure leads to decrease venous return. This leads to decreased preload.
Which Of the Following Occur With Emphysema?
The walls of the alveoli degenerate, decreasing the surface area for gas exchange.
A researcher is conducting an experiment on pulmonary physiology. He is studying differences in blood flow and ventilation in various regions of the lung when a patient is sitting upright. A diagram of the lung is shown below. Which of the following best describes the region of the lung with the highest V/Q ratio and the corresponding physiological significance? -- zones in lung
Zone 1, due to wasted ventilation
Regarding spirometry results, which of the following can be interpreted from a FEV1/FVC ratio < 70%?
an obstructive order is present
Dilation of bronchial smooth muscle is mediated by activation of:
beta 2 adrenergic receptors
A 57-year-old man with chronic obstructive pulmonary disease comes to the emergency department because of leg swelling for 2 weeks. He has smoked 2 packs of cigarettes daily for the past 20 years. His vital signs are within normal limits. Physical examination shows jugular venous distention, hepatomegaly, and pitting edema of both lower extremities. Cardiac examination shows a regular heart rate and normal heart sounds. Auscultation of the lungs shows scattered wheezing without crackles. Left ventricular ejection fraction is 60%. Which of the following is the most likely underlying cause of this patient's condition?
chronic hypoxic vasoconstriction
Intrapleural pressure is positive during
forced expiration
Which of the following would make the oxygen-hemoglobin curve shift right?
increased H+ concentration
A patient presents to your ED with an acute asthmatic attack. Having recently reviewed respiratory disease, you already know that his FEV1/FVC will be:
less than 0.8
A 30-year-old woman comes to the physician because of worsening fatigue and shortness of breath for the past 7 months. She emigrated from China 2 years ago. Cardiac examination shows a loud S1. Which of the following contributes most to this auscultation finding?
mitral valve closure
Which of the following would you expect on physical examination in a patient with mitral valve stenosis?
open snap
Which of the following would you expect on physical examination in a patient with mitral valve stenosis?
opening snap
Which of the following is responsible for the movement of O2 from the alveoli into the blood in the pulmonary capillaries?
passive diffusion
Despite a three to fold increase in cardiac output, mean pulmonary artery pressure was observed to increase only by 20% during dynamic exercise. This is most likely due to:
recruitment of collapsed pulmonary capillaries
What pattern is suggested by the following flow-volume loop?
restrictive pulmonary disease
A 21-year-old lacrosse player comes to the doctor for an annual health assessment. She does not smoke or drink alcohol. She is 160 cm (5 ft 3 in) tall and weighs 57 kg (125 lb); BMI is 22 kg/m2. Pulmonary function tests show an FEV1 of 90% and an FVC of 3600 mL. Whole body plethysmography is performed to measure airway resistance. Which of the following structures of the respiratory tree is likely to have the highest contribution to total airway resistance?
segmental bronchi
