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Flashcards in Respiratory System Deck (37)
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1

A 69-year-old asthmatic man has had a persistent cough and felt feverish for the last week. He is wheezy and having difficulty breathing, and his inhalers are not having any effect. Which of the following is the most consistent with a severe attack of asthma?

A. BP 90/60 mmHg
B. Inability to complete sentences
C. Inaudible air entry bilaterally
D. SaO2 < 75% on air

B. Inability to complete sentences

Running out of breath before the end of a sentence, together with a PEFR 33-50% of predicted and HR > 110/min is consistent with a severe attack of asthma.
A and C indicate hypotension; D suggests a life-threatening asthma attack which should prompt immediate referral to ITU.

2

A 21-year-old woman has had left-sided chest pain for a week, sharp in nature and worse on inspiration. The left medial border of her sternum is tender but her chest is otherwise clear. Temperature, heart rate, respiration rate and SaO2 are within normal range. Which is the most likely diagnosis?

A. Pneumonia
B. Myocardial infarction
C. Costochondritis
D. Pulmonary embolus

C. Costochondritis

3

A 30-year-old woman has had a severe acute episode of asthma, her first in ten years – she has a salbutamol inhaler for occasional use, and beclometasone for use twice daily. Which single measure is most likely to improve her long-term asthma control?

A. Add montelukast tablets to prescription
B. Add salmeterol inhaler
C. Ensure up-to-date spirometry and lung function tests
D. Write a plan of how and when to take the inhalers

D. Write a plan of how and when to take the inhalers

4

A 26-year-old man has a sudden pain over his lower sternum. He feels breathless and nauseous. On auscultation, there is decreased air entry at the right apex. Which is the most likely diagnosis?

A. Acute pericarditis
B. Pneumonia
C. Pneumothorax
D. Pulmonary embolus

C. Pneumothorax

5

The PO2 (mm Hg) inside skeletal muscle cells during exercise is closest to?

A. 3
B. 10
C. 20
D. 30

A. 3

6

Which of these is unlikely to be true for a normal, healthy individual?

A. Tidal volume = 0.5L
B. Respiratory rate = 13 breaths per minute
C. Partial pressure of oxygen in the arteries = 10.2kPa
D. Vital capacity = 3.9
E. Physiological dead space = 350ml

C. Partial pressure of oxygen in the arteries = 10.2kPa

7

Which of the following is untrue?

A. Central chemoreceptors are found on the medulla, they respond to pH and pCO2
B. Respiratory neurons in the medulla have pacemaker activity
C. Peripheral chemoreceptors are found on the aortic arch and can respond to hypoxia, pCO2 and pH
D. Sensitivity to CO2 decreases in sleep
E. Pharyngeal resistance increases during sleep

B. Respiratory neurons in the medulla have pacemaker activity

8

The most important stimulus controlling the level of resting ventilation is:

A. PCO2 on peripheral chemoreceptors.
B. PCO2 on central chemoreceptors.
C. pH on peripheral chemoreceptors.
D. pH of CSF on central chemoreceptors.

D. pH of CSF on central chemoreceptors.

9

Match the following description of lung cells to the cell types given above

1. These make up 95% of the surface area of the alveoli and are large and thin
2. These are simple columnar epithelial cells which secrete mucin from granules into the bronchus and large bronchioles
3. These are modified columnar epithelial cells in the upper airways, they move mucus towards the oropharynx
4. These are found in the bronchioles, have microvilli, and secrete products that are protective to the bronchial epithelium
5. These destroy foreign material in the alveoli

A. Goblet cells
B. Astrocytes
C. Paneth cells
D. Type I pneumoncytes
E. Schwann cells
F. Macrophages
G. Oligodendrocytes
H. Basal cells
I. Mesangial cells
J. Clara cells
K. Ciliated cells
L. Type II pneumocytes

1 = D
2 = A
3 = K
4 = J
5 = F

10

A patient with asthma is prescribed inhaled corticosteroids – why?

A. To build smooth muscle in the conducting airways
B. Because studies have shown a positive correlation with good patient outcomes
C. To cause prolonged bronchodilation
D. To attenuate the underlying immune response

D. To attenuate the underlying immune response

11

Which of these is unlikely to be true for a normal, healthy individual?

A. Tidal volume = 0.5L
B. Respiratory rate = 13 breaths per minute
C. Partial pressure of oxygen in the arteries = 10.2kPa
D. Vital capacity = 3.9
E. Physiological dead space = 350ml

E. Physiological dead space = 350ml

12

Which of the following is untrue?

A. Central chemoreceptors are found on the medulla, they respond to pH and pCO2
B. Respiratory neurons in the medulla have pacemaker activity
C. Peripheral chemoreceptors are found on the aortic arch and can respond to hypoxia, pCO2 and pH
D. Sensitivity to CO2 decreases in sleep
E. Pharyngeal resistance increases during sleep

A. Central chemoreceptors are found on the medulla, they respond to pH and pCO2

Central chemoreceptors respond only to pCO2

13

The CXR shows a patient who has had contrast injected and then had a CXR straight away. What do the arrows show?


A. Pulmonary Arteries
B. L and R Main Bronchi
C. The Azygous Vein System
D. The aortic bifurcation

A. Pulmonary Arteries

14

Pulmonary surfactant is produced by:

A. Alveolar macrophages.
B. Goblet cells.
C. Leukocytes.
D. Type I alveolar cells.
E. Type II alveolar cells.

E. Type II alveolar cells.

15

The basal regions of the upright human lung are normally better ventilated than
the upper regions because:

A. Airway resistance to the upper regions is higher than to the lower regions.
B. There is less surfactant in the upper regions.
C. The blood flow to the lower regions is higher.
D. The lower regions have a small resting volume and a relatively large increase in
volume.
E. The PCO2 of the lower regions is relatively high.

C. The blood flow to the lower regions is higher.

16

Pulmonary surfactant:

A. Increases the surface tension of the alveolar lining liquid.
B. Is secreted by type I alveolar epithelial cells.
C. Is a protein.
D. Increases the work required to expand the lung.
E. Helps to prevent transudation of fluid from the capillaries into the alveolar spaces.

A. Increases the surface tension of the alveolar lining liquid.

17

Do the following all affect airway resistance?

A. Bronchial smooth muscle contraction
B. Mucus plugging
C. Oedema
D. Foreign bodies
E. Left ventricular ejection fraction

A. Bronchial smooth muscle contraction - YES
B. Mucus plugging - YES
C. Oedema - YES
D. Foreign bodies - YES
E. Left ventricular ejection fraction - NO

18

Is air flow limitation in COPD fully reversible?

A. Yes, always
B. Yes, with LABAs therapy
C. Sometimes
D. No

D. No

19

Match the following to either
A. Asthma or B. COPD

1. CD4 T Cells
2. CD8 T Cells
3. Mast Cells
4. Neutrophils
5. Reduced gas transfer ability
6. No change in gas transfer ability
7. Hyperinflated chest -
8. Alpha 1 Anti-trypsin deficiency in about 1%
9. Pulmonary rehabilitation

1. CD4 T Cells --> Asthma
2. CD8 T Cells --> COPD
3. Mast Cells --> Asthma
4. Neutrophils --> COPD
5. Reduced gas transfer ability --> COPD
6. No change in gas transfer ability --> Asthma
7. Hyperinflated chest --> COPD
8. Alpha 1 Anti-trypsin deficiency in about 1% --> COPD
9. Pulmonary rehabilitation --> COPD

20

Match the appropriate pathogen with the descriptions provided in the question:

A. Coronavirus
B. Rhinoviruses
C. Rotavirus
D. Staphylococcus epidermidis
E. Influenza A family viruses
F. Hantavirus

1. Causes Severe Respiratory Distress Syndrome (SARS). No drug has been proven effective against the pathogen. Management is supportive. First discovered in 2003.
2. Can cause rapidly- progressive pneumonia ± ARDS. The most common types which infect humans are designated as H1N1 and H3N2. Oseltamivir (Tamiflu) and zanamivir (Relenza) can be used to reduce morbidity.
3. Pulmonary oedema and ARDS are present in 80-90% of patients. Cough and upper respiratory symptoms are uncommon. Renal syndrome is also presentable. No drug has been proven effective against the pathogen. Management is supportive. First discovered in 1950s.

1 = A
2 = E
3 = F

21

25) Which of the following about oseltamivir (Tamiflu) is INCORRECT? (More than one option might be correct)

A. It can be used in prophylaxis for influenza A infection
B. Resistance has been reported for H1N1 strain
C. It is administered in oral, intravenous and inhaled routes
D. It is a neuraminidase inhibitor
E. It can be used to treat Haemophilus influenzae infection

A - Oseltamivir is used for prophylaxis of influenza A and B once the infection has been circulating. It is contra-indicated in children <1 YO and >48h post-exposure.

B - Rare cases of oseltamivir-resistant H1N1 strain were reported in 2009 (and possibly earlier). Zanamivir, where no resistance has been reported by far, is believed to be a more effective treatment option.
C - CORRECT: Oseltamivir is only available in oral form. European Medicines Agency (EMA) holds a positive stance towards Tamiflu IV, which is the intravenous form of oseltamivir. However by January 2010 it has yet to be approved. Zanamivir is available in inhaled form but not oseltamivir.

D - Oseltamivir inhibits neuraminidase expressed by the influenza virus, which the enzyme is crucial for viral budding. It is a competitive inhibitor for neuraminidase, by binding to sialic acid expressed on normal cells.

E - CORRECT: Oseltamivir is only used to treat influenza A and B infections. It has no efficacy in treating Gram- positive bacterial infection in the case of H. influenzae.

22

26) Which of the following about FiO2 is INCORRECT?

A. It is defined as the fraction of oxygen in inspired air in a gas mixture
B. It can be increased by artificial ventilation
C. It has a maximum value of 1.0
D. It may cause lung injury when >0.50
E. It is always positively related with SaO2

A. It is defined as the fraction of oxygen in inspired air in a gas mixture
CORRECT - FiO2 = fraction (F) of inspired (i) oxygen (O2); normal value in the atmosphere = 0.21 (21%); does not vary with altitude, unlike partial pressure of inspired oxygen (PiO2).

B. It can be increased by artificial ventilation
CORRECT - FiO2 can be manipulated by altering oxygen content in the gas mixture, to a maximum of 1.0 (100%).

C. It has a maximum value of 1.0
CORRECT - Expressed as a number w/o unit from 0.0-1.0

D. It may cause lung injury when >0.50
CORRECT

E. It is always positively related with SaO2
INCORRECT - At the presence of right-to-left shunting (V/Q mismatch), SaO2 might not respond to an increasing FiO2

23

A 65-year old male presents FiO2 = 0.40, PaO2 = 8.0, reduced HCO3-, elevated urea and creatinine levels. PH indicates he had no pre-existing renal conditions. Which of the following is the most likely diagnosis? (ARDS: Acute Respiratory Distress Syndrome; ALI: Acute Lung Injury; ARF: Acute Renal Failure; CRF: Chronic Renal Failure)

A. Acute Respiratory Distress Syndrome
B. Acute Respiratory Distress Syndrome with Acute Renal Failure
C. Acute Lung Injury with Acute Renal Failure
D. Acute Respiratory Distress Syndrome with Chronic Renal Failure
E. Acute Lung Injury

A. Acute Respiratory Distress Syndrome
NO - Patient presents elevated urea and creatinine, which is a sign of renal failure instead of ARDS alone.

B. Acute Respiratory Distress Syndrome with Acute Renal Failure
YES - PaO2:FiO2 ratio = 20, which falls within the cut-off of ARDS (26.6kPa). Patient presents renal failure w/o pre-existing renal conditions --> acute --> Likely diagnosis = ARDS with ARF.

C. Acute Lung Injury with Acute Renal Failure
NO - PaO2:FiO2 cut-off for ALI is 40kPa --> Patient therefore experiences ARDS but not ALI.

D. Acute Respiratory Distress Syndrome with Chronic Renal Failure
NO - Renal failure in this case is acute, but CRF refers to deterioration of renal fxn over >3 months.
E. Acute Lung Injury
NO - Same as C

24

Concerning the pressure-volume behaviour of the lung:

A. Compliance decreases with age.
B. Filling an animal lung with saline decreases compliance.
C. Removing a lobe reduces total pulmonary compliance.
D. Absence of surfactant increases compliance.
E. In the upright lung at FRC, for a given change in intrapleural pressure, the alveoli
near the base of the lung expand less than those near the apex.

C. Removing a lobe reduces total pulmonary compliance.

25

The basal regions of the upright human lung are normally better ventilated than
the upper regions because:

A. Airway resistance to the upper regions is higher than to the lower regions.
B. There is less surfactant in the upper regions.
C. The blood flow to the lower regions is higher.
D. The lower regions have a small resting volume and a relatively large increase in
volume.
E. The PCO2 of the lower regions is relatively high.

D. The lower regions have a small resting volume and a relatively large increase in
volume.

26

Pulmonary surfactant:

A. Increases the surface tension of the alveolar lining liquid.
B. Is secreted by type I alveolar epithelial cells.
C. Is a protein.
D. Increases the work required to expand the lung.
E. Helps to prevent transudation of fluid from the capillaries into the alveolar spaces.

E. Helps to prevent transudation of fluid from the capillaries into the alveolar spaces.

27

Concerning normal expiration during resting conditions:

A. Expiration is generated by the expiratory muscles.
B. Alveolar pressure is less than atmospheric pressure.
C. Intrapleural pressure gradually falls (becomes more negative) during the expiration.
D. Flow velocity of the gas (in cm/sec) in the large airways exceeds that in the
terminal bronchioles.
E. Diaphragm moves down as expiration proceeds.

D. Flow velocity of the gas (in cm/sec) in the large airways exceeds that in the
terminal bronchioles.

28

When a normal subject develops a spontaneous pneumothorax of his right lung, you would expect the following to occur:

A. Right lung expands.
B. Chest wall on the right expands.
C. Diaphragm moves down.
D. Mediastinum moves to the left.
E. Blood flow to the right lung is reduced.

E. Blood flow to the right lung is reduced.

29

Concerning airflow in the lung:

A. Flow is more likely to be turbulent in small airways than in the trachea.
B. The lower the viscosity, the less likely is turbulence to occur.
C. In pure laminar flow, halving the radius of the airway increases its resistance eightfold.
D. For inspiration to occur, mouth pressure must be less than alveolar pressure.
E. Airway resistance increases during scuba diving.

E. Airway resistance increases during scuba diving.

30

The most important factor limiting flow rate during most of a forced expiration
from total lung capacity is:

A. Rate of contraction of expiratory muscles.
B. Action of diaphragm.
C. Constriction of bronchial smooth muscle.
D. Elasticity of chest wall.
E. Compression of airways.

E. Compression of airways.

31

Which of the following factors increases the resistance of the airways?

A. Increasing lung volume above FRC.
B. Increased sympathetic stimulation of airway smooth muscle.
C. Going to high altitude.
D. Inhaling cigarette smoke.
E. Breathing a mixture of 21% O2 and 79% helium (molecular weight 4).

D. Inhaling cigarette smoke.

32

A normal subject makes an inspiratory effort against a closed airway. You would
expect the following to occur:

A. Tension in the diaphragm decreases.
B. The internal intercostal muscles become active.
C. Intrapleural pressure increases (becomes less negative).
D. Alveolar pressure falls more than intrapleural pressure.
E. Pressure inside the pulmonary capillaries falls.

E. Pressure inside the pulmonary capillaries falls.

33

Which of the following statements about lung volumes is incorrect?

A. The Vital Capacity is the total volume of gas that can be ventilated by the lungs in one inspiratory/expiratory cycle.
B. A person cannot use their entire Functional Residual Capacity.
C. Residual Volume can be calculated using a Helium dilution test.
D. Total Lung Capacity is decreased in obstructive lung disease
E. Total Lung Capacity is decreased in restrictive lung disease

D. Total Lung Capacity is decreased in obstructive lung disease

34

Concerning the chest cavity and ventilation:

A. The diaphragm contracts, raising thoracic pressure, forcing exhalation.
B. The FEV1 is the total volume of gas exhaled after maximal inhalation
C. Acute Hyperventilation causes a drop in PCO2
D. PEFR is the volume of gas exhaled in the first second
E. Ventilation is primarily driven by a drop in PO2

C. Acute Hyperventilation causes a drop in PCO2

35

Which of these arterial blood test values would you expect to find in a normal, healthy adult male at rest?

A. [Haemoglobin] = 8 g/dl
B. PO2 = 11.9kPa
C. pH = 7.25
D. PCO2 = 8.1kPa
E. Base Excess = -3mmol/L

B. PO2 = 11.9kPa

36

Which of the following statements about breathing at altitude and at depth is incorrect?

A. The partial pressure of all gases at the summit of a 3500m mountain will be significantly lower than at sea level.
B. Shallow water blackout is caused by a reduced urge to breathe underwater even during hypoxia.
C. Atmospheric pressure in a commercial aircraft cabin is lower than normal atmospheric pressure at sea level.
D. Boyles law does not apply to breath-hold divers because they do not have an oxygen reservoir.
E. Noble gases such as helium are used to mix oxygen for divers working in very deep water

D. Boyles law does not apply to breath-hold divers because they do not have an oxygen reservoir.

37

The following points about pulmonary surfactant are correct, except:

A. That it increases lung compliance
B. That it promotes atelectasis
C. That it is needed because of the of the Law of Laplace
D. That it contributes to innate immunity
E. That is is produced by Type 2 pneumocytes

B. That it promotes atelectasis