2009

In a 58-year-old woman with difficulty breathing, the TLC and FRC are lower than
normal and FEV1/FVC is slightly higher than normal. These findings are most consistent with
which of the following?
Increased lung elastic recoil
Decreased pulmonary blood flow
Decreased strength of the chest wall muscles
Increased airway resistance
Increased chest wall elastic recoil
A patient has reduced TLC and increased RV. FRC is normal. These findings are most
consistent with which of the following?
Decreased strength of the muscles of respiration
Decreased pulmonary blood flow
Increased airway resistance
Increased chest wall elastic recoil
Increased lung elastic recoil
A chest x-ray of a patient with left-sided heart failure indicates pulmonary edema.
Additional examination probably would reveal which of the following?
Increased pulmonary venous pressure
Decreased pulmonary artery pressure
Decreased pulmonary lymph flow
Normal arterial oxygen partial pressure
Normal vital capacity
A 24-year-old medical student awakens to get ready for classes. When he arises from a
lying down to a standing up position, changes occur to his lungs. Which of the following
describes the alterations that occur in the alveoli at the top of his lungs compared with those at
the bottom of his lungs?
Have larger radii
Exhibit greater compliance
Have a lower ventilation-perfusion ratio
Receive a greater percentage of the pulmonary blood flow
Receive a greater percentage of the tidal volume
A premature newborn infant is noted to have a deficiency of pulmonary surfactant.
Which of the following muscles will the infant likely require to use to accomplish adequate
respiration?
Diaphragm, external intercostals, scalene, sternomastoids
Diaphragm, internal intercostals, scalene, sternomastoids
Diaphragm,internal intercostals,sternomastoids,rectus abdominis
Diaphragm, external intercostals, internal intercostals, rectus abdominis
Diaphragm, external intercostals, scalene, rectus abdominis
A pulmonary physiologist notes that the lung characteristics of individuals who lack
surfactant and those with pulmonary fibrosis are similar. Which of the following occurs in
patients who lack surfactant but not in patients with pulmonary fibrosis?
Collapse of small alveoli and expansion of large alveoli
Decreased lung compliance
Decreased total lung capacity
Increased work of breathing
Intrapleural pressures more subatmospheric than normal
A 35-year-old man is noted to have generalized weakness of the skeletal muscles but is
otherwise normal. Which of the following lung volumes or lung capacities most likely would be
normal?
Functional residual capacity
Inspiratory reserve volume
Residual volume
Total lung capacity
Vital capacity
A 15-year-old female has the autosomal recessive disease cystic fibrosis. The airway
epithelial cells secrete mucus that is more viscous than normal. Which of the following happens
as a consequence?
Mucus is propelled orally more slowly
Bacteria are cleared more readily from the airways
Cilia on the epithelial cells beat more easily
Inhaled particles are not trapped
A 56-year-old female is brought into the office complaining of difficulty breathing for
several weeks. Physical examination is performed, and office spirometry is utilized. The, total
lung capacity (TLC) and functional residual capacity (FRC) are noted to be greater than normal,
and forced vital capacity (FVC) and FEV1/FVC are lower than normal. These findings are most
consistent with which of the following?
Increased airway resistance
Decreased lung compliance
Decreased strength of the chest wall muscles
Increased chest wall compliance
The lung function tests of a patient show a markedly reduced FEV1 and an FRC of 4.2 L
(normal 2.3 L). Which of the following is the most likely cause of the reduced FEV1?
Dynamic compression of airways
Weak expiratory muscles
Small-diameter airways
Pulmonary congestion
Pulmonary fibrosis
Mr Smith complains of shortness of breath and difficulty with moderate exercise.
Pulmonary function tests indicate a reduced FRC, and his FEV1 was 2.6 L (78%). His FVC was
3.1 L (70%). Which of the following is the most likely cause of Mr Smith’s problems?
Pulmonary fibrosis
Weak expiratory muscles
Small-diameter airways
Pulmonary congestion
Dynamic compression of airways
A 36-year-old woman undergoes chemotherapy with bleomycin for an ovarian germ cell
cancer. She develops mild pulmonary fibrosis secondary to the chemotherapy. Which of the
following agents is most likely affected in its diffusion across the alveoli-pulmonary capillary
barrier?
CO
CO2
N2O
O2
A 32-year-old woman is theorizing that breathing 100% oxygen should increase the
amount of oxygen in her blood about fivefold, because room air is composed of approximately
21% oxygen. Which of the following statements is the most accurate answer to her hypothesis?
The amount of oxygen carried in her blood will not rise appreciably.
The amount of oxygen carried by her hemoglobin probably will increase markedly,but the
amount soluble in her serum will remain the same.
The amount of oxygen in her blood will rise about fivefold.
The partial pressure of oxygen in her blood probably will remain unchanged.
A 56-year-old man is admitted to the coronary care unit (CCU) for an acute inferior wall
myocardial infarction. The cardiologist is trying to optimize the oxygen delivery to the
myocardial tissue. Supplemental oxygen is provided by nasal cannula at 3 L/min. Which of the
following best describes the oxygen-carrying capacity of whole blood?
The sum of the dissolved O2 plus the amount of O2 bound to hemoglobin under saturating
conditions
Dependent on the alveolar PO2
The amount of O2 dissolved in the blood
The sum of the dissolved O2 plus the amount bound to hemoglobin
Limited by O2 diffusion
In the case above, the patient had been sleeping in a small room at his house heated with
a space heater. He suffered from carbon monoxide poisoning. The carbon monoxide has bound
to hemoglobin and reduced its oxygen-binding capacity. Which of the following best describes
the PO2 level in the patient’s arterial blood when the paramedics were called to evaluate him?
Dependent on the alveolar PO2
Dependent on the amount of CO bound to hemoglobin
Increased from normal because of displaced oxygen from hemoglobin
Reduced from normal because of the CO bound to hemoglobin
O2 binding to hemoglobin in the pulmonary capillary is inhibited by which of the
following?
Shift to more acidic pH than is found in venous blood
CO2 dissociation from hemoglobin
Diffusion of CO2 from pulmonary capillary to alveolus
Reaction of bicarbonate with H+
A 17-year-old male develops pneumonia, diabetic ketoacidosis, and metabolic acidosis.
Respiratory compensation to a metabolic acidosis consists of hyperventilation to lower the
arterial PCO2. The cause of the hyperventilation is described by which of the following
statements?
H+ stimulates peripheral chemoreceptors.
CO2 produced from the reaction of the acid with bicarbonate stimulates central chemoreceptors.
A decrease in the bicarbonate concentration stimulates ventilation.
H+ stimulates central chemoreceptors.
A 21-year-old woman is admitted to the intensive care unit for an opiate drug overdose
that probably has suppressed her central chemoreceptor response to CO2, diminishing the drive
for ventilation. Her respiratory rate is diminished at eight breaths per minute. Which of the
following is the best course of action for this patient?
Leaving the patient on room air
Administration of oxygen by mask
Administration of benzodiazepine for possible alcohol withdrawal
Placing the patient on a low opiate infusion to prevent opiate withdrawal
A 29-year-old man who lives at sea level drives up a mountain to a high altitude (17,000
feet) for over 3 hours. Which of the following statements best describes his condition after the
elevation climb?
Decreased arterial PCO2
Increased arterial PO2
Decreased arterial pH
Decreased respiratory rate

2010
Which one of the following returns closest to normal during chronic respiratory acidosis?
Arterial concentration of hydrogen ion
Alveolar ventilation
Arterial PCO2
Arterial PO2
Plasma concentration of bicarbonate
A respiratory acidosis that results in an increase in the concentration of hydrogen ion in
arterial blood from 40 meq/L (pH 7.4) to 50 meq/L (pH 7.3) would
Stimulate the peripheral chemoreceptors
Decrease the amount of ammonium excreted in the urine
Inhibit the central chemoreceptors
Increase the pH of the urine
Decrease the concentration of HCO3− in arterial blood
The basic respiratory rhythm is generated in the
Dorsal medulla
Apneustic center
Nucleus parabrachialis
Pneumotaxic center
Cerebrum
At the end of a quiet inspiration, intra-alveolar pressure is normally
0 cm H2O
240 cmH2O
24 cmH2O
14 cmH2O
140 cmH2O
A woman has a respiratory rate of 18, a tidal volume of 350 mL, and a dead space of 100
mL. What is her alveolar ventilation?
4.5 L
4.0 L
5.0 L
5.5 L
6.0 L
The woman in the preceding question has a normal PaCO2 of 40 mmHg. If she increases
her tidal volume by 75 mL, her PaCO2 will become approximately
30 mmHg
15 mmHg
20 mmHg
25 mmHg
35 mmHg
Which one of the following would increase in obstructive, but not in restrictive, lung
disease?
Functional residual capacity
Vital capacity
Maximum breathing capacity
During the early stages of an asthmatic attack,
Arterial carbon dioxide tension decreases
The equal pressure point moves toward the mouth
Lung compliance increases
Airway resistance decreases
Arterial oxygen tension increases
Which one of the following will decrease in a person with ventilationperfusion (V/Q)
abnormalities?
Arterial carbon dioxide tension
Anion gap
Arterial pH
Alveolar-arterial (A-a) gradient for oxygen
Alveolar ventilation
Which one of the following is higher at the apex of the lung than at the base when a
person is standing?
V/Q ratio
Blood flow
Ventilation
PaCO2
Lung compliance
In areas of the lung with lower than normal V/Q ratios, the
Pulmonary vascular resistance is higher than normal
Capillary CO2 tension is lower than normal
Alveolar O2 tension is higher than normal
Water vapor pressure is higher than normal
Gas exchange ratio is higher than normal
Very small particles are removed from the respiratory system by
Phagocytosis
Bulk flow
Diffusion
Expectoration
Ciliary transport
Which of the following conditions causes a decrease in arterial O2 saturation without a
decrease in O2 tension?
Carbon monoxide poisoning
Anemia
A low V/Q ratio
Hypoventilation
Right-to-left shunt
The bulk of CO2 is transported in arterial blood as
Bicarbonate
Dissolved CO2
Carbonic acid
Carbaminohemoglobin
Carboxyhemoglobin
The partial pressure of oxygen inhaled from a tank containing 21% O2 by divers at a
depth of 100 ft below sea level (4 atmospheres) is approximately
200 mmHg
40 mmHg
100 mmHg
600 mmHg
1200 mmHg
Peripheral and central chemoreceptors may both contribute to the increased ventilation
that occurs as a result of
An increase in arterial carbon dioxide tension
A decrease in arterial oxygen content
A decrease in arterial blood pressure
A decrease in arterial oxygen tension
An increase in arterial pH
Complete transection of the brainstem above the pons would
Prevent any voluntary holding of breath
Result in cessation of all breathing movements
Prevent the central chemoreceptors from exerting any control over ventilation
Prevent the peripheral chemoreceptors from exerting any control over ventilation
Abolish the Hering-Breuer reflex
A deficiency of pulmonary surfactant would
Decrease lung compliance
Decrease surface tension in the alveoli
Decrease the change in intrapleural pressure required to achieve a given tidal volume
Decrease the work of breathing
Increase functional residual capacity (FRC)
Which one of the following is higher at total lung capacity than it is at residual volume?
Anatomical dead space
Maximum static inspiratory pressure
Lung compliance
Airway resistance
Alveolar pressure
Which one of the following components of a pulmonary function test will be closest to
normal in a patient with restrictive lung disease?
MVV
FEV1
FVC
FEV1/FVC
TLC
A man breathing room air at sea level has a PaCO2 of 48 mmHg. His alveolar oxygen
tension (PaO2) is
90 mmHg
150 mmHg
110 mmHg
100 mmHg
60 mmHg
Measurement of the lecithin-sphingomyelin (L-S) ratio in amniotic fluid assesses
Fetal lung maturity
The placenta’s ability to oxygenate the fetus
Fetal adrenal function
Fetal kidney development
Fetal brain development
When the respiratory muscles are relaxed, the lungs are at
Functional residual capacity (FRC)
Residual volume (RV)
Expiratory reserve volume (ERV)
Inspiratory reserve volume (IRV)
Total lung capacity (TLC)
Which one of the following is the most likely cause of a high arterial PCO2?
Depressed medullary respiratory centers
Increased metabolic activity
Increased alveolar dead space
Alveolar capillary block
Increased alveolar ventilation
Because the small airways produce a small fraction of the airway resistance, their
obstruction is difficult to detect. Which one of the following changes is indicative of small rather
than large airway obstruction?
An increase in the closing volume of the lung
An increase in maximum airflow during a forced expiration
A decrease in the maximum expiratory pressure that can be generated
An increase in the turbulent airflow produced during inspiration
A decrease in the forced vital capacity
Pulmonary vascular resistance decreases if
Cardiac output is increased
The lungs are inflated to total lung capacity
Sympathetic stimulation to the pulmonary vessels is increased
Alveolar oxygen tension is decreased
Plasma hydrogen ion concentration is decreased
Which of the following would normally be less in the fetus than in the mother?
PaO2
PaCO2
Pulmonary vascular resistance
Affinity of hemoglobin for oxygen
Arterial hydrogen ion concentration
An increase in the P50 of an oxyhemoglobin curve would result from a decrease in
pH
Metabolism
Temperature
Oxygen
2,3-DPG
During moderate aerobic exercise,
Alveolar ventilation increases
PaO2 increases
PaCO2 decreases
Arterial pH decreases
Blood lactate level increases
Reduction of functional hemoglobin associated with anemia, methemoglobinemia, or
carbon monoxide poisoning does not produce hyperpnea because the
PO2 of arterial blood is normal
Blood flow to the carotid body is decreased
Total arterial oxygen content is maintained within the normal range
Carotid body chemoreceptors are stimulated
Central chemoreceptors are stimulated
Pulmonary alveoli are kept dry by factors that include the
Negative interstitial fluid pressure
Phagocytic activity of alveolar macrophages
Low vapor pressure of water in inspired air
Secretion of surfactant
Tight junctions between the alveolar capillary endothelial cells
In which one of the following conditions will the diffusing capacity of the lung increase?
Polycythemia
Formation of pulmonary emboli
Fibrotic lung disease
Congestive heart failure
COPD
The percentage of hemoglobin saturated with oxygen will increase if
The arterial PO2 is increased
The arterial PCO2 is increased
The hemoglobin concentration is increased
The temperature is increased
The arterial pH is decreased
Which of the following will return toward normal during acclimatization to high altitude?
Arterial hydrogen ion concentration
Arterial carbon dioxide tension
Arterial bicarbonate ion concentration
Arterial hemoglobin concentration
Alveolar ventilation
Which one of the following statements characterizes pulmonary compliance?
It is inversely related to the elastic recoil properties of the lung
It decreases with advancing age
It increases in patients with pulmonary edema
It is equivalent to DP/DV
It increases when there is a deficiency of surfactant
The activity of the central chemoreceptors is stimulated by
An increase in the PCO2 of blood flowing through the brain
A decrease in the PO2 of blood flowing through the brain
A decrease in the oxygen content of blood flowing through the brain
A decrease in the metabolic rate of the surrounding brain tissue
An increase in the pH of the CSF
In an acclimatized person at high altitudes, oxygen delivery to the tissues may be
adequate at rest because of
An increase in hemoglobin concentration
The presence of an acidosis
A decrease in the number of tissue capillaries
The presence of a normal arterial PO2
The presence of a lower-than-normal arterial PCO2
Which of the following will increase as a result of stimulating parasympathetic nerves to
the bronchial smooth muscle?
Resistive work of breathing
Lung compliance
Airway diameter
Elastic work of breathing
Anatomic dead space
During a normal inspiration, more air goes to the alveoli at the base of the lung than to
the alveoli at the apex of the lung because
The alveoli at the base of the lung are more compliant
The alveoli at the base of the lung have more surfactant
The alveoli at the base of the lung have higher V/Q ratios
There is a more negative intrapleural pressure at the base of the lung
There is more blood flow to the base of the lung
A spirometer can be used to measure directly
Inspiratory capacity
Functional residual capacity
Residual volume
Total lung capacity
Physiological dead space
The affinity of hemoglobin for oxygen is increased by
Carbon monoxide poisoning
Metabolic acidosis
Exercise
Hypoxemia
Anemia
The oxygen consumption of the respiratory muscles is decreased by
A decrease in airway resistance
A decrease in lung compliance
An increase in the rate of respiration
A decrease in the production of pulmonary surfactant
An increase in tidal volume
Which one of the following characteristics is the most similar between the pulmonary and
skeletal muscle capillaries?
The capillary oncotic pressure
The interstitial protein concentration
The interstitial hydrostatic pressure
The capillary hydrostatic pressure
The capillary permeability to proteins
An increase in pulmonary blood flow during exercise
Causes pulmonary arterial resistance to decrease
Causes alveolar oxygen tension to decrease
Causes the V/Q ratio at the top of the lung to increase
Causes diffusion capacity to decrease
Causes arterial oxygen saturation to decrease
 Which one of the following will be greater than normal in a patient with a low V/Q ratio?
A-a gradient
PaCO2
PaO2
Oxygen dissolved in blood
Oxygen combined with hemoglobin
Which one of the following contributes to the normal difference between the alveolar and
arterial oxygen tension (A-a) gradient?
The shape of the oxyhemoglobin saturation curve
The low PO2 in the mixed venous blood
The inability of pulmonary capillary blood to equilibrate with alveolar gas
The low solubility of oxygen in blood
The high affinity of hemoglobin for oxygen in arterial blood
A patient with inadequate surfactant will have a relatively normal
FEV1/FVC
FEV1
FVC
MVV
V/Q ratio
Enzymes within the lung are responsible for the activation of
Angiotensin II
Bradykinin
Prostaglandins
Serotonin
Leukotrienes
When a person ascends to a high altitude, alveolar ventilation increases. Alveolar
ventilation continues to increase over the next several days because
The pH of the cerebrospinal fluid decreases
The central chemoreceptors become more sensitive to low oxygen tensions
The peripheral chemoreceptors increase their firing rate
The plasma concentration of 2,3-DPG increases
The oxygen-carrying capacity of hemoglobin increases
 The clinical sign of cyanosis is caused by
An increase in the concentration of deoxygenated hemoglobin
An increase in the affinity of hemoglobin for oxygen
A decrease in the percent of red blood cells (hematocrit)
An increase in the concentration of carbon monoxide in the venous blood
A decrease in the concentration of iron in the red blood cells
Which one of the following gases diffuses across the alveoli-capillary membrane by a
diffusion-limited transport process?
Carbon monoxide
Oxygen
Nitrogen
Carbon dioxide
Nitrous oxide (N2O)
Hyperventilation normally occurs during a
Pregnancy
Sleep
Morphine administration
Exercise
Metabolic alkalosis
Hyperventilation in response to a stressful situation leads to
A decrease in the blood flow to the brain
An increase in the activity of the central chemoreceptors
A decrease in pH of the arterial blood
An increase in the resistance of the pulmonary blood vessels
A decrease in the excitability of nerve and muscle cells
Patients with chronic lung disease are often divided into “blue bloaters” (those who are
cyanotic) and “pink puffers” (those who are not cyanotic). The presence of cyanosis in blue
bloaters but not in pink puffers results from difference in their
V/Q ratios
Vital capacities
Airway resistances
Total lung capacities
Expiratory flow rates
 A patient with reduced VC, FRC, and RV is found to have a normal pH. A tentative
diagnosis of diffuse interstitial fibrosis is made. Which of the following characteristics are
consistent with this disease?
An increase in the FEV1/FVC ratio
An increase in lung compliance
A decrease in respiratory rate
An increase in the V/Q ratio
A decrease in PaCO2
Airway resistance is lowest
At the total lung capacity
During a forced expiration
At the residual volume
During vagal stimulation
When breathing gas with low oxygen

2014
A group of third-year medical students accompanied a medical mission team to Peru,
South America. After arriving at the airport in Bolivia, they hiked to a remote mountain village
in the Andes at an elevation of 18,000 ft. With a barometric pressure of 380 mm Hg at this
altitude, what would be the resulting PO2 of the dry inspired air?
80 mm Hg
160 mm Hg
100 mm Hg
70 mm Hg
38 mm Hg
A 28-year-old man is admitted to the emergency department with multiple fractures
suffered in a car accident. Arterial blood gases are ordered while the patient is breathing room
air. After the first-year resident obtains an arterial blood sample from the patient, the glass
plunger slides back, drawing an air bubble into the syringe before it is handed to the blood gas
technician for analysis. How does exposure to room air affect the measured values of PO2 and
PCO2 in arterial blood?
The measured PaO2 will be higher and the measured PaCO2 will be lower than the patient’s
actual blood gas values.
The measured values of both PaO2 and PaCO2 will be higher than the patient’s actual values.
The measured values of both PaO2 and PaCO2 will be lower than the patient’s actual values.
The measured PaO2 will be lower and the measured PaCO2 will be higher than the patient’s
actual blood gas values.
The measured values of PaO2 and PaCO2 will accurately reflect the actual values.
A 68-year-old woman with pulmonary fibrosis presents with a complaint of increasing
dyspnea while performing activities of daily living. She is referred for pulmonary function
testing to assess the progression of her disease. Which of the following laboratory values is
consistent with her diagnosis?
Decreased diffusing capacity of the lung
Increased residual volume
Decreased forced expiratory volume exhaled in 1 second (FEV1)/forced vital capacity (FVC)
Increased lung compliance
Increased airway resistance corrected for lung volume
An insulation worker presents with a chief complaint of dyspnea on exertion. Pulmonary
function test is consistent with a restrictive impairment. His arterial PO2 is normal at rest but
hypoxemic during exercise stress testing. Which of the following is the most likely explanation
for the decline in the patient’s PaO2 during exercise compared with rest?
An underlying diffusion impairment coupled with a decrease in pulmonary capillary transit time
during exercise
A decreased partial pressure gradient for O2 diffusion during exercise
A decreased surface area for diffusion during exercise
An increase in hemoglobin’s affinity for O2 during exercise resulting in more oxygen being
transported as oxyhemoglobin and less in the dissolved state
An increased uptake of oxygen from the blood by exercising skeletal muscles
A 125-lb, 40-year-old woman with a history of nasal polyps and aspirin sensitivity since
childhood presents to the emergency department with status asthmaticus and hypercapnic
respiratory failure. She requires immediate intubation and is placed on a mechanical ventilator
on an FIO2 of 40%, a control rate of 15 breaths per minute, and a tidal volume of 500 mL.
Which of the following is her approximate alveolar ventilation?
5625 mL/min
375 mL/min
3500 mL/min
5250 mL/min
7500 mL/min
A 36-year-old man with a history of AIDS and Pneumocystis infection presents to the
emergency department with severe respiratory distress. The patient is placed on a ventilator at a
rate of 16, tidal volume of 600 mL, and FIO2 of 1.0. An arterial blood sample taken 20 minutes
later reveals a PO2 of 350 mm Hg, a PCO2 of 36 mm Hg, and a pH of 7.32. At a barometric
pressure of 757 mm Hg, and assuming a normal respiratory exchange ratio (R) of 0.8, the
patient’s alveolar oxygen tension is approximately which of the following?
665 mm Hg
105 mm Hg
355 mm Hg
576 mm Hg
712 mm Hg
A 58-year-old woman experiences an acute exacerbation of asthma, which causes her
breathing to become labored and faster. As a result, which of the following changes in airflow is
expected?
The pressure gradient required for airflow will increase.
Flow in the trachea and upper airways will become more laminar.
The resistance to airflow will decrease.
The resistance to airflow will increase linearly with the decrease in airway radius.
Reynolds number will decrease.
A newborn of 28 weeks of gestation develops respiratory distress syndrome. Mechanical
ventilation on 100% O2 with 10 cm H2O of positive end-expiratory pressure (PEEP) does not
provide sufficient oxygenation. After porcine surfactant is instilled via a fiberoptic
bronchoscope, the PaCO2, fraction of inspired oxygen (FIO2), and shunting improve
impressively. The improvements in respiratory function occurred because surfactant increased
which of the following?
Lung compliance
Alveolar surface tension
Bronchiolar smooth muscle tone
The pressure gradient needed to inflate the alveoli
The work of breathing
A 14-year-old adolescent girl presents with a lump in the neck. Fine needle aspiration
biopsy reveals acinic cell carcinoma of the parotid gland. During the parotidectomy, there is
compression injury of the glossopharyngeal nerve. As a result, which of the following respiratory
reflexes will be impaired?
Carotid body chemoreceptor reflex
Aortic baroreceptor reflex
Hering–Breuer inflation reflex
Irritant airway reflex
Juxta pulmonary capillary (J) receptor reflex
 Noninvasive color Doppler ultrasound studies are ordered on a term infant and a preterm
infant of 28 weeks gestation. Which of the following is likely to have a lower value in the
preterm infant compared with the term infant?
Pulmonary blood flow
Blood flow from the pulmonary artery through the ductus arteriosus
Pulmonary artery pressure
Pulmonary capillary hydrostatic pressure
Pulmonary vascular resistance
A 62-year-old man with congestive heart failure (CHF) develops increasing shortness of
breath in the recumbent position. A chest x-ray reveals cardiomegaly, horizontal lines
perpendicular to the lateral lung surface indicative of increased opacity in the pulmonary septa,
and lung consolidation. Pulmonary edema in CHF is promoted by which of the following?
Increased pulmonary capillary hydrostatic pressure
Decreased pulmonary capillary permeability
Decreased pulmonary interstitial oncotic pressure
Increased pulmonary capillary oncotic pressure
Increased pulmonary interstitial hydrostatic pressure
A 76-year-old patient with emphysema presents for his annual pulmonary function testing
to assess the progression of his disease. As a result of alveolar septal departitioning in
emphysema, there is a decrease in which of the following?
Diffusing capacity
Airway resistance
Alveolar dead space
Lung compliance
Total lung capacity
A 35-year-old woman with gestational diabetes develops hypertension and preeclampsia,
requiring the preterm delivery of her fetus of 30 weeks of gestation. The woman is given two
doses of betamethasone, 12 mg, intramuscularly, 24 hours apart. Which of the following is the
purpose of prenatal steroid therapy?
Increase the lecithin/sphingomyelin ratio in the amniotic fluid
Increase blood flow from the right atrium into the left atrium across the foramen ovale
Increase blood flow to the fetal lungs
Increase fetal PO2
Shift the fetal oxyhemoglobin dissociation curve to the right
A person with CHF and progressive shortness of breath is admitted to the hospital for
cardiac transplantation surgery. Hemodynamic recordings made with a Swan–Ganz catheter
were as follows: Mean pulmonary artery pressure (PAP): 35 mm Hg Mean left atrial pressure
(LAP): 20 mm Hg Pulmonary artery wedge pressure (PAWP): 25 mm Hg Cardiac Output: 3
L/min On a previous admission, the patient’s LAP was 15 mm Hg and cardiac output was 4
L/min. What can be deduced from these data?
Cardiac contractility is lower than on the previous admission.
Left ventricular preload is lower than on his previous admission.
Net fluid absorption into the pulmonary capillaries is increased.
Pulmonary capillary hydrostatic pressure is lower than normal.
Pulmonary vascular resistance is lower than normal at present.
A 68-year-old man with chronic obstructive pulmonary disease (COPD) entered the
emergency department complaining of shortness of breath. His respirations were 35 per minute
and labored. He had a productive cough and rales were heard over all lung fields. The patient had
a rather ashen complexion and his nail beds gave clear evidence of cyanosis. An arterial blood
sample was obtained and a chest x-ray was ordered. The patient was then placed on an O2 mask
delivering 40% O2. Onehalf hour later, the physician was called to the bedside by the nurse who
found the patient unresponsive. The patient’s complexion had changed to a flushed pink with no
trace of cyanosis. His respirations were quiet at a rate of 6 per minute and a tidal volume of 300
mL. Repeat arterial blood gases showed that his arterial PCO2 had increased from 55 to 70 mm
Hg, and his PaO2 increased from 55 to 70 mm Hg. Oxygen therapy most likely resulted in which
of the following?
Alveolar hypoventilation
Elimination of the hypercapnic drive
Hypoxic pulmonary vasoconstriction
Increased firing of carotid body chemoreceptors
Oxygen toxicity
A 42-week gestation infant is delivered by cesarean section. Which of the following
occurs with the baby’s first diaphragmatic respiration?
PaO2 increases.
All of the fetal vascular channels functionally close.
Pulmonary capillary hydrostatic pressure increases.
Pulmonary vascular resistance increases.
Systemic vascular resistance decreases.
A 29-year-old woman is admitted to the hospital because of increasing dyspnea and
swelling of both feet. An examination of her chest shows a severe pectus excavatum with only 2
cm of space between the vertebral bodies and the sternum. Pulmonary function tests show FVC
and FEV1/FVC values that were 15% and 100%, respectively, of predicted. Which of the
following laboratory measurements will most likely be below normal in this patient?
Arterial pH
Arterial PCO2
Elastic recoil of the chest wall
Hemoglobin concentration
Plasma bicarbonate concentration
An 18-year-old male college freshman living in a dormitory contracts meningitis, which
causes a centrally mediated increase in his respiratory rate. The pacemaker neurons responsible
for respiratory rhythmogenesis are located in which of the following regions of the brain?
Pre-Bötzinger complex in the ventral respiratory group
Apneustic center in the pons
Central chemoreceptors in the medulla
Inspiratory neurons in the dorsal respiratory group
Pontine respiratory groups
A 56-year-old man presents to the emergency department with severe abdominal pain and
a temperature of 103°F. The patient is in severe respiratory distress. Moderate amounts of
pulmonary edema fluid are aspirated during suctioning. The patient is placed on a ventilator with
an FIO2 of 0.5 and an arterial blood gas sample reveals a PO2 of 160 mm Hg and a PCO2 of 40
mm Hg. His alveolar oxygen tension, at a barometric pressure of 747 mm Hg and a respiratory
exchange ratio (R) of 0.8, is approximately what?
300 mm Hg
100 mm Hg
200 mm Hg
400 mm Hg
500 mm Hg
A 68-year-old man who has COPD presents to his pulmonologist with fatigue, dyspnea at
rest, and peripheral edema. His blood gases on room air are PaO2 = 60 mm Hg, PaCO2 = 60 mm
Hg, and pH = 7.36. His alveolar–arterial (A–a) O2 gradient, at a barometric pressure of 760 mm
Hg and a respiratory exchange ratio (R) of 0.8, is approximately what?
15 mm Hg
5 mm Hg
10 mm Hg
20 mm Hg
25 mm Hg
A 45-year-old man presents with severe back pain that he attributes to an injury from
operating a jackhammer for his job as a cement worker. An MRI of the spine confirms a
herniated disk. The patient reports that he has smoked one to two packs of cigarettes a day for 30
years, so the neurosurgeon requests pulmonary function studies prior to the patient’s back
surgery. During a forced expiration, the patient generates an intrapleural pressure of 20 mm Hg.
The patient’s equal pressure point will move closer to the mouth and forced expiratory volume
will increase if there is an increase in which of the following?
Inspired lung volume
Airway resistance
Airway smooth muscle tone
Expiratory effort
Lung compliance
A healthy, 24-year-old man is prescribed sustained-release bupropion (Zyban) for
smoking cessation. Three weeks later, he presents to his family physician with intermittent fever
and a generalized rash, at which time the bupropion is discontinued. A month later, he develops a
dry, intermittent cough and dyspnea. Which of the following pulmonary function results is
consistent with allergic bronchospasm?
A decreased FEV1/FVC
A decreased residual volume
An increased diffusing capacity
An increased FVC
An increased lung compliance
A 5-month-old infant is admitted to the hospital for evaluation because of repeated
episodes of sleep apnea. During a ventilatory response test, his ventilation did not increase when
PaCO2 was increased, but decreased during hyperoxia. Which of the following is the most likely
cause of this infant’s apnea?
Dysfunctional central chemoreceptors
Bronchospasm
Decreased irritant receptor sensitivity
Diaphragmatic fatigue
Peripheral chemoreceptor hypersensitivity
A 65-year-old smoker develops a squamous cell bronchogenic carcinoma that
metastasizes to the tracheobronchial and parasternal lymph nodes. The chest x-ray is consistent
with accumulation of fluid in the pulmonary interstitial space. Flow of fluid through the
lymphatic vessels will be decreased if there is an increase in which of the following?
Capillary oncotic pressure
Capillary permeability
Capillary pressure
Central venous pressure
Interstitial protein concentration
 A 24-year-old presents with a chief complaint of fatigue and daytime somnolence. His
wife has noticed that he stops breathing for periods of 30 to 60 seconds while he is sleeping and
that this happens many times throughout the night. His physician orders pulmonary function
testing including ventilatory response curves and polysomnography. The tests confirm apneic
episodes during sleep. During a ventilatory responsiveness test, his alveolar ventilation increased
as predicted in response to breathing 5% CO2, but his ventilatory response to breathing 16% O2
was depressed. Which of the following conditions are consistent with these findings?
Decreased peripheral chemoreceptor sensitivity
Central hypoventilation syndrome (Ondine curse)
Decreased central chemoreceptor sensitivity
Obstructive sleep apnea
Spinal cord injury affecting the fourth cervical vertebra
A 57-year-old woman presents with dyspnea on exertion. Pulmonary function studies
with plethysmography demonstrate an increased resting oxygen consumption and work of
breathing. Which of the following will decrease the oxygen consumption of the respiratory
muscles?
A decrease in airway resistance
A decrease in diffusing capacity of the lung
A decrease in lung compliance
An increase in rate of respiration
An increase in tidal volume
An 18-year-old man is life-flighted to a Level 1 trauma center after being thrown from his
motorcycle. It is determined that he has a brain tran-section above the pons. How will this lesion
affect the control of breathing in this patient?
The limbic system will no longer be able to exert any control over ventilation.
All breathing movements will cease.
The central chemoreceptors will no longer be able to exert any control over ventilation.
The peripheral chemoreceptors will no longer be able to exert any control over ventilation.
The Hering–Breuer reflex will be abolished.
A 48-year-old coal miner complains of shortness of breath and a productive cough. He
has smoked one to two packs of cigarettes per day since he was 16 years old. Pulmonary
function studies are ordered, including an esophageal balloon study to measure intrapleural
pressures. Normally, intrapleural pressure is negative throughout a tidal inspiration and
expiration because of which of the following?
The lungs and chest wall recoil away from each other throughout a tidal breath.
The lungs have the tendency to recoil outward throughout a tidal breath.
The chest wall has the tendency to recoil inward throughout a tidal breath.
The lungs and chest wall recoil in the same direction throughout a tidal breath.
A small volume of air leaves the pleural space during a tidal breath.
A 37-year-old woman is admitted to the hospital with severe kyphoscoliosis and
respiratory muscle weakness. Which of the following physiological variables is most likely
decreased in this patient?
Arterial carbon dioxide tension
Airway resistance
Alveolar surface tension
Chest wall compliance
FEV1/FVC
A 29-year-old man with AIDS presents with a painful, red, swollen area on top of his
shin, which is warm to the touch. He has a fever, tachypnea, and tachycardia, and is hospitalized
and started on IV antibiotics. His condition progresses rapidly to septicemia and septic shock. He
is transported to the ICU, intubated, and started on mechanical ventilation. A Swan-Ganz
catheter is inserted to monitor pulmonary hemodynamics and lung fluid balance. Which of the
following conditions will cause a decrease in PVR?
Increased cardiac output
Alveolar hypoxia
Decreased pH in the pulmonary artery
Inflation of the lungs to total lung capacity
Sympathetic stimulation of the pulmonary vessels
A healthy 32-year-old woman undergoes pulmonary exercise stress testing prior to
starting a training regimen in preparation for her first marathon. Normally, during moderate
aerobic exercise, which of the following occurs?
Alveolar ventilation increases
Arterial pH decreases
Arterial lactate level increases
PaCO2 decreases
PaO2 increases
A 56-year-old woman presents to her physician complaining of fatigue, headaches, and
dyspnea on exertion. She states that she sometimes gets blue lips and fingers when she tries to
exercise. Pulmonary function tests reveal an increase, rather than a decrease, in the diffusing
capacity of the lung. Which of the following conditions best accounts for an increase in the
diffusing capacity?
Polycythemia
CHF
COPD
Fibrotic lung disease
Pulmonary embolism
A 49-year-old farmer develops headache and becomes dizzy after working on a tractor in
his barn. His wife suspects carbon monoxide poisoning and brings him to the emergency
department where he complains of dizziness, lightheadedness, headache, and nausea. The
patient’s skin is red, he does not appear to be in respiratory distress, and denies dyspnea. Blood
levels of carboxyhemoglobin are elevated. Which of the following best explains the absence of
respiratory signs and symptoms associated with carbon monoxide poisoning?
Arterial oxygen tension is normal
Blood flow to the carotid body is decreased
Arterial oxygen content is normal
Cerebrospinal fluid (CSF) pH is normal
Central chemoreceptors are depressed
A 68-year-old patient with shortness of breath is referred for pulmonary function testing,
including lung volumes, flow–volume curves, and lung compliance. Which of the following
statements best characterizes lung compliance?
It is inversely related to the elastic recoil properties of the lung.
It decreases with advancing age.
It increases when there is a deficiency of surfactant.
It increases in patients with pulmonary edema.
It is equivalent to ΔP/ΔV.
A 36-year-old man visits his doctor because his wife has long complained of his snoring,
but recently observed that his breathing stops for a couple of minutes at a time while he is
sleeping. He undergoes polysomnography and ventilatory response testing to ascertain the extent
and cause of his sleep apnea. The activity of the central chemoreceptors is stimulated by which
of the following?
An increase in the PCO2 of blood flowing through the brain
A decrease in the metabolic rate of the surrounding brain tissue
A decrease in the PO2 of blood flowing through the brain
An increase in the pH of the CSF
Hypoxemia, hypercapnia, and metabolic acidosis
A patient complains of paroxysmal episodes of not being able to catch her breath. When
no abnormalities are detected with conventional pulmonary function screening, the
pulmonologist orders a methacholine challenge test. Which of the following will increase as a
result of stimulating cholinergic receptors on the bronchial smooth muscle?
Resistive work of breathing
Airway diameter
Anatomic dead space
Compliance of the lungs
Elastic work of breathing
A 43-year-old woman with a history of asthma presents to the emergency department
with an acute asthma attack after her bronchodilator inhaler ran out the day before. Airway
resistance is greater at which of the following?
At low lung volumes compared with high lung volumes
At lower values for Reynolds number
During inspiration compared with expiration
In the total cross-section of the small airways compared with the total cross-section of the central
airways
With laminar flow than with turbulent flow
A 78-year-old woman presents to her family physician’s office with a chief complaint of
fatigue and shortness of breath. The doctor indicates that he wants her to go to the hospital to get
some pulmonary function tests, but there is one who is able to do in the office. A spirometer can
be used to directly measure which of the following?
Vital capacity
FRC
Peak flow rate
Residual volume
Total lung capacity
A 24-year-old woman presents to her family physician with intractable hiccups. The
patient is instructed to breathe into and out of a bag in order to rebreathe exhaled CO2. In the
blood, the majority of CO2 is transported as which of the following forms?
Bicarbonate
Carbaminohemoglobin
Carbonic acid
Carboxyhemoglobin
Dissolved CO2
A 37-year-old man presents with low exercise tolerance. Blood work shows a normal
hematocrit and Hb concentration but a decreased P50. Which would be true of his
oxyhemoglobin transport and dissociation?
Hb’s affinity for oxygen is increased
O2 loading at the alveolar-capillary level is less than normal
O2 saturation is lower than normal at any PaO2
O2 unloading is increased at the tissue level
The differential diagnosis includes a point mutation resulting in increased binding of H+ to his
Hb chains.