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Respiratory
Questions ANATOMY AND PHYSIOLOGY
1. Which six structures make up the conducting zone of the respiratory tree? (p. 502) _____________ ______________________________________________________________________________ 2. What are the four functions of the conducting zone of the respiratory tree? (p. 502) _____________ ______________________________________________________________________________ 3. Which anatomic areas are encompassed by the respiratory zone, and what is their major function? (p. 502) ________________________________________________________________________ Match the functions and characteristics with the cell type that best describes them. (Numbers may be used more than once.) (p. 502) _____ A. Clear debris from alveoli _____ B. Ciliated _____ C. Comprise 3% of pneumocytes _____ D. Cuboidal _____ E. Degrade toxins _____ F. Make up the majority of pneumocytes _____ G. Nonciliated _____ H. Precursors to type I pneumocytes _____ I. Produce surfactant _____ J. Squamous cells 5. 6. 1. 2. 3. 4. 5. Clara cells Macrophages Pseudostratified columnar cells Type I pneumocytes Type II pneumocytes

4.

What is the function of surfactant? (p. 502) ____________________________________________ An O2 molecule is in the alveolus. In order, note the cells that the O2 molecule will cross to be able to bind to heme in RBCs. (p. 502) ___________________________________________________ A CO2 molecule resides in an RBC within the capillary lumen. In order, note the cells that the CO2 molecule will cross before it is exhaled. (p. 502) ________________________________________ Which two arteries are found in the center of each bronchopulmonary segment? (p. 503) _______ ______________________________________________________________________________

7.

8.

9.

Which two structures are found along the borders of each bronchopulmonary segment? (p. 503) __ ______________________________________________________________________________

10. 11.

During quiet breathing, which muscle is used for inspiration? (p. 504) _______________________ During quiet breathing, which muscle is used for expiration? (p. 504) ________________________

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12.

During exercise, which three muscle groups are used for inspiration? (p. 504) _________________ ______________________________________________________________________________

13.

Name the four abdominal wall muscle groups and the chest wall muscles used for expiration during exercise. (p. 504) ________________________________________________________________

PHYSIOLOGY
14. Match the term with its description. (p. 504) _____ A. Additional air that can be inspired after a normal breath _____ B. Air remaining in lung after maximal expiration _____ C. Air that can still be exhaled after normal expiration _____ D. Air that moves into lung with each quiet inspiration _____ E. IRV + TV _____ F. IRV + TV + ERV + RV _____ G. RV + ERV _____ H. TV + IRV + ERV 1. 2. 3. 4. 5. 6. 7. 8. ERV FRC IC IRV RV TLC TV VC

15.

On the image below, fill in the rectangles to describe the lung volume measurement. (p. 504)

16.

In which three conditions is lung compliance decreased? (p. 505) __________________________ ______________________________________________________________________________

17.

What are the two forms of hemoglobin? Which has a greater affinity for O 2? (p. 505) ___________ ______________________________________________________________________________

18.

When the oxygen-hemoglobin dissociation curve shifts to the right, the affinity of hemoglobin for O2 __________ (decreases/increases). When the oxygen-hemoglobin dissociation curve shifts to the left, the affinity of hemoglobin for O2 __________ (decreases/increases). (p. 506)

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19.

In the chart below, checkmark whether the effect shifts the oxygen-hemoglobin dissociation curve to the left or to the right. (p. 506) Effect Decreased 2,3-DPG Decreased pH Decreased temperature Fetal hemoglobin High altitude Increased metabolic needs Increased pH Increased temperature Shift to the Left Shift to the Right

20. 21.

How is the A-a gradient calculated? (p. 508) ___________________________________________ Which three pathologic processes can lead to an increased A-a gradient? (p. 508) ____________ ______________________________________________________________________________

22.

Which two processes lead to hypoxemia with a normal A-a gradient? (p. 508) ________________ ______________________________________________________________________________

23.

Which three processes can lead to hypoxemia with an increased A-a gradient? (p. 508) ________ ______________________________________________________________________________

24.

Name five processes that can lead to hypoxia (i.e., decreased O2 delivery to tissue). (p. 508) ______________________________________________________________________________ With respect to the lung apex (zone 1), arrange the following in order of increasing pressure: artery, vein, alveolus. (p. 509) ____________________________________________________________ With respect to zone 2 of the lung, arrange the following in order of increasing pressure: artery, vein, alveolus. (p. 509) ____________________________________________________________ With respect to the lung base (zone 3), arrange the following in order of increasing pressure: artery, vein, alveolus. (p. 509) ____________________________________________________________ In which forms is CO2 transported from the tissues to the lungs? (p. 509) ____________________ What enzyme catalyzes the conversion of CO2 and water into carbonic acid? (p. 509)___________ ______________________________________________________________________________

25.

26.

27.

28. 29.

30.

What is the name for the effect in which oxygenation of hemoglobin within the lungs promotes the dissociation of CO2 from hemoglobin? (p. 509) _________________________________________ In peripheral tissues, the right shift of the oxygen-hemoglobin dissociation curve that results from decreased pH causes an unloading of O2. What is the name for this effect? (p. 509) ____________

31.

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32.

For each item in the chart below, indicate whether altitude or exercise would induce the response. (p. 509) Effect Decreased pH Increased 2,3-DPG Increased CO2 production Increased erythropoietin Increased O2 consumption Increased mitochondria Increased pulmonary blood flow Increased renal excretion of bicarbonate Increased ventilation More uniform V/Q ratio from apex to base Right ventricular hypertrophy Response to Altitude Response to Exercise

PATHOLOGY
33. Name the six most common causes of emboli to the lungs. (p. 510) ________________________ ______________________________________________________________________________ 34. Which three factors that promote blood coagulation are collectively known as Virchow's triad? (p. 510) __________________________________________________________________________ For each patient, indicate the most likely type of pulmonary embolus. (p. 510) A. B. C. D. 36. A 30-year-old postpartum woman _______________________________________________ An 18-year-old man who sustained a motor vehicle collision __________________________ A 35-year-old professional wreck diver ___________________________________________ An 83-year-old woman with a hip fracture after falling _______________________________

35.

Match the characteristic finding with the obstructive lung disease with which it is associated. (Numbers may be used more than once.) (p. 510) _____ A. Associated with Kartageners syndrome _____ B. Chronic productive cough _____ C. Curschmanns spirals _____ D. Diminished breath sounds _____ E. Hypertrophy of mucus-secreting glands _____ F. Increased susceptibility to aspergillosis _____ G. Mucus plugs _____ H. Permanently dilated airways _____ I. Reid index >50% _____ J. Results from hyper-responsiveness of bronchi _____ K. Spontaneous pneumothorax _____ L. Wheezing and crackles on auscultation 1. 2. 3. 4. Asthma Bronchiectasis Chronic bronchitis Emphysema

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37. 38.

For patients with restrictive lung disease, what is the typical range of FEV1/FVC? (p. 511) _______ Which of the pneumoconioses is associated with an increased incidence of bronchogenic carcinoma? (p. 511) ______________________________________________________________ What are the risk factors for neonatal respiratory distress syndrome? (p. 511) _________________ ______________________________________________________________________________

39.

40.

What are the risk factors for acute respiratory distress syndrome? (p. 511) ___________________ ______________________________________________________________________________

41. 42. 43.

What is central sleep apnea? (p. 512) ________________________________________________ What is obstructive sleep apnea? (p. 512) _____________________________________________ Match the physical examination finding with its associated pathology. (p. 512) _____ A. _____ B. _____ C. _____ D. Dullness to percussion with fremitus Dullness to percussion with fremitus Tracheal deviation away from affected side Tracheal deviation toward affected side 1. 2. 3. 4. Bronchial obstruction Lobar pneumonia Pleural effusion Tension pneumothorax

44.

What are the four most common sites of lung cancer metastases? (p. 513) __________________ ______________________________________________________________________________

45.

Match the lung cancer with its characteristic. (Numbers may be used more than once.) (p. 513) _____ A. _____ B. _____ C. _____ D. _____ E. _____ F. _____ G. _____ H. _____ I. _____ J. _____ K. _____ L. _____ M. _____ N. _____ O. Amenable to surgical resection 1. Adenocarcinoma Arises in sites of prior injury 2. Carcinoid tumor Associated with asbestos exposure 3. Large cell carcinoma Associated with smoking 4. Mesothelioma Forms keratin pearls 5. Small cell carcinoma Inoperable 6. Squamous cell carcinoma May be associated with right heart failure May lead to Lambert-Eaton syndrome May produce ACTH or ADH Most common cancer among nonsmokers Parathyroid-like activity Pleomorphic giant cells with cytoplasmic leukocyte fragments in cytoplasm Precursors are neuroendocrine cells Psammoma bodies Secretes serotonin

PHARMACOLOGY
46. With respect to toxicity, what is the main difference between first- and second-generation H1blockers? (p. 514) ________________________________________________________________ What is the mechanism of action of albuterol? (p. 515) ___________________________________ Ipratropium is a member of which class of drugs? (p. 515) ________________________________

47. 48.

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49.

In the image below, fill in the rectangles to identify the treatments for asthma. (p. 515)

Answers ANATOMY AND PHYSIOLOGY

1. 2. 3. 4. 5. Nose, pharynx, trachea, bronchi, bronchioles, and terminal bronchioles. The conducting zone brings air in and out; it also warms, humidifies, and filters the air. The respiratory bronchioles, the alveolar ducts, and alveoli, all of which function in gas exchange. A-2, B-3, C-5, D-5, E-1, F-4, G-1, H-5, I-5, J-4. Decreases alveolar surface tension.

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6. 7.

Type I pneumocytes followed by endothelial cells. The majority of CO2 will exit RBCs as bicarbonate (in exchange for chloride), will cross endothelial cells, then type I pneumocytes, before entering the alveolar space. Bronchial artery, pulmonary artery. Veins and lymphatics. Diaphragm. No muscle is used. (The expiration of quiet breathing is passive.) Scalene muscles, external intercostals, and sternomastoids. Rectus abdominus, internal obliques, external obliques, transversus abdominus; the internal intercostals.

8. 9. 10. 11. 12. 13.

PHYSIOLOGY
14. 15. A-4, B-5, C-1, D-7, E-3, F-6, G-2, H-8.

16. 17. 18.

In pulmonary fibrosis, in pulmonary edema, and if surfactant production is insufficient. The relaxed (R) form has a higher affinity for O2 than the taut (T) form. Decreases; increases.

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19. Effect Decreased 2,3-DPG Decreased pH Decreased temperature Fetal hemoglobin High altitude Increased metabolic needs Increased pH Increased temperature 20. 21. 22. 23. 24. A-a gradient = PAO2 PaO2; normal is 10-15 mm Hg. Shunting, ventilation/perfusion mismatch, and fibrosis of the lungs. High altitude and hypoventilation. Ventilation/perfusion mismatch, diffusion limitation, and right-to-left shunt. Hypoxemia, anemia, cyanide poisoning, carbon monoxide poisoning, and decreased cardiac output. Vein < artery < alveolus. Vein < alveolus < artery. Alveolus < vein < artery. As bicarbonate, bound to hemoglobin as carbaminohemoglobin, and dissolved. Carbonic anhydrase. The Haldane effect. The Bohr effect. Shift to the Left Shift to the Right

25. 26. 27. 28. 29. 30. 31.

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32. Effect Decreased pH Increased 2,3-DPG Increased CO2 production Increased erythropoietin Increased O2 consumption Increased mitochondria Increased pulmonary blood flow Increased renal excretion of bicarbonate Increased ventilation More uniform V/Q ratio from apex to base Right ventricular hypertrophy Response to Altitude Response to Exercise

PATHOLOGY
33. 34. 35. 36. 37. 38. 39. 40. 41. 42. Fat, air, thrombus, bacteria, amniotic fluid, and tumor. Stasis, hypercoagulability, and endothelial damage. A = amniotic fluid; B = fat; C = air; D = thrombus. A-2, B-3, C-1, D-4, E-3, F-2, G-1, H-2, I-3, J-1, K-4, L-3. >80%. Asbestosis. Maternal diabetes, cesarean delivery, and premature birth. Trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, and amniotic fluid embolism. A form of sleep apnea that results from lack of respiratory effort. A form of sleep apnea in which there is a drive to breathe but respiration is prevented because of mechanical airway obstruction (usually from obesity). A-3, B-2, C-4, D-1. Adrenals, brain, bone, and liver. A-3, B-1, C-4, D-6, E-6, F-5, G-2, H-5, I-5, J-1, K-6, L-3, M-5, N-4, O-2.

43. 44. 45.

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PHARMACOLOGY
46. Second-generation H1-blockers are far less sedating because their CNS penetration is much lower than that of first-generation agents. Albuterol relaxes bronchial smooth muscle through its agonism of 2-adrenergic receptors. Muscarinic antagonists.

47. 48. 49.

(Modified, with permission, from Katzung BG, Trevor AJ. Pharmacology: Examination & Board Review, 5th ed. Stamford, CT: Appleton & Lange, 1998: 159, 161.)

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