Exam 3 Unit 7

1. A healthy, 45-year-old man is reading the newspaper. Which of the following muscles are used for

quiet breathing?

A) Diaphragm and external intercostals

B) Diaphragm and internal intercostals

C) Diaphragm, external intercostals and internal intercostals

D) Internal intercostals and abdominal recti

E) Scaleni

F) Sternocleidomastoid muscles

C) Diaphragm , external intercostals and internal intercostals

2. A healthy, 25-year-old medical student participates in a 10-km charity run for the American Heart

Association. Which of the following muscles does the student use (contract) during expiration?

A) Diaphragm and external intercostals

B) Diaphragm and internal intercostals

C) Diaphragm only

D) Internal intercostals and abdominal recti

E) Scaleni

F) Sternocleidomastoid muscles

D) Internal intercostals and abdominal recti

3. The pleural pressure of a normal 56-year-old woman is approximately −5 cm H2O during resting

conditions immediately before inspiration (i.e., at functional residual capacity). What is the pleural

pressure (in cm H2O) during inspiration?

A) +1

B) +4

C) 0

D) −3

E) −7

E) −7

4. The alveolar pressure of a normal 77-year-old woman is approximately 1 cm H2O during expiration.

What is the alveolar pressure during inspiration (in cm H2O)?

A) +0.5

B) +1

C) +2

D) 0

E) −1

F) −5

E) −1

5. A man inspires 1000 ml from a spirometer. The intrapleural pressure was −4 cm H2O before inspiration and −12 cm H2O the end of inspiration. What is the compliance of the lungs?

A) 50 ml/cm H2O

B) 100 ml/cm H2O

C) 125 ml/cm H2O

D) 150 ml/cm H2O

E) 250 ml/cm H2O

C) 125 ml/cm H2O

The oxyhemoglobin dissociation curve desribes teh relationship of oxygen saturation to oxygen tension. All of the following are true except

A/ Oxygen tension of 60mmg, the saturation is ~90%

B. The curve is shifted to the left with more acid pH

C. the curve is shifted to the right with an inrease in CO2 tension

D. the cruve is shifted to eh right with icnreased 2,3 DPG

B. The curve is shifted to the left with more acid pH

7. Which of the following regarding V/Q matching is true

A. west zone= shunt

B west zone 1 can be increased by PAP

C. West Zone 3 has PAP?PVP> alveolar pressure and therefore has perfusion in excess of ventilation

D. West zone 1, PCWP is transmitted to alveoli promoting alveolar collapse resulting in no ventilation to this area

C. West Zone 3 has PAP>PVP> alveolar pressure and therefore has perfusion of excess of ventilation

8. A 22-year-old woman has a pulmonary compliance of 0.2 L/cm H2O and a pleural pressure of −4 cm

H2O. What is the pleural pressure (in cm H2O) when the woman inhales 1.0 L of air?

A) −6

B) −7

C) −8

D) −9

E) −10

D) −9

9. A preterm infant has a surfactant deficiency. Without surfactant, many of the alveoli collapse at the

end of each expiration, which in turn leads to pulmonary failure. Which of the following sets of changes

are present in the preterm infant, compared to a normal infant?

Alveolar Sur. Ten/ Pulmon. Compliance

A) Decreased Decreased

B) Decreased Increased

C) Decreased No change

D) Increased Decreased

E) Increased Increased

F) Increased No change

G) No change No change

D) Increased Decreased

10. A patient has a dead space of 150 ml, functional residual capacity of 3 L, tidal volume of 650 ml,

expiratory reserve volume of 1.5 L, total lung capacity of 8 L, and respiratory rate of 15 breaths/min.

What is the residual volume?

A) 500 ml

B) 1000 ml

C) 1500 ml

C) 1500 ml

26. A 32-year-old man drives to the top of Pikes Peak where the oxygen tension is 85 mm Hg. Which of

the following best describes the effects of a hypoxic environment on the pulmonary and systemic vascular resistances?

Pulmonary vascular resistance/ Systemic vascular resistance

A) Decreases Decreases

B) Decreases Increases

C) Decreases No change

D) Increases Decreases

E) Increases Increases

F) Increases No change

G) No change Decreases

H) No change Increases

I) No change No change

D) Increases Decreases

which statmet concerning respiration is not true

C. the bohr effect allows CO2 to bind more easily to hgb that has released its oxygen

during expiration, volume of thorax ___; as diaphram___

decreased; relaxes

what is last component that is incapable gas exchange

terminal bronchioles

14. A patient has a dead space of 150 ml, functional residual capacity of 3 L, tidal volume of 650 ml,

expiratory reserve volume of 1.5 L, a total lung capacity of 8 L, respiratory rate of 15 breaths/min. What

is the alveolar ventilation?

A) 5 L/min

B) 7.5 L/min

C) 6.0 L/min

D) 9.0 L/min

B) 7.5 L/min

15. At the end of inhalation, with an open glottis, the pleural pressure is

A) greater than atmospheric pressure

B) equal to atmospheric pressure

C) less than alveolar pressure

D) equal to alveolar pressure

E) greater than alveolar pressure

C) less than alveolar pressure

16. As blood passes through systemic capillaries, what happens the affinity of the hgb for oxygen, and what happens to the Hb-O2 curve?

D. Hb affinity for O2 decreased and diss curve shifts to the right

17. A healthy 10-year-old boy breathes quietly under resting conditions. His tidal volume is 400 ml and

ventilation frequency is 12/min. Which of the following best describes the ventilation of the upper,

middle, and lower lung zones in this boy?

Lowest, Intermediate, Highest for Upper Zone, Middle Zone, Lower Zone

D. Lowest; Intermediate; Highest

18. A 34-year-old male sustains a bullet wound to the chest that causes a pneumothorax. Which of the

following best describes the changes in lung volume and thoracic volume in this man, compared to

normal?

Lung volume/ Thoracic volume

A) Decreased Decreased

B) Decreased Increased

C) Decreased No change

D) Increased Decreased

E) Increased Increased

F) No change Decreased

B) Decreased Increased

19. The resistance of the pulmonary tree is so low that a 1 cm of water pressure gradient is sufficient to

cause normal air flow during resting conditions. Which of the following often has a substantial resistance

during pulmonary disease states that can limit alveolar ventilation?

A) Alveoli

B) Bronchioles

C) Large bronchi

D) Small bronchi

E) Trachea

B) Bronchioles

21. The respiratory passageways have smooth muscle in their walls. Which of the following best

describes the effect of acetylcholine and epinephrine on the respiratory passageways?

Acetylcholine/ Epinephrine

A) Constrict Constrict

B) Constrict Dilate

C) Constrict No effect

D) Dilate Constrict

E) Dilate Dilate

F) Dilate No effect

G) No effect Constrict

H) No effect Dilate

B) Constrict Dilate

22. A 67-year-old man is admitted as an emergency to University Hospital because of severe chest pain.

A Swan-Ganz catheter is floated into the pulmonary artery, the balloon is inflated, and the pulmonary

wedge pressure is measured. The pulmonary wedge pressure is used clinically to monitor which of the

following pressures?

A) Left atrial pressure

B) Left ventricular pressure

C) Pulmonary artery diastolic pressure

D) Pulmonary artery systolic pressure

E) Pulmonary capillary pressure

A) Left atrial pressure

23. Which of the following sets of differences best describes the hemodynamics of the pulmonary

circulation when compared to the system circulation?

Higher, Lower, or the Same for Flow, Resistance, and Arterial Pressure

F. Same, Lower, Lower

25. A 30-year-old woman performs a valsalva maneuver about 30 min after eating lunch. Which of the

following best describes the changes in pulmonary and systemic blood volumes that occur in this woman?

Pulmonary volume/ Systemic volume

A) Decreases Decreases

B) Decreases Increases

C) Decreases No change

D) Increases Decreases

E) Increases Increases

F) Increases No change

G) No change Decreases

H) No change Increases

I) No change No change

B) Decreases Increases

28. A 65-year-old man with emphysema due to 34 years of cigarette smoking is admitted to hospital due

to dyspnea. With further tests the mean pulmonary arterial pressure is determined to be 45 mm Hg at rest.

He is hypoxic (Po2 = 49 mm Hg), hypercapnic (85 mm Hg), and slightly acidotic. The cardiovascular and

oxygen changes are due to which of the following?

A) Increased arterial Pco2

B) Increased parasympathetic activity

C) Decreased alveolar Po2

D) Decreased pH

E) Decreased pulmonary resistance

C) Decreased alveolar Po2

29. Which of the following will decrease pulmonary blood flow resistance?

A) IV injection of norepinephrine

B) Inhalation to total lung capacity

C) Breathing 5% O2

D) Having the lung at FRC

D) Having the lung at FRC

ideal ett 5-7 cm above carina. how many cm insert past incisors

19-21

31. A person's normal tidal volume is 400 ml with a dead space of 100 ml. The respiratory rate is 12

breaths/min. The person is placed on ventilator for surgery and the tidal volume is 700 with a rate of 12.

What is the approximate alveolar Pco2

for this person?

A) 10

B) 20

C) 30

D) 40

E) 45

B) 20

32. The forces governing the diffusion of a gas through a biological membrane include the pressure difference across the membrane (ΔP), the cross-sectional area of the membrane (A), the solubility of the gas (S), the distance of diffusion (d), and the molecular weight of the gas (MW). Which of the following

changes increases the diffusion of a gas through a biological membrane?

Increase or Decrease for ΔP, A, S, d, and MW?

E. ΔP Increase

A Increae

S Increase

d Decrease

MW Decrease

33. A person with normal lungs at sea level (760 mm Hg) is breathing 50% oxygen. What is the

approximate alveolar Po2?

A) 100

B) 159

C) 268

D) 306

E) 330

D) 306

34. A child has been eating round candies approximately 1 and 1.5 cm in diameter and inhaled one

down his airway blocking his left bronchiole. Which of the following will describe the changes that

occur?

Increase, Decrease, or Same:

Left Lung Alveolar Pco2, Left Lung Alveolar Po2, Systemic Arterial Po2

E. Left Lung Alveolar Pco2 INC

Left Lung Alveolar Po2 DEC

Systemic Arterial Po2 DEC

35. During exercise, the oxygenation of blood is increased not only by increased alveolar ventilation but

also by a greater diffusing capacity of the respiratory membrane for transporting oxygen into the blood.

Which of the following sets of changes occur during exercise?

Surface area of respiratory membrane/ Ventilation-perfusion ratio

A) Decrease Improvement

B) Increase Improvement

C) Increase No change

D) No change Improvement

E) No change No change

B) Increase Improvement

pleural pressure in stsanding person

highest at base of lungs

36. The diffusing capacity of a gas is the volume of gas that will diffuse through a membrane each minute for a pressure difference of 1 mm Hg. Which of the following gases is often used to estimate the oxygen diffusing capacity of the lungs?

A) Carbon dioxide

B) Carbon monoxide

C) Cyanide gas

D) Nitrogen

E) Oxygen

B) Carbon monoxide

37. A 23-year-old medical student has mixed venous oxygen and carbon dioxide tensions of 40 mm Hg

and 45 mm Hg, respectively. A group of alveoli are not ventilated in this student because mucus blocks a

local airway. What are the alveolar oxygen and carbon dioxide tensions distal to the mucus block (in mm Hg)?

Carbon dioxide Oxygen

A) 40 100

B) 40 40

C) 45 40

D) 50 50

E) 90 40

C) 45 40

38. A 45-year-old man at sea level has an inspired oxygen tension of 149 mm Hg, nitrogen tension of

563 mm Hg, and water vapor pressure of 47 mm Hg. A small tumor pushes against a pulmonary blood vessel that completely blocks the blood flow to a small group of alveoli. What are the oxygen and carbon dioxide tensions of the alveoli that are not perfused (in mm Hg)?

Carbon dioxide Oxygen

A) 0 0

B) 0 149

C) 40 104

D) 47 149

E) 45 149

B) 0 149

39. The O2

-CO2 diagram here shows a ventilation-perfusion ratio line for the normal lung. Which of the

following best describes the effect of decreasing ventilation-perfusion ratio on the alveolar Po2 and Pco2?

Carbon dioxide tension/ Oxygen tension

A) Decrease Decrease

B) Decrease Increase

C) Decrease No change

D) Increase Decrease

E) Increase Increase

D) Increase Decrease

40. In which of the following conditions is alveolar Po2

increased and alveolar Pco2 decreased?

A) Increased alveolar ventilation and unchanged metabolism

B) Decreased alveolar ventilation and unchanged metabolism

C) Increased metabolism and unchanged alveolar ventilation

D) Proportional increase in metabolism and alveolar ventilation

A) Increased alveolar ventilation and unchanged metabolism

41. A 67-year-old man has a solid tumor that pushes against an airway partially obstructing air flow to

the distal alveoli. Which point on the ventilation-perfusion line of the O2-CO2 diagram corresponds to the alveolar gas of these distal alveoli?

A)

B)

C)

D)

E)

B

42. A 55-year-old male has a pulmonary embolism that partially blocks the blood flow to his right lung.

Which point on the ventilation-perfusion line of the O2

-CO2 diagram corresponds to the alveolar gas of

his right lung?

A)

B)

C)

D)

E)

D

47. A 17-year-old female was bicycling without a helmet when she fell and hit her head. In theemergency room, she was not conscious and was receiving ventilator assistance. Her blood gases follow:

PaO2 = 52 mm Hg,

PaCO2 = 75 mm Hg, pH = 7.15, andHCO3− = 31 mM

The majority of the CO2 was being transported as

A) CO2 bound to plasma proteins

B) CO2 bound to hemoglobin

C) Bicarbonate ions

D) Dissolved

C) Bicarbonate ions

48. The following diagram shows a normal oxygen-hemoglobin dissociation curve. Which of the

following are approximate values of hemoglobin saturation (% Hb-O2), oxygen partial pressure (Po2), and

oxygen content (O2 content) for oxygenated blood leaving the lungs and reduced blood returning to thelungs from the tissues?

C. Oxygenated Blood

%Hb-O2 - 100

Po2 - 104

O2 Content- 20

Reduced Blood

% Hb-O2 - 30

Po2 - 20

O2 Content- 6

49. Arterial Po2 is 100 mm Hg and arterial Pco2

is 40 mm Hg. Total blood flow to all muscle is 700

ml/min. There is a sympathetic activation resulting in a decrease in blood flow to 350 ml/min. Which of the following will occur?

Venous Po2/ Venous Pco2

A) ↑ ↓

B) ↓ ↑

C) ↓ ↔

D) ↔ ↑

E) ↑ ↑

F) ↓ ↓

G) ↔ ↔

B) ↓ ↑

51. A 34-year-old woman is anemic with a blood hemoglobin concentration of 7.1 g/dL. Which of the

following sets of changes has occurred in this woman, compared to normal?

Increase, Normal, and Decrease for Arterial Po2, Mixed Venous Po2, and 2,3, Disphophosphloglycerate

H. Arterial Po2 Normal

Mixed Venous Po2 DEC

2,3, Disphophosphloglycerate INC

55. A person with anemia has a hemoglobin (Hb) concentration of 12 g/dL. He starts exercising and

uses 12 ml O2/dL. What is the mixed venous Po2?

A) 0 mm Hg

B) 10 mm Hg

C) 20 mm Hg

D) 40 mm Hg

E) 100 mm Hg

C) 20 mm Hg

56. Carbon dioxide is transported in the blood in the dissolved state, in the form of bicarbonate ion, and

in combination with hemoglobin (carbaminohemoglobin). Which of the following best describes the

quantitative relationship of these three mechanisms for transporting carbon dioxide in the venous blood

under normal conditions (in percentages)?

Dissolved State, Bicarbonate Ion, and Carbminohemoglobin

A. Dissolved State- 7 Bicarbonate Ion- 70

Carbminohemoglobin- 23

57. A 26-year-old medical student on a normal diet has a respiratory exchange ratio of 0.8. How much oxygen and carbon dioxide are transported between the lungs and tissues of this student (in ml gas/100 ml

blood)?

Oxygen Carbon dioxide

A) 4 4

B) 5 3

C) 5 4

D) 5 5

E) 6 3

F) 6 4

C) 5 4

59. The basic rhythm of respiration is generated by neurons located in the medulla. Which of the

following limits the duration of inspiration and increases respiratory rate?

A) Apneustic center

B) Dorsal respiratory group

C) Nucleus of the tractus solitarius

D) Pneumotaxic center

E) Ventral respiratory group

D) Pneumotaxic center

60. When respiratory drive for increased pulmonary ventilation becomes greater than normal, a special

set of respiratory neurons that are inactive during normal quiet breathing then becomes active,

contributing to the respiratory drive. These neurons are located in which of the following structures?

A) Apneustic center

B) Dorsal respiratory group

C) Nucleus of the tractus solitarius

D) Pneumotaxic center

E) Ventral respiratory group

E) Ventral respiratory group

61. The Hering-Breuer inflation reflex is mainly a protective mechanism that controls ventilation under

certain conditions. Which of the following best describes the effect of this reflex on inspiration and

expiration as well as the location of the stretch receptors that initiate the reflex?

Location of Stretch Receptors, Inspiration, and Expiration

E. Location of Stretch Receptors- Bronchi/ Bronchioles

Inspiration- Switches off

Expiration- No Effect

62. At a fraternity party a 17-year-old male places a paper bag over his mouth and breathes in and out

of the bag. As he continues to breathe into this bag, his rate of breathing continues to increase. Which of

the following is responsible for the increased ventilation?

A) Increased alveolar Po2

B) Increased alveolar Pco2

C) Decreased arterial Pco2

D) Increased pH

B) Increased alveolar Pco

63. Which of the following occurs with carbon monoxide inhalation?

Increase, decrease, or same for Alveolar Po2, Alveloar Pco2, and Peripheral Chemoreceptor Activity

B. Alveolar Po2- SAME Alveloar Pco2- SAME Peripheral Chemoreceptor Activity- SAME

66. An anesthetized male is breathing with no assistance. He is then artificially ventilated for 10 min at

his normal tidal volume but at twice his normal frequency. He is ventilated with a gas mixture of 60% O2

and 40% N2

. The artificial ventilation is stopped and he fails to breathe for several minutes. This apneic

episode is due to which of the following?

A) High arterial Po2 suppressing the activity of the peripheral chemoreceptors

B) Decrease in arterial pH suppressing the activity of the peripheral chemoreceptors

C) Low arterial Pco2 suppressing the activity of the medullary chemoreceptors

D) High arterial Pco2 suppressing the activity of the medullary chemoreceptors

B) Low arterial Pco2 suppressing the activity of the peripheral chemoreceptors

C) Low arterial Pco2 suppressing the activity of the medullary chemoreceptors

68. Alveolar ventilation increases several-fold during strenuous exercise. Which of the following

factors is most likely to stimulate ventilation during strenuous exercise?

A) Collateral impulses from higher brain centers

B) Decreased mean arterial pH

C) Decreased mean arterial Po2

D) Decreased mean venous Po2

E) Increased mean arterial Pco2

A) Collateral impulses from higher brain centers

except for cricothyroid muscle, intrinsic muscle of larynx are innervated by what motor nerve

rln

oxyhgb curve become steep when pao2 falls less than

60

5. the oxyhgb diss curve shift left in response to

A. hypercap

B. hypothermia

C. increased 2,3 DPG

D. metabolic acidosis

B. hypothermia

peripheral chemoreceptors

responsible for hypoxic drive to respiration

enzyme for bircarb in rbc

Carbonic anhydrase,

if PaCO2 is 30mmHg, how much CO2 dissolved in blood

2.01 mL/CO2/100mL blood

after it is produced, bicarbonate diffuses oupt of RBC in exchange for

Chloride ions

The diffusing capacity of a gas is the volume of gas that will diffuse through a membrane each minute for a pressure difference of 1 mmhg. Which of the following gases is often used to estimate oxygen diffusing capacity of the lungs

carbon monoxide (CO)

central chemoreceptors directly stimulated by

CO2

peripheral chemorecepotrs are most sensitive to which of the following

decreased PaO2

nerve carries sensory fro carotid; sensory for aortic bodies

glossopharyngeal; vagus

respiratory center in pons participes in shutting off inspiration

pneumotaxic center

during normal tidal breathing, what is intrapleural pressure positivie

never

where are ventialtion and perfusion greatest in normal healthy lungs in awake

ventilation= dependinent lung; perfusion= dependent lung

compared with non-dependent lung, PAO2 and ventialtion to perfusion ratio in dpeendent lung is

PAO2 low; VQ= low

compared with non-dependent lung, each of the following is greater in dependent lung EXCEPT

alveolar diameter

hypoxic pulmonary vasocinstrictin does what to shunt and PaO2

shunt= decreased; PaO2= increased

what intrinisic uscle closes larygneal inlet

Aryepiglottic

what nerve proivdes sensation to antoehrio and posterior sufrace of epiglottis

internal branch of SLN

what muscles involved in l arygnospasm

cricothryoids

contraction of all of the following muscles increase the A/P diameter of thorax except

internal intercostals

what is the anatomic dead speace of a 70kg adult

140ml

list laryngeal cartialges from superior to inferior from anterior view and indicate which are paired

Most superior = epiglottis (not paired)

thyroid (not paired)

cuneiform paired

corniculates (paired)

arytenoids (paired)

most inferior= cricoid (not paired

all responsible for glottic opening and closing edxcept

oblique arytenoids

what percent of work of qwiuet breathing is used to overcome elastic recoil of the lung and thorax

66%

match following with correct volume/capacity

IRV

TV

ERV

RV