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Chapter 19 JONES
What happens in the lungs when the diaphragm relaxes?
Air is forced out of the lungs.
The respiratory mucosa is continuous through the:
1. upper and lower respiratory tracts
2. nasal cavities and the sinuses
3. nasopharynx and oropharynx
4. middle ear cavity and auditory tube
Which of the following activities does NOT require muscle contractions and energy?
The maximum volume of air a person can exhale after a maximum inspiration is termed the:
Which of the following applies to the blood in the pulmonary artery?
PO2 is low.
Which of the following causes bronchodilation?
The central chemoreceptors are normally most sensitive to:
elevated carbon dioxide level
Oxygen diffuses from the alveoli to the blood because:
PO2 is lower in the blood.
Carbon dioxide is primarily transported in the blood:
as bicarbonate ion
What would hypercapnia cause?
Which of the following would result from hyperventilation?
Which of the following values is always decreased with respiratory alkalosis (compensated or decompensated)?
What would be the most effective compensation for respiratory acidosis?
the kidneys producing more bicarbonate ions
What is the acid-base status of a patient with the following values for arterial blood gases?
serum bicarbonate 36.5 mmol/L (normal range: 22-28)
PCO2 75 mm Hg (normal range: 35-45)
serum pH 7.0
decompensated respiratory acidosis
What does carbaminohemoglobin refer to?
carbon dioxide attached to an amino group on the hemoglobin molecule
How is oxygen toxicity manifested?
decreased pulmonary compliance with diffuse atelectasis
How is respiratory failure defined?
PaO2 less than 50 mm Hg or PaCO2 greater than 50 mm Hg
What does the term hemoptysis refer to?
bright red streaks of blood in frothy sputum
difficulty breathing in a recumbent position
Choose the correct information applying to laryngotracheobronchitis:
viral infection in child, 3 months to 3 years
Signs and symptoms of acute sinusitis usually include:
severe localized pain and tenderness in the face
What are early signs and symptoms of infectious rhinitis?
serous nasal discharge, congestion, and sneezing
Why does the influenza virus cause recurrent infection in individuals?
Viral mutation reduces immunity from prior infections.
What are typical signs and symptoms of epiglottitis?
sudden fever, sore throat, and drooling saliva
What is the most common cause of viral pneumonia?
Which of the following describes lobar pneumonia?
sudden onset of fever and chills, with rales and rusty sputum
How does severe hypoxia develop with pneumonia?
oxygen diffusion is impaired by the congestion
Rust-colored sputum in a patient with pneumonia usually indicates:
prolonged stasis of mucous secretions in the airways
What is the cause of Legionnaires' disease?
a gram-negative bacterium
Select the statement related to tuberculosis:
The microbe is an acid-fast bacillus, resistant to many disinfectants.
How is primary tuberculosis identified?
caseation necrosis and formation of a tubercle in the lungs
When does active (secondary) infection by M. tuberculosis with tissue destruction occur?
Host resistance is decreased for any reason.
Which of the following statements does NOT apply to M. tuberculosis?
Microbes can survive for a long time inside tubercles.
Which of the following confirms the presence of active (reinfection) tuberculosis?
identification of acid-fast bacilli in a sputum sample
Which of the following is a major factor contributing to the current increase in cases of tuberculosis?
the increase in immunodeficient individuals
Histoplasmosis is caused by a:
Cystic fibrosis is transmitted as a/an:
autosomal recessive gene
The basic pathophysiology of cystic fibrosis is considered to be:
an abnormality of the exocrine glands
Growth and development of a child with cystic fibrosis may be delayed because of:
mucus plugs obstructing the flow of pancreatic enzymes
Persistent thick mucus in the bronchioles of a child with cystic fibrosis may cause:
1. air trapping
3. repeated infections
4. irreversible damage to lung tissue
What is a common indicator of cystic fibrosis in the newborn?
failure to excrete meconium
What is an early sign of bronchogenic carcinoma?
Cigarette smoking predisposes to malignant neoplasms because smoking:
causes metaplasia and dysplasia in the epithelium
Why does hypercalcemia occur with bronchogenic carcinoma?
secretion of parathyroid or like hormone by the tumor
What is a sign indicating total obstruction of the airway by aspirated material?
rapid loss of consciousness
Which of the following predisposes to postoperative aspiration?
depression of the cough and swallow reflexes by drugs
What is the pathophysiology of an acute attack of extrinsic asthma?
type 1 hypersensitivity reaction
During an acute asthma attack, how does respiratory obstruction occur?
2. edema of the mucosa
3. increased secretion of thick, tenacious mucus
What cause the expanded A-P thoracic diameter (barrel chest) in patients with emphysema?
air trapping and hyperinflation
Which of the following is typical of progressive emphysema?
Residual lung volume increases.
Destruction of alveolar walls and septae is a typical change in:
When patients with chronic hypercapnia are administered oxygen:
blood levels of oxygen should remain slightly below normal
Which statement does NOT apply to emphysema?
The ventilation/perfusion ratio remains constant.
What is the cause of chronic bronchitis?
chronic irritation, inflammation, and recurrent infection of the larger airways
Which of the following are typical of chronic bronchitis?
fibrosis of the bronchial wall
What are typical pathological changes with bronchiectasis?
airway obstructions and weak, dilated bronchial walls
Which of the following are significant signs of bronchiectasis?
chronic cough producing large quantities of purulent sputum
Why does cor pulmonale develop with chronic pulmonary disease?
Pulmonary fibrosis and vasoconstriction increase vascular resistance.
What are common signs of cor pulmonale?
hepatomegaly and edema in the legs
What is caused by frequent inhalation of irritating particles such as silica?
fibrosis and loss of compliance
Pulmonary edema causes severe hypoxia because of:
increasing difficulty expanding the lungs
Which of the following is NOT a cause of pulmonary edema?
hyperproteinemia and increasing osmotic pressure of the blood
Which of the following is a common source of a pulmonary embolus?
thrombus forming in the femoral veins
What is a large-sized pulmonary embolus likely to cause?
hypotension and right-sided heart failure
Which manifestation(s) of atelectasis is/are associated with airway obstruction?
decreased breath sounds on the affected side
How does total obstruction of a major bronchus lead to atelectasis?
Air is absorbed from the alveoli distal to the obstruction.
How does a large pleural effusion cause atelectasis?
The cohesion between the pleural membranes is disrupted.
When does flail chest occur?
Several ribs are fractured at two sites.
With a flail chest injury, events during inspiration include:
the mediastinum shifts toward the unaffected side
How is cardiac output reduced with a flail chest injury?
Venous return is impaired.
Which of the following is a manifestation of a simple closed pneumothorax?
asymmetrical chest movements
Which of the following is an effect of a large open pneumothorax (sucking wound)?
With a tension pneumothorax, which factors contribute to severe hypoxia?
continually increasing pressure on the unaffected lung
Which of the following statements describe the pathophysiology of adult respiratory distress syndrome?
1. damage leading to increased permeability of the alveolar walls
3. excessive fluid and protein interstitially and in the alveoli
Infant respiratory distress syndrome results from:
insufficient surfactant production
Obstruction in the upper airway is indicated by
Which of the following does NOT apply to carbon dioxide?
It is replaced on hemoglobin by oxygen in the lungs.
Whenever PO2 levels decrease below normal, then PCO2 levels:
may or may not change
Laryngotracheobronchitis is typically manifested by:
hoarse voice and barking cough
Lobar pneumonia is usually caused by:
Severe acute respiratory syndrome (SARS) is caused by a/an:
SARS typically begins as a flulike syndrome followed after a few days by:
interstitial lung congestion, dyspnea, and dry cough
In addition to effects on the lungs and pancreas, cystic fibrosis causes:
high sodium chloride content in saliva and sweat
Which of the following is a significant early sign of bronchogenic carcinoma in a smoker?
hemoptysis and weight loss
Which of the following is likely to cause pneumothorax or hemothorax in a patient with bronchogenic carcinoma?
The tumor causes inflammation and erosion of the pleural membranes.
Which of the following would confirm a diagnosis of primary tuberculosis?
small areas of calcification on a chest X-ray
Which of the following drugs is usually prescribed for prophylaxis in persons in close contact with a patient with active tuberculosis?
Which of the following statements is FALSE?
Active TB must be treated in hospital for many months.
Choose the correct reason for severe hypoxia occurring with pulmonary edema:
Diffusion of oxygen into the pulmonary capillaries is impaired.
Which of the following drugs in an inhaler would likely be carried by individuals to provide immediate control of acute asthma attacks?
a beta-2-adrenergic agent
Which of the following values for arterial blood gases would be expected in a patient with advanced emphysema?
increased PCO2, increased bicarbonate ion, serum pH 7.35
Which factors contribute to postoperative atelectasis?
2. drug-related respiratory depression
3. abdominal distention and pain
Pleurisy associated with lobar pneumonia is manifested by:
cyclic chest pain and friction rub
All of the following are expected with infant respiratory distress syndrome EXCEPT:
Which factor usually causes metabolic acidosis to develop in association with hypoxia?
Mediastinal flutter associated with chest injury is likely to:
decrease venous return to the heart
Which of the following individuals is NOT considered to be at high risk for developing active tuberculosis?
persons who experience acute asthma attacks
Which of the following distinguishes influenza from infectious rhinitis?
Influenza has a sudden onset with fever, marked muscle aching, and severe malaise.
The use of a continuous positive airway pump in the treatment of sleep apnea will:
prevent collapse of pharyngeal tissues
Hemoptysis is a significant sign of:
Which of the following applies to anthrax infection?
When inhaled it causes flulike symptoms followed by acute respiratory distress.
The mutated gene for cystic fibrosis is located on the:
Aspiration pneumonia is usually caused by aspiration of:
liquids such as oils or milk
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