Deck 3: Pulmonology

Question 1

Normal exhalation involves all of the following EXCEPT:

A) decreased intrathoracic volume.
B) phrenic nerve stimulation.
C) relaxation of the diaphragm.
D) elastic recoil of lung tissue.

Answer 1

phrenic nerve stimulation.

Question 2

An example of diffusion in the respiratory system is movement of:

A) oxygen from the alveoli into the pulmonary capillaries.
B) air from the outside environment into the lungs.
C) oxygen from the tissues into the systemic capillaries.
D) carbon dioxide from the alveoli into the pulmonary capillaries.

Answer 2

oxygen from the alveoli into the pulmonary capillaries.

Question 3

Your ICU patient has ARDS with a pO₂ of 62 mmHg, despite mechanical ventilation and oxygenation. Which of the following best explains this finding?

A) It is a problem with perfusion.
B) It is a problem with ventilation.
C) It is a problem with the blood gas sample collection.
D) It is a problem with gas diffusion in the lung.

Answer 3

It is a problem with gas diffusion in the lung.

Question 4

After a normal inspiration and expiration, an adult patient has about 2,400 mL of air remaining in the lungs, known as the:

A) expiratory reserve volume.
B) residual volume.
C) functional residual capacity.
D) vital capacity.

Question 5

The diaphragm is controlled by the ________ nerve.

A) vagus
B) olfactory
C) abducens
D) phrenic

Question 6

Most carbon dioxide from cellular metabolism reaches the alveoli by being transported:

A) bound to hemoglobin.
B) as bicarbonate ion.
C) dissolved in plasma.
D) as carbonic anhydrase.

Question 7

A 19-year-old female with difficulty breathing produces a peak expiratory flow rate of 425 lpm, indicating:

A) moderate bronchoconstriction.
B) mild bronchoconstriction.
C) normal ventilatory state.
D) severe bronchoconstriction.

Question 8

You have been called to treat a patient complaining of difficulty breathing. Which of the findings should concern you the most?

A) The patient is confused, agitated, and angry that you are trying to help him.
B) The patient is sitting in the "tripod" position.
C) The patient has a heart rate of 126.
D) The patient can speak only one to two words between breaths.

Question 9

Pulmonary embolism is a problem of:

A) interstitial edema.
B) ventilation of lungs.
C) thickness of the respiratory membrane.
D) perfusion of the lungs.

Question 10

Which of the following patients are at risk for the most common cause of upper airway obstruction?

A) 4-year-old male with croup
B) 21-year-old female unconscious and supine on the floor
C) 22-year-old female stung by a wasp
D) 5-year-old female with epiglottitis

Question 11

Air entering and leaving the lungs via inspiration and expiration is known as:

A) ventilation.
B) respirations.
C) perfusion.
D) oxygenation.

Question 12

Stretch receptors in the lungs send a signal to the inspiratory center of the medulla, inhibiting its stimulation of the phrenic and intercostal nerves. This is called the ________ reflex.

A) Cushing's
B) Hering-Breuer
C) Moro
D) Cheyne-Stokes

Question 13

The most important factor in determining the respiratory rate is:

A) arterial pCO_2.
B) arterial pO_2.
C) alveolar pCO_2.
D) alveolar pO_2.

Question 14

You are working in the ED caring for a 55-year-old female with a long history of COPD. She is more short of breath today than usual and states she has an increased cough. She has a tympanic temperature of 99.8°F. You have drawn arterial blood gases with the patient on room air and when the report comes back, it shows that the patient has a pO₂ of 52 mmHg. Which of the following is most likely?

A) You have inadvertently drawn a venous sample.
B) The patient is critically hypoxic and requires assisted ventilation.
C) This is the typical value for this patient.
D) The lab performed the test incorrectly.

Question 15

Normal tidal volume in an average 70 kg adult is approximately ________ e.

A) 1,500
B) 1,000
C) 750
D) 500

Question 16

Which of the following is the most important intrinsic risk factor for respiratory disease?

A) Environment
B) Smoking
C) Sedentary lifestyle
D) Family history

Question 17

Obstructive sleep apnea is a problem of the:

A) phrenic nerve.
B) upper airway.
C) medulla oblongata.
D) larynx and vocal cords.

Question 18

Airway resistance is increased by:

A) sympathetic nervous system stimulation.
B) decreased elasticity of the chest wall.
C) anticholinergic drugs.
D) bronchospasm.

Question 19

Which of the following provides evidence that a patient is using accessory muscles to breathe?

A) The patient is using his diaphragm with inspiration.
B) The patient's lips are pursed.
C) There is noticeable contraction of the intercostal muscles.
D) The patient is sitting up, leaning forward to breathe.

Question 20

Your patient complains of coughing up "greenish-brown" sputum. This is most consistent with:

A) cancer.
B) bronchitis.
C) seasonal allergies.
D) pulmonary edema.

Question 21

Your patient is a 20-year-old male with a peanut allergy who inadvertently ate some candy containing peanuts. He is complaining of a "lump" in his throat, his voice is hoarse with mild inspiratory stridor, and he appears anxious. You are giving oxygen by nonrebreathing mask and have started an IV. Next, you should:

A) place the patient in a supine position and prepare for transtracheal ventilation.
B) administer an induction agent and a paralytic and perform endotracheal intubation.
C) administer 0.4 mg of 1:1000 epinephrine SQ and 50 mg diphenhydramine IV.
D) administer 2.5 mg albuterol by nebulizer.

Question 22

As you are palpating your patient's chest, he speaks, and you can feel the vibration through the chest wall. You should document this as:

A) crepitus.
B) tactile fremitus.
C) bronchovesicular sounds.
D) a pleural friction rub.

Question 23

Which of the following characteristics is least associated with emphysema?

A) Polycythemia
B) Cor pulmonale
C) Barrel chest appearance
D) Productive cough throughout the day

Question 24

You have applied a CO-oximeter to your patient, and it is displaying an SpCO of 15 percent. Which of the following is the most appropriate interpretation of this finding?

A) This is consistent with a fatal level of carbon monoxide poisoning.
B) This is a normal reading for a smoker and nothing to worry about.
C) This is a normal reading for a nonsmoker and nothing to worry about.
D) This is consistent with mild carbon monoxide poisoning.

Question 25

An increased hydrogen ion concentration in the cerebrospinal fluid results in a(n) ________ respiratory rate.

A) erratic
B) decreased
C) unchanged
D) increased

Question 26

Your patient is a 24-year-old male Chinese citizen on vacation in the United States. He is in moderate distress, complaining of difficulty breathing and gives a four-day history of runny nose, sore throat, fever, chills, and general malaise with a productive cough. His sputum production was significantly worse when he woke this morning, and he developed difficulty breathing this afternoon. HR = 134, BP = 132/84, RR = 26, SaO₂ = 90%. This presentation is most consistent with:

A) pneumonia.
B) tuberculosis.
C) SARS.
D) hantavirus pulmonary syndrome.

Question 27

Your patient is a 15-year-old asthmatic who has been having difficulty breathing for 45 minutes but does not have his Xopenex inhaler with him. Capnography shows an ETCO₂ of 45 mmHg. The best way to interpret this finding is:

A) this is a normal ETCO₂, indicating that this is a mild asthma attack.
B) the patient's ETCO₂ first dropped as he began to hyperventilate but now is rising again and may continue to rise to dangerous levels.
C) this is a high ETCO₂, and the patient requires immediate ventilatory assistance to prevent respiratory arrest.
D) this is a low ETCO₂ indicating that the patient is hyperventilating and thus in the early stages of an asthma attack.

Question 28

The amount of air moved in and out of the lungs during a normal, quiet respiration is called:

A) tidal volume.
B) dead space volume.
C) inspiratory capacity.
D) functional reserve capacity.

Question 29

The carpopedal spasms that occur due to hyperventilation syndrome are a result of a relative ________, secondary to ________.

A) hypocalcemia, decrease in unbound calcium
B) hypercalcemia, respiratory alkalosis
C) hypocalcemia, increase in bound calcium
D) hyponatremia, respiratory alkalosis

Question 30

You are working at the triage desk in the ED when a young man on crutches approaches the desk. He appears moderately short of breath. He states he had a cast put on his left leg seven days ago after surgery for a ruptured Achilles tendon. This morning, while he was watching television, he suddenly became short of breath. He has a history of asthma, for which he takes Xopenex as needed, and is taking Tylenol with codeine for pain related to his surgery. The patient's lung sounds are clear and equal, SpO₂ is 90 percent on room air, heart rate is 100 and regular, respirations are 24 and slightly labored, blood pressure is 128/88, and the patient is afebrile. These findings are most consistent with:

A) allergic reaction to codeine.
B) asthma exacerbated by recent anesthesia.
C) pneumonia secondary to recent anesthesia.
D) pulmonary embolism associated with immobilization of the lower extremity.

Question 31

Your patient is a 60-year-old male with an acute exacerbation of COPD. You may consider giving the patient ipratropium because, in addition to reversing bronchospasm, it is helpful in:

A) reducing inflammation.
B) drying bronchial secretions.
C) expectoration of mucus.
D) stimulating the respiratory center in the medulla.

Question 32

ETCO₂ is recorded during phase ________ of the capnogram.

A) I
B) II
C) III
D) IV

Question 33

Your patient is a 68-year-old male complaining of difficulty breathing for two days. He is sitting up, conscious, alert, and oriented and appears to be in mild respiratory distress. Physical examination reveals cool, dry, pink skin; he is thin with well-defined accessory muscles, and you note diffuse wheezing to all lung fields. HR = 102, BP = 136/96, RR = 20, SaO₂ = 92%. The patient gives a 20-pack-a-year history of smoking. These findings are most typical of:

A) emphysema.
B) asthma.
C) chronic bronchitis.
D) congestive heart failure.

Question 34

You are caring for a patient with Guillain-Barré syndrome. The most likely cause of hypoxia in this patient would be:

A) impaired perfusion.
B) inadequate lung volume.
C) impaired ventilation.
D) increased thickness of the respiratory membrane.

Question 35

In which of the following situations is a significant amount of carboxyhemoglobin most likely to be present?

A) A patient who is being treated with nitrites for cyanide poisoning
B) A patient with COPD who is short of breath with an SpO₂ of 90 percent
C) A patient found unresponsive in an apartment in which there is a gas furnace
D) A patient who inhaled anhydrous ammonia fumes

Question 36

Your patient is a 52-year-old male complaining of shortness of breath. He is sitting up, alert, and oriented and appears to be in moderate respiratory distress. He states that he "always gets a chest cold in the winter" and describes a three-week history of productive cough and increasing shortness of breath. Physical examination reveals coarse rhonchi to the upper lobes bilaterally, air movement is decreased in the bases, and his skin is cool with peripheral cyanosis. You note that he is overweight and describes an 18-pack-a-year smoking history. Based on these clinical exam findings, the most clinically relevant finding you might also expect is:

A) pursed-lipped breathing.
B) JVD, ankle edema, and hepatic congestion.
C) pulmonary edema and hypotension.
D) barrel chest and increased anterior/posterior chest diameter.

Question 37

Capnometry measures the partial pressure of CO₂ in:

A) venous blood.
B) arterial blood.
C) expired air.
D) inspired air.

Question 38

Which of the following statements about adult respiratory distress syndrome (ARDS) is FALSE?

A) PEEP is often required to adequately ventilate ARDS patients.
B) The mortality rate is 20 to 30 percent.
C) Pulmonary edema and disruption of the alveolar-capillary membrane contribute to respiratory failure in ARDS.
D) The causes of ARDS include pancreatitis, oxygen toxicity, sepsis, and tumor destruction.

Question 39

When using CPAP in patients with COPD, in general, PEEP should be:

A) < 10 mm Hg.
B) > 10 mm Hg.
C) < 10 cm H₂O.
D) > 10 cm H₂O.

Question 40

Your patient is a 23-year-old female who is 30 weeks pregnant. She choked on some cheese while eating a piece of pizza. When asked if she can speak, she replies "yes," although with some difficulty. Your next step should be to:

A) perform a series of abdominal thrusts.
B) perform a series of chest thrusts.
C) ask the patient to cough as hard as she can.
D) attempt to remove the bolus of cheese with Magill forceps.

Question 41

The most important determinant of ventilatory rate is:

A) arterial PO.
B) SpPO.
C) arterial PCO₂.
D) arterial NaHCO₃.

Question 42

Which of the following would result in an increased respiratory rate?

A) A decrease of cerebrospinal fluid PO₂
B) Stimulation of chemoreceptors by an increase of PCO₂
C) An increase of cerebrospinal fluid pH
D) Stimulation of baroreceptors by an increase of PCO₂

Question 43

A 72-year-old female has a one-week history of 101°F fever, chills, and dark-brown sputum production. She also has rhonchi and rales throughout her right lung. If this condition is left untreated, it could result in:

A) cardiogenic shock.
B) chronic bronchitis.
C) septic shock.
D) pneumonia.

Question 44

Which of the following is the most important determinant of ventilatory rate?

A) Arterial PO₂
B) Venous PCO₂
C) Venous PO₂
D) Arterial PCO₂

Question 45

Lung perfusion depends on all of the following EXCEPT:

A) efficient pumping of blood by the heart.
B) intact pulmonary capillaries.
C) an intact alveolar membrane.
D) adequate blood volume.

Question 46

Your patient is a 16-year-old male who attempted suicide. He is unconscious and apneic, lying supine on a garage floor. The family states they found the patient unconscious in the front seat of a car that was running in an enclosed garage. HR = 70, BP = 100/60, RR = 0. In addition to an IV of normal saline, which of the following is the most appropriate?

A) Intubate, remove the patient from the garage, and transport to a hospital with a hyperbaric chamber.
B) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to a hospital with a hyperbaric chamber.
C) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to the nearest facility.
D) Remove the patient from the garage, intubate, and transport to the nearest hospital.

Question 47

Which of the following is NOT a role of the upper respiratory system?

A) Warm inspired air
B) Filter inspired air
C) Carry out gas exchange with inspired air
D) Humidify inspired air

Question 48

Lung compliance is described as:

A) the ease with which the chest expands.
B) the diameter of the chest wall.
C) the depth at which the chest expands.
D) the rate at which the chest expands.

Question 49

Your patient is a 72-year-old female, alert and oriented, sitting up in bed at a nursing home. She is in mild respiratory distress. The staff describes a four-day history of fever, malaise, and productive cough. The patient also states that she has been experiencing chills and chest pain with deep inspiration. Physical examination reveals rales and rhonchi in the right upper lobe and warm, moist skin. HR = 116, BP = 104/76, RR = 20, SaO₂ = 93%. Based on the clinical exam findings, the most appropriate diagnosis would be:

A) pneumonia.
B) emphysema.
C) congestive heart failure.
D) chronic bronchitis.

Question 50

An intrinsic risk factor is one that is influenced:

A) within the patient.
B) outside the patient.
C) by the atmosphere.
D) by a carcinogen.

Question 51

A patient with COPD should present with a PO₂ of:

A) 35-45 mmHg.
B) 70-80 mmHg.
C) 50-60 mmHg.
D) 94-96 mmHg.

Question 52

Which of the following structures FIRST allows gas exchange as air enters the lungs?

A) Respiratory bronchioles
B) Alveolar ducts
C) Alveolar sacs
D) Terminal bronchioles

Question 53

Which of the following statements about pulse oximetry is FALSE?

A) Oxygen saturation is the percentage of hemoglobin that is bound with some molecular structure.
B) Pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia.
C) Pulse oximetry should be used on all patients with respiratory complaints.
D) Pulse oximetry has the ability to noninvasively measure total hemoglobin (SpHb) in addition to SpO₂ and other parameters.

Question 54

The average adult tidal volume is:

A) 750 mL.
B) 1200 mL.
C) 2400 mL.
D) 500 mL.

Question 55

Which of the following is the purpose of lung surfactant?

A) Destroy and remove foreign material from the alveoli.
B) Aid in the facilitated diffusion of oxygen across the alveolar membrane.
C) Decrease the surface tension of water in the alveoli.
D) Aid in the facilitated diffusion of carbon dioxide and oxygen across the alveolar membrane.

Question 56

The diaphragm is innervated by the:

A) renal nerve.
B) renic nerve.
C) pulmonary nerve.
D) phrenic nerve.

Question 57

You have intubated a 66-year-old female who was experiencing an acute exacerbation of her emphysema. What special consideration does this patient, with her specific pathology, require?

A) She requires hyperventilation to blow off excess CO₂.
B) Oxygen flow should be limited to 4 lpm because of the hypoxic drive common in COPD patients.
C) While ventilating, you must allow for a prolonged expiratory phase.
D) She requires frequent, deep suctioning.

Question 58

A majority of carbon dioxide in the body is transported as:

A) bicarbonate ion.
B) hydrogen ion.
C) hemoglobin.
D) plasma.

Question 59

Ventilation is:

A) the diffusion of gases at the alveoli.
B) the diffusion of the gas at the cellular level.
C) the mechanical process of moving air in and out of the lungs.
D) done to allow the gas to escape the chest wall.

Question 60

Your patient is a 24-year-old male who has been an in-patient in a rehabilitation hospital following surgical fixation of a fractured pelvis. Staff reports sudden development of hypotension and severe respiratory distress about 30 minutes ago. There is no other significant history. Physical exam findings include cold, diaphoretic skin with peripheral cyanosis; jugular venous distension; clear breath sounds bilaterally; and vitals as follows: HR = 134, BP = 74/50, RR = 28, SaO₂ = 84%. Which of the following is most likely?

A) Spontaneous tension pneumothorax
B) Pulmonary embolism
C) Myocardial infarction
D) Idiopathic congestive heart failure

Question 61

You are performing a physical exam on a patient with emphysema. You note that the patient has a pink hue to her skin. You should suspect:

A) cor pulmonale.
B) polycythemia.
C) methahemoglobinemia.
D) carboxyhemoglobinemia.

Question 62

Pulmonary shunting can be seen in patients with suspected:

A) tension pneumothorax.
B) hemothorax.
C) pulmonary embolism.
D) hypovolemic shock.

Question 63

You are evaluating a patient complaining of having a productive cough. The patient states the sputum is green to brown. You suspect:

A) infection.
B) inflammation.
C) allergies.
D) hemoptysis.

Question 64

Your patient is complaining of "coughing up blood," or, in medical terms:

A) hemothorax.
B) hemoptysis.
C) neoplasm.
D) hemopulmonary spasm.

Question 65

A disorder of lung diffusion that results from increased fluid in the interstitial space is known as:

A) ARDS.
B) COPD.
C) AIDS.
D) PHTN.

Question 66

Paradoxical movement is associated with:

A) tension pneumothorax.
B) hemothorax.
C) flail chest.
D) simple pneumothorax.

Question 67

Which of the following is NOT part of the respiratory status assessment?

A) Mental status
B) Color
C) Respiratory effort
D) Lung compliance

Question 68

You are called to a patient with severe shortness of breath. Upon arrival, you find your patient in the tripod position, with pursed lips and audible wheezing. SpO₂ is at 89% and capnography shows a "shark fin" pattern with an ETCO₂ of 50. You should:

A) administer a beta agonist.
B) administer a beta antagonist.
C) administer an alpha antagonist.
D) administer an alpha agonist.

Question 69

A sudden disruption of pulmonary perfusion caused by a blood clot is known as:

A) pulmonary occlusion.
B) pulmonary diffusion.
C) pulmonary edema.
D) pulmonary embolism.

Question 70

Which of the following is NOT a common obstructive lung disease encountered in the prehospital setting?

A) Asthma
B) CHF
C) Emphysema
D) Chronic bronchitis

Question 71

You are assessing your respiratory patient. Of the following findings, which would concern you the most?

A) Tachycardia
B) Intercostal retractions
C) Altered mental status
D) Stridor

Question 72

You respond to a patient with difficulty breathing. Upon assessment you notice that the patient is sitting in the tripod position, with marked JVD. The patient has clubbing in the fingers and new pitting edema. You should suspect:

A) CHF.
B) COPD.
C) cor pulmonale.
D) pulmonary neoplasm.

Question 73

You are assessing a patient who is presenting with shortness of breath, JVD, and tracheal deviation. You suspect:

A) flail chest.
B) tracheal tugging.
C) subcutaneous emphysema.
D) tension pneumothorax.

Question 74

Upon examining your patient, you note that he has a clubbing of the fingers. You would suspect a history of:

A) hypoxemia.
B) neoplasm.
C) hypertension.
D) peripheral vascular disease.

Question 75

The hallmark treatment of ARDS is to:

A) administer corticosteroids.
B) treat the underlying condition.
C) treat the increased fluid with diuretics.
D) perform renal dialysis to remove the fluid.

Question 76

You are called to care for a patient with severe shortness of breath. The patient has an SpO₂ of 88%, audible wheezing, and a capnography reading of 54 with a shark fin wave form. You are administering albuterol for the second time without relief. You suspect:

A) status epilepticus.
B) status asthmaticus.
C) anaphylaxis.
D) septic shock.

Question 77

You arrive on the scene of a patient who complains of worsening shortness of breath for the past few days. The patient presents with an SpO₂ of 90%, ETCO₂ of 45, normal wave form, crackles, and a temperature of 101.5°F. You should suspect:

A) CHF.
B) COPD.
C) pneumonia.
D) ARDS.

Question 78

Obstructive sleep apnea is an example of:

A) lower airway obstruction.
B) upper airway obstruction.
C) COPD.
D) CHF.

Question 79

You are caring for a patient with chronic bronchitis. The patient has an SpO₂ of 90%. You should:

A) administer supplemental oxygen at high flow 15 lpm via NRB.
B) administer supplemental oxygen at high flow, via CPAP.
C) administer supplemental oxygen at low flow, via nasal cannula.
D) do nothing, as this is an expected reading.

Question 80

You are called to the home of a patient who suddenly "stopped breathing." The patient has a history of a neoplasm at C-3 and C-4. You suspect:

A) impingement on the phrenic nerve.
B) cervical fractures.
C) lung cancer.
D) myocardial infarction.