PRACTICE QUESTIONS: RESPIRATORY SYSTEM

1. As part of a regular physical examination, 2 athletes undergo lung function tests. Both have
respiratory rates of 11/min and tidal volumes of 550 ml. However, arterial blood gas values show that
the arterial PCO2 of 1 is 35 mmHg and the other is 42 mmHg. Their doctor believes that the difference
in the dead space value is likely to be responsible for the difference in the athletes' arterial PCO2
values. What is dead space?

A. The volume of blood the heart pumps per minute

B. Air which is inhaled that does not take part in the gas exchange
C. The amount of air contained in the lung at the end of a maximal inhalation
D. Measure of the lung's ability to stretch and expand
E. The amount of air that the lungs can expel after having been filled completely

2. A 75-year-old man comes to the physician with an acute stroke including right-sided paralysis and
altered mental status. Two days after admission, he notes cough and right-sided pleuritic chest pain.
He is tachycardic, tachypneic, and has a fever of 102°F (38.8°C). His breath is foul smelling. Physical
examination shows egophony, decreased breath sounds, and dullness to percussion in the right lower
lung field. He is diagnosed with aspiration pneumonia. Which of the following right lung segment is
most likely be affected?
A. Superior segment of lower lobe
B. Anterior segment of the upper lobe
C. Lateral segment middle lobe
D. Posterior basal segment lower lobe
E. Apical segment upper lobe

3. A 32-year-old man from Africa, a recent immigrant to US, comes to the physician because of a
persistent nonproductive cough, night sweats and weight loss. A PPD-skin test reveals a 11 mm of
induration. He received BCG as an infant. His chest X-ray shows posterior segment right upper lobe
density. He is diagnosed with pulmonary tuberculosis. Which of the following cells are involved in the
fighting against tuberculosis?
A. CD8 and Macrophages
B. Neutrophils and macrophages
C. CD4 Natural Killer cells
D. CD4 and Macrophages
E. Langerhans cells and macrophages

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4. A 60-year-old man comes to the physician because of shortness of breath especially after walking
even short distances. He has smoked a pack of cigarettes a day for almost 40 years. The patient is
diagnosed with emphysema. Which of the following cells are involved in production of elastase in his
lungs?
A. Eosinophils
B. Type II pneumocytes
C. Macrophages
D. Type I pneumocytes
E. Endothelial cells

5. A 30-year-old Rh-negative woman gives birth to her first child, an Rh-negative male infant, at 32
weeks. The infant has a birth weight of 2kg. Within an hour of birth, the newborn becomes cyanotic and
shows labored breathing. The PCO2 is elevated and chest X-ray shows significant abnormal density in
the lungs. The patient is diagnosed with respiratory distress syndrome because of the lack of surfactant.
What is the function of lung surfactants?
A. Increase surface area
B. Decrease the diffusion barrier
C. Decrease surface tension
D. Decrease elasticity of the lung
E. Increase lung recoil

6. A 59-year-old man with a history of smoking comes to his physician with shortness of breath and
cough. His symptoms began 8 days ago with rhinorrhea. He reports a chronic morning cough productive
of white sputum, which has increased over the past 3 days. He has had similar episodes for the past 5
years. He was later diagnosed with chronic bronchitis. Which of the following cells acts as a
regeneration source of ciliated cells in the bronchioles?
A. Goblet cells
B. Type II pneumocytes
C. Club (Clara)cells
D. Cuboidal ciliated cells
E. Basal cells

7. A 1-year-old boy is brought to the physician because of failure to thrive. The boy has more bowel
movements per day than other children of the same age, and the stools often look shiny and have an
unusually foul smell. In addition, he has been treated with multiple courses of antibiotics for a persistent,
wet cough. On examination the child is small for age, with weight and length below the third percentile.
He is diagnosed with cystic fibrosis. Mutation in the ion transport of which of the following electrolytes
is responsible for this disease?
A. Sodium
B. Chloride
C. Potassium
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 D. Calcium
E. Bicarbonate

8. A 27-year-old woman with 24 weeks of gestation comes to the physician for a routine checkup. The
physician orders an ultrasound to determine the sex of the baby. Ultrasound examination of the fetus
shows a female fetus that has congenital diaphragmatic hernia. Which of the following structures
perforate the diaphragm at 8th thoracic vertebra (T8)?
A. Esophagus
B. Vagus nerve
C. Aorta
D. Thoracic duct
E. Inferior vena cava

9. A 55-year-old woman comes to the physician because of a progressive dyspnea. She has a 45 pack-
year history of smoking. Physical examination, blood studies and lung function studies confirm the
diagnosis of emphysema. Which of the following definitions correctly matches with the vital capacity?
A. The volume of air inspired during quiet breathing
B. Maximum volume of gas that can be expired after maximum inspiration
C. Volume of air in the lung after normal expiration
D. The volume of air in the lung after maximum inspiration
E. Volume of left in the lung after maximum expiration

10. A 10-year-old boy is brought to the emergency department because of difficulty breathing,
nonproductive cough and wheezing. Physical examination shows prolonged expiration and end
expiratory wheeze. He is suspected to have asthma and a pulmonary function study is performed.
Which of the following lung volumes cannot be measured with spirometry?
A. Inspiratory reserve volume
B. Expiratory reserve volume
C. Residual volume
D. Tidal volume
E. Inspiratory capacity.

11. A 60-year-old man who is a chronic smoker comes to the physician because of shortness of
breath. Physician orders pulmonary function studies. Which of the following formulae correctly
represents the calculation of minute ventilation (VE)?
A. VE = (VT-VD) x RR
B. VE = PIO2 – (PaCO2/R)
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 C. VE = (VT x RR)
D. VE=VT x (PaCO2 – PECO2/PaCO2)
E. VE = (IRV + TV + ERV + RV)

12. A newborn male infant is delivered at 26 weeks’ gestation. At birth, the infant weighs 1.8 kg but
otherwise appears normal. Soon after birth, the infant started showing signs of respiratory distress.
Physician suspects insufficient lung surfactants which affects the lung compliance. Which of the
following statements correctly describes lung compliance?
A. It is directly proportional to wall stiffness
B. Higher the compliance the harder it is for the lung to fill
C. Lower the compliance the easier it is for the lungs to fill
D. It is inversely proportional to wall stiffness
E. It is the tendency for the lungs to collapse inward

13. A 74-year-old chronic smoker comes to the physician because of a 3-day history of a productive
cough with yellow sputum, chest tightness, and fever. Physical examination shows a temperature
of 102°F (38.8°C), BP of 150/95 mmHg, heart rate of 85/min, and a respiratory rate of 22/min. His
arterial oxygen saturation is 89%. An x-ray of his chest shows a left lower lobe infiltrate. He is
diagnosed with lobar pneumonia. What is meant by oxygen content of blood?
A. The amount of oxygen dissolved in blood
B. The amount of oxygen combined with hemoglobin
C. The concentration of hemoglobin in blood
D. Combination of A and B
E. Amount of oxygen delivered to the tissues
F. Combination of A and E

14. A 35-year-old African American woman comes to the physician because of a 9-month history of dry
cough and progressive dyspnea. The patient denies chest pain. Her blood pressure is 138/90 mmHg.
There is no history of taking any medication, smoking or alcohol consumption. A tuberculin skin test is
negative. Histologic examination of his lung biopsy shows noncaseating granulomas. She is diagnosed
with sarcoidosis. Which of the following diagram best represents the restrictive state of this patient
lung?

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 A. A
B. B
C. C
D. D
E. E

15. An 18-year-old man is training for the next Olympics in which he hopes to run in the 400 meters
race. Soon after he completes his practice run, arterial and venous blood samples are drawn and sent
for analysis of PCO2, PO2 and pH. Which of the following result is most likely expected?
A. Increase in arterial PCO2
B. Decrease in arterial PO2
C. No change in arterial pH
D. Increase in venous pH
E. Decrease in venous PCO2

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ANSWER KEYS:
1. B
2. A
3. D
4. C
5. C
6. C
7. B
8. E
9. B
10.C
11. C
12. D
13. D
14. A
15. C