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Mccance Chapter 36 Pulmonary Test
Bank Questions AND ANSWERS A+
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Besides dyspnea, what is the most common characteristic associated with pulmonary disease?
a. Chest pain
b. Digit clubbing
c. Cough
d. Hemoptysis
Correct answer: c. Cough
Why it's correct: Cough is one of the most common symptoms associated with pulmonary diseases, including conditions like chronic obstructive pulmonary disease (COPD), pneumonia, bronchitis, and asthma. It serves as a defense mechanism to clear the airway and is often the body's response to irritation or the presence of foreign substances.
Why others are wrong:
a. Chest pain: While chest pain can be a feature of some lung diseases, such as pleuritis or pneumonia, it is not the most common characteristic associated with pulmonary disease. Chest pain is also a symptom commonly associated with cardiovascular issues, not exclusively pulmonary diseases.
b. Digit clubbing: Clubbing of the fingers and toes is a more rare symptom seen in chronic respiratory diseases. It usually indicates long-standing hypoxia and is not commonly present in most cases of pulmonary disease.
d. Hemoptysis: Coughing up blood is a concerning symptom but is relatively uncommon in comparison to cough. It usually indicates more severe disease or complications and is not the most common characteristic of pulmonary diseases.
3 multiple choice options
Sitting up in a forward-leaning position generally relieves which breathing disorder?
a. hyperpnea
b. orthopnea
c. apnea
d. dyspnea on exertion
Correct answer: b. orthopnea
Why it's correct: Orthopnea is the difficulty in breathing that occurs when lying down and is relieved by sitting or standing. In a forward-leaning position, the diaphragm and lungs have more room to expand, making breathing easier for patients with conditions like congestive heart failure or some types of pulmonary disease.
Why others are wrong:
a. hyperpnea: Hyperpnea is an increased depth of breathing. This type of respiration is not specifically relieved by sitting up in a forward-leaning position.
c. apnea: Apnea is the absence of breathing, typically seen in conditions like sleep apnea. Sitting up does not generally relieve this condition.
d. dyspnea on exertion: This refers to shortness of breath that occurs with activity. It is not specifically relieved by sitting up in a forward-leaning position.
Respirations that are characterized by alternating periods of deep and shallow breathing are a result of which respiratory mechanism?
a. Decreased blood flow to the medulla oblongata
b. Increased partial pressure of arterial carbon dioxide (PaCO2), decreased pH, and
decreased partial pressure of arterial oxygen (PaO2)
c. Stimulation of stretch or J-receptors
d. Fatigue of the intercostal muscles and diaphragm
Correct answer: a. Decreased blood flow to the medulla oblongata
Why it's correct: Alternating periods of deep and shallow breathing, also known as Cheyne-Stokes respiration, can occur due to decreased blood flow to the medulla oblongata. The medulla oblongata controls the respiratory center, and impaired blood flow can lead to irregular breathing patterns.
Why others are wrong:
b. Increased PaCO2, decreased pH, and decreased PaO2: These parameters indicate respiratory failure and acidemia, not specifically Cheyne-Stokes respirations.
c. Stimulation of stretch or J-receptors: Stimulation of these receptors usually leads to shallow, rapid breathing, not Cheyne-Stokes respirations.
d. Fatigue of the intercostal muscles and diaphragm: Muscle fatigue would generally lead to decreased ability to sustain respirations, but it does not typically result in alternating deep and shallow breathing.
3 multiple choice options
Which statement is true regarding ventilation?
a. Hypoventilation causes hypocapnia.
b. Hyperventilation causes hypercapnia.
c. Hyperventilation causes hypocapnia.
d. Hyperventilation results in an increased partial pressure of arterial carbon dioxide (PaCO2).
Correct answer: c. Hyperventilation causes hypocapnia
Why it's correct: Hyperventilation increases the rate and depth of breaths, causing excessive expulsion of CO2 from the body. This results in a state of hypocapnia, or reduced levels of CO2 in the blood.
Why others are wrong:
a. Hypoventilation causes hypocapnia: Hypoventilation results in hypercapnia, not hypocapnia, as it causes retention of CO2.
b. Hyperventilation causes hypercapnia: Hyperventilation actually causes a reduction in CO2 levels, resulting in hypocapnia, not hypercapnia.
d. Hyperventilation results in an increased PaCO2: Hyperventilation leads to a reduction in PaCO2, not an increase, as more CO2 is expelled from the body.
What term is used to describe the selective bulbous enlargement of the distal segment of a digit that is commonly associated with diseases that interfere with oxygenation of the blood?
a. Edema
b. Clubbing
c. Angling
d. Osteoarthropathy
Correct answer: b. Clubbing
Why it's correct: Clubbing refers to the bulbous enlargement of the distal segments of a digit. It's commonly associated with diseases that interfere with the oxygenation of the blood, such as lung cancer, interstitial lung disease, and congenital heart disease.
Why others are wrong:
a. Edema: Edema refers to swelling caused by fluid accumulation, not the specific bulbous enlargement seen in clubbing.
c. Angling: This term is not related to any known symptom or sign associated with diseases affecting oxygenation of the blood.
d. Osteoarthropathy: While this involves joint issues, it does not describe the bulbous enlargement of the distal segments of a digit and is not directly associated with diseases that interfere with oxygenation.
3 multiple choice options
Pulmonary edema and pulmonary fibrosis cause hypoxemia by which mechanism?
a. Creating alveolar dead space
b. Decreasing the oxygen in inspired gas
c. Creating a right-to-left shunt
d. Impairing alveolocapillary membrane diffusion
Correct answer: d. Impairing alveolocapillary membrane diffusion
Why it's correct: Both pulmonary edema and pulmonary fibrosis affect the alveolocapillary membrane, thereby impairing diffusion. This results in hypoxemia because oxygen cannot effectively move from the alveoli into the bloodstream.
Why others are wrong:
a. Creating alveolar dead space: Dead space is an area where air is not exchanged effectively. Neither pulmonary edema nor pulmonary fibrosis primarily creates alveolar dead space.
b. Decreasing the oxygen in inspired gas: Neither condition impacts the levels of oxygen in the air that is inhaled.
c. Creating a right-to-left shunt: These conditions do not create a right-to-left shunt, which would bypass the alveoli altogether, leading to hypoxemia.
3 multiple choice options
High altitudes may produce hypoxemia through which mechanism?
a. Shunting
b. Hypoventilation
Correct answer: b. Pulmonary emboli
Why it's correct: Pulmonary emboli can block the pulmonary blood flow, leading to alveolar dead space. In these areas, ventilation occurs but no perfusion, effectively making them dead spaces for gas exchange.
Why others are wrong:
a. Pulmonary edema: While this can cause hypoxemia, it does so by impairing alveolocapillary membrane diffusion rather than creating alveolar dead space.
c. Atelectasis: This refers to the collapse of alveoli and does not specifically create alveolar dead space. It primarily affects ventilation, not perfusion.
d. Pneumonia: Pneumonia affects the alveoli by filling them with pus and other liquid, impairing gas exchange but not creating alveolar dead space.
What is the most common cause of pulmonary edema?
a. Right-sided heart failure
b. Left-sided heart failure
c. Mitral valve prolapse
d. Aortic stenosis
Correct answer: b. Left-sided heart failure
Why it's correct: Left-sided heart failure is the most common cause of pulmonary edema. In this condition, the left ventricle fails to pump blood effectively, causing a backup of blood and increased
pressure in the pulmonary veins. This increased pressure forces fluid out of the capillaries into the alveolar spaces, leading to pulmonary edema.
Why others are wrong:
a. Right-sided heart failure: Right-sided heart failure causes a backup of blood in the systemic circulation rather than the pulmonary circulation. It usually leads to peripheral edema but not pulmonary edema.
c. Mitral valve prolapse: While mitral valve problems can be associated with left-sided heart failure and subsequently pulmonary edema, mitral valve prolapse by itself is not the most common cause of pulmonary edema.
d. Aortic stenosis: This condition can contribute to left-sided heart failure but is not the most common cause of pulmonary edema.
Pulmonary edema usually begins to develop at a pulmonary capillary wedge pressure or left atrial pressure of how many millimeters of mercury (mm Hg)?
a. 10
b. 20
c. 30
d. 40
Correct answer: b. 20
Why it's correct: Pulmonary edema typically begins to develop when the pulmonary capillary wedge pressure or left atrial pressure reaches about 20 mm Hg. Normal pulmonary capillary wedge pressure is usually around 8-12 mm Hg. An increase to around 20 mm Hg means that the system is becoming overloaded, and fluid starts to leak into the alveolar spaces.
a. Compression: Compression atelectasis occurs due to external pressure on the lung tissue, such as a tumor or pneumothorax, not from the lack of collateral ventilation.
b. Perfusion: Perfusion-related issues would typically cause problems related to blood flow, not air flow, and would not directly cause atelectasis.
d. Hypoventilation: Hypoventilation atelectasis could theoretically result from inadequate ventilation, but it is not specifically linked to lack of collateral ventilation through the pores of Kohn.
In what form of bronchiectasis do both constrictions and dilations deform the bronchi?
a. Varicose
b. Symmetric
c. Cylindric
d. Saccular
Correct answer: a. Varicose
Why it's correct: In varicose bronchiectasis, both constrictions and dilations deform the bronchi. The airways resemble varicose veins, being irregularly widened in some places and constricted in others, leading to impaired mucociliary clearance and increased risk of infection.
Why others are wrong:
b. Symmetric: Symmetric bronchiectasis does not specifically involve both constrictions and dilations.
c. Cylindric: Cylindric bronchiectasis involves uniform dilations but not constrictions.
d. Saccular: Saccular bronchiectasis involves saccule-like dilations but not constrictions.
Which pleural abnormality involves a site of pleural rupture that acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration?
a. Spontaneous pneumothorax
b. Tension pneumothorax
c. Open pneumothorax
d. Secondary pneumothorax
Correct answer: b. Tension pneumothorax
Why it's correct: In a tension pneumothorax, air enters the pleural space during inspiration but cannot escape during expiration because the site of pleural rupture acts as a one-way valve. This results in increasing intrapleural pressure, which can lead to compression of the lung and mediastinal structures, creating a life-threatening situation.
Why others are wrong:
a. Spontaneous pneumothorax: This occurs without any obvious cause and is not characterized by a one- way valve effect.
c. Open pneumothorax: In an open pneumothorax, the pleural space communicates freely with the atmosphere; there is no one-way valve effect.
d. Secondary pneumothorax: This refers to a pneumothorax that occurs due to underlying lung disease but does not specifically involve a one-way valve mechanism.
Which condition involves an abnormally enlarged gas-exchange system and the destruction of the lung's alveolar walls?
a. Transudative effusion
b. Emphysema
c. Exudative effusion
d. Abscess
Correct answer: b. Emphysema
Why it's correct: Emphysema involves the abnormal enlargement of the gas-exchange system along with destruction of the alveolar walls. This leads to reduced surface area for gas exchange, poor recoil, and airflow limitation.
Why others are wrong:
a. Transudative effusion: Transudative effusion is a type of pleural effusion and doesn't involve abnormal enlargement of the gas-exchange system or destruction of the alveolar walls.
c. Exudative effusion: Like transudative effusion, this is a type of pleural effusion and doesn't involve the pathophysiological changes seen in emphysema.
d. Abscess: An abscess is a localized collection of pus within the lung tissue but does not involve the global enlargement and destruction of the alveolar walls as seen in emphysema.
Which term is used to identify a circumscribed area of suppuration and destruction of lung parenchyma?
a. Consolidation
b. Cavitation
c. Empyema
d. Abscess
Correct answer: d. Abscess
Why it's correct: An abscess is a circumscribed area of suppuration and destruction of lung parenchyma. This is often due to bacterial infection and is characterized by a localized collection of pus, inflammatory cells, and tissue debris.
Why others are wrong:
a. Consolidation: While consolidation refers to the filling of alveoli with fluids, cells, or tissues, it is a broader term and does not specifically refer to the localized suppuration and destruction characteristic of an abscess.
b. Cavitation: Cavitation refers to the formation of a cavity in the lung tissue, often as a result of necrosis. It does not specifically describe a circumscribed area of suppuration.
c. Empyema: Empyema refers to the collection of pus within the pleural cavity, not within the lung parenchyma itself.
Which condition is not a cause of chest wall restriction?
a. Pneumothorax
c. Exposure to asbestos
d. Inhalation of cigarette smoke
Correct answer: b. Inhalation of inorganic dust particles
Why it's correct: Pneumoconiosis is caused by the long-term inhalation of inorganic dust particles, such as coal dust, silica, or asbestos fibers. This leads to chronic lung disease characterized by inflammation and scarring.
Why others are wrong:
a. Pneumococci bacteria: These bacteria can cause pneumonia but are not responsible for pneumoconiosis, which is a result of inhaled particles.
c. Exposure to asbestos: While asbestos exposure can lead to a specific type of pneumoconiosis known as asbestosis, the term "pneumoconiosis" is broader and refers to conditions caused by the inhalation of various types of inorganic dust.
d. Inhalation of cigarette smoke: Cigarette smoke can lead to a variety of lung diseases like COPD or lung cancer but is not the cause of pneumoconiosis, which is related to inhaled inorganic particles.
Which condition is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury?
a. Acute respiratory distress syndrome (ARDS)
b. Pneumonia
c. Pulmonary emboli
d. Acute pulmonary edema
Correct answer: a. Acute respiratory distress syndrome (ARDS)
Why it's correct: Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury characterized by acute inflammation and diffuse alveolocapillary injury. This leads to rapid onset of hypoxemia and often requires mechanical ventilation for respiratory support. The hallmark of ARDS is non-cardiogenic pulmonary edema caused by increased permeability of the alveolocapillary barrier.
Why others are wrong:
a. Pneumonia: Pneumonia is an infection of the lung parenchyma and not necessarily a fulminant form of respiratory failure. While severe pneumonia can progress to ARDS, pneumonia itself does not entail the diffuse alveolocapillary injury seen in ARDS.
c. Pulmonary emboli: Pulmonary embolism is the blockage of the pulmonary arteries by a clot or other material. It may cause acute respiratory distress but does not involve the diffuse alveolocapillary injury characteristic of ARDS.
d. Acute pulmonary edema: Acute pulmonary edema refers to the rapid accumulation of fluid in the lungs, often due to cardiac failure. While it is an acute condition that can lead to respiratory failure, it lacks the diffuse alveolocapillary injury and inflammatory cascade seen in ARDS.
Which structure(s) in acute respiratory distress syndrome (ARDS) release inflammatory mediators such as proteolytic enzymes, oxygen-free radicals, prostaglandins, leukotrienes, and platelet-activating factor?
a. Complement cascade
b. Mast cells
c. Macrophages
d. Neutrophils
