RESP

Question 1

which statement is true about chemoreceptors?

1. they are only based in the central nervous system
2. they are only based in the large main arteries
3. they all sense PaO2 levels as their main function
4. they all sense PaCO2 levels
5. they act in isolation of each other

Answer 1

4. they all sense PaCO2 levels

Question 2

in the control of human breathing:

1. only the centres in the pons are important in the basic breathing rhythm
2. centres in both the pons and medulla oblongata are important
3. the dorsal respiratory group has no function during inspiration
4. the ventral respiratory group has no function in inspiration
5. the DRG and VRG are unilateral structures

Answer 2

2. centres in both the pons and medulla oblongata are important

Question 3

which statement is true about the larynx?

1. it has 10 cartilages, all in pairs
2. its main function is to humidify the inspired air
3. its main motor function is taken from the recurrent laryngeal nerve
4. its main motor function is taken from the external branch of the superior laryngeal nerve
5. recurrent laryngeal nerve damage does not normally lead to significant hoarseness

Answer 3

3. its main motor function is taken from the recurrent laryngeal nerve

Question 4

when considering an emergency chest drain position

1. the third rib is always lateral to the angle of Louis of the sternum
2. the third intercostal space is always lateral to the angle of Louis of the sternum
3. a chest drain can be inserted just lateral to the sternum anteriorly with complete safety
4. a chest drain can be inserted at the cardiac apex completely safely
5. the second intercostal space is below the second rib

Answer 4

5. the second intercostal space is below the second rib

Question 5

the right main bronchus

1. is less vertically disposed than the left main bronchus
2. is closely applied to the arch of the aorta
3. always divides immediately after the carina into two main lobar bronchi
4. is equally vertically disposed to the left main bronchus
5. is more vertically disposed than the left main bronchus

Answer 5

5. is more vertically disposed than the left main bronchus

Question 6

gas exchange between alveolus and haemoglobin:

1. most often occurs through the thin walls of the terminal bronchioles
2. is an entirely passive process
3. occurs through a membrane approx. 10 microns thick
4. occurs through a membrane approx. 1 micron thick
5. depends almost entirely on supplying bulk gas to the alveoli

Answer 6

4. occurs through a membrane approx. 1 micron thick

Question 7

during inspiration, the diaphragm:

1. relaxes and descends
2. contracts and descends
3. relaxes and ascends
4. contracts and ascends
5. does not normally move in quiet respiration

Answer 7

2. contracts and descends

Question 8

expiration is:

1. largely an active process with contraction of the hemi diaphragm
2. largely an active process with relaxation of the hemi diaphragm
3. largely a passive process with contraction of the hemi diaphragm
4. largely a passive process with relaxation of the hemi diaphragm

Answer 8

4. largely a passive process with relaxation of the hemi diaphragm

Question 9

the physiological dead space is defined as:

1. the volume of air in the trachea that does not contribute to gas exchange
2. the volume of air in the alveoli that does not contribute to gas exchange
3. the volume of air in the trachea that does not contribute to gas exchange minus the volume of air in the alveoli that does not contribute to gas exchange
4. the volume of air in the trachea that does not contribute to gas exchange plus the volume of air in the alveoli that does not contribute to gas exchange
5. the volume of air in the alveoli that contributes to gas exchange

Answer 9

4. the volume of air in the trachea that does not contribute to gas exchange plus the volume of air in the alveoli that does not contribute to gas exchange

Question 10

hypoxia (low oxygen levels):

1. in the lung causes vasodilation
2. in the lung causes vasoconstriction
3. in the systemic circulation causes vasoconstriction
4. in the lung causes the bronchi to dilate
5. in the lung causes the bronchi to constrict

Answer 10

2. in the lung causes vasoconstriction

Question 11

arterial PaCO2 depends on:

1. a constant, the production of CO2 and alveolar ventilation
2. alveolar ventilation only
3. the production of CO2 only
4. a constant, the production of CO2, alveolar ventilation and PaO2
5. PaO2 only

Answer 11

1. a constant, the production of CO2 and alveolar ventilation

Question 12

the oxygen/haemoglobin dissociation curve:

1. is almost linear
2. is not influenced by 2,3 DPG
3. is influenced by changing affinity for sequential oxygen molecule binding
4. is not influenced by temperature
5. is not influenced by (H+) concentration

Answer 12

3. is influenced by changing affinity for sequential oxygen molecule binding

Question 13

in respiratory acidosis:

1. the PaCO2 initially rises
2. the PaO2 initially rises
3. the kidneys excrete more bicarbonate
4. the pH rises
5. H+ concentration falls in arterial blood

Answer 13

1. the PaCO2 initially rises

Question 14

the FEV1:

1. is the flow rate of air generated maximally one second after the start of forced expiration
2. is not related to height
3. is not related to age
4. is the volume of air expelled after one second of forced expiration
5. is always reduced in patients with asthma

Answer 14

4. is the volume of air expelled after one second of forced expiration

Question 15

peak flow variation:

1. is typically seen in COPD
2. is typical in asthma, and measured at less than 5% normally
3. is typical in asthma, and measured at less than 10% normally
4. is typical in asthma, and measured at more than 20% normally
5. is typically 20% in hypersensitivity pneumonitis

Answer 15

4. is typical in asthma, and measured at more than 20% normally

Question 16

a patient with breathing problems has the following lung function: FEV1 1.6l (predicted value 3.2l) and FVC 4.8l (predicted value 4.7l). Which is the most accurate:

1. the patient has airways obstruction and a normal FEV1
2. the patient has airways obstruction and a reduced FEV1
3. the patient has a normal FEV1 and FVC
4. the patient has airways restriction
5. the patient has both airways obstruction and restriction

Answer 16

2. the patient has airways obstruction and a reduced FEV1

Question 17

the carbon monoxide single breath transfer factor:

1. is a good estimate of small airway function
2. is a good estimate of tracheal dimensions
3. is a good measure of the anatomical dead space
4. is a good measure of gas exchange into the alveolar capillary
5. is a good measure of diaphragmatic function during quiet breathing

Answer 17

4. is a good measure of gas exchange into the alveolar capillary

Question 18

the FEV1:

1. is the volume of air that can be expelled at a constant 1 litre/min
2. is the volume of air that can be expelled in a relaxed manner in one second
3. is the volume of air that can be expelled in a forced manner in one second
4. is the total volume of air that can be expelled in a forced manner

Answer 18

3. is the volume of air that can be expelled in a forced manner in one second

Question 19

when a climber ascends a mountain, which statement best describes the physiology:

1. the pressure of inspired oxygen falls
2. the fraction of inspired oxygen falls
3. the pH of the arterial blood falls
4. the PAO2 rises
5. the PaCO2 rises

Answer 19

1. the pressure of inspired oxygen falls

Question 20

which of the following is NOT a feature of pulmonary oxygen toxicity (Lorraine Smith effect):

1. shortness of breath
2. cough
3. chest tightness
4. convulsions
5. sub sternal pain

Answer 20

4. convulsions

Question 21

Which of these cells provides cilia for the mucociliary escalator?
A. Macrophages
B. Columnar Epithelial Cells
C. Goblet Cells
D. Mast cells
E. Vascular Endothelial Cells

Answer 21

B. Columnar Epithelial Cells

Question 22

The Vagus Nerve supplies voluntary motor function to which of these structures?             
A. Bronchiole
B. Larynx
C. Nostril
D. Trachea
E. Main Bronchus

Answer 22

B. Larynx

Question 23

Changes in which of these blood parameters stimulates carotid chemoreceptors?
A. Carbon dioxide only
B. Oxygen, carbon dioxide and H+ ions
C. Carbon dioxide and HCO3- ions
D. Carbon dioxide and H+ ions
E. Oxygen and HCO3- ions

Answer 23

B. Oxygen, carbon dioxide and H+ ions

Question 24

Central chemoreceptors are located in the ventral medulla and respond to:                        
A. CSF haemoglobin
B. CSF pH
C. CSF bicarbonate
D. CSF oxygen
E. CSF carbon dioxide

Answer 24

B. CSF pH

Question 25

``` Which nerve supplies motor function to the diaphragm? A. Intercostal Nerves B. Lateral Thoracic Nerves C. Vagus Nerve D. Accessory Nerve E. Phrenic Nerve ```

Answer 25

E. Phrenic Nerve

Question 26

``` If an adult inhales a peanut, where is it most likely to become lodged in their airway? A. Right main bronchus B. Alveoli C. Trachea D. Left Main Bronchus E. Terminal bronchiole ```

Answer 26

A. Right main bronchus Trachea too large Terminal bronchiole and alveoli too small Bronchus just right. Preferentially goes down Right main bronchus due to the angle it comes off trachea.

Question 27

``` Type 1 Respiratory Failure is characterised by arterial blood gas picture of: A. normal pO2, low pCO2 B. low pO2, high pCO2 C. high pO2, high pCO2 D. high pO2, normal/low pCO2 E. low pO2, normal/low pCO2 ```

Answer 27

E. low pO2, normal/low pCO2 Type 1 respiratory failure is defined as a low level of oxygen in the blood (hypoxaemia) without an increased level of carbon dioxide in the blood (hypercapnia), and indeed the PaCO2 may be normal or low.

Question 28

``` Which of these conditions would normally lead to Type 2 Respiratory Failure? A. Pulmonary embolism B. Right middle lobe collapse C. Small Pneumothorax D. Chronic Obstructive Pulmonary Disease E. Pneumonia ```

Answer 28

D. Chronic Obstructive Pulmonary Disease The underlying causes of type 2 include: Increased airways resistance - chronic obstructive pulmonary disease Reduced breathing effort (drug effects, brain stem lesion, extreme obesity) A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis) Neuromuscular problems

Question 29

``` Which of these conditions would normally lead to Type 1 Respiratory Failure? A. Pulmonary Embolism B. Chronic Obstructive Pulmonary Disease C. Widespread pulmonary tuberculosis D. Pulmonary Hypertension E. Severe Motor Neurone Disease ```

Answer 29

A. Pulmonary Embolism This type of respiratory failure is caused by conditions that affect oxygenation such as: Low ambient oxygen (e.g. at high altitude) Ventilation-perfusion mismatch (parts of the lung receive oxygen but not enough blood to absorb it, e.g. pulmonary embolism) Alveolar hypoventilation due to reduced respiratory muscle activity, e.g. in acute neuromuscular disease (this form can also cause type 2 respiratory failure if severe) Diffusion problem (oxygen cannot enter the capillaries due to parenchymal disease, e.g. in pneumonia) Shunt (oxygenated blood mixes with non-oxygenated blood from the venous system, e.g. right to left shunt)

Question 30

``` The main peripheral chemoreceptors are located in the: A. Jugular veins and vena cava B. Pulmonary veins and left atrium C. Trachea and main bronchi D. Carotid arteries and aortic arch E. Skeletal muscle ```

Answer 30

D. Carotid arteries and aortic arch

Question 31

Vital capacity (VC) is calculated by A. Functional residual capacity + Inspired reserve volume B. Tidal volume + Inspired reserve volume + Expired reserve volume C. Tidal volume + Inspired reserve volume + Expired reserve volume + Anatomical dead space D. Total lung capacity – Tidal volume

Answer 31

B. Tidal volume + Inspired reserve volume + Expired reserve volume

Question 32

``` What is the term used to describe a malignant tumour of the pleural membranes? A. Pleuroma B. Mesotheliocarcinoma C. Mesodermocarcinoma D. Pleurocarcinoma E. Mesothelioma ```

Answer 32

E. Mesothelioma

Question 33

``` Which of these factors will contribute to causing bronchodilation? A. Beta-Blockers B. Adrenaline C. Parasympathetic stimulation D. Histamine release E. Cold dry air ```

Answer 33

B. Adrenaline Adrenaline causes bronchodilation, by binding to β 2 -receptors in the smooth muscle of the bronchioles and causing their relaxation. All the other factors are associated with causing bronchoconstriction

Question 34

``` Chronic Type 2 Respiratory Failure is characterised by arterial blood gas picture of: A. low pO2, high pCO2, low HCO3 B. normal pO2, low pCO2, low-normal HCO3 C. low pO2, low pCO2, low HCO3 D. low pO2, high pCO2, normal-high HCO3 E. low pO2, low pCO2, normal HCO3 ```

Answer 34

D. low pO2, high pCO2, normal-high HCO3 Hypoxemia (PaO2 <8kPa) with hypercapnia (PaCO2 >6.0kPa). Type 2 respiratory failure is caused by inadequate alveolar ventilation; both oxygen and carbon dioxide are affected. Defined as the build-up of carbon dioxide levels (PaCO2) that has been generated by the body but cannot be eliminated.

Question 35

``` Which of the following is defined as ‘the amount of air remaining in the lungs after normal quiet expiration’? A. Functional residual capacity B. Expiratory reserve volume C. Physiological dead space D. Residual volume E. Tidal volume ```

Answer 35

A. Functional residual capacity