Pathophysiology revision - SECTION II - Respiratory Systems

Question 1 of 56

1

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Label the areas of the respiratory CONDUCTING zones as appropriate:

Explanation

Question 2 of 56

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The passage of air into the lungs is governed by pressure differences caused by changes in ( lung volume, lung capacity, lung residue, lung resilience ). The ( thoracic diaphragm, lumbar diaphram, cervical diaphram, adregeneric diaphragm ) is the principle muscle of respiration which is innervated by the phrenic nerves derived from the ventral rami of cervical segments 3 – 5.

Explanation

Question 3 of 56

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When the diaphragm ( contracts, relaxes, inverts ), the vertical diameter of the thoracic cavity increases and air moves into the lungs. This relationship between volume and pressure is represented in ( Boyle’s Law, Charles' Law, Henry's Law, Starling's Law )

Explanation

Question 4 of 56

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( Muscles of inspiration, Muscles of expiration, Normal conditions ): external intercostals, sternocleidomasoids, scalei, anterior serrate, trapezius, posterior neck muscles.

( Muscles of expiration, Muscles of inspiration, Normal conditions ): internal intercostals, posterior inferior serrate, abdominal muscles.

( Normal conditions, Muscles of inspiration, Muscles of expiration ): diaphragm and intercostals

Explanation

Question 5 of 56

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In a patient with a pneumothorax, the lung collapses when the ( intraplural space, extraplural space, intercostal space, myocardial space ) is violated and the ( negative, positive, inerrant, backforce ) pressure between the lung and chest wall is no longer maintained

Explanation

Question 6 of 56

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Patients with Asthma have narrowed air passages due to smooth muscle contraction, mucus plugging and inflammation. This leads to an ( increase, decrease ) in residual volume, a ( decrease, increase ) in vital capacity and a ( decrease, increase ) in expiratory reserve volume

Explanation

Question 7 of 56

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In patients with emphysema, lung tissue is destroyed and weakened airway walls collapse during ( expiration, inspiration ). Because of chronic lung tissue inflammation and swelling, the airway walls have decreased recoil and elasticity. Thus, inspiritory capacity and expiratory reserve volume ( decease, increase ) while reserve volume ( increases, decreases, remains the same )

Explanation

Question 8 of 56

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According to ( La Place’s, Boyle's, Charles', Henry's, Starling's ) Law, the surface tension of smaller alveoli is ( greater, lesser, the same ) than that of larger alveoli. ( Surfactant, Lubriol, Protasine, Pluratol ) is a substance produced by type II alveolar cells which decreases surface tension of the alveoli and is an important component to think about when dealing with ( pre-mature babies, obese patients, geriatrics, teenagers )

Explanation

Question 9 of 56

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Damage to the capillary membrane, heart failure and valvular disease can all lead to ( pulmonary odeama, Emphysema, Asthma, Bronchitis ). This is due to an imbalance in the normal forces at the alveolar capillary membrane, causing fluid to accumulate in the pulmonary interstitial space and alveoli. This is best illustrated by ( Starling’s Law, Henry's Law, Charles's Law, La Place's Law )

Explanation

Question 10 of 56

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Excess fluid accumulating within the pulmonary interstitial space is usually taken up by the ( lymphatic system, artieral system, pulmonary system, endocrine system )

Explanation

Question 11 of 56

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Airway diameter and secretions are primarily controlled by the ( autonomic nervous system, cardiac receptor system, somatic nervous system, enteric system ). ( Beta-2, Beta-1, Alfa-1, Alfa-2 ) receptors function to dilate the bronchioles when activated by adrenergic agonists such as epinephrine and norepinephrine. Stimulation of these receptors also ( decreases, increases ) the secretions of mucus and serous glands

Explanation

Question 12 of 56

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( Inspiration, Expiration, Respiratory syncope ) is controlled neurologically via the medullary respiratory centre which sends signals via the phrenic nerve. ( Expiration, Inspiration, Respiratory syncope ) is controlled via the ventral respiratory group and is usually only activated during exercise or with certain diseases (COPD) where where ( expiration, inspiration, respiratory syncope ) becomes an active process.

Explanation

Question 13 of 56

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Chemoreceptors play an important role in the regulation of respiration. Central chemoreceptors in the ( medulla, aorta, cerebellum, cerebrum ) are sensitive to PH of cerebrospinal fluid. When the PH level drops, the ventilary rate ( increases, decreases ). This would be due to an ( increase, decrease ) in C02 levels

Explanation

Question 14 of 56

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Why would a hyperventilating patient lose consciousness?

Select one or more of the following:

PH levels will fall, causing central chemoreceptors to reduce the ventilary rate
PH levels will rise, causing central chemoreceptors to reduce the ventillary rate
PH levels will fall, causing central chemoreceptors to increase the ventillary rate
PH levels will rise, causing the central chemoreceptors to increase ventilary rate

Explanation

Question 15 of 56

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Peripheral chemoreceptors exist in the ( carotid and aortic bodies, medulla, recticular respiratory zone, pluralistic bodies ). These are sensitive to ( oxygen, carbon dioxide, hydrogen ions, bicarbonate ) and hence, if levels fall to a very low rate (below 60 mmHg), these are activated to increase ventillary rate. Those who have this system consistently activated are said to have a ( hypoxic drive, asthmatic tendancy, ventilation to perfusion mismatch, tachypnoeic altercation )

Explanation

Question 16 of 56

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Albuteral, bitolterol and salmeterol are all examples of ( Beta-2 Agonists, anticholinergic agents, Glucocorticoids, Afla-1 Agonists ), used for treating Asthma and COPD. These work by inducing ( relaxation, constriction, spasm, exitation ) of the bronchial musculature. However, they can also have an effect on Beta-1 receptors causing ( increased heart rate, reduced heart rate, Atrial fibrillation, Atrial flutter )

Explanation

Question 17 of 56

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Ipratopium bromide works to reverse overstimulation of the autonomic nervous system by blocking the ( parasympathetic, sympathetic ) neurotransmitters. They are hence known as ( anticholinergic agents, Beta-2 agonists, glucocorticoids, Beta blockers )

Explanation

Question 18 of 56

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Glucocorticoids also reffered to as corticosteroids are compounds synthesized from the ( zona recticulars fasciculars, zona glomerulosa, zona medullla ) of the adrenal cortex. ( Methylprednisolone, ibatropium, albuterol, salbutamol ) is an example of this steroid

Explanation

Question 19 of 56

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Your unit is called to the scene of a 33-year old asthmatic complaining of severe shortness of breath. Lung sounds are decreased with diffuse wheezing and a prolonged expiratory component. All of the following are muscles of expiration, EXCEPT:

Select one or more of the following:

Internal instercostals
Prosterior inferior serrate
Rectus abdominous
Sternocleidomastoids
External Obliques

Explanation

Question 20 of 56

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What would pulmonary function testing be likely to show in a patient experiencing a severe asthma attack?

Select one of the following:

Increased residual volume
Increased expiratory reserve volume
Increased vital capacity
Decreased inspiritory capacity
Little change in lung capacity

Explanation

Question 21 of 56

1

Patients with COPD are expected to have which of the following?

Select one of the following:

Difficulty with inspiring air due to bronchial narrowing
A decreased residual volume due to air trapped in dilated alveoli
Increased inspiratory capacity and decreased expiratory reserve volume
Increased elastic recoil of the lung segments
Difficulty with expiration due to chronic lung tissue inflammation and swelling

Explanation

Question 22 of 56

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Neonatal respiratory distress syndrome occurs in certain infants as a result of:

Select one of the following:

Chronic airways inflammation
Hypertrophy of type II alveolar cells
Hyperactivity of type I alveolar cells
Collapse of the alveoli during expiration due to a lack of surfactant
Bronchoconstriction due to hyperresponsiveness to supplemental oxygen

Explanation

Question 23 of 56

1

The mechanism of beta-2 agonists in asthma is:

Select one of the following:

Activation of the parasympathetic neurons to provide bronchodilation
Stimulation to increase the secreations of the mucous glands to rid the lungs of irritants
Stimulation of beta-2 adrenergic receptors on cells in the terminal bronchioles
Stimulation of beta-2 adrenergic receptors on cells in the proximal bronchi
Disinhibation of the medullary respiratory centre located in the brainstem

Explanation

Question 24 of 56

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A patient is hyperventilating and loses consciousness – what is the pathologic mechanism responsible for this?

Select one of the following:

Increased carbon dioxide levels in the CSF
Decreased carbon dioxide and hydrogen concentrations in the CSF
Increased oxygen levels in the CSF
Inhibition of the central chemoreceptors in the medulla
Activation of the carotid bodies in response to decreased inhaled carbon dioxide

Explanation

Question 25 of 56

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A 69-year old with emphysema becomes less responsive with decreased respirations while on 4 lpm of oxygen during a prolonged inter-facility transport. What is the likely mechanism for these findings?

Select one of the following:

Lowering of the P02 to very low levels causing a hypoxic drive, stimulated by peripheral chemoreceptors in the carotid bodies – now being suppressed by the prolonged administration of oxygen
Lowing of the P02 to very low levels causing suppression of the hypoxic drive, stimulated by peripheral chemoreceptors in the carotid bodies
Build-up of C02 and hydrogen ions in the CSF, causing activation of the central chemoreceptors which will suppress ventilations
Lowering of the P02 to very low levels causing suppression of the hypoxic drive, stimulated by the central chemoreceptors of the medulla
Lowering of the PC02 to very low levels causing suppression of the hypoxic drive, stimulated by the central chemoreceptors of the medulla

Explanation

Question 26 of 56

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The National Heart, Lung and Blood institute defines asthma as a ( chronic inflammatory disorder, acute respiratory implication, rare pathological damage, pulmonary odemic complication ) of the airways

Explanation

Question 27 of 56

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( Extrinsic, Intrinsic, Excretory, Excitory ) asthma is believed to be caused by an antibody-dependant (IgE) activation of cells that release inflammatory mediators. For that reason, it is also known as allergic asthma and is usually picked up in ( childhood, adulthood, teenagers, geriatrics, newborns )

Explanation

Question 28 of 56

1

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( Intrinsic, Extrinsic, Intubatory, Allergic ) asthma is more common in adults, is not related to antibody activation, tends to be more chronic, is severe and often controlled only with ( corticosteroids, Beta-2 agonists, anticholinergic agents, Beta blockers ). Triggers include exercise or infections rather than exposure to allergens

Explanation

Question 29 of 56

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When mast cells are stimulated by IgE antibodies, numerous mediators (i.e. cytokines) are released, contributing to what is known as a generalised state of bronchial hyperresponsiveness. This causes:

Select one or more of the following:

Smooth muscle constriction in the bronchioles
edema
increased mucus secretion
decreased mucus secretion
smooth muscle construction in the trachea
smooth muscle dilation in the bronchioles
dehydration

Explanation

Question 30 of 56

1

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The ( late response, after response, by-response, recurrent response ) represents the secondary phase of an asthma episode, typically occurring ( 4-12, 24, 1-2, 6 ) hours after the initial allergen introduction. This is significant as the cycle primes patients for future episodes by exposing sensitive irritant receptors that can later be more easily activated

Explanation

Question 31 of 56

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People who have symptom free intervals between episodes are said to have:

Select one of the following:

episodic asthma
intrinsic asthma
extrinsic asthma
adolescent asthma
allergic asthma

Explanation

Question 32 of 56

1

Match these signs with their main symptoms:

Airways narrowing due to smooth muscle contraction / Inflammation of the airways – ❌

Hyperinflation from trapped air in the distal airways – ❌

Airway narrowing and hypersecretion – ❌

A fall of more than 10 mmHg in systolic pressure during inspiration as a consequence of lung hyperinflation which compresses the left ventricle (right ventricular end systolic pressure increases, compressing the intraventricular septum) – ❌

Increased ventilation-perfusion mismatching due to airway obstruction – ❌

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wheeze

pulsus paradoxus

hypoxaemia

dyspnoea and tachyponea

cough and chest tightness

Explanation

Question 33 of 56

1

Match the clinical features with the asthma classification:

❌ (Step 1) – symptoms <2x/wk, brief exacerbations, PEF >80%

❌ (Step 2) - symptoms >2x/wk, night symptoms >2x/mo, exacerbations effect activity, PEF >80%

❌ (Step 3) – symptoms daily, daily use of albuterol, excaserbations greater than 2x/week, night symptoms >1x/wk, PEF >60 - <80%

❌ (Step 4) – symptoms continuous, liminted physical activity, frequent night symptoms, PEF ,60%

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Mild Intermittent

Mild Persistent

Moderate Persistent

Severe Persistant

Explanation

Question 34 of 56

1

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Fill in the blanks:

Step 1 (mild intermittent) : QUICK RELIEF ( Short acting bronchodilator, No daily medication required, Low dose inhaled corticosteroid, Mast Cell Stabliser, Leukotrine inhibitor, Long acting bronchodilator ); LONG TERM CONTROL ( No daily medication required, Long acting bronchodilator, Short acting bronchodilator, High dose inhaled corticosteroid )

Step 2 (mild persistent): QUICK RELIEF ( Short acting bronchodilator, No daily medication required, Low dose inhaled corticosteroid, mast cell stabilizer, long acting bronchodilator ) ; LONG TERM CONTROL ( Low dose inhaled corticosteroid, No daily medications, high dose inhaled corticosteroid, long acting bronchodilator ) OR ( Mast Cell Stabiliser, corticosteroid tablets ) OR ( Leukotrine inhibitor, Mast cell activator, long acting brocnhodilator )

Step 3 (moderate persistent) : QUICK RELIEF ( short acting bronchodilator, no daily tablets, mast cell stablisers, luekotrine inhibitors ); LONG TERM CONTROL ( Medium dose inhaled corticosteroid, Low dose inhaled corticosteroid, High dose corticosteroid, Mast cell activator ) AND ( long acting bronchodilator, short acting bronchodilator, corticosteroid tablets, Leukotrine inhibitor )

Step 4 (severe persistent): QUICK RELIEF ( short acting bronchodilator, long acting bronchodilator, Mast cell stabilizer, No quick relief ) ; LONG TERM CONTROL ( high dose inhaled corticosteroid, medium dose inhaled corticosteroid, low dose inhaled corticosteroid, Leukotrine inhibitor ) AND ( long acting bronchodilator, short acting bronchodilator ) AND ( corticosteroid tablets, corticosteroid injections, corticosteroid inhibitors )

Explanation

Question 35 of 56

1

Match the drug to the action:

Relaxes smooth muscle while also decreasing the release of mediators from mast cells and basophils –
DRUG TYPE ❌ – EXAMPLE ❌

Inhibitory effect on bronchoconstricting leutrienes and prostaglandins by stopping phospholipid A2 –
DRUG TYPE ❌, EXAMPLE ❌

Inhibition of the parasympathetic nervous system by selectively binding and blocking the neurotransmitter acetylcholine to its receptor in nerve cells –
DRUG TYPE ❌, EXAMPLE ❌

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Beta-adrenergic agonist

albuterol, epinephrine

anti-inflamitory agent (corticosteroids)

prednisolone

anticholinergic

Ipatropium

Explanation

Question 36 of 56

1

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Several risk factors for COPD have been identified, but by far the primary cause is related to ( tobacco smoke exposure, obesity, cardiac failure, excessive exercise )

Explanation

Question 37 of 56

1

The four main actions of tobacco smoke are:

Select one or more of the following:

impairs ciliary movement
inhibits the function of macrophages
overstimulates the mucus glands
Stimulates irritant receptors
Induces smooth muscle contraction
Causes bronchoconstriction
inhibits the mucus glands
causes vasodilation of the alveoli
Reduces irritant receptor sensitivity

Explanation

Question 38 of 56

1

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Someone who is known to be a “pink puffer” will be likely to have what characteristics?

Age: ( >50, Young (50s) )
Disease process: ( Emphysema, Bronchitis )
Cough: ( Mild, Chronic )
Weight Changes: ( weight loss, weight gain )
Sputum: ( Scant, Copious )
Degree of hypoxia: ( Mild, Severe )
Response to bronchodilators: ( Mild improvement, Great improvement )
Cough type: ( Dyspneic, Tussive )
Accessory Muscle Use: ( Yes, No )
Hyperventillation: ( Yes, No )

Explanation

Question 39 of 56

1

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Someone who is known to be a “blue bloater” will be likely to have what characteristics?

Age: ( Young (50s), >50 )
Disease process: ( Bronchitis, Emphysema )
Cough: ( Chronic, Mild )
Weight Changes: ( weight gain, weight loss )
Sputum: ( copious, scant )
Degree of hypoxia: ( Can be severe, Mild )
Response to bronchodilators: ( great improvement, mild improvement )
Cough: ( Tussive, Dyspneic )
Accessory muscle use: ( No, Yes )
Hyperventilation: ( No, Yes )

Explanation

Question 40 of 56

1

You are called to a 60 y/o patient who is sat in the tripod position on arrival. Respiratory inspection reveals use of excessory muscles to breathe, mild hypoxia and a mild cough producing little sputum. Pt is found to have a prolonged expiratory component with a wheeze on exhalation. Without any further history taking, what disease process could this patient have?

Select one of the following:

Emphysema
Bronchitis
Asthma

Explanation

Question 41 of 56

1

Permanent destruction of elastic segments of the alveoli by mechanical, chemical, or other factors is the pathogenetic hallmark of:

Select one of the following:

Emphysema
Bronchitis
Asthma

Explanation

Question 42 of 56

1

You are called to a 49 y/o patient with a chronic cough producing copious amounts of sputum. You notice the patient is overweight and on examination find them to be hypoxic but with only a small, insignificant rise in RR. The patient tells you that his breathing symptoms are part of a chronic condition and this is not acute.

Select one of the following:

Emphysema
Bronchitis
Asthma

Explanation

Question 43 of 56

1

Irritation of the mucosa by smoke, chemicals and other irritants leading to the hyperplasia of mucus glands and disruption of the normal function of cilia in the respiratory tissue lining the airways describes:

Select one of the following:

Bronchitis
Emphysema

Explanation

Question 44 of 56

1

What pathologic changes are thought o be responsible for the development of the barrel chest of emphysema?

Select one of the following:

Permanent dilation of the pulmonary air spaces with the destruction of the airway walls
Stretching of bronchi with air trapping in the plural space
Formation of small air spaces in segments of lung with air leakage into the plura
Alveolar expansion during expiration due to increased surfactant formation
Increased vital capacity

Explanation

Question 45 of 56

1

All of the following classes of medications can be used in the acute COPD exacerbations, EXCEPT:

Select one of the following:

Beta-2 adrenergic receptor agonists
Systemic corticosteroids
Methylated Xanthines
Cholinergic agonists

Explanation

Question 46 of 56

1

While all of these are a risk factor for COPD, which is the most likely to cause it?

Select one of the following:

Previous exposure to sulphur dioxide and nitrogen dioxide
History of alfa1-antitrypsin deficiency
Exposure to significant air pollution
A history of severe viral pneumonia during infancy
Tobacco smoke exposure

Explanation

Question 47 of 56

1

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Match the following clinical characteristics to the most appropriate type of COPD patient:

- A 66 y/o woman with dyspnoea, mild hypoxia and a history of weight loss – ( EMPHYSEMA (pink puffer), BRONCHITIS (blue bloater), NEITHER )

- A 55 y/o morbidly obese smoker with dyspnoea who improves significantly after two treatments of nebulised albuterol – ( BRONCHITIS (blue bloater), EMPHYSEMA (pink puffer), NEITHER )

- A 72 y/o male smoker with accessory muscle use, hyperventilation and a barrel chest – ( EMPHYSEMA (pink puffer), BRONCHITIS (blue bloater), NEITHER )

- A 50 y/o female with a history of chronic occupational smoke exposure who presents with copious sputum, chronic cough and severe hypoxia – ( BRONCHITIS (blue bloater), EMPHYSEMA (pink puffer), NEITHER )

- An 8 y/o female with a history of wheezing after exposure to a new pet – ( NEITHER, BRONCHITIS (blue bloater), EMPHYSEMA (pink puffer) )

Explanation

Question 48 of 56

1

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Venostsis; vessel wall inflammation and/or endothelial injury; hypercoagulability all relate to ( Virchow’s triad, Cushing's triad, Beck's triad, Dieulafoy's triad ) for pulmonary embolism.

Explanation

Question 49 of 56

1

While all of these are a risk factor for PE, which is the most likely to cause it?

Select one of the following:

Recent surgery
Pregnancy
Prolonged immobilisation
Presence of an underlying malignancy
Previous history of a DVT or PE

Explanation

Question 50 of 56

1

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With few exceptions, almost all emboli arise within the large deep veins of the ( pelvis, humerus, sternum, ulna, ribcage, spine ) and ( lower extremities, upper extremities, mid auxiliary components ).

Explanation

Question 51 of 56

1

Thrombus almost always starts in the veins of the calf (saphenous vein) and propagates to veins above the knee. Over 90% of emboli arise from the following viens (TICK THREE):

Select one or more of the following:

Femoral
Popliteal
Illiac
Renal
Pulmonary
Basilic
Auxiliary

Explanation

Question 52 of 56

1

Signs and symptoms of a PE include:

Select one or more of the following:

Haemoptysis
Dyspnoea
Pleuritic chest pain
Apprehension
Tachypnoea
Tachycardia
Fever
Sweating
Syncope
Cyanosis

Explanation

Question 53 of 56

1

All of the following are risk factors for developing a PE, EXCEPT:

Select one of the following:

Venostasis, vessel wall inflammation
Known hypercoaguable state
Pregnancy
Prolonged strenuous exercise
Recent surgery

Explanation

Question 54 of 56

1

While all of these are signs and symptoms of a PE, which are the most sensitive indications?

Select one of the following:

Tachypnoea and dyspnoea
Diaphoresis and tachycardia
Fever and syncope
Pleuritic chest pain and apprehension
Crackles on lung exam and cyanosis

Explanation

Question 55 of 56

1

All of the following are acceptable actions during pre-hospital transport of a patient with suspected pulmonary embolism, EXCEPT:

Select one of the following:

Supplemental oxygen to maintain SP02 above 95%
Pre-hospital 12-lead ECG
Heparin or low molecular weight heparin if approved by medical control during a prolonged transport
Intravenous thrombolytics if approved by medical control during a prolonged transport
Application of compression stockings and intravenous fluids titrated to keep the cannulated vein open

Explanation

Question 56 of 56

1

Match the situation with the type of emboli risk:

Fracture of a long bone (tibula/fibula) – ❌
At the end of the first stage of labour – ❌
During placement of central cannulated lines – ❌
Prolonged immobilisation – ❌

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FAT EMBOLI

AMNIOTIC FLUID EMBOLI

AIR EMBOLI

BLOOD CLOT EMBOLI

	Created by Kaylee Garrick over 4 years ago

Test your knowledge on respiratory systems and pathology of Asthma, COPD (Emphysema/bronchitis) and pulmonary embolisms

Pathophysiology revision - SECTION II - Respiratory Systems

Question 1 of 56

Click on each orange point and select the correct answer.

Label the areas of the respiratory CONDUCTING zones as appropriate:

Explanation

Question 2 of 56

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Explanation

Question 3 of 56

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Explanation

Question 4 of 56

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Explanation

Question 5 of 56

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Question 6 of 56

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Explanation

Question 7 of 56

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Explanation

Question 8 of 56

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Explanation

Question 9 of 56

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Explanation

Question 10 of 56

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Excess fluid accumulating within the pulmonary interstitial space is usually taken up by the lymphatic system artieral system pulmonary system endocrine system( lymphatic system, artieral system, pulmonary system, endocrine system )

Explanation

Question 11 of 56

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Explanation

Question 12 of 56

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Explanation

Question 13 of 56

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Explanation

Question 14 of 56

Why would a hyperventilating patient lose consciousness?

Select one or more of the following:

Explanation

Question 15 of 56

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Explanation

Question 16 of 56

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Explanation

Question 17 of 56

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Explanation

Question 18 of 56

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Explanation

Question 19 of 56

Your unit is called to the scene of a 33-year old asthmatic complaining of severe shortness of breath. Lung sounds are decreased with diffuse wheezing and a prolonged expiratory component. All of the following are muscles of expiration, EXCEPT:

Select one or more of the following:

Explanation

Question 20 of 56

What would pulmonary function testing be likely to show in a patient experiencing a severe asthma attack?

Select one of the following:

Explanation

Question 21 of 56

Patients with COPD are expected to have which of the following?

Select one of the following:

Explanation

Question 22 of 56

Neonatal respiratory distress syndrome occurs in certain infants as a result of:

Select one of the following:

Explanation

Question 23 of 56

The mechanism of beta-2 agonists in asthma is:

Select one of the following:

Explanation

Question 24 of 56

Excess fluid accumulating within the pulmonary interstitial space is usually taken up by the ( lymphatic system, artieral system, pulmonary system, endocrine system )

Several risk factors for COPD have been identified, but by far the primary cause is related to ( tobacco smoke exposure, obesity, cardiac failure, excessive exercise )