Chapter 8 THE RESPIRATORY SYSTEM

Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition
Chapter 8: The Respiratory System
Test Bank
MULTIPLE CHOICE
1. What is the primary purpose of the respiratory system?

a. continuous absorption of oxygen and excretion of carbon dioxide
b. filtering to prevent allergens and microbes from reaching the lungs
c. transport oxygenated blood to the tissues
d. warm and humidify inspired gas
ANS: A
The respiratory system's primary function is the continuous absorption of oxygen and the
excretion of carbon dioxide.
DIF: Application REF: p. 148 OBJ: 1
2. What is meant by “internal respiration”?

a. any gas exchange that occurs inside the body
b. consumption of oxygen in the mitochondria
c. continuous absorption of oxygen and excretion of carbon dioxide
d. exchange of gases between the blood and the tissue
ANS: D
This process supports internal respiration, which is the exchange of gases between blood and
tissues.
3. By what mechanism does gas exchange across the lung occur?

a. active transport
b. facilitated diffusion
c. facilitated transport
d. simple diffusion
ANS: D
This close “match” of gas and blood across a large but extremely thin blood-gas barrier
membrane enables efficient gas exchange to occur by simple diffusion.
4. The human genome contains _____ pairs of chromosomes.

a. 16
b. 23
c. 46
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Test bank 8-2
d. 50
ANS: B
DNA is organized into 23 pairs of supercoiled masses that are called chromosomes.
DIF: Recall REF: p. 150 OBJ: 2
5. Which chromosome has been found to carry the defective gene responsible for the
development of cystic fibrosis?
a. 1
b. 7
c. 15
d. 23
ANS: B
The defective gene that is responsible for defective CFTR is located on chromosome 7 in the
q31.2 region and has been found to be mutable in more than 1500 different ways.
6. Developmental morphogenesis of the human respiratory system can be categorized into:

a. three periods
b. five stages
c. 6 weeks
d. 40 weeks
ANS: B
Figure 8-1 shows the various stages of lung development, and Table 8-1 summarizes the
major developmental events in each phase.
7. The fetus is potentially viable if born prematurely after how many weeks of gestation?
a. 12 to 16 weeks
b. 18 to 20 weeks
c. 24 to 26 weeks
d. 28 to 32 weeks
ANS: C
At the end of the canalicular period (24 to 26 weeks of gestation), the fetus, if born, is capable
of sufficient gas exchange and is viable if supported completely with an artificial airway,
oxygen, ventilatory support, and surfactant administration.
8. The fetus is potentially viable if born at the end of which stage of development?
a. alveolar
Test bank 8-3
b. canalicular
c. pseudoglandular
d. saccular
ANS: B
At the end of the canalicular period (24 to 26 weeks of gestation), the fetus, if born, is capable
of sufficient gas exchange and is viable if supported completely with an artificial airway,
oxygen, ventilatory support, and surfactant administration.
9. During which phase of fetal development do mature alveoli appear?

a. alveolar
b. canalicular
c. pseudoglandular
d. saccular
ANS: A
The development of mature alveoli, accompanied by capillary proliferation within the walls,
marks the final phase of lung development and is known as the alveolar period.
10. Which of the following is an index commonly used to determine relative lung maturity?
a. FRC/TLC ratio
b. L:S ratio
c. RQ ratio
d. SP-A
ANS: B
Quantification of these phospholipids (the L:S ratio and PG concentration) provides a
predictive index of the lung maturity in the fetus before birth and the risks of developing
respiratory disease.
11. What maintains lung inflation during fetal development?

a. fetal lung fluid
b. radial tethering
c. rigidity of the chest wall
d. surfactant
ANS: A
Fetal lung fluid is constantly produced and keeps the fetal lung inflated at a slight positive
pressure with respect to amniotic fluid pressure and is important in promoting normal lung
development.
Test bank 8-4
12. By which of the following routes does blood flow through the umbilical cord between the
placenta and the fetus?
a. one umbilical vein and one umbilical artery
b. one umbilical vein and two umbilical arteries
c. two umbilical veins and one umbilical artery
d. two umbilical veins and two umbilical arteries
ANS: B
Maternal blood flows into the intervillous space through the spiral arteries, while fetal blood is
supplied to the villi from two umbilical arteries. Oxygenated fetal blood leaves the chorionic
villi capillaries through placental venules and returns to the fetus through a single umbilical
vein.
13. Abnormalities of the placenta that can cause intrauterine growth retardation or fetal asphyxia
include which of the following?
1. abnormal implantation of the placenta
2. separation of the placenta from the uterine wall
3. decreased placental blood flow
a. 2 and 3
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3
ANS: D
Abnormal implantation of the placenta, tearing of the placenta from the uterine wall, or
decreased placental blood flow can retard intrauterine growth and in severe cases can cause
fetal asphyxia and increases the risk for brain damage and respiratory distress in the
immediate postnatal period.
14. What would be a normal P50 for a fetus?

a. 10
b. 15
c. 20
d. 25
ANS: C
Figure 8-6 illustrates how the increased oxygen affinity is manifested by a leftward shift of the
fetal oxyhemoglobin dissociation curve. The P50 (PO2 that saturates 50% of the hemoglobin)
is 6 to 8 mm Hg less than adult hemoglobin (HbA), which indicates the degree of the shift
toward higher affinity.
Test bank 8-5
15. In the fetal heart, the foramen ovale allows blood to flow between which two structures?
a. bypass the liver and enter the inferior vena cava
b. pulmonary artery to aortic arch
c. right atrium to left atrium
d. right atrium to left ventricle
ANS: C
Approximately 50% of this blood is shunted from the right atrium into the left atrium through
an opening in the interatrial septum called the foramen ovale.
16. Which factors contribute to maintaining a patent ductus arteriosus during fetal life?
1. large amounts of fetal hemoglobin
2. low PaO2
3. presence of LDH
4. presence of prostaglandins
a. 1, 2, and 3
b. 2 and 4
c. 3 only
d. 1, 2, 3, and 4
ANS: B
The relatively low PO2 and various prostaglandins in fetal blood cause the ductus arteriosus, a
muscular vessel attached to the trunk of the pulmonary artery and the aorta, to dilate and the
pulmonary arteries to constrict.
17. What percentage of right ventricular output is circulated through the fetal lungs?
a. 10%
b. 35%
c. 75%
d. 100%
ANS: A
As a result, 90% of the blood flow entering the pulmonary artery takes the path of least
resistance by shunting through the ductus arteriosus and flows to the aorta. Only 10% flows
into the lungs.
18. During a vaginal delivery, what facilitates the removal of fetal lung fluid from the pulmonary
system?
a. high PaO2
Test bank 8-6
b. low intrapulmonary pressures

c. thoracic compression
d. triaging of core functions
ANS: C
During normal vaginal delivery, approximately one third of the lung fluid is cleared by
compression of the thorax in the birth canal.
19. What strong stimulus to the infant provides the impetus for the first breath?
a. acidosis
b. exposure to warmth
c. fright from passing through the birth canal
d. high PaO2
ANS: A
The newborn infant is stimulated by new tactile and thermal stimuli, all of which stimulate
breathing. In addition, as placental gas transfer is suddenly interrupted, the newborn quickly
becomes hypoxemic, hypercapnic, and acidotic.
OBJ : 4
DIFF: Application
20. Which of the following would NOT promote transition from fetal circulation to a normal
extrauterine circulatory pattern?
a. closure of the foramen ovale
b. constriction of the ductus arteriosus
c. decreased pulmonary vascular resistance
d. decreased systemic vascular resistance
ANS: D
Figure 8-9 summarizes the major cardiopulmonary changes that take place during the
transition from the fluid-filled lung to an air filled lung. As the lung expands with air and gas
exchange starts within the lung, pulmonary blood PO2 increases, PCO2 decreases, and the pH
rises. This results in pulmonary vasodilation, lower pulmonary vascular resistance, and
constriction of the ductus arteriosus. This facilitates greater blood flow through the
pulmonary circulation. Ductus arteriosus closure is further stimulated by the loss of maternal
prostaglandins. The combination of increasing alveolar air content and constriction of the
ductus arteriosus promotes progressive improvement in the matching of ventilation and blood
flow, which, in turn, increases the PO2 and decreases the PCO2 of blood leaving the lungs.
Cessation of umbilical and placental blood flow, following the clamping of the umbilical cord,
causes closure of the ductus venosus and a rapid rise in systemic vascular resistance. The
combination of the above events establish a normal extrauterine circulatory pattern.
Test bank 8-7
21. What factor contributes to increased likelihood of an upper airway obstruction in an infant
compared to an adult?
a. higher percentage of body fat
b. higher volumes of sinus discharge
c. relatively smaller head size
d. tongue that is proportionally larger
ANS: D
Infant neck flexion causes acute airway obstruction. Although the head is larger, an infant’s
nasal passages are proportionately smaller than are an adult’s. In addition, the infant’s jaw is
much rounder and the tongue is much larger relative to the size of the oral cavity. These
anatomic differences increase the likelihood of airway obstruction when an infant becomes
unconscious and loses muscle tone.
22. How short could the trachea of a small preterm infant be?
a. 2 cm
b. 4 cm
c. 6 cm
d. 8 cm
ANS: A
In small preterm infants, the trachea may be only 2 cm long and 2 to 3 mm wide
23. Approximately how many alveoli are there in a 10-year-old’s lung?

a. 50 million
b. 200 million
c. 350 million
d. 500 million
ANS: D
The human lung continues to develop alveoli for years until it reaches a stable stage where the
total number have increased to about 480 million alveoli. All of the development is complete
by 10 years of age.
24. What is unique regarding the blood supply to the lung?

a. It receives blood from right and left ventricles.
b. It requires no dedicated blood supply as it exists in a gas environment.
c. Pulmonary venous drainage contributes to the normal anatomic shunt.
d. The pulmonary arteries are the primary source of oxygen for lung structures.
Test bank 8-8
ANS: A
The respiratory system is a unique organ in that it receives a double blood supply: one from
the left ventricle and one from the right ventricle.
25. What is the physiologic result of the infants’ more compliant thorax compared with that of an
adult?
a. It is easier for infants to breathe.
b. Their functional residual capacity is reduced based on ideal body weight (IBW).
c. They breathe larger tidal volumes based on IBW.
d. They have less of a tendency to develop atelectasis.
ANS: B
With a more compliant thorax, the resultant balance of these static forces in the infant favors a
reduced FRC and total lung capacity (TLC). Proportionately lower lung volumes in the infant
can lead to early airway closure, atelectasis, ventilation/perfusion mismatch, shunting, and
resultant hypoxemia.
26. Infants are more susceptible to profound hypoxemia than are adults.
a. True
b. False
c. unable to determine
ANS: A
The combination of a reduced FRC and high oxygen consumption in infants renders them
more susceptible to profound hypoxemia in situations that further disturb ventilation, lung
volume, and/or ventilation/perfusion matching.
27. Infants can generate auto-PEEP by which of the following methods?

a. active expiration
b. increased diaphragmatic excursion
c. laryngeal braking
d. Retractions
ANS: C
The infant, especially one in distress, can actively end expiration and begin the next
inspiratory phase to cause gas trapping, which leads to elevated FRC and better
ventilation/perfusion matching. This can be accomplished actively using their diaphragm
during exhalation to slow expiration and to adduct (close) their vocal cords and narrow the
glottis. The combination of these two maneuvers effectively regulates volume in the lung and
dynamically elevates the FRC. The narrowing of the glottis or larynx during exhalation is
referred to as “laryngeal braking.”
Test bank 8-9
OBJ 5
DIFF: Application
28. Running vertically down each hemithorax anteriorly is an imaginary line that is used as an
anatomical landmark. What is that line called?
a. anterior axillary line
b. midaxillary line
c. midclavicular line
d. midsternal line
ANS: C
The left and right midclavicular lines are parallel to the midsternal line. These are drawn
through the midpoints of the left and right clavicles, respectively (Figure 8-13).
29. What is the function of the thorax?

a. facilitate digestion
b. heat, humidify, and filter gases
c. protect the vital organs
d. vocalization
ANS: C
The thorax is a cone-shaped cavity that houses the lungs and the contents of the mediastinum
(Figure 8-16). It functions to protect the vital organs within and has the capability of changing
shape to enable air to be moved into and out of the lungs.
30. What is the name of the thin serous membrane that covers the inner layer of the thoracic wall?
a. cupula
b. mesothelioma
c. parietal pleura
d. visceral pleura
ANS: C
The inner layer of the thoracic wall is lined with a serous membrane called the parietal pleura.
31. What is the name of the upper portion of the sternum?

a. angle of Louis
b. manubrium
c. vertebral process
d. xiphoid process
Test bank 8-10
ANS: B
The sternum is a long, vertical flat bone found on the anterior side (Figure 8-18). It is
comprised of three bones including the manubrium which comprises the upper portion.
32. Where does the sternal angle lie?

a. at the depression in the body of the sternum to which the clavicles attach
b. at the join between the manubrium and sternal body
c. at the superior edge of the sternum
d. where the xiphoid process connects to the sternum
ANS: B
The fused connection between the manubrium and the body is known as the sternal angle. It is
also known as the angle of Louis.
33. What is the name of the external landmark that identifies the point at which the trachea
branches into the right and left mainstem bronchi?
a. angle of Louis
b. cricoid cartilage
c. suprasternal notch
d. xiphoid process
ANS: A
The sternal angle is an external marker of the point where the trachea divides into the left and
right mainstem bronchi.
34. Which of rib pairs connect directly to the sternum?

a. 1 through 4
b. 1 through 7
c. 1 through 12
d. 11 through 12
ANS: B
Rib pairs 1 through 7 are known as the true ribs because they are attached directly to the
sternum.
35. What are rib pairs 11 and 12 known as?

a. false ribs
b. faux ribs
Test bank 8-11
c. floating ribs
d. true ribs
ANS: C
Rib pairs 11 and 12 are called floating ribs because they are not attached to the sternum.
36. The intercostal arteries, veins, and nerves run through which of the following?
a. costal groove on the top of each rib
b. costal groove on the bottom of each rib
c. fibers of the intercostal musculature
d. surface of the parietal pleura
ANS: B
Just below each rib are a thoracic artery, vein, and nerve that supply blood flow and nerve
communications to that region of the chest wall (Figure 8-17).
37. What does the “pump handle” movement of rib pairs 2 through 7 achieve?
a. anchor of the upper chest for diaphragmatic contraction
b. diminish of the energy wasted by inefficient muscular contraction
c. increase in the anteroposterior diameter of the chest
d. increase in the lateral dimensions of the chest
ANS: C
Ribs 2 through 7 move simultaneously about two axes (Figure 8-20). As each rib rotates about
the axis of its neck, its sternal end rises and falls. This movement increases the anteroposterior
thoracic diameter in what is commonly referred to as a “pump handle” like motion.
38. Which of the following muscles are considered primary muscles of ventilation?
1. diaphragm
2. intercostals
3. scalenes
4. Sternomastoid
a. 1, 3, and 4
b. 1 and 2
c. 3 only
d. 1, 2, 3, and 4
ANS: B
The diaphragm and intercostal muscles are the primary muscles of ventilation.
Test bank 8-12
39. What external landmark can be used to show the highest point the dome of the right
hemidiaphragm reaches in a healthy individual?
a. fifth rib posteriorly
b. sixth rib posteriorly
c. seventh rib posteriorly
d. eighth rib posteriorly
ANS: D
The highest portion of the right dome sits at the eighth or ninth thoracic vertebra posteriorly
and at the fifth rib anteriorly.
40. Approximately what percent of the normal changes in thoracic volume during quiet
inspiration is due to the action of the diaphragm?
a. 15
b. 25
c. 50
d. 75
ANS: D
During quiet breathing, the diaphragm is responsible for approximately 75% of the change in
thoracic volume.
41. How far is the diaphragm pulled down during tidal breathing?
a. 1 to 2 cm
b. 3 to 5 cm
c. 6 to 8 cm
d. 8 to 10 cm
ANS: A
When the muscle fibers of the diaphragm are tensioned during inspiration, the dome of the
diaphragm is pulled down 1 to 2 cm.
42. Compared to a normal diaphragm, contraction of a diaphragm that is low and flat may result
in which of the following?
a. compression of the thoracic cavity
b. enhanced venous return and thus cardiac output
c. greater diaphragmatic efficiency
d. larger than normal change in thoracic volume
ANS: A
Test bank 8-13
Increased lung volume causes the diaphragm to flatten out. Contraction of a flattened
diaphragm can result in tension on the lower ribs that causes them to be pulled inward, which
results in compression of the thoracic cavity. This condition can occur in individuals with
severe gas trapping as a result of emphysema or asthma. To compensate for this, these
individuals must recruit other muscles to enlarge the thorax. This results in less efficient
breathing and excessive muscle work.
DIF: Analysis REF: p. 167-168 OBJ: 7
43. What pulmonary disorder could lead to acute flattening of the diaphragm?
a. adult respiratory distress syndrome
b. asthma
c. atelectasis
d. aneumonia
ANS: B
Increased lung volume causes the diaphragm to flatten out. This condition can occur in
individuals with severe gas trapping as a result of emphysema or asthma.
44. The diaphragm is innervated by which of the following nerves?

a. glossopharyngeal
b. phrenic
c. seventh cranial
d. vagus
ANS: B
Functionally, the diaphragm is divided into a right and left hemidiaphragm. Each
hemidiaphragm is innervated by a phrenic nerve that arises from branches of spinal nerves C3,
C4, and C5.
45. The nerves that innervate the diaphragm arise from which area?
a. lumbar region of the spine
b. sacral vertebrae 4 and 5
c. spinal plexuses at T2 to T11
d. spinal nerves C3 to C5
ANS: D
Functionally, the diaphragm is divided into a right and left hemidiaphragm. Each
hemidiaphragm is innervated by a phrenic nerve that arises from branches of spinal nerves C3,
C4, and C5.
Test bank 8-14
46. What is the lowest level on the spinal cord that an injury could cause diaphragmatic
impairment or paralysis?
a. C3
b. L2
c. S5
d. T4
ANS: A
Spinal cord injuries at or above the level of the third cervical vertebrae result in diaphragmatic
paralysis.
47. Limited, short-term spontaneous ventilation is possible in a patient with a paralyzed

diaphragm.
a. True
b. False
ANS: A
Although the diaphragm is the primary ventilatory muscle, it is not essential for survival.
Limited, short-term ventilation is possible using accessory muscles, even if the diaphragm is
paralyzed.
The diaphragm does not actively participate in exhalation. During exhalation, it returns to its
resting position during the passive recoil of the lungs and thorax. During forced exhalation,
abdominal wall muscles compress the abdominal cavity and increase pressure in the
abdominal cavity. This forces the diaphragm upward and compresses the lungs and forces gas
from them. The diaphragm performs important functions other than ventilation. It aids in
generating high intra-abdominal pressures by remaining fixed while the abdominal muscles
contract. This facilitates vomiting, coughing, sneezing, defecation, and parturition.
48. Which accessory muscles are active during resting and active inspiration and pull up on all the
ribs expanding the thorax?
a. external intercostals
b. internal intercostals
c. scalenes
d. sternocleidomastoids
ANS: A
The external intercostals (Figure 8-22) originate on the upper ribs and attach to the lower ribs.
The fibers of these muscles run at an oblique angle between the ribs. When they generate
tension, they lift the ribs upward and cause the thoracic cavity to enlarge the thorax.
Test bank 8-15
49. Which of the following is the most important ventilatory function of the scalene muscles?
a. Activate if intrathoracic pressure falls to –40 cm H2O.
b. Elevate and fix the first seven ribs.
c. Lift upper chest particularly during times of high ventilatory demand.
d. Support the trachea within the thorax during heavy exercise.
ANS: C
Three pairs of scalene muscles (scalenus anterior, scalenus medius, and scalenus posterior)
arise from the lower five or six cervical vertebrae and insert on the clavicle and first two ribs
(Figure 8-23). They lift the upper chest when active.
50. As ventilatory muscles, the sternocleidomastoids do which of the following?

a. They elevate the upper chest, increasing chest anteroposterior diameter.
b. They levate the ribs and decrease chest anteroposterior diameter.
c. They increase lateral chest movement during inspiration.
d. They llower the sternum, thus increasing chest anteroposterior diameter.
ANS: A
The sternocleidomastoid muscles can function to lift the upper chest. They receive nerve
impulses from branches of the accessory nerves (cranial nerve XI) and cervical nerves C1 and
C2. These muscles are active during forceful inspiration and become visible as thick bands on
either side of the neck during the inspiratory phase in an individual who is in respiratory
distress. This motion increases the anteroposterior diameter of the chest.
51. When a COPD patient leans forward braced in a tripod position, this lends particular
advantage to which accessory muscles of inspiration?
b. pectoralis
c. scalenes
ANS: B
The major and minor pectoralis muscles are broad fan-shaped muscles of the upper anterior
chest (Figure 8-25). The pectoralis major originates on the humerus and inserts onto the
clavicle and sternum. The pectoralis minor originates on the scapula and inserts on the
anterior portions of ribs 3 through 5. When these muscles receive impulses from the pectoral
nerves, they normally function to adduct the arms in a hugging motion. They are also capable
of generating some anterior thoracic lift when the arms are braced on a surface in front of a
subject. Those individuals who suffer with chronic shortness of breath often utilize these
muscles by sitting in a “tripod” position. This is performed by sitting upright and leaning
forward with both arms braced on a table.
Test bank 8-16
52. Which accessory muscles of ventilation work to pull the ribs closer together?
b. internal intercostals
c. scalenes
ANS: B
The internal intercostal muscles (Figure 8-22) lie between the ribs and just behind the external
intercostal muscles. They originate along the inferior border of the upper ribs and insert into
the superior border of the lower ribs. The muscle fibers of the internal intercostal muscles run
downward and less obliquely than the external intercostal muscle fibers. This orientation
causes these muscles to pull the ribs together, which results in compression of the thoracic
cavity.
53. Which of the muscles below when stimulated will contract and push up on the diaphragm?
1. external intercostals
2. external obliques
3. internal obliques
4. rectus abdominous
a. 1, 2, and 3
b. 1 and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4
ANS: C
When the abdominal wall muscles contract, they compress the abdominal cavity. This forces
the diaphragm upward and compresses the thoracic cavity. The abdominal muscles include
pairs of external oblique, internal oblique, transverse abdominis, and rectus abdominous
muscles (Figure 8-27).
54. The abdominal muscles can actually contribute to inspiration by contraction at the end of
exhalation.
a. True
b. False
ANS: A
The abdominals can also contribute to inspiration by contracting at end-exhalation. This
reduces end-expiratory lung volume, so the chest wall can recoil outward, assisting the next
inspiratory effort.
Test bank 8-17
55. To what structures do the parietal pleural membranes adhere or cover?

a. fissures
b. intrapulmonary bronchi
c. lung
d. mediastinum
ANS: D
The parietal pleural membrane lines the chest wall and mediastinum, while the lungs are
covered by the visceral pleura.
56. What is the function of the very small amount of pleural fluid that is found in the pleural
space?
a. composes part of anatomic shunt
b. liquid barrier for pathogens
c. part of pulmonary blood flow
d. reduces friction
ANS: D
The small volume of pleural fluid is spread out over the entire surface of both lungs and
functions as a lubricant to reduce friction as the lungs move within the thorax and as an
airtight seal that adheres together the two pleural membranes.
57. What is the name given to the acute angle formed by the costal pleura joining the
diaphragmatic pleura?
a. angle of Louis
b. costophrenic angle
c. diaphragmatic groove
d. oblique fissure
ANS: B
The angles where the costal parietal pleura joins the diaphragmatic parietal pleura is known as
the costophrenic angle.
58. What will most commonly blunt the costophrenic angle as seen on chest radiograph in an
upright individual?
a. air
b. bile
c. excess fluids
d. liver on the right, intestines on the left
Test bank 8-18
ANS: C
Excess fluids between the visceral and parietal pleura tend to pool here in an upright
individual. This causes the angle to appear blunted or flattened to 90 degrees when viewed in
the chest radiograph.
59. What is the mediastinum?

a. membranous sac surrounding the heart and great vessels
b. middle layer of muscle fibers constituting the heart
c. point of division of the trachea into the bronchi
d. structure separating the right and left thoracic cavities
ANS: D
The mediastinum lies between the left and right pleural cavities that contain the lungs (Figure
8-16).
60. Why is the left lung narrower than the right lung?
a. Liver compresses the left lung.
b. Mediastinal organs push laterally into the left hemithorax.
c. There is poorer blood flow during fetal development.
d. There is upward pressure of the abdominal contents.
ANS: B
The organs within the mediastinum bulge into the left hemithorax, resulting in a narrower and
slightly smaller left lung.
61. About how far do the normal adult lungs extend above the clavicles?
a. 2 cm
b. 3 cm
c. 4 cm
d. 5 cm
ANS: A
The lungs extend from the diaphragm to a point 1 to 2 cm above the medial third of the
clavicles.
62. Which of the following statements describes a normal adult lung?

a. The left lung is bisected by two fissures.
b. The left lung has an upper, a middle, and a lower lobe.
c. The right lung has only an upper and a lower lobe.
Test bank 8-19
d. The right lung has three lobes and two fissures.
ANS: D
Each lung is divided into two or three lobes (Figure 8-28), which are separated by one or more
fissures. The right lung has upper, middle, and lower lobes. The left lung has only an upper
and a lower lobe. Both lungs have an oblique fissure that begins on the anterior chest at
approximately the sixth rib at the midclavicular line. These fissures extend laterally and
upward until they cross the fifth rib on the lateral chest in the midaxillary line. The fissures
continue on the posterior chest to approximately the third thoracic vertebra. The right lung
also has a horizontal or “minor” fissure that separates the upper and middle lobes.
63. What will happen when the lung is surgically removed from the thorax?
a. The lung will appear to undergo no change.
b. The lung will collapse.
c. The lung will expand.
d. The response of the lung will depend on its age and pathology.
ANS: B
When a lung is removed from the chest cavity, it quickly collapses to a smaller size.
64. What is the primary mechanism that stops the lungs from collapsing at the end of exhalation?
a. Radial tethers, stretched to their maximum length, then halt lung collapse.
b. Surfactant neutralizes the tendency of the lung to collapse.
c. There is a tendency of the chest wall to lock at the level of FRC.
d. There is an equal opposing tendency of the chest wall to expand.
ANS: D
This tendency of the lung to collapse is counteracted by the thoracic wall’s tendency to spring
outward and to hold the lung inflated.
65. What forces establish the subatmospheric pressure found in the pleural space?
a. contraction of accessory muscles of inspiration
b. contraction of expiratory muscles
c. equal opposing tendency of the chest wall to expand and lung to collapse.
d. effect of gravity, particularly at the base of the lungs
ANS: C
This tendency of the lung to collapse is counteracted by the thoracic wall's tendency to spring
outward and to hold the lung inflated. The “tension” developed by these two opposing
tendencies results in development of subatmospheric intrapleural pressure.
Test bank 8-20
66. Fluid transport to and from the lungs is provided by which of the following?
1. bronchial circulation
2. lymphatic system
3. pulmonary circulation
a. 2 and 3
b. 1 and 3
c. 2 only
d. 1, 2, and 3
ANS: D
The vascular supply of the lungs is composed of the pulmonary and bronchial circulations.
The pulmonary circulation carries mixed venous blood from the systemic circuit to the lungs
to increase oxygen and reduce carbon dioxide content of blood. The bronchial circulation
provides systemic arterial blood to the airways and pleura to support their metabolic needs. A
network of lymphatics is also involved in fluid transport from the lungs. The lymphatic
system removes fluid from the lung tissue and pleural space and returns it to the systemic
circulation.
67. The pulmonary arterial circulation does which of the following?

1. delivers oxygenated blood back to the heart
2. delivers unoxygenated blood to the lungs
3. originates on the left side of the heart
4. originates on the right side of the heart
a. 1 and 4
b. 2 and 4
c. 1 and 3
d. 2 and 3
ANS: B
The pulmonary circulation arises from the right heart (Figure 8-30) and carries the entire
cardiac output through the lung each minute. Oxygen-reduced systemic venous blood returns
to the right heart via the inferior and superior venae cavae. This blood is pumped to the lungs
by the right ventricle through the pulmonic semilunar valve and on to the trunk of the
pulmonary artery.
68. The pulmonary venous circulation does which of the following?

1. delivers oxygenated blood back to the heart
2. delivers unoxygenated blood to the lungs
3. empties into the left atrium
4. empties into the right atrium
a. 2 and 3
Test bank 8-21
b. 1 and 4
c. 2 and 4
d. 1 and 3
ANS: D
The pulmonary venous system drains the capillary beds that have received oxygen from the
alveoli and delivers the oxygenated blood into the left atrium.
69. Which of the following describes a function of pulmonary circulation?

a. breakdown of angiotensin II
b. filtering of blood clots
c. production of erythropoietin
d. regulation of breathing
ANS: B
The third function is nonrespiratory and participates in the production, processing, and
clearance of a large variety of chemicals and blood clots.
70. Compared with the systemic circulation, pressure in the normal pulmonary circulation is:
a. higher
b. lower
c. the same
ANS: B
While the entire cardiac output passes through both pulmonary and systemic circuits, the
pulmonary circulation offers much lower resistance and, as a result, has a much lower blood
pressure.
71. Pressures in the pulmonary circulation are lower than those in the systemic circulation
because of what characteristic of the pulmonary circulation?
a. higher resistance than the systemic circulation
b. less blood flow than the systemic circulation
c. lower resistance than the systemic circulation
d. more blood flow than the systemic circulation
ANS: C
While the entire cardiac output passes through both pulmonary and systemic circuits, the
pulmonary circulation offers much lower resistance and, as a result, has a much lower blood
pressure.
Test bank 8-22
72. Which of the following statements is NOT true regarding the pulmonary circulation?
a. Pulmonary blood flow is highly dependent on gravity.
b. The pulmonary circulation is a low-pressure system.
c. Toward the top of the upright lung, blood flow is high.
d. Toward the top of the upright lung, blood flow is low.
ANS: C
As a consequence of having a low blood pressure and being susceptible to gravity, blood flow
is much higher in the lung bases in resting upright subjects. Gravity-related effects also occur
in recumbent positions but are less pronounced.
73. How would lung perfusion in a “zone 1” area best be described?

a. increased
b. normal or average
c. reduced
ANS: C
Areas that experience higher airway pressure (e.g., during positive pressure ventilation) that
equal or exceed local arteriole and capillary pressure will have reduced blood flow as a result
of the opposing airway pressure (zone 1 airways).
74. How does the lung respond to regional lung hypoxia?

a. bronchial artery vasoconstriction
b. bronchial artery vasodilation
c. pulmonary artery vasoconstriction
d. pulmonary artery vasodilation
ANS: C
Areas of regional lung hypoxia, as the result of reduced ventilation, congestion, and/or airway
obstruction, can result in local pulmonary arterial vasoconstriction and cause blood flow to be
shifted from these areas toward areas of higher oxygen content and pulmonary vasodilation.
75. How does the lung parenchyma receive most of its oxygen?
a. from the alveolar gases
b. from the bronchial arteries/capillaries
c. from the pulmonary arteries/capillaries
d. from the pulmonary lymphatic system
ANS: A
Test bank 8-23
A separate arterial supply called the bronchial circulation supplies blood to the airways from
the trachea to the bronchioles and to most of the visceral pleurae. The metabolic needs of the
lung are comparatively low, and much of the lung parenchyma is oxygenated by direct contact
with inspired gas.
76. Via what pathway does much of the bronchial venous drainage occur?
a. bronchial veins emptying into the inferior vena cava
b. bronchopulmonary veins emptying into pulmonary veins
c. direct connections between bronchial and pulmonary arteries
d. thebesian venous drainage into the heart chambers
ANS: B
Bronchial venous blood drains through the azygos, hemiazygos, and intercostal veins to the
right atrium, and some drains through the pulmonary capillaries to the pulmonary veins and to
the left atrium.
77. How does the body compensate for a pulmonary embolus that occludes a branch of the
pulmonary artery?
a. increased bronchial arterial flow to the area
b. increased cardiac output
c. pulmonary arteriole and metarteriole vasodilation
d. release of prostaglandins to fight inflammation
ANS: A
The bronchial and pulmonary circulations share an important compensatory relationship.
Decreased pulmonary arterial blood pressure tends to cause an increase in bronchial artery
blood flow to the affected area. This minimizes the danger of pulmonary infarction, as
sometimes occurs when a blood clot (pulmonary embolus) enters the lung.
78. Which of the following statements are true of the pulmonary lymphatic system?
1. It consists of both superficial and deep vessels.
2. It drains into the right lymphatic or thoracic duct.
3. Vessels begin as dead-end lymphatic channels in the lung.
4. With phagocytes, it defends against foreign material.
a. 1, 3, and 4
b. 2, 3, and 4
c. 2 only
d. 1, 2, 3, and 4
ANS: D
Test bank 8-24
The lymphatic system plays an important role in the specific defenses of the immune system.
It removes bacteria, foreign material, and cell debris via the lymph fluid and through the
action of various phagocytic cells (e.g., macrophages) that provide defense against foreign
material and cells that are able to penetrate deep into the lung. It also produces a variety of
lymphocytes and plasma cells to aid in defense. Both roles are essential for maintaining
normal function of the respiratory system.
Most of the pulmonary lymphatic system consists of superficial and deep vessels. The
superficial (pleural) vessels that drain the lung surface and pleural space are more numerous
over the lower half of the upright lung. Both drain the blind lymphatic capillaries in the
respective regions. The deeper lymph vessels are closely associated with the small airways but
do not extend into the walls of the alveolar-capillary membranes.
Lymph fluid is collected by the loosely formed lymphatic capillaries and drains through the
lymph vessels toward the hilum. The lymph fluid rejoins the general circulation after passing
through the right lymphatic or thoracic duct, which drains into the jugular, subclavian, and/or
innominate veins. The lymph fluid then mixes with blood and returns to the right heart.
79. What does the detection of lymphatic channels on standard chest radiographs indicate?
a. abnormally low pressures in the lymphatic channels
b. anastomoses with the pulmonary circulation
c. normal fibrotic changes that occur with aging
d. system that is overwhelmed by excessive fluid
ANS: D
Lymphatic channels are usually not visible on chest radiographs. They may be detected if they
are distended or thickened by disease. The “butterfly” pattern that radiates from the hilar
region of both lungs during acute development of pulmonary edema is thought to largely be
the result of interstitial and lymph vessel distension with fluid. In this situation, the lymphatic
drainage system has been overwhelmed by a sudden and excessive surge of fluid from the
circulation. The development of a pleural effusion is also evidence that the lymphatic system
is unable to remove excess fluid in the lung.
80. What is the affect of damage to the recurrent laryngeal nerves?

a. diaphragmatic paralysis
b. pulmonary circulatory failure
c. inactivation of pulmonary surfactant production
d. vocal cord impairment or paralysis
ANS: D
Damage to laryngeal nerves can cause unilateral or bilateral vocal cord paralysis, depending
on which branches are involved. This may result in hoarseness, loss of voice, and an
ineffective cough.
Test bank 8-25
81. What determines the airway diameter in the normal lung?

a. balance between sympathetic and parasympathetic tone
b. in large part, the amount of patient effort
c. activity level of the submucosal glands
d. amount of dopamine present in the airway walls
ANS: A
Both sympathetic and parasympathetic postganglionic efferents innervate the smooth muscle
and glands of the airways. They influence the diameter of the airway by causing more or less
tension in the smooth muscles that wrap the airway and influence glandular secretion. The
combined effects of the parasympathetic and sympathetic nervous activity, which generally
oppose each other's action, result in a balanced control of airway diameter.
82. What is the name of the negative feedback reflex associated with the termination of
inspiration?
a. carotid sinus
b. Head’s paradoxical
c. Hering-Breuer
d. vagovagal
ANS: C
Pulmonary stretch receptors progressively discharge during lung inflation and are linked to
inhibition of further inflation. This is a type of negative feedback known as the inflation reflex
or the Hering-Breuer inflation reflex.
83. What is the name of the reflex associated with the sensory stimulation of the pulmonary
stretch receptors that stimulates a deeper breath upon inspiration?
a. carotid sinus
b. Head’s paradoxical
c. Hering-Breuer
d. vagovagal
ANS: B
Another reflex that is associated with stretch receptor activity is Head’s paradoxical reflex.
This reflex stimulates a deeper breath rather than inhibiting further inspiration. It may be the
basis for occasional deep breaths or gasps. Deep breaths or sighs occur with normal breathing,
presumably preventing alveolar collapse. Head’s reflex may also be responsible for gasping in
newborn infants as they progressively inflate their lungs.
84. What may happen if the irritant receptors in the lung are stimulated?
Test bank 8-26
1. bronchoconstriction
2. reflex closure of the glottis
3. reflex slowing of the heart (bradycardia)
a. 2 and 3
b. 1 and 3
c. 2 only
d. 1, 2, and 3
ANS: D
When the irritant receptors are stimulated, it can result in bronchoconstriction, hyperpnea,
glottic closure, cough, and sneeze. Stimulation of these receptors can also cause a reflex
slowing of the heart rate (bradycardia).
85. The upper respiratory tract traditionally ends at what point?

a. branching of the trachea into right and left main-stem bronchi
b. hypopharynx
c. inferior border of the larynx
d. the end of the conducting airways
ANS: C
The upper respiratory tract is defined as those airways starting at the nose and mouth and that
extend down to the trachea (Figure 8-36).
86. What are the three bony projections that arise from the lateral walls of the nasal cavity that
enhance filtration and humidification?
a. alar nasi
b. frontal sinuses
c. palatine tonsils
d. turbinates
ANS: D
Three shelf-like bones protrude into the cavity from the lateral walls. These bony shelves are
called the superior, middle, and inferior concha or turbinates. The concha function to increase
the surface area of the nasal cavity, which enhances filtration and humidification.
87. Which of the following is NOT a primary function of the nasal cavity?
a. conduction of gases
b. filtration and defense
c. gas exchange
d. heat and humidify
Test bank 8-27
ANS: C
The primary functions of the nasal cavity are to serve as a gas passageway, and to filter,
humidifier, and heat inhaled gases.
88. Which of the following help comprise the defense system of the nose?
1. clearance of foreign matter by ciliary action
2. gross filtration by the large hairs of the nasal vestibule
3. impaction of particulate foreign matter on the nasal mucosa
4. laminar flow through the concha
a. 1, 2, and 3
b. 2 and 4
c. 3 only
d. 1, 2, 3, and 4
ANS: A
Filtration of inhaled air is carried out by the hair in the anterior portion of the cavity and the
sticky mucous membrane that covers the complex surface of the cavity. Filtration is enhanced
by the flow pattern through the nasal cavity. Inspired gas is accelerated to a high velocity
through the anterior nares. It then changes direction sharply as it enters the internal nasal cavi-
ty. This pattern causes particles larger than 10 µm in diameter to impact on the nasal mucosa.
Ciliary action or nose blowing then clears these particles. Past the external nares, the cross-
sectional area increases. This results in a decrease in gas velocity. Turbulence increases be-
cause of the narrow convolutions of the passages. Low velocity and turbulence combine to
remove any remaining particles.
89. What are the vascularized lymphoidal tissues that have a particularly active immunological
role in children?
a. lingual tonsils
b. palatine tonsils
c. pharyngeal tonsils
d. superior turbinates
ANS: B
The palatine tonsils are vascularized lymphoidal tissues that play an immunologic role,
especially in childhood.
90. What is your primary concern if you discover that a patient does not have a gag reflex?
a. fear of aspiration of bacteria or food
b. that their tonsilar tissues are grossly swollen
c. that they will not be able to breathe adequately
d. tracheal collapse
Test bank 8-28
ANS: A
Reflexes of the mouth, pharynx, and larynx help to protect the lower respiratory tract during
swallowing. These protective functions can be severely compromised during anesthesia or
unconsciousness. Loss or compromise of these important reflexes can result in aspiration of
bacteria colonized saliva or food and can cause pulmonary infection and asphyxiation in
severe cases.
91. The subdivisions of the pharynx include which of the following?

1. nasopharynx
2. oropharynx
3. laryngopharynx
a. 2 and 3
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3
ANS: D
The pharynx is subdivided into the nasopharynx, oropharynx, and hypopharynx or
laryngopharynx.
92. Into what structure do the eustachian tubes drain?

a. larynx
b. nasopharynx
c. oropharynx
d. vestibule
ANS: B
In the lateral nasopharynx, there are two openings into the left and right eustachian tubes that
link the upper airway with the middle ear (Figure 8-36). The eustachian tubes drain fluid out
of the middle ear and allows gas to move in or out of the middle to equalize pressure on either
side of the tympanic membrane.
93. What results in partial or total obstruction of the airway in an unconscious patient?
a. closed mouth coexistent with nasal congestion
b. epiglottis relaxes and occludes the laryngeal opening
c. relaxation of tongue and hypopharyngeal muscles.
d. the uvula occluding the airway
ANS: C
Test bank 8-29
During unconsciousness, the muscles of the tongue and hypopharynx can relax and allow the
tongue and other soft tissues to collapse and occlude the opening of the hypopharynx. This
condition can result in partial to complete blockage of the upper airway and limit air
movement to and from the respiratory tract. This is a primary cause of obstructive sleep
apnea.
94. What is a primary function of the larynx?

a. cover the glottic opening during forced expiration
b. house Waldeyer’s ring of tonsilar material for airway defense
c. protect airway during eating or drinking
d. provide a common passageway for food and gas
ANS: C
Generally, it functions to protect the respiratory tract during eating and drinking and in
phonation.
95. What is the cartilage that is commonly referred to as the Adam’s apple?
a. arytenoid
b. cricoid
c. cuneiform
d. thyroid
ANS: D
The thyroid cartilage forms most of the upper portion of the larynx and is generally referred to
as the Adam's apple.
96. What is the only complete circular cartilage of the larynx?

a. arytenoid
b. corniculate
c. cricoid
d. Thyroid
ANS: C
Just below the thyroid cartilage is the cricoid cartilage, which is the only laryngeal structure
that forms a complete ring of cartilage around the airway and is the narrowest region of the
upper airway in infants.
97. What is the leaf-shaped cartilage that extends from the base of the tongue and is attached by
ligaments to the thyroid cartilage?
Test bank 8-30
a. arytenoid cartilage
c. cuneiform cartilage
d. Epiglottis
ANS: D
The cartilaginous and leaf-shaped epiglottis lies within and is attached to the thyroid cartilage
by a flexible joint.
98. Three folds of tissue between the posterior base of the tongue and the epiglottis form a small
space that is a key landmark in oral intubation. What is this called?
a. false vocal cords
b. palatine fold
c. taurus tubularus
d. vallecula
ANS: D
The base of the tongue is attached to the epiglottis by three folds. These folds form a space
between the tongue and the epiglottis called the vallecula, which is a key landmark in oral
intubation (Figure 8-36).
99. What is the space that separates the true vocal cords?
a. epiglottis
b. glottis
c. vallecula
d. vestibule
ANS: B
The opening formed between the vocal cords is called the glottis.
100. Changes in the tension on the vocal cords, allowing phonation, are produced by the interaction
of the laryngeal muscles and the movement of which cartilage?
a. arytenoids
b. corniculates
c. cricoid
d. cuneiforms
ANS: A
Test bank 8-31
The laryngeal component of speech is called phonation. It requires the adjustment of vocal
cord tension and position relative to one another. The action of the posterior cricoarytenoid
muscles causes the arytenoid cartilages to rotate and opens the vocal cords. Closure of the
vocal cords is carried out by rotating the arytenoids in the opposite direction through the
action of the lateral cricoarytenoid and oblique arytenoid muscles.
101. What could the “effort closure” of the larynx facilitate?

a. crying
b. talking
c. whispering
d. yelling
ANS: D
Tight closure of the larynx and the buildup of intrapulmonary pressure through muscular
effort is called effort closure. Effort closure of the larynx is necessary for generating loud
sounds and for effective coughing and sneezing.
102. What position is used to open the airway in an unconscious patient?

a. neck extension
b. neck flexion
c. recovery position
d. sniff position
ANS: D
With loss of consciousness, the head flexes forward, which can partially or completely
obstruct the upper airway. (Figure 8-41, A). Extension of the head and lower jaw into the
“sniff” position alleviates this obstruction (Figure 8-41, C). Extension of the head moves the
tongue away from the rear of the pharynx. This technique is used to maintain the airway in
unconscious patients and facilitates placement of artificial airways.
103. The adult trachea is approximately how long?

a. 5 to 8 cm
b. 10 to 12 cm
c. 16 to 18 cm
d. 20 to 24 cm
ANS: B
The adult trachea is approximately 12 cm long and has an inner diameter of about 2.0 cm.
Test bank 8-32
104. At what point does the trachea branch into two mainstem bronchi?
a. carina
c. glottis
d. manubrium
ANS: A
At the base of the trachea, the last cartilaginous ring that forms the bifurcation for the two
bronchi is called the carina. The carina is an important landmark that is used to identify the
level at which the two mainstem bronchi branch off from the trachea.
105. Why do most aspirated objects and fluids end up in the right mainstem bronchus instead of the
left mainstem bronchus?
a. The left bronchus is more in line with the trachea.
b. The left bronchus is shorter than the right.
c. The right bronchus is larger than the left.
d. The right bronchus is more in line with the trachea.
ANS: D
The right bronchus branches off from the trachea at an angle of about 20 to 30 degrees, and
the left bronchus branches with an angle of about 45 to 55 degrees (Figure 8-44). The right
bronchus’s lower angle of branching results in a greater frequency of foreign body passage
into the right lung because of the more direct pathway.
106. What portion of the left lung corresponds anatomically to the middle lobe of the right lung?
a. cardiac notch
b. lingula
c. medial segment
d. superior segment
ANS: B
See Table 8-8.
107. Which of the following statements about the terminal bronchioles is true?
a. They are generally five divisions below the segmental bronchi.
b. They are the smallest of the purely conducting airways.
c. They average 3 to 4 mm in diameter.
d. They have well-defined and predictable amounts of cartilage.
ANS: B
Test bank 8-33
Terminal bronchioles are the smallest conducting airways and function to supply gas to the
respiratory zone of the lung.
108. What type of flow is seen in and beyond the terminal bronchioles?
a. laminar
b. transitional
c. turbulent
d. varies among individuals
ANS: A
Low-velocity gas movement at the level of the terminal bronchiole and beyond is
physiologically important for two reasons. First, laminar flow develops, which minimizes
resistance in the small airways and decreases the work associated with inspiration. Second,
low gas velocity facilitates rapid mixing of gases.
109. What is the most common cell type found in the mucosa of the larger airways?
a. pseudostratified ciliated columnar epithelium
b. pseudostratified ciliated cuboidal epithelium
c. stratified ciliated squamous epithelium
d. stratified unciliated serous endothelium
ANS: A
The most common type of epithelia is the numerous pseudostratified, ciliated, columnar
epithelia.
110. What can the release of histamine and other chemical mediators from the mast cells in the
airways cause?
1. bronchoconstriction
2. bronchodilation
3. vasoconstriction
4. vasodilation
a. 2 and 4
b. 1 and 3
c. 2 and 3
d. 1 and 4
ANS: D
Mast cells are also found in the submucosa and release numerous and potent vasoactive and
bronchoactive substances such as histamine. Histamine causes vasodilation and
bronchoconstriction, acting directly on smooth muscle.
Test bank 8-34
111. What is the major source of respiratory tract secretions in the normal lung?
a. bronchial glands
b. Clara cells
c. goblet cells
d. mast cells
ANS: A
Normally, the respiratory tract produces about 100 ml of mucus per day. Most of the mucus
formed in the larger airways is produced by the bronchial glands.
112. Identify functions of airway mucus in the normal lung.

1. increased mucus production decreases bronchospasm
2. protect the airways from excessive water loss
3. shield the airway from toxic particles
4. trap inhaled contaminants
a. 1, 2, and 3
b. 2, 3, and 4
c. 1 and IV4
d. 3, and 4
ANS: B
Mucus functions to protect the underlying tissue. It helps to prevent excessive amounts of
water from moving into and out of the epithelia. It shields the epithelia from direct contact
with potentially toxic materials and microorganisms. It acts like sticky flypaper to trap
particles that make contact with it. This makes mucus an important part of the pulmonary
defenses.
113. What is the name given to the action produced by the forward stroking of millions of cilia?
a. coughing
b. mucociliary escalator
c. mucus stroking
d. the wave
ANS: B
The stroking action of millions of cilia propels the surrounding mucus at a speed of about 2
cm per minute. This action is commonly referred to as the mucociliary escalator.
114. Which of the following can impair or inhibit ciliary activity?

1. drying of the respiratory tract mucosa
Test bank 8-35
2. exposure to smoke
3. parasympatholytic drugs
a. 1 and 2
b. 1 only
c. 1, 2, and 3
d. 2 and 3
ANS: C
Ciliary beating can be effectively slowed or even stopped if the viscosity of the sol layer is
increased by exposure to dry gas. Ciliary motion is also stopped following exposure to smoke,
high concentrations of inhaled oxygen, and drugs like atropine.
115. What is the common name given to classify the airway from the nares to the terminal
bronchioles?
a. conducting airways
b. respiratory airways
c. transitional airways
d. upper airway
ANS: A
The airways from the nares to and including the terminal bronchioles comprise the conducting
zone airways, which do not participate in gas exchange.
116. What is normal amount of anatomic dead space found in a healthy lung?
a. 1 ml/kg ideal body weight
b. 2 ml/kg ideal body weight
c. 3 ml/kg ideal body weight
d. 4 ml/kg ideal body weight
ANS: B
These airways constitute the anatomic dead space of the respiratory system that is rebreathed
with each breath. In the adult human, the volume filling the airways of the anatomic dead
space is approximately 2 ml/kg of lean body weight, or about 150 ml in the typical adult.
117. Which of the following describes an acinus?

a. Each acinus is comprised of five terminal respiratory units.
b. It consists of all structures distal to a terminal bronchiole.
c. It is composed of the smaller conducting airways.
d. It is the transitional portion of the lung between conduction and respiration.
ANS: B
Test bank 8-36
A single terminal bronchiole supplies a cluster of respiratory bronchioles. Collectively, this

unit is referred to as the acinus.
118. What is called the “functional unit of the lungs”?

a. only the alveoli
b. acinus
c. alveolar-capillary membranes
d. terminal bronchioles
ANS: B
The primary lobule or acinus forms the functional unit of the lungs.
119. Where are the largest alveoli found in the lung?

a. acinus
b. apices
c. bases
d. middle
ANS: B
Alveoli found in the apical regions of the vertical lung have greater diameters than those in
the basal regions as a result of the gravitational effects. Those in the basal regions are partially
collapsed as a result of the weight of the organ.
120. What type of alveolar cells cover over 90% of the surface area of the alveolar-capillary
membrane?
a. alveolar macrophages
b. granular pneumocytes
c. type I cells
d. type II cells
ANS: C
The alveolar septa are covered with extremely flat squamous epithelia called type I
pneumocytes (Figure 8-54). While they represent only about 8% of all the cells found in the
alveolar region, the type I cells cover about 93% of the alveolar surface.
121. Pulmonary surfactant is secreted by which type of lung cells?

b. type I cells (pneumocytes)
c. type II pneumocytes
Test bank 8-37
d. type III pneumocytes
ANS: C
Type II cells do not function as gas exchange membranes like the type I cells. They
manufacture surfactant, store it in vesicles called lamellated bodies, and secrete it onto the
alveolar surface.
122. Why is pulmonary surfactant such an important biologic substance?

a. It clears out cellular debris.
b. It is an alveolar macrophage.
c. It promotes lung contraction aiding exhalation.
d. It promotes lung stability.
ANS: D
Surfactant functions to reduce the surface tension of the alveolus, which results in shedding
water from the alveolar surface; helps to prevent alveolar surface tension driven collapse;
improves lung compliance; and reduces the work of breathing.
123. What are the free-wandering phagocytic cells that ingest foreign material in the respiratory
zone of the lungs?
b. granular pneumocytes
c. type I cells
d. type II cells
ANS: A
Macrophages are another common cell found in the alveolar region. They can move from the
pulmonary capillary circulation by squeezing through openings in the alveolar septa and then
move out onto the alveolar surface. They are defensive cells that patrol the alveolar region and
phagocytize foreign particles and cells (e.g., bacteria).
124. What intercommunicating channels permit collateral ventilation between adjacent alveoli and
primary lobules?
1. bronchial anastomoses
2. canals of Lambert
3. pores of Kohn
4. terminal bronchioles
a. 1, 2, and 3
b. 1 and 4
c. 2 and 3
d. 1, 2, 3, and 4
Test bank 8-38
ANS: C
Small openings are located in the alveolar septa. Some of the openings allow gas to move
from one alveolus to another. These are called the pores of Kohn. Other openings connect
alveoli with secondary respiratory bronchioles. These passageways are called the canals of
Lambert. All of these alveolar openings and passageways facilitate the collateral movement of
gas and help maintain alveolar volume.
125. To what does the term “faster-weaker” refer when discussing the alveolar-capillary
membrane?
a. portion of the alveolar-capillary membrane that is average in thickness
b. shortest airways in the acinus, which allow fast gas exchange
c. thinnest portion of the alveolar-capillary membrane
d. thickest portion of the alveolar-capillary membrane
ANS: C
On one side of the alveolar wall, the type I cell and capillary endothelial cells lie close togeth-
er with a thin interstitial space. This part of the blood-gas barrier is, on average, 0.2 to 0.3 µm
thick and it is where the alveolar capillary bulges into the alveolar space. On the other side,
where there is a thicker interstitial space with greater fiber, matrix, and nuclear material con-
tent, the barrier can be more than 3 to 10 times thicker. This functionally results in “faster-
weaker” and “slower-stronger” diffusion sides of the blood-gas barrier.
126. Which of the following have been shown to injure the alveolar-capillary membrane?
1. excessive pressures
2. excessive tidal volumes
3. increased intracranial pressures
4. pulmonary hypertension
a. 1, 2, and 4
b. 2 and 3
c. 4 only
d. 1, 2, 3, and 4
ANS: A
Conditions of pulmonary hypertension (e.g., capillary pressure greater than 30 mm Hg during
congestive heart failure and high-altitude pulmonary edema) and excessive tidal volume and
airway pressure during positive-pressure ventilation (e.g., tidal volume greater than 6 ml/kg
and airway pressures greater than 30 cm H2O) can result in stress failure of the blood-gas
membrane. Stress failure results in endothelial and/or type I cell stretching and shearing
injuries.
Test bank 8-39
127. Identify the non-primary function(s) of the respiratory system:

a. filter out inhaled contaminants, various chemicals, and small blood clots
b. exchange of gases between blood and tissues
c. continuous absorption of oxygen and excretion of carbon dioxide
d. transport oxygenated blood to the tissues
ANS: A
The primary role of the respiratory system is breathing, external respiration (the continuous
absorption of oxygen and the excretion of carbon dioxide), and the support of internal
respiration, which is the exchange of gases between blood and tissues. The respiratory system
is also equipped to filter out inhaled contaminants, while warming and humidifying inspired
gas and simultaneously filter out various chemicals and small blood clots that are deposited or
formed in the blood.
128. What happens throughout fetal period?

a. All major organs begin their development.
b. Some of the major organs complete their development.
c. Organs continue to develop and refine their structure and function.
d. Gas exchange begins.
ANS: C
The fetal period occurs during the remaining 32 weeks of gestation. During this period, the
organs continue to develop and refine their structure and function.
129. Which of following are the embryonic germinal tissue layers form all tissues and organs?
1. endoderm
2. mesoderm
3. ectoderm
4. rectoderm
a. 2 only
b. 2 and 3
c. 1, 2, and 4
d. 1, 2, and 3
ANS: D
The three embryologically distinct germinal tissue layers form all tissues and organs:
endoderm, mesoderm, and ectoderm.
130. Which phospholipid ratio would indicate a neonate with a low risk of developing respiratory
distress syndrome (RDS)?
a. L/S ratio of 1
Test bank 8-40
b. L/S ratio of 2 or more

c. L/S ratio of less than 1.5
d. L/S ratio of less then 1
ANS: B
An L/S ratio of 2 or more indicates a relatively low risk for the development of respiratory
distress syndrome, while an L/S ratio of less than 1.5 is associated with a high risk.
131. If premature delivery is anticipated, all of the following will help determine lung maturity,
except:
a. the presence of oligohydramnios
b. ecithin-sphingomyelin (L:S) ratio
c. phosphatidylglycerol (PG) concentration
d. body mass index (BMI)
ANS: D
Quantification of these phospholipids (the L/S ratio and PG concentration) provides a
predictive index of the lung maturity in the fetus before birth and the risks of the development
of respiratory distress.14 For example, an L/S ratio of 2 or more indicates a relatively low risk
for the development of respiratory distress syndrome while an L/S ratio of less than 1.5 is
associated with a high risk. Conditions that lead to reduced fetal breathing and amniotic fluid
formation (oligohydramnios) are linked to incomplete inflation of the lung with fluid and
poorly developed (hypoplastic) lungs.

Chapter 8 THE RESPIRATORY SYSTEM

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Chapter 8 THE RESPIRATORY SYSTEM

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Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition

Chapter 8: The Respiratory System

1. What is the primary purpose of the respiratory system?

DIF: Application REF: p. 148 OBJ: 1

2. What is meant by “internal respiration”?

DIF: Application REF: p. 148 OBJ: 1

3. By what mechanism does gas exchange across the lung occur?

DIF: Application REF: p. 148 OBJ: 1

4. The human genome contains _____ pairs of chromosomes.

DIF: Recall REF: p. 150 OBJ: 2

DIF: Recall REF: p. 191 OBJ: 2

6. Developmental morphogenesis of the human respiratory system can be categorized into:

DIF: Application REF: p. 149 OBJ: 1

DIF: Application REF: p. 149 OBJ: 1

DIF: Application REF: p. 149 OBJ: 1

9. During which phase of fetal development do mature alveoli appear?

DIF: Application REF: p. 149 OBJ: 1

DIF: Application REF: p. 153 OBJ: 1

11. What maintains lung inflation during fetal development?

DIF: Application REF: p. 153 OBJ: 2

DIF: Application REF: p. 154 OBJ: 3

DIF: Application REF: p. 154 OBJ: 3

14. What would be a normal P50 for a fetus?

DIF: Application REF: p. 155 OBJ: 3

DIF: Application REF: p. 156 OBJ: 3

DIF: Application REF: p. 156 OBJ: 3

DIF: Recall REF: p. 156 OBJ: 3

b. low intrapulmonary pressures

DIF: Application REF: p. 156 OBJ: 3

DIF: Application REF: p. 156 OBJ: 4

DIF: Application REF: p. 156 OBJ: 3

DIF: Application REF: p. 162 OBJ: 10

DIF: Recall REF: p. 159 OBJ: 5

23. Approximately how many alveoli are there in a 10-year-old’s lung?

DIF: Recall REF: p. 160 OBJ: 5

24. What is unique regarding the blood supply to the lung?

DIF: Application REF: p. 160 OBJ: 8

DIF: Application REF: p. 162 OBJ: 6

DIF: Application REF: p. 162 OBJ: 5

27. Infants can generate auto-PEEP by which of the following methods?

DIF: Application REF: p. 162 OBJ: 5

DIF: Application REF: p. 62 OBJ: 6

29. What is the function of the thorax?

DIF: Application REF: p. 163 OBJ: 6

DIF: Recall REF: p. 164 OBJ: 6

31. What is the name of the upper portion of the sternum?

DIF: Recall REF: p. 164 OBJ: 6

32. Where does the sternal angle lie?

DIF: Recall REF: p. 164 OBJ: 6

DIF: Recall REF: p. 164 OBJ: 6

34. Which of rib pairs connect directly to the sternum?

DIF: Recall REF: p. 165 OBJ: 6

35. What are rib pairs 11 and 12 known as?

DIF: Application REF: p. 165 OBJ: 6

DIF: Recall REF: p. 173 OBJ: 6

DIF: Application REF: p. 166 OBJ: 6

DIF: Recall REF: p. 166 OBJ: 7

DIF: Recall REF: p. 166 OBJ: 7

DIF: Recall REF: p. 167 OBJ: 7

DIF: Recall REF: p. 167 OBJ: 7

DIF: Analysis REF: p. 167-168 OBJ: 7

DIF: Application REF: p. 168 OBJ: 7

44. The diaphragm is innervated by which of the following nerves?