APPENDIX B

Multiple-Choice Examination

1. If a patient’s total lung capacity is 5.0 L with a tidal vol- 9. Hyperventilation
ume of 0.5 L, an inspiratory reserve volume of 3.0 L, and 10. Flow resistance across a set of airways is lowest under
an expiratory reserve volume of 1.0 L, then the residual the following conditions:
volume is: a. Airway radius is large, airways are in series, gas is of
a. 0.5 L low viscosity
b. 1.0 L b. Airway radius is large, airways are in parallel, gas is
c. 1.5 L of high viscosity
d. 2.0 L c. Airway radius is small, airways are in series, gas is of
e. 2.5 L low viscosity
2. The minute ventilation of an individual with a tidal vol- d. Airway radius is small, airways are in parallel, gas is
ume of 500 mL and a respiratory rate of 12 breaths per of high viscosity
minute is: e. Airway radius is large, airways are in parallel, gas is
a. 42 mL of low viscosity
b. 500 mL 11. The airways most responsible for the resistance of the
c. 42 L/min respiratory system during nasal breathing are:
d. 5 L/min a. The nose to the larynx
e. 6 L/min b. The trachea to segmental bronchi
3–9. Match the arterial blood gas values (a to g) with the c. The subsegmental airways
most likely condition (3 to 9). A condition can be used d. The terminal bronchioles
more than once. e. The alveoli and alveolar ducts
12. Which of the following factors does not contribute to
lung resistance?
a. Lung volume
Pao2 Paco2 Cao2 Sao2% b. Number and length of conducting airways
mm Hg mm Hg Vol % c. Airway smooth muscle tone
a. 100 40 20 97 d. Elastic recoil
b. 100 40 10 98 e. Static lung compliance
c. 100 40 10 50 13. Expiratory flow limitation occurs when:
d. 120 20 20 99 a.  Pleural (intrathoracic) pressure exceeds elastic
e. 650 40 22 100 recoil pressure
f. 60 60 17 85 b. The pressure outside an airway is greater than the
g. 45 48 20 80 pressure inside the airway
c. Dynamic lung compliance is greater than static
lung compliance
3 . A person with normal lungs breathing 100% oxygen d. Lung volume is increased
4. Anemia e. Expiratory flow rates are high
5. Hypoventilation 14. A person’s respiratory rate at rest is determined by:
6. Carbon monoxide poisoning a. The compliance and resistance of their respiratory
7. Severe chronic bronchitis system
8. Normal b. The minimal oxygen cost of breathing

179
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180 APPENDIX B  Multiple-Choice Examination
c. The metabolic demands of the body
d. The work of breathing
e. All of the above
15. Which of the following statements about the measure-
ment of lung volumes is correct?
a. FRC by helium dilution technique is the same as
FRC measured by body plethysmography in indi-
viduals with obstructive and restrictive pulmonary
disease.
b. TLC is determined by inspiratory muscle strength
and lung elastic recoil.
c. The FVC is greater than the SVC in individuals
with obstructive pulmonary disease.
d.  The functional residual capacity is increased in
individuals with muscle weakness.
e. One of the hallmarks of obstructive lung disease is
an RV/TLC ratio less than 25%.
16. 
Which of the following pulmonary function test
results best describes an individual with moderate
chronic bronchitis?
a. Normal vital capacity, normal FEV1, normal FEV1/
FVC, reduced expiratory flow rates, decreased Dlco
b.  Normal vital capacity, reduced FEV1, decreased
FEV1/FVC, reduced expiratory flow rates, decreased
Dlco
c. Normal vital capacity, normal FEV1, normal FEV1/
FVC, reduced expiratory flow rates, normal Dlco
d.  Normal vital capacity, reduced FEV1, decreased
FEV1/FVC, reduced expiratory flow rates, normal
Dlco
e. Reduced vital capacity, reduced FEV1, normal FEV1/
FVC, reduced expiratory flow rates, normal Dlco
17. A 55-year-old woman, a former smoker, complains of
shortness of breath. She has an FVC of 2.4 L and an
SVC of 2.9 L. These findings suggest:
a. Restrictive lung disease
b. Obstructive lung disease
c. Muscle weakness
d. Anemia
e. Upper airway obstruction
18. Pulmonary function tests (spirometry and lung vol-
umes) might be indicated in all of the following except:
a. Smokers older than 20 years of age
b. Evaluation of the severity of pulmonary hypertension
c. Assessment of the risk of lung resection
d. Congestive heart failure
e. Children with asthma
19. Factors affecting normal values for pulmonary func-
tion tests include all except:
a. Age
b. Sex
c. Ethnicity
d. Barometric pressure
e. Height
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20. Which of the following statements about the effort-
independent part of the expiratory flow volume curve
is correct?
a. It occurs in the first 20% of the expiratory maneuver.
b. It depends on expiratory muscle force.
c. It is a measure of small airway function.
d.  Abnormalities are indicative of severe airway
obstruction.
e. Abnormalities occur early in restrictive lung disease.
21. The Dlco is frequently abnormal in all except which
of the following conditions?
a. Lung resection
b. Chemotherapy-induced pulmonary toxicity
c. Pulmonary hypertension
d. Multiple pulmonary emboli
e. Idiopathic pulmonary fibrosis
22. A 40-year-old mountain climber has the following
blood gas values at sea level (760 mm Hg): Pao2 = 96
torr, Paco2 = 40 torr, pH = 7.40, and Fio2 = 0.21. He
climbs to the top of Pike’s Peak (barometric pressure,
445 mm Hg). What is his Pao2 at the top of Pike’s Peak
(assume that his Paco2 and R are unchanged)?
a. 25 mm Hg
b. 34 mm Hg
c. 44 mm Hg
d. 55 mm Hg
e. 60 mm Hg
23. An increase in dead space ventilation without a change
in tidal volume will result in:
a. An increase in alveolar Pco2 without significant
change in alveolar Po2
b. An increase in alveolar Pco2 with a decrease in alve-
olar Po2
c.  A decrease in alveolar Pco2 without significant
change in alveolar Po2
d.  A decrease in alveolar Pco2 without significant
change in alveolar Po2
e. No change in alveolar Pco2 or alveolar Po2
24. The inspired oxygen tension at the level of the trachea
when an individual is at the summit of Mt. Everest
(barometric pressure, 250 torr) is:
a. 25 mm Hg
b. 43 mm Hg
c. 62 mm Hg
d. 75 mm Hg
e. 100 mm Hg
25. Anatomic dead space is determined by:
a. The size and number of the airways
b. The number of alveoli that are ventilated but not
perfused
c. The mechanical properties of the chest and chest
muscles
d. The characteristics of inspired gas
e. Physiologic dead space
 APPENDIX B  Multiple-Choice Examination 181

26. If the alveolar ventilation is 4 L/min and the CO2 pro- d. The higher the molecular weight, the greater the
duction is 200 mL/min, what is the Paco2 (assume diffusion.
barometric pressure is 760 torr)? e. Diffusion will be perfusion-limited.
a. 31 torr 32. 
Which of the following factors is associated with
b. 36 torr enhanced O2 release to the tissues?
c. 38 torr a. Decreased temperature
d. 50 torr b. Increased Pco2
e. 55 torr c. Decreased 2,3-DPG
27. How many milliliters of O2 does 100 mL of blood con- d. Increased pH
tain at a Pao2 of 40 mm Hg? e. Tissue bicarbonate levels
a. 4 mL 33. What of the following statements about the Bohr effect
b. 6 mL is correct?
c. 8 mL a. It is primarily due to the effect of CO2 on pH and
d. 10 mL on hemoglobin.
e. 12 mL b. It shifts the oxyhemoglobin dissociation curve to
28. A patient has a hemoglobin level of 10 g/100 mL of the left in the tissues.
blood. What is his O2-carrying capacity? c. It enhances CO2 uptake from the tissues and CO2
a. 10 mL O2/100 mL blood unloading in the lung.
b. 13 mL O2/100 mL blood d. It increases the levels of 2,3-DPG in red blood cells.
c. 15 mL O2/100 mL blood e. It is related to chloride exchange processes in the
d. 20 mL O2/100 mL blood red blood cell.
e. 25 mL O2/100 mL blood 34–37. Match the blood gas values in a to e with the acid–
29. If the arterial–venous difference is 5 mL O2/100 mL base disorders shown in 34 to 37.
blood in the preceding question, what is the O2 con-
tent of the venous blood? −
a. 5 mL O2/100 mL blood pH HCO3 Paco2
b. 8 mL O2/100 mL blood a. 7.23 10 25
c. 10 mL O2/100 mL blood b. 7.34 26 50
d. 15 mL O2/100 mL blood c. 7.37 28 50
e. 18 mL O2/100 mL blood d. 7.46 30 44
30. A sample of blood has a Po2 of 100 mm Hg and is 98% e. 7.66 22 20
saturated. The hemoglobin is 15 g/100 mL. The O2 3 4. Metabolic acidosis with respiratory compensation
content of this blood is: 35. Respiratory acidosis with renal compensation
a. 10 mL/100 mL blood 36. Metabolic alkalosis with respiratory compensation
b. 15 mL/100 mL blood 37. Respiratory alkalosis with renal compensation
c. 20 mL/100 mL blood 38. A 65-year-old retired man has been homebound for 5
d. 23 mL/100 mL blood years because of shortness of breath. He has increased
e. 25 mL/100 mL blood sputum production after a cold and complains of dys-
31. Investigators are studying a recently discovered gas. pnea so severe that it interferes with his smoking cig-
This gas has a high solubility in the alveolar–capillary arettes. His chest is hyperinflated, with distant breath
membrane and a low solubility in the plasma. It does sounds and loud rhonchi on auscultation. Of the three
not appear to bind chemically to blood. Which of the possible sets of arterial blood gas values shown (A, B,
following statements is true about this gas? C), which best fits the patient’s condition and history?
a.  The amount of gas absorbed into the blood is
inversely proportional to the partial pressure gra-
dient across the alveolar–capillary membrane. A B C
b. Diffusion across the capillary–tissue interface will pH 7.30 7.18 7.45
be greater than diffusion across the alveolar–capil- Pao2 45 28 65
lary interface. Paco2 70 70 70
c. Diffusion will be directly related to the thickness of HCO3− 35 24 50
the membrane. Be +10 0 +20

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182 APPENDIX B  Multiple-Choice Examination
39. Which of the following would increase the ventilatory
response to CO2?
a. Barbiturates
b. Hypoxia
c. Sleep
d. Chronic obstructive pulmonary disease
e. Anesthesia
40. Breath-holding for 90 seconds will:
a. Increase Pco2
b. Decrease Po2
c. Stimulate central chemoreceptors
d. Stimulate peripheral chemoreceptors
e. Result in all of the above
41. Which of the following statements is not true about
peripheral chemoreceptors?
a. They respond to decreases in Po2 and O2 content.
b. They respond to changes in arterial pH.
c. They respond to increases in Pco2.
d. They account for ∼40% of the ventilatory response
to CO2.
e. They are rich in dopamine.
42. Which of the following responses would be expected
in a normal individual after 1 week of residence at an
altitude of 12,500 ft?
a. Increased alveolar ventilation (relative to sea level)
b. Normal Paco2
c. Normal pulmonary artery pressure
d. Normal Pao2
e. Normal plasma bicarbonate
43. An 80-year-old man in congestive heart failure has a
respiratory rate of 26 breaths/min, arterial pH of 7.08,
Po2 of 60 torr, and Pco2 of 31 torr. He is treated with
diuretics, oxygen, and digitalis and is given bicarbon-
ate intravenously. The following day his respiratory
rate remains elevated, and he has an arterial pH of
7.49, Po2 of 102 torr on 28% O2, and Pco2 of 31 torr.
The best explanation for his current respiratory alka-
losis is:
a. Excessive bicarbonate administration
b. Cerebrospinal fluid central acidosis
c. Compensatory metabolic acidosis
d. Peripheral chemoreceptor stimulation
e. Hypoxia-induced hyperventilation
44. An individual with pneumonia is receiving 30% sup-
plemental O2 by a facemask. Arterial blood gas values
are pH = 7.40, Paco2 = 44 mm Hg, and a Pao2 = 70
mm Hg (assume that the individual is at sea level and
his respiratory quotient is 0.8). What is his AaDo2?
a. 15 mm Hg
b. 35 mm Hg
c. 55 mm Hg
d. 89 mm Hg
e. 94 mm Hg
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4 5. Moderate levels of exercise result in:
a. An increase in total lung capacity
b. An increase in pulmonary vascular resistance
c. A decrease in the diffusion capacity for carbon
monoxide
d. A lack of significant changes in arterial blood gases
e. A decrease in CO2 production
46. The effects of training on the ability to perform exer-
cise can be described as:
a. A lowering of the resting heart rate
b. An increase in the maximum heart rate
c. No change in resting stroke volume
d. Decreases in glycogen synthesis
e. Increases in blood lactate levels
47. The first time that extrauterine life can exist is:
a. When the airways are fully developed.
b. When acinar development is complete
c. At the end of the canalicular stage
d. At the end of the saccular stage
e. At birth
48. The most important change in the pulmonary circula-
tion at birth is:
a. The decrease in pulmonary vascular resistance
b. Stimulation of respiration by progesterone
c. Delivery of the placenta
d. Pulmonary vasoconstriction
e. All of the above
49. Ascent to high altitude is associated with:
a. Hyperventilation
b. A decrease in inspired oxygen
c. A respiratory alkalosis
d. A rightward shift of the oxyhemoglobin dissocia-
tion curve
e. All of the above
50. The respiratory control center is located in the:
a. Cerebral cortex
b. Pons
c. Medulla oblongata
d. Cerebellum
e. Spinal motor tract
51. The carotid body responds to:
a. Hypoxia
b. Hypercarbia
c. Change in pH
d. All of the above
e. None of the above
52. The response to increases in Pco2 is characterized by:
a. A curvilinear increase in minute ventilation
b. A linear increase in alveolar ventilation
c. Decreased carotid sinus nerve firing
d. Inhibition by low levels of O2
e. Inhibition by low pH
 APPENDIX B  Multiple-Choice Examination 183

53. Central chemoreceptors respond to:
a. Low Po2
b. Changes in blood bicarbonate levels
c. Changes in H+ ion concentrations
d. Changes in molecular CO2
e. All of the above
54. The Hering–Breuer reflex is stimulated by:
a. Spinal motor neurons
b. Nasal or facial receptors
c. Increases in lung volume
d. Irritant receptors
e. J receptors
55. Which of the following statements about obstructive
sleep apnea (OSA) is true?
a. OSA is most commonly caused by obesity.
b. OSA is associated with a decrease in ventilatory
drive to the respiratory motor neurons.
c. OSA is associated with an absence of ventilatory
effort.
d.  OSA is associated with lower respiratory tract
obstruction.
e. OSA is never associated with hypoxia.
56. Which of the following statements about mucus in
chronic bronchitis is not true?
a. Submucosal glands increase in number and size
with chronic bronchitis.
b. Surface secretory cells increase in number and size
with chronic bronchitis.
c. The chemical composition of surface secretory cells
changes with chronic bronchitis.
d. The chemical composition of submucosal glands
changes with chronic bronchitis.
e. Particulate smoke deposition occurs in respiratory
bronchioles in chronic bronchitis.
5 7. Particle retention in the lung most often occurs:
a. At the transition between the conducting airways
and the terminal respiratory units
b. At bifurcations in large airways
c. At bifurcations in small airways
d. In the nose
e. In the trachea
58. Important defense systems in the respiratory system
include:
a. Mucociliary transport
b. Innate immunity
c. Adaptive immunity
d. Migratory phagocytic and inflammatory cells
e. All of the above
59. Alveolar macrophages:
a. Are derived from blood monocytes
b. Live 1 to 5 weeks in the respiratory tract
c. Both dissolve and engulf foreign materials
d. Are characterized by all of the above
e. Are characterized by none of the above
60. Surfactants:
a. Decrease surface tension at all lung volumes
b. Increase surface tension at low lung volumes and
decrease surface tension at high lung volumes
c. Are resistant to hypoxia and sheer stress
d. Are produced by type I epithelial cells
e. Are characterized by all of the above

ANSWERS TO MULTIPLE-CHOICE EXAMINATION

1. a 13. b 25. a 37. e 49. e
2. e 14. e 26. b 38. a 50. c
3. e 15. b 27. e 39. b 51. d
4. b 16. d 28. b 40. e 52. b
5. f 17. b 29. b 41. a 53. d
6. b 18. b 30. c 42. a 54. c
7. g 19. d 31. e 43. b 55. a
8. a 20. c 32. b 44. d 56. d
9. d 21. c 33. a 45. d 57. a
10. e 22. b 34. a 46. a 58. e
11. a 23. b 35. c 47. c 59. d
12. e 24. b 36. d 48. a 60. a

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