PULMONARY IMCQ SESSION 10

1. A 5-month-old infant is brought to the emergency

department because of breathing disturbance during sleep for
2 weeks. Physical examination shows no abnormality.
Investigations show marked hypoventilation during sleep and,
congenital central hypoventilation syndrome is diagnosed.
Which of the following changes is most likely to occur when
she is hypoventilating?

A. Increased A-a gradient

B. Increased PaCO2
C. Increased PAO2
D. Increased FIO2

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2. A healthy 24-year-old woman who lives in a beach-front
property travels by plane to visit a relative who resides in Tibet,
15,000 feet above sea level. The journey is undertaken in one
day. Which of the following changes would most likely be
expected to occur on arrival?

A. Increased PaCO2 levels

B. Maximum increased in alveolar ventilation
C. Decreased PAO2
D. Decreased cardiac output
E. Decreased firing of peripheral O2 receptors

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3. A 72-year-old man comes to the physician because of
difficulty breathing, coughing and fatigue for 2 weeks. His
respirations are 25/min. Blood gas studies on room air show
PaO2 = 60 mm Hg and PaCO2= 56 mm Hg. If the patient has a
PAO2 of 80 mm Hg at a barometric pressure of 760 mm Hg,
which of the following is most likely his A-a gradient?

A. 4 mm Hg
B. 10 mm Hg
C. 20 mm Hg
D. 60 mm Hg
E. 80 mm Hg

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4. A 65-year-old woman comes to the physician complaining of
shortness of breath, headache, and fatigue. She underwent
gastric bypass 1 year ago, and is post-menopausal. She
mentions a craving for ice. Her conjunctiva and oral mucosa are
pale. Her temperature is 37.6 C, respirations 22/min and blood
pressure 120/80 mmHg. Blood tests reveal low haemoglobin, and
vitamin B12 indicative of pernicious anemia. Which of the
following blood measures would be normal?

A. Oxygen content
B. Dissolved carbon dioxide
C. Dissolved oxygen
D. pH

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5. A 60-year old man presents to his physician for fatigue,
headaches, and dyspnea (shortness of breath) on exertion. He
sometimes get blue lips and fingers when he exercises.
Pulmonary tests reveal an increase, rather than decrease, in the
diffusing capacity of the lung. Which of the following conditions
best accounts for an increase in diffusing capacity.

A. Anemia
B. Congestive heart failure
C. Chronic obstructive pulmonary disease (COPD)
D. Fibrotic lung disease
E. Polycythemia (increase in RBCs)
F. Pulmonary embolism

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6. A 62-year-old man comes to his physician complaining of shortness
of breath. He notes that he cannot breath when he lies down flat
(orthopnea, and sometimes he cannot catch his breath at night
(paroxysmal nocturnal dyspnea). He has a history of congestive heart
failure. His blood pressure is 160/90 m Hg. His PaO2 is decreased.
Pitting edema is observed in his lower extremities. There are no thrills
or murmurs, and no pulmonary rales with auscultation. ECG shows a
widened QRS duration. Ultrasound reveals cardiomegaly (enlarged
heart), a reduced ejection fraction, and rules out valvular dysfunction.
There is also increased opacity in the pulmonary septa. Which of the
below directly contributed to the patients reduced PaO2?

A. Pulmonary edema
B. Systemic heart failure
C. Reduced hemoglobin levels
D. Decreased lung perfusion
E. Decreased lung ventilation

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7. A 25-year-old man is admitted to hospital after suffering a stab
wound to his R. thigh. A day after admission his hemoglobin was
rechecked and found to have dropped from 9 g/dl on admission to 5
g/dl (normal 13–15 g/dl). He is transfused 2-units transfusion of
packed red blood cells.
Which of the following changes would you expect to see as a result of
the transfusion?

A. Decreased arterial oxygen concentration

B. Increased arterial PO2
C. Increased oxygen concentration of mixed venous blood
D. Increased arterial oxygen saturation
E. Increased tissue oxygen consumption

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8. A 74 year-old lady is admitted to hospital with a history of
dyspnea, fever, pleuritic chest pain in the right lateral region and a
cough productive of rust colored sputum. She was a heavy smoker
for more than 20 years. Arterial blood gases were performed upon
arrival in the emergency department and after being placed on
supplemental oxygen. The results were as follows:
F IO2 pH Pa CO2 PaO2 HCO3-
0.21 7.48 32 51 23
0.80 7.47 33 55 23
What is the predominant mechanism(s) of her hypoxemia?

A. Hypoventilation
B. Ventilation-perfusion inequality
C. Hypoventilation and ventilation-perfusion inequality
D. Diffusion impairment
E. Shunt
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9. A 32-year-old man is in a car crash and suffers concussive injuries
to the thorax. X-rays do not reveal any intrathoracic hemorrhage or
any lung consolidation, but multiple rib fractures. He is conscious and
alert, though in severe pain. His breathing is rapid (30 bpm) and
shallow. His PaO2 is 80 mmHg and PaCO2 55 mmHg. What
mechanism is leading to his hypoxemia?

A. V/Q mismatch
B. Diffusion problem
C. Shunt
D. Hypoventilation

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10. A 9-year-old boy is brought to the emergency department
because of coughing and dyspnea after choking on peanuts 1
hour ago. He has no known allergies. His pulse is 100/min
and respirations are 22/min. Physical examination shows
wheezing and decreased breath sounds over the left and right
lung fields. Imaging studies show bilateral bronchial foreign
body aspiration. An increase in which of the following is most
likely in this patient?

A. Alveolar ventilation
B. V/Q Ratio
C. pH
D. PaCO2
E. PaO2

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11. A 62-year-old man comes to his physician complaining of shortness
of breath. He notes that he cannot breath when he lies down flat
(orthopnea, and sometimes he cannot catch his breath at night
(paroxysmal nocturnal dyspnea). He has a history of congestive heart
failure. His blood pressure is 160/90 m Hg. Pitting edema is observed
in his lower extremities. With auscultation there no thrills or murmurs,
and no pulmonary rales. ECG shows a widened QRS duration.
Ultrasound reveals cardiomegaly (enlarged heart), a reduced ejection
fraction, and rules out valvular dysfunction. There is also increased
opacity in the pulmonary septa. Which of the below contributed to the
patients disease?

A. Decreased pulmonary interstitial oncotic pressure

B. Increased pulmonary capillary hydrostatic pressure
C. Increased pulmonary capillary oncotic pressure
D. Increased pulmonary interstitial hydrostatic pressure
E. Decreased pulmonary capillary permeability

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 Answer Key
CPR iMCQ10

1. B 6. A
2. C 7. C
3. C 8. E
4. C
5. E 9. D
10. D
11. B