PROBLEMS: Respiratory System

Consider the following pulmonary function test data from a patient with pulmonary fibrosis in answering questions 1-5 below. Vital Capacity (Liters) Expiratory Reserve Volume (Liters) Residual Lung Volume (Liters) Total Lung Capacity (Liters) Tidal Volume (Liters) Anatomic Dead Space (Liters) Frequency (f) Pulmonary Diffusing Capacity (ml/min per mmHg) Arterial Blood Gases: PO2 = 50 mm Hg PCO2 = 49 mm Hg 1. For this patient, the functional residual capacity (FRC) would be closest to: a. 2.4 Liters b. 1.4 Liters c. 2.8 Liters d. 1.2 Liters 2. A likely reason for the lower than normal diffusing capacity is: a. increased surface area of the alveolar-capillary membrane b. increased driving pressure gradient for diffusion of oxygen c. increased thickness of the alveolar capillary membrane d. decreased diffusion constant for CO2. 3. If the patients tidal volume is 0.6 L and the anatomic dead space is 0.14 L, the estimated alveolar ventilation would be closest to: a. 8.28 Liters/min b. 10.8 Liters/min c. 2.80 Liters/min d. 5.10 Liters/min 4. Fibrosis patients, such as this one, often have a functional residual capacity that is smaller than normal because a. The diameter of their airways is greater than normal b. The compliance of the lung is decreased c. The compliance of the chest wall is decreased d. The total lung capacity is greater than normal Predicted 4.1 1.4 2.3 6.4 0.6 0.14 Observed 1.4 0.2 1.2 2.6 18 breaths/min 14.1 8.6 62 %Predicted 34 14 52 41

e. The elastic recoil of the lungs is decreased

5. a. b. c.

Which of the following FEV1 curves would most likely be obtained from this patient: Curve X Curve Y Curve Z

6. In a patient diagnosed with emphysema: a. lung elastic recoil is greater than normal due to damage of elastic fibers. b. functional residual capacity is greater than normal due to increased lung compliance. c. airway compression during forced expiration is less than normal because pleural pressure decreases more than it does in a normal individual. d. total lung capacity is less than normal due to increased lung compliance. 7. If a person is stabbed with a knife and air enters the intrapleural space (pneumothorax), the most likely response would be for the: a. lung to expand outward and the chest wall to spring inward b. lung to expand outward and the chest wall to spring outward c. lung to collapse inward and the chest wall to collapse inward d. lung to collapse inward and the chest wall to spring outward 8. At the end of a maximal inspiration with the glottis open: a. alveolar pressure will be greater than 0. b. intrapleural pressure will be greater than atmospheric pressure. c. alveolar pressure will be equal to atmospheric pressure. d. intrapleural pressure will be equal to atmospheric pressure.

e. intrapleural pressure will be greater than alveolar pressure

9. Total lung capacity is: a. measured with a spirometer. b. approximately 500 ml in an adult. c. the sum of residual volume and vital capacity. d. the sum of FRC plus tidal volume.

10. John is a 27 year old marathon runner. He theorizes that breathing 100% O2 should increase the amount of O2 in his blood about 5-fold because room air is 21% O2. Which of the following statements is the most accurate answer to his hypothesis? a. The amount of O2 carried by Hb will increase markedly but the amount of soluble O2 in his blood will remain the same. b. The amount of O2 carried by Hb in the blood will not rise appreciably. c. The amount of O2 carried by Hb in the blood will rise 5-fold. 11. John is almost finished with his 5 mile bike race. Relative to his baseline condition at the start of the race, the amount of O2 delivered to his leg muscles is: a. increased due to the rise in temperature and fall in pH. b. increased due to the rise in temperature and rise in pH. c. decreased due to the shortened time for equilibration across the alveolar membrane. d. decreased due to the rise in blood CO2 which displaces O2 on Hb. 12. A decrease in blood pH will (increase, decrease, not change) the rate of breathing.

13. At the first half mile of a marathon run, ______.

a. the partial pressures of arterial CO2 decreases while O2 shows little change. b. the partial pressures of arterial CO2 and O2 show little change or no change from resting values. c. the partial pressure of arterial CO2 increases and O2 decreases. d. the partial pressures of both arterial CO2 and O2 decrease markedly.

14. In the last half mile of a marathon run, you would expect that _____. a. the partial pressure of arterial CO2 increases b. the partial pressure of arterial CO2 decreases c. the partial pressure of arterial CO2 is fixed at 40 mmHg always

ANSWERS 1. B 2. C 3. A 4. B 5. C 6. B 7. D 8. C 9. C 10. B 11. A 12. Increase 13. B. 14. B due to an increase in circulating H+ (due to lactic acid), ventilation increases to blow off CO2.