1.

A medical student class is studying regulation of pulmonary blood flow and the importance of ventilation
and perfusion being matched in an appropriate fashion. Various mechanisms for ventilation/perfusion
(V/Q) ratio imbalance conditions are being taught to the class. Which of the following most likely
contributes to a low ventilation/perfusion ratio?
A. Low heart rate
B. Low hemoglobin
*C. Airway obstruction
D. Pulmonary vasoconstriction

2. During vigorous exercise, rapid and deep breathing occurs as well as an increase in heart rate. The
resulting increased cardiac output will induce which of the following changes?
*A. An opening of previously closed pulmonary capillaries
B. An increase in resistance of the pulmonary circulation to flow
C. An increase in tone of the pulmonary vessels
D. A localized pulmonary vasoconstriction

3. A physiology professor is explaining the Hering-Breuer inflation reflex to a class of medical students.
The main purpose of this reflex in control of respiration is that it:
A. Increases the inspiratory effort needed to activate pulmonary stretch receptors
B. Is triggered to stimulate the central chemoreceptors to control breathing frequency
*C. Is triggered to prevent over-inflation of the lung
D. Initiates coughing because it is the reflex response to activation of irritant receptors

4. A patient is on a ventilator that is set for a respiratory rate of 20 breaths/min. The patient’s anatomic
dead space is 150 ml and the ventilator’s dead space is 250 ml. To what volume should the output
(tidal volume) of the ventilator be adjusted so that the alveolar ventilation is 4 L/min, assuming that total
dead space = anatomic + ventilator dead space?
A. 150 ml
B. 250 ml
C. 400 ml
*D. 600 ml
E. 1000 ml

5. An individual has anxiety panic attacks because of being very anxious about a presentation they need
to give to some supervisors at work. He begins to hyperventilate with a respiratory rate of 40
breaths/min and becomes lightheaded. Which of the following statements is correct concerning
hyperventilation?
A. It results in hypercapnia
*B. It leads to a low systemic arterial PCO2
C. It leads to a low systemic arterial PO2
D. It can lead to a respiratory acidosis
6. A 65 year old man with a 50 year history of smoking has chronic obstructive pulmonary disease. His
arterial blood gases show that his PaO2 is decreased and PaCO2 is elevated. He is chronically short of
breath. Which of the following is correct regarding the transport of CO2 in the blood?
A. A reaction between CO2 and H2O does not contribute to the mechanism of CO2 transport.
*B. The diffusion of HCO3- out of red blood cells is accompanied by the movement of Cl- into these
cells
C. CO2 transported by blood is solely in the form of carbamino hemoglobin
D. The largest amount of CO2 transported in plasma is as dissolved CO2.

7. A 45 year old patient is brought to the emergency room because they are short of breath. The patient
has a 20 years history of smoking. A blood gas is drawn and the PaO2 indicates that the patient is
hypoxemic. Which of the following is the most likely cause of the patient’s condition?

✓A. Thickening of the alveolar membrane

B. Trying to inhale too high a tidal volume in response to their feeling of “shortness of breath”
C. Hyperventilation because they had been trying to exercise
D. They are most likely anemic.

8. A patient who is taking shallow breaths is instructed to take deep breaths instead in order to increase
their gas exchange in the lungs. Which of the following explains why deep breathing is more effective to
improve gas exchange than just increasing respiratory rate?

A. Deep breathing decreases the anatomic dead space

B. Deep breathing keeps the tidal volume stable
C. Deep breathing diminishes the residual volume in the lungs
✓D. Deep breathing increases the patient’s minute alveolar ventilation

9. A medical school faculty member is explaining the coordination of the activity of respiratory neurons
and lung mechanics. Activation of the inspiratory neurons will result in which of the following effects on
mechanisms involved in mechanics of the lungs?

A. This will raise alveolar pressure higher than atmospheric pressure

✓B. It will inhibit activity of expiratory neurons
C. An effect to increase lung volume will be relaxation of the external intercostal muscles
D. This neuronal excitation will result in relaxation of the diaphragm
10. Both PaO2 and PaCO2 play a role in controlling ventilation. Which of the following combinations of
arterial blood gases values would cause the largest increase in minute ventilation?

PaO2 PaCO2
A. 75 mmHg 40 mmHg
B. 100 mmHg 55 mmHg
C. 75 mmHg 30 mmHg
✓D. 50 mmHg 55 mmHg
E. 90 mmHg 40 mmHg

11. A 65 year old man is brought to the hospital with symptoms of COPD which include but not limited to
persistent cough with mucus and shortness of breath. Some of his alveoli are not being ventilated
because of mucus plugs. Which of the following is correct concerning ventilation and perfusion of these
particular alveoli?

✓A. Perfusion of plugged alveoli will become lower

B. Perfusion of plugged alveoli will become higher
C. The ventilation/perfusion ratio in these alveoli will be greatly increased to compensate for the
mucus plugging
D. The ventilation/perfusion ratio is these alveoli will remain normal because hyperventilation will
occur

12. A 54-year-old man is being evaluated in the pulmonary clinic for a complaint of increasing shortness of
breath for the past 6 months. A pulmonary function test is performed. During this test, which of the
following muscles are used in a forced inspiration in addition to the primary inspiratory muscles?

A: The external intercostal muscles, internal intercostal muscles, and sternocleidomastoid muscles.
B: The scalenes; internal intercostal muscles; sternocleidomastoid muscles; neck and back muscles;
upper respiratory tract muscles.
✓C: The scalenes; sternocleidomastoid muscles; neck and back muscles; upper respiratory tract
muscles.
D: The abdominal muscles: rectus abdominis, transverse and oblique muscles; neck and back muscles.

13. A human subject is performing tidal breathing under resting conditions. Which of the following most
likely occurs at the point of functional residual capacity with the subject’s glottis open?

A: Pleural pressure becomes higher than atmospheric pressure

B: Alveolar pressure becomes much lower than atmospheric pressure
C: The recoil forces of the lungs and chest wall are equal and in the same direction
✓D: The recoil forces of the lungs and chest wall are equal but opposite in direction
E: Alveolar pressure becomes higher than atmospheric pressure
14. An investigator is studying normal respiratory tissues in humans. A biopsy is performed on an
asymptomatic participant as part of the study. The image below represents the microscopic findings for
this study participant. The structure depicted in the image is best classified as which of the following?

A. Alveolar duct
*B. Conducting bronchiole
C. Larynx
D. Primary bronchus
E. Trachea

15. A pregnant female suffering from hypertension and thrombocytopenia and has elevated liver function
tests suddenly has a seizure. Suspecting eclampsia, the obstetrics team performs an emergency
cesarean section. The neonate is delivered at 30 weeks gestation and is found to have bradycardia.
The child also appears to have labored breathing. The infant is rushed to the neonatal intensive care
unit, where he is intubated and treated with steroids. Which of the following is a characteristic of the
alveoli of this neonate’s lungs?

A. An increased pressure in needed to collapse the lungs

*B. Increased alveolar surface tension is observed
C. The lungs have increased compliance
D. The lungs lack a substance produced by Type I pneumocytes
E. The lungs produce a substance with a lecithin to sphingomyelin ratio
> 1.5
16. An investigator is studying normal respiratory tissues in humans. A biopsy is performed on an
asymptomatic participant as part of the study. The image below represents the microscopic findings for
this study participant. Which of the following is the functional significance of the structure indicated by
the yellow star?

*A. Increases the force of expired air

B. Moves particulates out of the airway
C. Prevents over distension of the airway
D. Prevents collapse of the airway
E. Secretes mucous to lubricate the airway

TRACHEA

17. A 61 year-old man presented to his physician with a one day history of shaking chills, followed by sharp
pain in the right lateral chest with inspiration, and production of yellow blood-streaked sputum. Culture
of a sputum specimen on blood agar revealed alpha ( )-hemolytic cocci sensitive to Optochin. His
temperature was 39.3˚ C. His respiratory infection responded rapidly to penicillin and he felt much
better within 48 hours. Which of the following pathogens was most likely to be the cause of this
patient’s disease?

A. Mycoplasma pneumoniae
B. Mycobacterium tuberculosis
C. Chlamydia pneumoniae
**D. Streptococcus pneumoniae

18. A 35 year-old, small animal veterinarian presented with severe headache, myalgias, and splenomegaly
in addition to dyspnea and a productive cough. A scanty sputum sample was obtained, which contained
a few bacteria and scattered mononuclear cells on routine Gram staining. An immunofluorescent
antibody assay revealed the causative agent to be Chlamydophila psittaci. Which of the following is a
characteristic of this pathogen?

A. Forms colonies on artificial culture medium

**B. Incapable of making ATP
C. Transmitted easily from person-to-person
D. Replicates outside of host cells
19. Within a 2-week period, nine adults in a small town in Michigan were diagnosed with Legionnaires
Disease. On questioning, eight patients acknowledged all of the possible exposures listed below. Which
of the following of these exposures is the most likely source of the outbreak?

A. Attending the same screening of the latest Star Wars movie

B. Eating the same brand of locally-produced ice cream
**C. Buying fresh produce in the vegetable isle of a local supermarket
D. Playing on the same softball team as one of the patients.

20. A 5 year-old girl is brought to her pediatrician’s office with fever and joint aches. Two weeks previously,
she had a severe sore throat and fever, both of which resolved spontaneously without treatment. A
throat swab taken at that time was cultured and revealed the presence of Streptococcus pyogenes. On
cardiac examination, there is a new systolic murmur at the cardiac apex. All of the following are
characteristics of the causative agent of this patient’s disease EXCEPT:

A. Transmitted from person-to-person

B. Contains antigens that mimic heart muscle
C. Immunity is based upon the capsular M protein serotype
**D. Disease can be prevented by vaccination

21. A 5 year-old girl is brought to her pediatrician with a fever of 40.0˚C, difficulty eating, and drooling. Her
mother states that she has had very rapid, “noisy” breathing. The mother states that she does not believe
in childhood vaccinations due to the risks, her daughter has not received any of the common childhood
vaccines. The Gram stain of a throat swab reveals Gram-negative coccobacilli consistent with
Haemophilus influenzae type b. Which of the following is a characteristic of this pathogen?

**A. Capable of causing serious systemic complications

B. Vaccine consists of a toxoid
C. Cell wall composed of sterols with no peptidoglycan
D. Replicates only within host cells

22. A 28 year-old man with HIV infection had increasing fever and a dry cough for the past 5 days. Though
his HIV test was positive 1 year ago, he chose not to take antiretroviral medication despite the
recommendation of his physician as the drugs made him nauseated. Vitals signs demonstrated a
temperature of 38.8˚C, blood pressure of 138/75 mmHg, and respiratory rate of 18/ min. He was mildly
short of breath. Physical exam was significant for decreased bilateral breath sounds and white creamy
lesions on the palate and buccal mucosa that bled slightly when touched. A chest radiograph showed
diffuse reticular infiltrates in both lungs and an interferon gamma release assay (IGRA) was negative. A
deep sputum specimen was induced and sent to the laboratory. Attempts to culture the causative agent
failed. Which of the following was most likely be seen in the sputum sample?

A. Gram-positive diplococci
B. Acid-fast bacilli
**C. Silver-stained spherical cysts
D. Yeast cells surrounded by a clear zone on India ink examination
23. A 48 year-old man developed a high fever, cough, and shortness of breath 10 days after helping to
dismantle a beaver dam obstructing a creek in central Michigan. He admits to smoking 1 pack of
cigarettes per day. Vital signs are significant for a temperature of 39˚C, blood pressure of 125/70 mmHg,
and a respiratory rate of 15/min. On physical examination, he has dry crackles in both lungs. In addition,
he has deep nodular skin lesions, some of which have erupted to the surface of the skin. A chest
radiograph shows bilateral opacities. A sputum smear shows occasional large, round, thick-walled yeast
cells. Which of the following organisms is the most likely cause of this patient’s condition?

A. Cryptococcus neoformans
B. Histoplasma capsulatum
C. Coccidioides immitis
**D. Blastomyces dermatitidis