Anatomy & Physiology ch 22
Anatomy & Physiology ch 22 Biol 2301
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Human Anatomy & Physiology, 8e (Marieb/Hoehn) Chapter 22 The Respiratory System Matching Questions Figure 22.1 Using Figure 22.1, match the following: 1) Main (primary) bronchus. Answer: D Diff: 1 Page Ref: 805; Fig. 22.1 2) Pharynx. Answer: A Diff: 1 Page Ref: 805; Fig. 22.1 3) Larynx. Answer: B Diff: 1 Page Ref: 805; Fig. 22.1 4) Carina of trachea. Answer: E Diff: 1 Page Ref: 805; Fig. 22.1 5) Trachea. 1 Copyright © 2010 Pearson Education, Inc. Answer: C Diff: 1 Page Ref: 805; Fig. 22.1 Figure 22.2 Using Figure 22.2, match the following: 6) Tidal volume. Answer: B Diff: 1 Page Ref: 825; Fig. 22.16 7) Inspiratory reserve volume. Answer: A Diff: 1 Page Ref: 825; Fig. 22.16 8) Residual volume. Answer: D Diff: 1 Page Ref: 825; Fig. 22.16 9) Expiratory reserve volume. Answer: C Diff: 1 Page Ref: 825; Fig. 22.16 10) Air that does not participate in the exchange of gases. Answer: D Diff: 2 Page Ref: 825; Fig. 22.16 2 Copyright © 2010 Pearson Education, Inc. Match the following: A) Segmental bronchi B) Type II cells C) Alveolar duct D) Respiratory bronchioles E) Type I cells 11) No exchange of gases occurs here. Diff: 1 Page Ref: 814 12) Secrete a fluid containing surfactant. Diff: 1 Page Ref: 815 13) Where the respiratory zone of the lungs begins. Diff: 1 Page Ref: 815 14) Composed of simple squamous epithelium. Diff: 1 Page Ref: 815 15) Terminates in alveoli. Diff: 1 Page Ref: 815 16) Composed of cuboidal cells. Diff: 2 Page Ref: 815 17) The respiratory membrane is composed of fused basement membrane of the capillary walls and ________. Diff: 2 Page Ref: 815 Answers: 11) A 12) B 13) D 14) E 15) C 16) B 17) E True/False Questions 1) Ventilation perfusion coupling means that more blood flows past functional alveoli than past nonfunctional alveoli. Answer: TRUE Diff: 1 Page Ref: 829830 2) The olfactory mucosal lining of the nasal cavity contains the receptors for the sense of smell. Answer: TRUE Diff: 1 Page Ref: 806807 3) The functions of the nasal conchae are to enhance the air turbulence in the cavity and to increase the mucosal surface area exposed to the air. 3 Copyright © 2010 Pearson Education, Inc. Answer: TRUE Diff: 1 Page Ref: 807, 809 4) The lungs are perfused by two circulations: the pulmonary and the bronchial. The pulmonary circulation is for oxygenation of blood. The bronchial circulation supplies blood to the lung structures (tissue). Answer: TRUE Diff: 1 Page Ref: 818 5) Changes in arterial pH can modify respiration rate and rhythm even when carbon dioxide and oxygen levels are normal. Answer: TRUE Diff: 3 Page Ref: 834 6) Intrapleural pressure is normally about 4 mm Hg less than the pressure in the alveoli. Answer: TRUE Diff: 1 Page Ref: 819 7) During normal quiet breathing, approximately 750 ml of air moves into and out of the lungs with each breath. Answer: FALSE Diff: 1 Page Ref: 825; Fig. 22.16 8) The alveolar ventilation rate is the best index of effective ventilation. Answer: TRUE Diff: 1 Page Ref: 826 9) In chronic bronchitis, mucus production is decreased and this leads to the inflammation and fibrosis of the mucosal lining of the bronchial tree. Answer: FALSE Diff: 1 Page Ref: 840841 10) Labored breathing is termed dyspnea. Answer: TRUE Diff: 1 Page Ref: 840 11) The largest amount of carbon dioxide is transported in the bloodstream in the form of carbonic anhydrase. Answer: FALSE Diff: 1 Page Ref: 834 12) Increased temperature results in decreased O unloading from hemoglobin. 2 Answer: FALSE 4 Copyright © 2010 Pearson Education, Inc. Diff: 1 Page Ref: 831 5 Copyright © 2010 Pearson Education, Inc. 13) The epiglottis is a smooth muscle that covers the glottis during swallowing. Answer: FALSE Diff: 1 Page Ref: 811812 14) Valsalva's maneuver involves closing off the glottis (preventing expiration) while contracting the muscles of expiration, causing an increase in intraabdominal pressure. Answer: TRUE Diff: 1 Page Ref: 811812 15) Smoking diminishes ciliary action and eventually destroys the cilia. Answer: TRUE Diff: 1 Page Ref: 813 16) Tracheal obstruction is life threatening. Answer: TRUE Diff: 1 Page Ref: 813 17) The parietal pleura lines the thoracic wall. Answer: TRUE Diff: 1 Page Ref: 818819 18) The average individual has 500 ml of residual volume in his lungs. Answer: FALSE Diff: 1 Page Ref: 824 19) Atelectasis (lung collapse) renders the lung useless for ventilation. Answer: TRUE Diff: 2 Page Ref: 820 20) The HeringBreuer reflex is a potentially dangerous response that may cause overinflation of the lung. Answer: FALSE Diff: 2 Page Ref: 839 21) Strong emotions and pain acting through the limbic system activate sympathetic centers in the hypothalamus, thus modulating respiratory rate and depth by sending signals to the respiratory centers. Answer: TRUE Diff: 2 Page Ref: 836 22) As carbon dioxide enters systemic blood, it causes more oxygen to dissociate from hemoglobin (the Haldane effect), which in turn allows more CO 2o combine with hemoglobin and more bicarbonate ion to be generated (the Bohr effect). Answer: FALSE Diff: 2 Page Ref: 834 6 Copyright © 2010 Pearson Education, Inc. 7 Copyright © 2010 Pearson Education, Inc. 23) Dalton's law states that the total pressure exerted by a mixture of gases is the sum of the pressures exerted independently by each gas in the mixture. Answer: TRUE Diff: 2 Page Ref: 827 24) Oxygenated hemoglobin releases oxygen more readily when the pH is more basic. Answer: FALSE Diff: 3 Page Ref: 831 25) Nasal conchae mainly work on inhalation to warm and moisten air. They serve minor functions for exhalation. Answer: FALSE Diff: 1 Page Ref: 807, 809 26) Under certain conditions, the vocal folds act as a sphincter that prevents air passage. Answer: TRUE Diff: 1 Page Ref: 811 27) Apneustic breathing is characterized by prolonged inspirations. Answer: TRUE Diff: 1 Page Ref: 835 MultipleChoice Questions 1) Which of the choices below is not a functional process performed by the respiratory system? A) pulmonary ventilation B) transport of respiratory gases C) external respiration D) pulmonary respiration Answer: B Diff: 1 Page Ref: 805 2) The loudness of a person's voice depends on the ________. A) thickness of vestibular folds B) length of the vocal folds C) strength of the intrinsic laryngeal muscles D) force with which air rushes across the vocal folds Answer: D Diff: 1 Page Ref: 811812 8 Copyright © 2010 Pearson Education, Inc. 3) The walls of the alveoli are composed of two types of cells, type I and type II. The function of type II is to ________. A) secrete surfactant B) trap dust and other debris C) replace mucus in the alveoli D) protect the lungs from bacterial invasion Answer: A Diff: 1 Page Ref: 815 4) Complete the following statement using the choices below. Air moves out of the lungs when the pressure inside the lungs is A) less than the pressure in the atmosphere. B) greater than the pressure in the atmosphere. C) equal to the pressure in the atmosphere. D) greater than the intraalveolar pressure. Answer: B Diff: 2 Page Ref: 820 5) Unlike inspiration, expiration is a passive act because no muscular contractions are involved. Expiration, however, depends on two factors. Which of the choices below lists those two factors? A) the recoil of elastic fibers that were stretched during inspiration and the inward pull of surface tension due to the film of alveolar fluid B) the expansion of respiratory muscles that were contracted during inspiration and the lack of surface tension on the alveolar wall C) the negative feedback of expansion fibers used during inspiration and the outward pull of surface tension due to surfactant D) combined amount of CO in 2he blood and air in the alveoli Answer: A Diff: 2 Page Ref: 822 6) Which of the following maintains the patency (openness) of the trachea? A) surface tension of water B) surfactant C) cartilage rings D) pseudostratified ciliated epithelium Answer: C Diff: 1 Page Ref: 813 7) Intrapulmonary pressure is the ________. A) pressure within the pleural cavity B) pressure within the alveoli of the lungs C) negative pressure in the intrapleural space D) difference between atmospheric pressure and respiratory pressure Answer: B 9 Copyright © 2010 Pearson Education, Inc. Diff: 1 Page Ref: 819 8) The relationship between the pressure and volume of gases is given by ________. A) Boyle's law B) Henry's law C) Charles' law D) Dalton's law Answer: A Diff: 1 Page Ref: 820 9) The statement, "in a mixture of gases, the total pressure is the sum of the individual partial pressures of gases in the mixture" paraphrases ________. A) Henry's law B) Boyle's law C) Dalton's law D) Charles' law Answer: C Diff: 1 Page Ref: 827 10) Surfactant helps to prevent the alveoli from collapsing by ________. A) humidifying the air before it enters B) warming the air before it enters C) interfering with the cohesiveness of water molecules, thereby reducing the surface tension of alveolar fluid D) protecting the surface of alveoli from dehydration and other environmental variations Answer: C Diff: 1 Page Ref: 823 11) For gas exchange to be efficient, the respiratory membrane must be ________. A) at least 3 micrometers thick B) 0.5 to 1 micrometer thick C) between 5 and 6 micrometers thick D) The thickness of the respiratory membrane is not important in the efficiency of gas exchange. Answer: B Diff: 1 Page Ref: 830 12) With the Bohr effect, more oxygen is released because a(n) ________. A) decrease in pH (acidosis) strengthens the hemoglobinoxygen bond B) decrease in pH (acidosis) weakens the hemoglobinoxygen bond C) increase in pH (alkalosis) strengthens the hemoglobinoxygen bond D) increase in pH (alkalosis) weakens the hemoglobinoxygen bond Answer: B Diff: 1 Page Ref: 832 10 Copyright © 2010 Pearson Education, Inc. 13) The most powerful respiratory stimulus for breathing in a healthy person is ________. A) loss of oxygen in tissues B) increase of carbon dioxide C) pH (acidosis) D) pH (alkalosis) Answer: B Diff: 1 Page Ref: 836 14) Nerve impulses from ________ will result in inspiration. A) the ventral respiratory group B) the chemoreceptor center C) Broca's center D) the preoptic nucleus of the hypothalamus Answer: A Diff: 1 Page Ref: 835 15) In the plasma, the quantity of oxygen in solution is ________. A) only about 1.5% of the oxygen carried in dissolved form B) about equal to the oxygen combined with hemoglobin C) greater than the oxygen combined with hemoglobin D) not present except where it is combined with carrier molecules Answer: A Diff: 1 Page Ref: 830831 16) Which of the following statements is incorrect? A) During fetal life, lungs are filled with fluid. B) Respiratory rate is lowest in newborn infants. C) Descent of the diaphragm results in abdominal breathing. D) The chest wall becomes more rigid with age. Answer: B Diff: 1 Page Ref: 843 17) Which of the choices below describes the forces that act to pull the lungs away from the thorax wall and thus collapse the lungs? A) the natural tendency for the lungs to recoil and the surface tension of the alveolar fluid B) compliance and transpulmonary pressures C) the natural tendency for the lungs to recoil and transpulmonary pressures D) compliance and the surface tension of the alveolar fluid Answer: A Diff: 2 Page Ref: 819 11 Copyright © 2010 Pearson Education, Inc. 18) Which of the following does not influence the increase in ventilation that occurs as exercise is initiated? A) psychic stimuli B) decrease in lactic acid levels C) proprioceptors D) simultaneous cortical motor activation of the skeletal muscles and respiratory center Answer: B Diff: 1 Page Ref: 839 19) Which of the following is not a form of lung cancer? A) adenocarcinoma B) Kaposi's sarcoma C) small cell carcinoma D) squamous cell carcinoma Answer: B Diff: 1 Page Ref: 842 20) Which of the following is not an event necessary to supply the body with O and dispose of 2 CO 2 A) pulmonary ventilation B) blood pH adjustment C) internal respiration D) external respiration Answer: B Diff: 1 Page Ref: 828831 21) Which of the following is not true of the respiratory tract from the medium bronchi to the aveoli? A) Cartilage gradually decreases and disappears at the bronchioles. B) Resistance to air flow increases due to the increase in crosssectional diameter. C) Proportionally, smooth muscle decreases uniformly. D) Lining of the tubes changes from ciliated columnar to simple squamous epithelium in the alveoli. Answer: B Diff: 1 Page Ref: 815, 823 22) Which of the following determines lung compliance? A) airway opening B) flexibility of the thoracic cage C) muscles of inspiration D) alveolar surface tension Answer: D Diff: 2 Page Ref: 823 12 Copyright © 2010 Pearson Education, Inc. 23) Tidal volume is air ________. A) remaining in the lungs after forced expiration B) exchanged during normal breathing C) inhaled after normal inspiration D) forcibly expelled after normal expiration Answer: B Diff: 1 Page Ref: 824 24) Which of the choices below determines the direction of respiratory gas movement? A) solubility in water B) partial pressure gradient C) the temperature D) molecular weight and size of the gas molecule Answer: B Diff: 1 Page Ref: 828829 25) Possible causes of hypoxia include ________. A) too little oxygen in the atmosphere B) obstruction of the esophagus C) taking several rapid deep breaths D) getting very cold Answer: A Diff: 1 Page Ref: 832 26) The lung volume that represents the total volume of exchangeable air is the ________. A) tidal volume B) vital capacity C) inspiratory capacity D) expiratory reserve volume Answer: B Diff: 1 Page Ref: 824 27) Because the lungs are filled with fluid during fetal life, which of the following statements is true regarding respiratory exchange? A) Respiratory exchanges are made through the ductus arteriosus. B) Respiratory exchanges are not necessary. C) Respiratory exchanges are made through the placenta. D) Because the lungs develop later in gestation, fetuses do not need a mechanism for respiratory exchange. Answer: C Diff: 1 Page Ref: 842843 13 Copyright © 2010 Pearson Education, Inc. 28) Which of the following is not a stimulus for breathing? A) rising carbon dioxide levels B) rising blood pressure C) arterial P2 below 60 mm Hg D) arterial pH resulting from CO 2retention Answer: B Diff: 2 Page Ref: 836837 29) Respiratory control centers are located in the ________. A) midbrain and medulla B) medulla and pons C) pons and midbrain D) upper spinal cord and medulla Answer: B Diff: 1 Page Ref: 835 30) The amount of air that can be inspired above the tidal volume is called ________. A) reserve air B) expiratory reserve C) inspiratory reserve D) vital capacity Answer: C Diff: 1 Page Ref: 824 31) Which statement about CO i2 incorrect? A) Its concentration in the blood is decreased by hyperventilation. B) Its accumulation in the blood is associated with a decrease in pH. C) More CO 2issolves in the blood plasma than is carried in the RBCs. D) CO concentrations are greater in venous blood than arterial blood. 2 Answer: C Diff: 2 Page Ref: 831832 32) Oxygen and carbon dioxide are exchanged in the lungs and through all cell membranes by ________. A) osmosis B) diffusion C) filtration D) active transport Answer: B Diff: 1 Page Ref: 830 14 Copyright © 2010 Pearson Education, Inc. 33) Select the correct statement about the pharynx. A) The pharyngeal tonsil is located in the laryngopharynx. B) The auditory tube drains into the nasopharynx. C) The laryngopharynx blends posteriorly into the nasopharynx. D) The palatine tonsils are embedded in the lateral walls of the nasopharynx. Answer: B Diff: 1 Page Ref: 809 34) The larynx contains ________. A) the thyroid cartilage B) a cricoid cartilage also called the Adam's apple C) an upper pair of avascular mucosal folds called true vocal folds D) lateral cartilage ridges called false vocal folds Answer: A Diff: 1 Page Ref: 810 35) Which respiratoryassociated muscles would contract if you were to blow up a balloon? A) diaphragm would contract, external intercostals would relax B) internal intercostals and abdominal muscles would contract C) external intercostals would contract and diaphragm would relax D) diaphragm contracts, internal intercostals would relax Answer: B Diff: 1 Page Ref: 822 36) How is the bulk of carbon dioxide carried in blood? A) chemically combined with the amino acids of hemoglobin as carbaminohemoglobin in the red blood cells B) as the bicarbonate ion in the plasma after first entering the red blood cells C) as carbonic acid in the plasma D) chemically combined with the heme portion of hemoglobin Answer: B Diff: 1 Page Ref: 833834 37) Which of the following is not found on the right lobe of the lung? A) middle lobe B) cardiac notch C) horizontal fissure D) oblique fissure Answer: B Diff: 1 Page Ref: 815 15 Copyright © 2010 Pearson Education, Inc. 38) Which of the choices below is not a role of the pleura? A) allows the lungs to inflate and deflate without friction B) helps divide the thoracic cavity into three chambers C) helps limit the spread of local infections D) aids in blood flow to and from the heart because the heart sits between the lungs Answer: D Diff: 2 Page Ref: 818819 39) Which of the following correctly describes mechanisms of CO transport? 2 A) 710% of CO i2 dissolved directly into the plasma B) 20% of CO i2 carried in the form of carbaminohemoglobin C) as bicarbonate ion in plasma D) attached to the heme part of hemoglobin Answer: D Diff: 1 Page Ref: 832834 40) Factors that influence the rate and depth of breathing include ________. A) thalamic control B) voluntary cortical control C) stretch receptors in the alveoli D) composition of alveolar air Answer: B Diff: 1 Page Ref: 838839 41) Which of the following provide the greatest surface area for gas exchange? A) alveolar sacs B) alveoli C) respiratory bronchioles D) alveolar ducts Answer: B Diff: 2 Page Ref: 815 42) The respiratory membrane is a combination of ________. A) respiratory bronchioles and alveolar ducts B) alveolar and capillary walls and their fused basement membranes C) atria and alveolar sacs D) respiratory bronchioles and alveolar sacs Answer: B Diff: 2 Page Ref: 815 43) Gas emboli may occur because a ________. A) person holds his breath too long B) diver holds his breath upon ascent C) pilot holds her breath upon descent D) person breathes pure oxygen in a pressurized chamber 16 Copyright © 2010 Pearson Education, Inc. Answer: B Diff: 2 Page Ref: 837 44) Inspiratory capacity is ________. A) the total amount of air that can be inspired after a tidal expiration B) the total amount of exchangeable air C) functional residual capacity D) air inspired after a tidal inhalation Answer: A Diff: 2 Page Ref: 824 45) Which center is located in the pons? A) pontine respirator group (PRG) B) expiratory C) inspiratory D) pacemaker neuron center Answer: A Diff: 2 Page Ref: 835 46) The nose serves all the following functions except ________. A) as a passageway for air movement B) as the initiator of the cough reflex C) warming and humidifying the air D) cleansing the air Answer: B Diff: 2 Page Ref: 806 47) A premature baby usually has difficulty breathing. However, the respiratory system is developed enough for survival by ________. A) 17 weeks B) 24 weeks C) 28 weeks D) 36 weeks Answer: C Diff: 2 Page Ref: 842 48) Which of the following statements is true regarding the respiratory rate of a newborn? A) The respiratory rate of a newborn is slow. B) The respiratory rate of a newborn varies between male and female infants. C) The respiratory rate of a newborn is approximately 30 respirations per minute. D) The respiratory rate of a newborn is, at its highest rate, approximately 4080 respirations per minute. Answer: D Diff: 2 Page Ref: 842843 17 Copyright © 2010 Pearson Education, Inc. 49) Select the correct statement about the neural mechanisms of respiratory control. A) The pons is thought to be instrumental in the smooth transition from inspiration to expiration. B) The dorsal respiratory group neurons depolarize in a rhythmic way to establish the pattern of breathing. C) The pontine respirator group (PRG) continuously stimulates the medulla to provide inspiratory drive. D) The ventral respiratory group is contained within the pons. Answer: A Diff: 2 Page Ref: 835 50) Which of the choices below is not a factor that promotes oxygen binding to and dissociation from hemoglobin? A) partial pressure of oxygen B) temperature C) partial pressure of carbon dioxide D) number of red blood cells Answer: D Diff: 2 Page Ref: 831 51) The factors responsible for holding the lungs to the thorax wall are ________. A) the smooth muscles of the lung B) the diaphragm and the intercostal muscles alone C) the visceral pleurae and the changing volume of the lungs D) surface tension from pleural fluid and negative pressure in the pleural cavity Answer: D Diff: 3 Page Ref: 818 52) The erythrocyte count increases after a while when an individual goes from a low to a high altitude because the ________. A) temperature is lower at higher altitudes B) basal metabolic rate is higher at high altitudes C) concentration of oxygen and/or total atmospheric pressure is higher at higher altitudes D) concentration of oxygen and/or total atmospheric pressure is lower at high altitudes Answer: D Diff: 2 Page Ref: 839840 53) Most inspired particles such as dust fail to reach the lungs because of the ________. A) ciliated mucous lining in the nose B) abundant blood supply to nasal mucosa C) porous structure of turbinate bones D) action of the epiglottis Answer: A Diff: 2 Page Ref: 806 18 Copyright © 2010 Pearson Education, Inc. 54) Which of the following is not possible? A) Gas flow equals pressure gradient over resistance. B) Pressure gradient equals gas flow over resistance. C) Resistance equals pressure gradient over gas flow. D) The amount of gas flowing in and out of the alveoli is directly proportional to the difference in pressure or pressure gradient between the external atmosphere and the alveoli. Answer: B Diff: 3 Page Ref: 822823 55) Select the correct statement about the physical factors influencing pulmonary ventilation. A) A decrease in compliance causes an increase in ventilation. B) A lung that is less elastic will require less muscle action to perform adequate ventilation. C) As alveolar surface tension increases, additional muscle action will be required. D) Surfactant helps increase alveolar surface tension. Answer: C Diff: 3 Page Ref: 822823 56) Select the correct statement about oxygen transport in blood: A) During normal activity, a molecule of hemoglobin returning to the lungs carries one molecule of O 2 B) During conditions of acidosis, hemoglobin is able to carry oxygen more efficiently. C) Increased BPG levels in the red blood cells enhance oxygencarrying capacity. D) A 50% oxygen saturation level of blood returning to the lungs might indicate an activity level higher than normal. Answer: D Diff: 3 Page Ref: 831 57) Which of the disorders below is characterized by destruction of the walls of the alveoli producing abnormally large air spaces that remain filled with air during exhalation? A) pneumonia B) tuberculosis C) emphysema D) coryza Answer: C Diff: 2 Page Ref: 840 58) Which of the following does not influence hemoglobin saturation? A) temperature B) DPG C) carbon dioxide D) nitric oxide Answer: D Diff: 2 Page Ref: 831 19 Copyright © 2010 Pearson Education, Inc. FillintheBlank/Short Answer Questions 1) Type II alveolar cells secrete ________. Answer: surfactant Diff: 1 Page Ref: 815 2) ________ law is called the law of partial pressure. Answer: Dalton's Diff: 1 Page Ref: 827 3) ________ law would apply to the amount of CO you2could dissolve in a Pepsi. Answer: Henry's Diff: 1 Page Ref: 827 4) Oxygen unloading in a RBC due to declining pH is called the ________. Answer: Bohr effect Diff: 1 Page Ref: 832 5) The ________ regulates smoothing of transitions from inspiration to expiration. Answer: pontine respiratory group (PRG) Diff: 1 Page Ref: 835 6) ________ is the most common lethal genetic disease in the United States. Answer: Cystic fibrosis Diff: 1 Page Ref: 843 7) The cartilaginous flap that closes the trachea during swallowing is called the ________. Answer: epiglottis Diff: 1 Page Ref: 811 8) The archway in the back of the throat is called the ________. Answer: fauces Diff: 1 Page Ref: 809 9) The trachea is lined with ________ epithelium. Answer: ciliated pseudostratified columnar Diff: 2 Page Ref: 812813 10) Terminal bronchioles are lined with ________ epithelium. Answer: cuboidal Diff: 1 Page Ref: 814815 20 Copyright © 2010 Pearson Education, Inc. 11) How is alveolar gas exchange affected by emphysema and pneumonia? Answer: With pneumonia, if the lungs become edematous, the thickness of the exchange membrane may increase dramatically, restricting gas exchange, and body tissues begin to suffer from hypoxia. With emphysema, the lungs become progressively less elastic and more fibrous, which hinders both inspiration and expiration. Gas exchange remains adequate initially, but muscular activity must be enlisted to expire. Additionally, a symptom of emphysema is fusion of alveoli, resulting in less surface area for gas exchange. Diff: 2 Page Ref: 830, 840 12) Briefly differentiate between atmospheric pressure, intrapulmonary pressure, and intrapleural pressure. Which of these is always negative in a healthy individual during normal breathing? What happens if intrapleural pressure becomes equal to atmospheric pressure? Answer: Atmospheric pressure is the pressure exerted by gases of the atmosphere. Intrapulmonary pressure is the pressure within the alveoli of the lungs. Intrapleural pressure is the pressure within the intrapleural space. Intrapleural pressure is negative relative to the other two during normal inspiration/expiration. Equalization of the intrapleural pressure with atmospheric pressure or intrapulmonary pressure immediately causes lung collapse. Diff: 3 Page Ref: 819820 13) The contraction of the diaphragm and the external intercostal muscles begins inspiration. Explain exactly what happens, in terms of volume and pressure changes in the lungs, when these muscles contract. Answer: With contraction of the diaphragm, the height of the thoracic cavity increases. Contraction of the intercostal muscles expands the diameter of the thorax. With an increase in volume of the thorax, the intrapulmonary volume increases, causing a drop in pressure relative to atmospheric pressure. Air rushes into the lungs along this pressure gradient until intrapulmonary and atmospheric pressures are equal. Diff: 2 Page Ref: 820; Fig. 22.13 14) What is the chloride shift and why does it occur? Answer: The chloride shift is an ionic exchange process whereby chloride ions move from the plasma into the erythrocytes to counterbalance the net positive charge left within the erythrocytes by the rapid outrush of negative bicarbonate ions. Diff: 2 Page Ref: 834 15) If a baby is born at 28 weeks' gestation, what major problem will the doctors look for? Answer: The type II alveolar cells may not have fully developed; therefore, there is the possibility of lung collapse, resulting in severe breathing difficulties. Diff: 2 Page Ref: 842 16) How is it possible to change the pitch of our voice from high to low? Answer: Usually, the tenser the vocal folds, the faster they vibrate and the higher the pitch. To produce deep tones, the glottis widens, and to produce highpitched tones, the glottis becomes a slit. Intrinsic laryngeal muscles control the true vocal folds and the size of the glottis. Diff: 3 Page Ref: 811812 21 Copyright © 2010 Pearson Education, Inc. 22 Copyright © 2010 Pearson Education, Inc. 17) The partial pressure gradient for oxygen (in the body) is much steeper than that for carbon dioxide. Explain how equal amounts of these two gases can be exchanged (in a given time interval) in the lungs and at the tissues. Answer: Equal amounts of O 2nd CO ca2 be exchanged in the lungs and at the tissues because CO 2solubility in plasma and alveolar fluid is 20 times greater than that of2O . Diff: 3 Page Ref: 828829 18) Define anatomical dead space. What is the relationship between anatomical and alveolar dead space? Which value is likely to increase during lung pathology? Answer: Anatomical dead space is the space in the conducting respiratory passageways. Alveolar dead space is the space in nonfunctional alveoli. Anatomical dead space and alveolar dead space together make up the total dead space. Alveolar dead space will increase during lung pathology. Diff: 3 Page Ref: 824 19) Distinguish among anemic, ischemic, histotoxic, and hypoxemic hypoxia. Answer: Anemic hypoxia reflects poor oxygen delivery resulting from too few RBCs or RBCs that contain abnormal or too little Hb. Ischemic hypoxia results when blood circulation is impaired or blocked. Histotoxic hypoxia occurs when body cells are unable to use O even 2 though adequate amounts are delivered. Hypoxemia hypoxia is indicated by reduced arterial P . O2 Diff: 2 Page Ref: 832 23 Copyright © 2010 Pearson Education, Inc. Clinical Questions 1) Timothy has been having difficulty breathing since he had pneumonia last month. Recently he had severe pain in his chest and back, and his breathing was extremely irregular. The doctor at the emergency room told him that one of the lobes of his lung had collapsed. How could this happen? Answer: Timothy suffered atelectasis, or lung collapse, most likely caused by air entering the pleural cavity due to a rupture of the visceral pleura. The rupture could have happened as a result of coughing during his bout with pneumonia. Diff: 3 Page Ref: 820 2) While having a physical examination, a young male informed his doctor that at age 8 he had lobar pneumonia and pleurisy in his left lung. The physician decided to measure his VC. Describe the apparatus and method used for taking this measurement. Define the following terms used in the description of lung volumes: TV, IRV, ERV, RV, and VC. Answer: His vital capacity (VC) was measured using a spirometer. As he breathed into a mouthpiece, a hollow bell, inverted over water, was displaced, giving a graphic recording on a rotating drum. Tidal volume (TV) is the amount of air that moves into and out of the lungs with normal breathing. Inspiratory reserve volume (IRV) is the amount of air that can be forcibly inhaled beyond the tidal volume. The expiratory reserve volume (ERV) is the amount of air that can be evacuated from the lungs over and above a tidal expiration. Residual volume (RV) is the amount of air that remains in the lungs even after the most strenuous expiration. Vital capacity (VC) is the total amount of exchangeable air. Diff: 3 Page Ref: 824826 3) Jane had been suffering through a severe cold and was complaining of a frontal headache and a dull, aching pain at the side of her face. What regions are likely to become sites of secondary infection following nasal infection? Answer: Following nasal infection, the paranasal sinuses can become infected. Diff: 2 Page Ref: 809 4) A smoker sees his doctor because he has a persistent cough and is short of breath after very little exertion. What diagnosis will the doctor make and what can the person expect if he does not quit smoking? Answer: The person is suffering from chronic bronchitis, which causes the dyspnea and coughing. If he does not stop smoking, he can expect frequent pulmonary infections, more coughing, and progressively worse dyspnea (all symptoms of chronic obstructive pulmonary disease). Ultimately, he can expect to develop hypoxemia, CO retention, and respiratory 2 acidosis. He may develop emphysema or lung cancer. Diff: 3 Page Ref: 840841 24 Copyright © 2010 Pearson Education, Inc. 5) After a long scuba diving session on a Caribbean reef, Carl boards a plane to Dallas. He begins to feel pain in his elbow on the flight back to Dallas. What is happening to him? Answer: Carl is experiencing the bends due to several problems: (1) Applying Boyle's law, a lot of gas was forced into Carl's bloodstream during the dive and there was not sufficient time to decompress the excess before he boarded the plane. (2) The plane is not pressurized to sea level, which further reduced atmospheric pressure holding the gases in suspension (Henry's law). Carl will have to be transported to a hyperbaric chamber to be repressurized. This will reduce the volume of the gas bubbles in his arm so that normal circulation can resume. Diff: 3 Page Ref: 820, 827 6) A patient was admitted to the hospital with chronic obstructive pulmonary disease. His P O2 was 55 and P CO2 was 65. A new resident orders 54% oxygen via the venturi mask. One hour later, after the oxygen was placed, the nurse finds the patient with no respiration or pulse. She calls for a Code Blue and begins cardiopulmonary resuscitation (CPR). Explain why the patient stopped breathing. Answer: In people who retain carbon dioxide because of pulmonary disease, arterial P CO2 is chronically elevated and chemoreceptors become unresponsive to this chemical stimulus. In such cases, declining P O2evels act on the oxygensensitive peripheral chemoreceptors and provide the principle respiratory stimulus, or the socalled hypoxic drive. Pure oxygen will stop a person's breathing, because his respiratory stimulus (low P O2evels) would be removed. Diff: 3 Page Ref: 840 7) While dining out in a restaurant a man suddenly chokes on a piece of meat. The waitress is also a student nurse and comes to the man's aid. She asks him if he can talk. The man responds by shaking his head no and grabbing at his neck. What is the significance of the man's inability to talk? Answer: Speech involves the intermittent release of expired air and opening and closing of the glottis. Because the man is unable to speak, this indicates that he is choking on a piece of food that suddenly closed off the glottis in the larynx. Diff: 3 Page Ref: 813 8) How will the lungs compensate for an acute rise in the partial pressure of CO 2n arterial blood? Answer: Respiratory rate will increase. Diff: 2 Page Ref: 837 9) A patient with tuberculosis is often noncompliant with treatment. Explain why this may happen. Answer: Noncompliance may occur because of the length of treatment. Treatment entails a 12 month course of antibiotics. Once the patient begins to feel better and the clinical symptoms dissipate, the patient may stop taking the medication. Diff: 3 Page Ref: 841842 25 Copyright © 2010 Pearson Education, Inc. 10) John has undergone surgery and has developed pneumonia. He also has a history of emphysema. Which assessment parameters would the nurse expect to find? Answer: 1. The patient may have dyspnea. 2. The patient may have hypoxemia because of increased secretions in the lungs. 3. The patient may use his accessory muscles to assist breathing. 4. The patient may have a productive cough. 5. The patient's breath sounds may have crackles. Diff: 3 Page Ref: 840 26 Copyright © 2010 Pearson Education, Inc.