Chapter 11

Respiratory System

QUESTIONS 5 Which of the following anatomic relationships best

describes the structural basis for gas exchange in the lungs?
Select the single best answer.
(A) Association of pulmonary veins with the bronchial
1 A 5-year-old girl with cystic fibrosis is admitted to the tree
hospital with pneumonia. As you examine the patient, (B) Close association of alveolar spaces and pulmonary
you recall the anatomy and histology of the respiratory capillaries
system. Which of the following air passages is the most (C) Continuous branching of the bronchopulmonary tree
distal part of the conducting portion of the patient’s lungs? (D) Dual blood supply to the lungs
(A) Alveolar ducts (E) Intimate relationship of pulmonary arteries and veins
(B) Respiratory bronchioles
6 A segment of trachea is obtained at autopsy. Paraffin
(C) Secondary bronchi sections are stained with H&E and examined by light
(D) Segmental bronchi microscopy (shown in the image). Identify the structure
(E) Terminal bronchioles within the oval.
2 During a problem-based learning session, your facilita-
tor asks about proper usage of the term “bronchial tree.”
Which of the following structures is a component of the
bronchial tree in the respiratory system?
(A) Alveolar ducts
(B) Alveolar sacs
(C) Bronchioles
(D) Larynx
(E) Trachea

3 The respiratory portion of the respiratory system begins

at which of the following locations in the lungs?
(A) Alveolar ducts
(B) Alveolar sacs
(C) Alveoli
(D) Respiratory bronchioles (A) Artery
(E) Terminal bronchioles (B) Lymphoid follicle
(C) Mucous gland
4 The parents of an 8-year-old boy with bronchial asthma
(D) Nerve
ask about the anatomy and physiology of the lungs, to
(E) Serous gland
better understand their child’s medical condition. Which
of the following components of the respiratory system is 7 Which of the following best describes the function of the
the major site of gas exchange? structure identified in Question 6?
(A) Alveoli (A) Conditioning of inhaled air
(B) Respiratory bronchioles (B) Polypeptide hormone secretion
(C) Secondary bronchi (C) Production of secretory IgA antibody
(D) Segmental bronchi (D) Source of pulmonary surfactant
(E) Terminal bronchioles (E) Substrate for inflammatory cell adhesion
146
 Respiratory System 147

8 A 14-year-old girl with the common cold presents with (A) Basal cells
a “stuffy nose” due to nasal congestion. Which of the (B) Brush cells
following represents a hallmark of the lamina propria in (C) Goblet cells
the nasal cavity? (D) Neurons
(A) Elastic fibers (E) Supporting cells
(B) Loose connective tissue
12 The cell described in Question 11 is best characterized as
(C) Lymphocytes which of the following types of neurons?
(D) Reticular fibers (A) Bipolar
(E) Rich vascular plexus (B) Interneuron
(C) Motor
9 Which of the following mechanisms of disease best
(D) Multipolar
describes the pathogenesis of nasal congestion in the
patient described in Question 8? (E) Pseudounipolar
(A) Increased secretion from mucous glands in the lam- 13 Which of the following cells in the olfactory epithelium
ina propria of the nasal cavity is responsible for the recovery of olfac-
(B) Increased secretion from serous glands in the lamina tory perception in the patient described in Question 10?
propria (A) Basal cells
(C) Infiltration of the lamina propria with chronic (B) Brush cells
inflammatory cells (C) Goblet cells
(D) Overproduction of mucus by goblet cells in the (D) Olfactory neurons
respiratory epithelium
(E) Supporting cells
(E) Swelling of the lamina propria of the nasal
mucosa 14 Which of the following cells of the olfactory epithelium
is equivalent functionally to neuroglial cells of the cen-
10 A 48-year-old woman with a 3-day history of an upper tral nervous system?
respiratory infection complains that she has lost her (A) Basal cells
sense of smell. Her perception of smell recovers about (B) Brush cells
1 week later. The epithelial lining of which portion of (C) Goblet cells
the respiratory system was temporally affected in this (D) Olfactory neurons
patient?
(E) Supporting cells
(A) Larynx
(B) Nasal vestibule 15 A portion of olfactory mucosa is obtained at autopsy and
(C) Nasopharynx examined by light microscopy (shown in the image).
(D) Olfactory region of nasal cavity Identify the structure indicated by the arrow.
(E) Respiratory region of nasal cavity

11 A biopsy of the olfactory mucosa is examined by light

microscopy (shown in the image). Which of the follow-
ing cells in the olfactory epithelium is responsible for the
sense of smell?

(A) Blood vessel

(B) Lymphatic nodule
(C) Mucous gland
(D) Nerve
(E) Olfactory gland
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16 A 49-year-old woman with a history of recurrent para-

nasal sinusitis presents with facial pain and fever. Which
of the following types of epithelium normally lines the
paranasal sinus cavities?
(A) Ciliated, pseudostratified columnar epithelium with
goblet cells
(B) Keratinized, stratified squamous epithelium
(C) Nonkeratinized, stratified squamous epithelium
(D) Simple columnar epithelium
(E) Simple squamous epithelium

17 Loss of function of which of the following cells or subcel-

lular structures is a likely cause of chronic sinusitis?
(A) Basal cells
(B) Cilia
(A) Cartilaginous rings
(C) Goblet cells
(B) Connective tissue in the adventitia
(D) Microvilli
(C) Dense connective tissue in the submucosa
(E) Mucous glands
(D) Proximity of the esophagus to the posterior tracheal
18 A 29-year-old opera singer complains about recent wall
changes in the frequency of her vibrato and the quality (E) Respiratory epithelium with elastic fibers in the
of her vocal sound. Phonation in your patient is initiated lamina propria
and shaped by which of the following structures of the
head and neck? 21 The posterior aspect of the trachea described in Question
(A) Epiglottis 20 is examined at higher magnification (shown in the
image). Identify the structure indicated by the arrow.
(B) Oropharynx
(C) Ventricle of the larynx
(D) Ventricular folds
(E) Vocal folds

19 Which of the following types of epithelium covers the

vocal folds in the patient described in Question 18?
(A) Pseudostratified columnar
(B) Simple columnar
(C) Simple squamous
(D) Stratified columnar
(E) Stratified squamous

20 A 50-year-old woman with lung cancer develops

respiratory insufficiency and expires. A transverse
section of the trachea is examined at autopsy. The pos-
terior aspect of the patient’s trachea appears normal (A) Adventitia
(shown in the image). Which of the following struc-
(B) Dense regular connective tissue
tures is essential for maintaining an open tracheal air
(C) Hyaline cartilage
passage?
(D) Smooth muscle
(E) Submucosa
 Respiratory System 149

22 Respiratory epithelium of the trachea is examined at

high magnification (shown in the image). Identify the
cell indicated by the arrow.

(A) Basement membrane

(B) Lamina propria
(C) Lymphatic vessel
(A) Basal cell (D) Mucosa
(B) Brush cell (E) Submucosa
(C) Ciliated columnar cell
(D) Goblet cell 26 You are part of a team that prepares to remove a tumor
(E) Small granule cell from the lung of a 68-year-old woman. Prior to surgery,
you review the organization of bronchopulmonary seg-
23 Which of the following describes the principal function ments. How many segmental bronchi arise from the
of ciliated columnar epithelial cells in respiratory epithe- right primary bronchus?
lium of the lungs? (A) 3 segments
(A) Coordinated motion of mucus (B) 6 segments
(B) Degradation of mucus polysaccharides (C) 8 segments
(C) Fluid uptake via pinocytosis (D) 10 segments
(D) Production of anti-inflammatory molecules (E) 12 segments
(E) Receptors for binding and internalization of inhaled
pathogens 27 A 54-year-old woman with a history of smoking pres-
ents with hemoptysis and chest pain. A CT scan of the
24 You are asked to give a seminar on the endocrine func- thorax reveals a 5-cm mass in the middle lobe of the
tions of the lungs. Which of the following cells in the right lung. The mass is removed using a pulmonary seg-
respiratory system is a neuroendocrine cell? mentectomy. Which of the following pulmonary units
(A) Basal cells best characterizes the structural basis for your surgical
(B) Brush cells resection?
(C) Ciliated cells
(D) Goblet cells (A) Bronchopulmonary segment
(E) Small granule cells (B) Pulmonary acinus
(C) Pulmonary lobe
25 Various regions of the respiratory system are reviewed (D) Pulmonary lobule
at autopsy for evidence of histopathology. Identify the (E) Respiratory bronchiolar unit
component of the normal trachea that is indicated by
arrowheads (shown in the image). 28 The specimen obtained at surgery from the patient
described in Question 27 reveals an adenocarcinoma,
with a margin of normal lung parenchyma. Examination
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of the tumor margin shows an intrapulmonary bronchus
(shown in the image). Which of the following histologic
features distinguishes this intrapulmonary bronchus
from an extrapulmonary primary bronchus?
30 Sections through an intrapulmonary bronchus and a
pulmonary artery (shown in the image) are examined in
the pathology department. Which of the following tissue
components is responsible for the folded appearance of
the mucosa in this bronchus?

(A) Absence of submucosal glands

(B) Adventitia composed of connective tissue (A) Basement membrane
(C) Lack of cartilage in the bronchial wall (B) Cartilaginous plates
(D) Loss of respiratory epithelium (C) Elastic fibers in the adventitia
(E) Presence of cartilage plates (D) Fibroelastic tissue in the lamina propria
(E) Muscularis mucosa
29 The wall of the intrapulmonary bronchus described in
Question 28 is examined at higher magnification (shown 31 The parents of a 10-year-old boy with asthma ask you
in the image). Identify the structure indicated by the about the mechanisms that control airflow in the lungs.
arrow. Which of the following nerve fibers stimulates contrac-
tion of smooth muscle fibers in the muscularis mucosa of
the respiratory system and thereby reduces the diameter
of the conducting air passages?
(A) Parasympathetic
(B) Somatic motor
(C) Somatic sensory
(D) Sympathetic
(E) Visceral afferent

32 A 49-year-old woman with bronchial asthma receives

a prescription for an inhaler to help relieve her short-
ness of breath. This β2-adrenergic receptor agonist (sal-
butamol) has a direct effect on which of the following
components of the conducting portion of the patient’s
respiratory system?
(A) Basement membranes
(A) Basement membrane (B) Cartilage plates
(B) Dense connective tissue (C) Cilia of the epithelium
(C) Lamina propria (D) Smooth muscle
(D) Muscularis mucosa (E) Submucosal glands
(E) Submucosa
 Respiratory System 151

33 A lung specimen (shown in the image) is examined in 35 The area within the rectangular box shown in the
the pathology department. Identify the structure within image described in Question 34 is examined at higher
the oval. magnification (shown in the image). Identify the cells
indicated by the arrows.

(A) Bronchiole
(B) Extrapulmonary bronchus (A) Basal cells
(C) Pulmonary artery (B) Brush cells
(D) Respiratory bronchiole (C) Clara cells
(E) Segmental bronchus (D) Goblet cells
(E) Small granule cells
34 Another area from the specimen described in
Question 33 is examined by light microscopy (shown 36 You are involved in a research project to study the biol-
in the image). Identify the structure within the oval ogy of Clara cells. As part of your research, you develop
line. a monoclonal antibody that identifies these cells in
paraffin-embedded sections. Immunohistochemical
assays using your antibody confirm that Clara
cells first appear in the epithelium of the broncho-
pulmonary tree at which of the following anatomic
locations?
(A) Alveolar sacs
(B) Alveoli
(C) Large bronchioles
(D) Segmental bronchi
(E) Terminal bronchioles

37 Which of the following cellular activities best describes

the principal function of Clara cells in terminal and
respiratory bronchioles?
(A) Degradation of mucin
(B) Fluid uptake via pinocytosis
(A) Alveolar duct (C) Production of inflammatory cytokines
(B) Bronchiole (D) Receptors for binding pathogens
(C) Intrapulmonary bronchus (E) Secretion of surfactant
(D) Respiratory bronchiole
(E) Terminal bronchiole
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38 A section of normal lung tissue is examined by light 41 In the image shown for Question 40, the space indicated
microscopy at low magnification (shown in the image). by number 1 is best identified as which of the following
Identify the space indicated by the asterisk. components of the respiratory system?
(A) Alveolar duct
(B) Alveolar sac
(C) Alveolus
(D) Respiratory bronchiole
(E) Terminal bronchiole

42 In the image shown for Question 40, which of the num-

bered spaces represents a respiratory alveolus?
(A) Space 1
(B) Space 2
(C) Space 3
(D) Space 4
(E) Space 5

43 A lung biopsy is examined at high magnification (shown

(A) Alveolar duct in the image). Identify the cells indicated by the arrows.
(B) Alveolar sac
(C) Large-diameter bronchiole
(D) Respiratory bronchiole
(E) Terminal bronchiole

39 You are asked to discuss the physiology of pulmonary

gas exchange during a laboratory meeting. Gas exchange
begins at what point in the respiratory tree?
(A) Alveoli
(B) Large-diameter bronchioles
(C) Respiratory bronchioles
(D) Segmental bronchi
(E) Terminal bronchioles

40 Another area of the specimen described in Question 38

is examined at low magnification (shown in the image).
Which of the numbered spaces represents an alveolar duct? (A) Brush cells
(B) Macrophages
(C) Small granule cells
(D) Type I alveolar cells
(E) Type II alveolar cells
4
3 44 The squamous epithelial cells that cover most (95%) of
the surface area of the pulmonary alveoli are connected
to one another through junctions that prevent the leak-
age of interstitial fluid into the alveolar air spaces. Which
5 of the following types of intercellular junctions serve this
important biological function?
2 1 (A) Cadherins
(B) Hemidesmosomes
(C) Macula adherens
(D) Zonula adherens
(A) Space 1 (E) Zonula occludens
(B) Space 2
(C) Space 3
(D) Space 4
(E) Space 5

45 Identify the cells indicated by arrowheads in the image
shown for Question 43.
(A) Alveolar macrophages
(B) Clara cells
(C) Kulchitsky cells
(D) Type I alveolar cells
(E) Type II alveolar cells
46 Which of the following best describes the function of
type II alveolar cells?
(A) Cytokine production
(B) Fluid transport
(C) IgA antibody production
(D) Phagocytosis of pathogens
(E) Secretion of surfactant
47 A 50-year-old woman with leukemia undergoes che-
motherapy. During treatment, she develops increasing
cough and shortness of breath. Sputum cultures are
negative, and the patient does not respond to antibi-
otic therapy. If this patient has acquired a viral pneu-
monia, with alveolar damage, which of the following
cells can regenerate the alveolar epithelium during
healing?
(A) Clara cells
(B) Enterochromaffin cells
(C) Small granular cells
(D) Type I alveolar cells
(E) Type II alveolar cells
48 An electron micrograph of the alveolus is examined for
evidence of structural changes. The barrier that sepa-
rates atmospheric gasses from blood features which of
the following important biological adaptations?
(A) Fusion of epithelial and endothelial basal laminae
(B) Gap junctions between epithelial and endothelial
cells
(C) Interdigitation of microvilli on adjacent epithelial
and endothelial cells
(D) Sinusoidal alveolar capillaries
(E) Tight junctions between epithelial and endothelial
cells
49 A 72-year-old woman with a history of heavy smok-
ing dies of congestive heart failure. The patient’s lungs
(shown in the image) are examined at autopsy. Identify
the cells indicated by the arrows.
Respiratory System 153
(A) Clara cells
(B) Macrophages
(C) Neutrophils
(D) Plasma cells
(E) Type II alveolar cells
50 During cadaver dissection, a student notices that the
lymph nodes at the hilum of her cadaver’s lungs appear
black. Which of the following best explains the dark
color of these hilar lymph nodes?
(A) Acute inflammatory cell infiltrate
(B) Aggregates of senescent red blood cells
(C) Carbon particles within macrophages
(D) Pollen and dust within the lymph fluid
(E) Primary and secondary lymphoid nodules
51 A 67-year-old smoker presents with increasing short-
ness of breath and dry cough. He is constantly “gasping
for air” and walks with difficulty because he becomes
breathless after only a few steps. A chest x-ray discloses
hyperinflation of the lungs, and the patient is diagnosed
with pulmonary emphysema. This disease is caused by
smoking-related injury to which of the following com-
ponents of the respiratory system?
(A) Alveolar septa
(B) Capillary endothelial cells
(C) Respiratory epithelial cells
(D) Submucosal cartilage plates
(E) Submucosal mucous glands
52 A 32-year-old woman delivers a baby prematurely at 25
weeks of gestation. Shortly after birth, the neonate becomes
short of breath, with intercostal retraction and nasal flaring
during respiration. The neonate is placed on a ventilator
but dies of respiratory insufficiency. Respiratory distress in
your patient is most likely caused by injury to which of the
following components of the respiratory system?
(A) Alveoli
(B) Bronchioles
(C) Main stem bronchi
(D) Segmental bronchi
(E) Trachea
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53 Respiratory distress syndrome described in Question 56 A lung carcinoma is resected, and the tumor margin is
52 was most likely caused by lack of fetal development carefully examined in the pathology department (shown
(immaturity) of which of the following cells? in the image). The arteriole indicated by the arrow on the
(A) Brush cells image is a branch from which of the following arteries?
(B) Clara cells
(C) Goblet cells
(D) Type I alveolar cells
(E) Type II alveolar cells

54 A section of lung parenchyma is examined by light

microscopy (shown in the image). Identify the tissue
indicated by the arrows.

(A) Internal thoracic

(B) Lateral thoracic
(C) Pulmonary
(D) Thoracic aorta
(E) Thyrocervical trunk

57 The artery indicated by the dagger on the image shown

in Question 56 supplies blood to which of the following
structures of the respiratory system?
(A) Cartilage
(A) Alveoli and alveolar septa
(B) Connective tissue
(B) Connective tissue at hilum of lungs
(C) Lamina propria
(C) Large-diameter bronchioles
(D) Mucous glands
(D) Segmental bronchi
(E) Smooth muscle
(E) Terminal bronchioles
55 Identify the structure within the rectangular box in the
image described in Question 54.
(A) Extrapulmonary bronchus
(B) Intrapulmonary bronchus
(C) Large bronchiole
(D) Small bronchiole
(E) Terminal bronchiole