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Wilkins: Egan's Fundamentals of Respiratory Care, 9th Edition
Chapter 8: The Respiratory System
Test Bank
MULTIPLE CHOICE
1. What is the primary purpose of the respiratory system?

A. continuous absorption of oxygen and excretion of carbon dioxide
B. filtering to prevent allergens and microbes from reaching the lungs
C. transport oxygenated blood to the tissues
D. warm and humidify inspired gas
ANS: A
The respiratory system's primary function is the continuous absorption of oxygen and
the excretion of carbon dioxide.
REF: 140
2. What is meant by “internal respiration”?

A. any gas exchange that occurs inside the body
B. consumption of oxygen in the mitochondria
C. continuous absorption of oxygen and excretion of carbon dioxide
D. exchange of gases between the blood and the tissue
ANS: D
This process supports internal respiration, which is the exchange of gases between
blood and tissues.
REF: 140
3. By what mechanism does gas exchange across the lung occur?

A. active transport
B. facilitated diffusion
C. facilitated transport
D. simple diffusion
ANS: D
This close “match” of gas and blood across a large but extremely thin blood-gas
barrier membrane enables efficient gas exchange to occur by simple diffusion.
REF: 140
Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank 8-2
4. The human genome contains _____ pairs of chromosomes.

A. 16
B. 23
C. 46
D. 50
ANS: B
DNA is organized into 23 pairs of supercoiled masses that are called chromosomes.
REF: 141
5. Which chromosome has been found to carry the defective gene responsible for the
development of cystic fibrosis?
A. 1
B. 7
C. 15
D. 23
ANS: B
The defective gene that is responsible for defective CFTR is located on chromosome 7
in the q31.2 region and has been found to be mutable in more than 1500 different
ways.
REF: 141
6. What genetic disorder has been linked to emphysema?

A. 1-antitrypsin deficiency
B.  protease dysfunction
C. IgA deficiency
D. X-linked agammaglobulinemia
ANS: A
Deficiency of 1-antitrypsin in plasma is caused by failure of the liver cells to secrete
this protein and is the result of inheriting an autosomal recessive gene on chromosome
14 at site q32.1. Like cystic fibrosis, emphysema caused by 1-antitrypsin deficiency
is most severe when the individual inherits defective recessive genes from both
parents.
REF: 141
Test Bank 8-3
7. Which of the following diseases have been found to have a genetic component?
I. cancer
II. asthma
III. pneumonia
IV. pulmonary fibrosis
A. I, II, and III

B. II and IV
C. I only
D. I, II, III, and IV
ANS: D
Asthma affects approximately 10% of the general population and clearly has a genetic
component Asthma is associated with alterations in multiple gene regions rather than a
single gene. Regions of chromosome 5 that code for various inflammatory cytokines,
ADAM33 gene on chromosome 20, and many other genes have been implicated in the
pathogenesis of asthma. The interactions of various defective and overexpressive
genes make the etiology of asthma a much more complex picture than perceived just a
decade ago.
Lung cancer is caused by multiple gene mutations that accumulate over time to
result in the formation of malignant cells that divide uncontrollably. Chromosomal
abnormalities are commonly found in lung cancer cells. The genetic abnormalities that
are often associated with the formation of lung cancer involve chromosomes 3, 8, 9,
11, 15, and 17, where entire regions or sections are missing or altered. This results in
abnormal regulation of cell development and proliferation. Individual growth and
differentiation controlling genes can be mutated into cancer producing genes. These
are known as “oncogenes.” When portions of chromosomes are missing or oncogenes
form by mutations in critical numbers, the development of cancerous cells can form,
multiply, and metastasize to other organs.
Other pulmonary diseases that have been found to have a genetic component for
susceptibility include pneumonia, neonatal respiratory distress, acute lung injury,
pulmonary embolism, primary pulmonary hypertension, and pulmonary fibrosis.
REF: 141-142
8. Developmental morphogenesis of the human respiratory system can be categorized

into:
A. three periods
B. five stages
C. 6 weeks
D. 40 weeks
ANS: B
Figure 8-1 shows the various stages of lung development, and Table 8-1 summarizes
the major developmental events in each phase.
REF: 141
Test Bank 8-4
9. The fetus is potentially viable if born prematurely after how many weeks of gestation?
A. 12 to 16 weeks
B. 18 to 20 weeks
C. 24 to 26 weeks
D. 28 to 32 weeks
ANS: C
At the end of the canalicular period (24 to 26 weeks of gestation), the fetus, if born, is
capable of sufficient gas exchange and is viable if supported completely with an
artificial airway, oxygen, ventilatory support, and surfactant administration.
REF: 145
10. The fetus is potentially viable if born at the end of which stage of development?
A. alveolar
B. canalicular
C. pseudoglandular
D. saccular
ANS: B
At the end of the canalicular period (24 to 26 weeks of gestation), the fetus, if born, is
capable of sufficient gas exchange and is viable if supported completely with an
artificial airway, oxygen, ventilatory support, and surfactant administration.
REF: 145
11. During which phase of fetal development do mature alveoli appear?

A. alveolar
B. canalicular
C. pseudoglandular
D. saccular
ANS: A
The development of mature alveoli, accompanied by capillary proliferation within the
walls, marks the final phase of lung development and is known as the alveolar period.
REF: 145
12. Which of the following is an index commonly used to determine relative lung
maturity?
A. FRC/TLC ratio
B. L:S ratio
C. RQ ratio
D. SP-A
Test Bank 8-5
ANS: B
Quantification of these phospholipids (the L:S ratio and PG concentration) provides a
predictive index of the lung maturity in the fetus before birth and the risks of
developing respiratory disease.
REF: 147
13. What maintains lung inflation during fetal development?

A. fetal lung fluid
B. radial tethering
C. rigidity of the chest wall
D. surfactant
ANS: A
Fetal lung fluid is constantly produced and keeps the fetal lung inflated at a slight
positive pressure with respect to amniotic fluid pressure and is important in promoting
normal lung development.
REF: 147
14. By which of the following routes does blood flow through the umbilical cord between
the placenta and the fetus?
A. one umbilical vein and one umbilical artery
B. one umbilical vein and two umbilical arteries
C. two umbilical veins and one umbilical artery
D. two umbilical veins and two umbilical arteries
ANS: B
Maternal blood flows into the intervillous space through the spiral arteries, while fetal
blood is supplied to the villi from two umbilical arteries. Oxygenated fetal blood
leaves the chorionic villi capillaries through placental venules and returns to the fetus
through a single umbilical vein.
REF: 147
15. Abnormalities of the placenta that can cause intrauterine growth retardation or fetal
asphyxia include which of the following?
I. abnormal implantation of the placenta
II. separation of the placenta from the uterine wall
III. decreased placental blood flow
A. II and III
B. I and II
C. I and III
D. I, II, and III
Test Bank 8-6
ANS: D
Abnormal implantation of the placenta, tearing of the placenta from the uterine wall,
or decreased placental blood flow can retard intrauterine growth and in severe cases
can cause fetal asphyxia and increases the risk for brain damage and respiratory
distress in the immediate postnatal period.
REF: 147
16. What would be a normal P50 for a fetus?

A. 10
B. 15
C. 20
D. 25
ANS: C
Figure 8-6 illustrates how the increased oxygen affinity is manifested by a leftward
shift of the fetal oxyhemoglobin dissociation curve. The P50 (PO2 that saturates 50% of
the hemoglobin) is 6 to 8 mm Hg less than adult hemoglobin (HbA), which indicates
the degree of the shift toward higher affinity.
REF: 148
17. In the fetal heart, the foramen ovale allows blood to flow between which two
structures?
A. bypass the liver and enter the inferior vena cava
B. pulmonary artery to aortic arch
C. right atrium to left atrium
D. right atrium to left ventricle
ANS: C
Approximately 50% of this blood is shunted from the right atrium into the left atrium
through an opening in the interatrial septum called the foramen ovale.
REF: 149
18. Which factors contribute to maintaining a patent ductus arteriosus during fetal life?
I. large amounts of fetal hemoglobin
II. low PaO2
III. presence of LDH
IV. presence of prostaglandins
A. I, II, and III

B. II and IV
C. III only
Test Bank 8-7
ANS: B
The relatively low PO2 and various prostaglandins in fetal blood causes the ductus
arteriosus, a muscular vessel attached to the trunk of the pulmonary artery and the
aorta, to dilate and the pulmonary arteries to constrict.
REF: 149
19. What percentage of right ventricular output is circulated through the fetal lungs?
A. 10%
B. 35%
C. 75%
D. 100%
ANS: A
As a result, 90% of the blood flow entering the pulmonary artery takes the path of
least resistance by shunting through the ductus arteriosus and flows to the aorta. Only
10% flows into the lungs.
REF: 149
20. During a vaginal delivery, what facilitates the removal of fetal lung fluid from the
pulmonary system?
A. high PaO2
B. low intrapulmonary pressures
C. thoracic compression
D. triaging of core functions
ANS: C
During normal vaginal delivery, approximately one third of the lung fluid is cleared by
compression of the thorax in the birth canal.
REF: 149
21. What strong stimulus to the infant provides the impetus for the first breathe?
A. acidosis
B. exposure to warmth
C. fright from passing through the birth canal
D. high PaO2
ANS: A
The newborn infant is stimulated by new tactile and thermal stimuli, all of which
stimulate breathing. In addition, as placental gas transfer is suddenly interrupted, the
newborn quickly becomes hypoxemic, hypercapnic, and acidotic.
REF: 149
Test Bank 8-8
22. Which of the following would NOT promote transition from fetal circulation to a
normal extrauterine circulatory pattern?
A. closure of the foramen ovale
B. constriction of the ductus arteriosus
C. decreased pulmonary vascular resistance
D. decreased systemic vascular resistance
ANS: D
Figure 8-9 summarizes the major cardiopulmonary changes that take place during the
transition from the fluid filled lung to an air filled lung. As the lung expands with air
and gas exchange starts within the lung, pulmonary blood PO2 increases, PCO2
decreases, and the pH rises. This results in pulmonary vasodilation, lower pulmonary
vascular resistance, and constriction of the ductus arteriosus. This facilitates greater
blood flow through the pulmonary circulation. Ductus arteriosus closure is further
stimulated by the loss of maternal prostaglandins. The combination of increasing
alveolar air content and constriction of the ductus arteriosus promotes progressive
improvement in the matching of ventilation and blood flow, which, in turn, increases
the PO2 and decreases the PCO2 of blood leaving the lungs. Cessation of umbilical and
placental blood flow, following the clamping of the umbilical cord, causes closure of
the ductus venosus and a rapid rise in systemic vascular resistance. The combination
of the above events establish a normal extrauterine circulatory pattern.
REF: 149, 151
23. What factor contributes to increased likelihood of an upper airway obstruction in an

infant compared to an adult?
A. higher percentage of body fat
B. higher volumes of sinus discharge
C. relatively smaller head size
D. tongue that is proportionally larger
ANS: D
Infant neck flexion causes acute airway obstruction. Although the head is larger, an
infant’s nasal passages are proportionately smaller than are an adult’s. In addition, the
infant’s jaw is much rounder and the tongue is much larger relative to the size of the
oral cavity. These anatomic differences increase the likelihood of airway obstruction
when an infant becomes unconscious and loses muscle tone.
REF: 152
24. How short could the trachea of small preterm infant to be?
A. 2 cm
B. 4 cm
C. 6 cm
D. 8 cm
Test Bank 8-9
ANS: A
In small preterm infants, the trachea may be only 2 cm long and 2 to 3 mm wide.
REF: 152
25. Approximately how many alveoli are there in a 10-year-old’s lung?

A. 50 million
B. 200 million
C. 350 million
D. 500 million
ANS: D
The human lung continues to develop alveoli for years until it reaches a stable stage
where the total number have increased to about 480 million alveoli. All of the
development is complete by 10 years of age.
REF: 153
26. What is rather unique regarding the blood supply to the lung?
A. It receives blood from right and left ventricles.
B. It requires no dedicated blood supply as it exists in a gas environment.
C. Pulmonary venous drainage contributes to the normal anatomic shunt.
D. The pulmonary arteries are the primary source of oxygen for lung structures.
ANS: A
The respiratory system is a unique organ in that it receives a double blood supply: one
from the left ventricle and one from the right ventricle.
REF: 153
27. What is the physiologic result of the infant’s more compliant thorax compared with
that of an adult?
A. It is easier for the infant to breathe.
B. Their functional residual capacity is reduced based on ideal body weight (IBW).
C. They breathe larger tidal volumes based on IBW.
D. They have less of a tendency to develop atelectasis.
ANS: B
With a more compliant thorax, the resultant balance of these static forces in the infant
favors a reduced FRC and total lung capacity (TLC). Proportionately lower lung
volumes in the infant can lead to early airway closure, atelectasis,
ventilation/perfusion mismatch, shunting, and resultant hypoxemia.
REF: 155
Test Bank 8-10
28. Infants are more susceptible to profound hypoxemia than are adults.
A. true
B. false
C. unable to determine
ANS: A
The combination of a reduced FRC and high oxygen consumption in an infant renders
them more susceptible to profound hypoxemia in situations that further disturb
ventilation, lung volume, and/or ventilation/perfusion matching.
REF: 155
29. Infants can generate auto-PEEP by which of the following methods?

A. active expiration
B. increased diaphragmatic excursion
C. laryngeal braking
D. retractions
ANS: C
The infant, especially one in distress, can actively end expiration and begin the next
inspiratory phase to cause gas trapping, which leads to elevated FRC and better
ventilation/perfusion matching. This can be accomplished actively using their
diaphragm during exhalation to slow expiration and to adduct (close) their vocal cords
and narrow the glottis. The combination of these two maneuvers effectively regulates
volume in the lung and dynamically elevates the FRC. The narrowing of the glottis or
larynx during exhalation is referred to as “laryngeal braking.”
REF: 155
30. Running vertically down each hemithorax anteriorly is an imaginary line that is used
as an anatomical landmark. What is that line called?
A. anterior axillary line
B. midaxillary line
C. midclavicular line
D. midsternal line
ANS: C
The left and right mid clavicular lines are parallel to the midsternal line. These are
drawn through the midpoints of the left and right clavicles, respectively (Figure 8-13).
REF: 155
31. What is the function of the thorax?

A. facilitate digestion
B. heat, humidify, and filter gases
C. protect the vital organs
D. vocalization
Test Bank 8-11
ANS: C
The thorax is a cone-shaped cavity that houses the lungs and the contents of the
mediastinum (Figure 8-16). It functions to protect the vital organs within and has the
capability of changing shape to enable air to be moved into and out of the lungs.
REF: 156
32. What is the name of the thin serous membrane that covers the inner layer of the
thoracic wall?
A. cupula
B. mesothelioma
C. parietal pleura
D. visceral pleura
ANS: C
The inner layer of the thoracic wall is lined with a serous membrane called the parietal
pleura.
REF: 157
33. What is the name of the upper portion of the sternum?

A. angle of Louis
B. manubrium
C. vertebral process
D. xiphoid process
ANS: B
The sternum is a long, vertical flat bone found on the anterior side (Figure 8-18). It is
comprised of three bones including the manubrium which comprises the upper portion.
REF: 157
34. Where does the sternal angle lie?

A. at the depression in the body of the sternum to which the clavicles attach
B. at the join between the manubrium and sternal body
C. at the superior edge of the sternum
D. where the xiphoid process connects to the sternum
ANS: B
The fused connection between the manubrium and the body is known as the sternal
angle. It is also known as the angle of Louis.
REF: 157
Test Bank 8-12
35. What is the name of the external landmark that identifies the point at which the trachea
branches into the right and left mainstem bronchi?
A. angle of Louis
B. cricoid cartilage
C. suprasternal notch
D. xiphoid process
ANS: A
The sternal angle is an external marker of the point where the trachea divides into the
left and right mainstem bronchi.
REF: 157
36. Which of rib pairs connect directly to the sternum?

A. 1 and 4
B. 1 and 7
C. 1 and 12
D. 11 and 12
ANS: B
Rib pairs 1 through 7 are known as the true ribs because they are attached directly to
the sternum.
REF: 158
37. What are rib pairs 11 and 12 known as?

A. false ribs
B. faux ribs
C. floating ribs
D. true ribs
ANS: C
Rib pairs 11 and 12 are called floating ribs because they are not attached to the
sternum.
REF: 158
38. The intercostal arteries, veins, and nerves run through which of the following?
A. costal groove on the top of each rib
B. costal groove on the bottom of each rib
C. fibers of the intercostal musculature
D. surface of the parietal pleura
ANS: B
Just below each rib is a thoracic artery, vein, and nerve that supply blood flow and
nerve communications to that region of the chest wall (Figure 8-17).
REF: 158
Test Bank 8-13
39. What does the “pump handle” movement of rib pairs 2 through 7 achieve?
A. anchor of the upper chest for diaphragmatic contraction
B. diminish the energy wasted by inefficient muscular contraction
C. increase in the anteroposterior diameter of the chest
D. increase in the lateral dimensions of the chest
ANS: C
Ribs 2 through 7 move simultaneously about two axes (Figure 8-20). As each rib
rotates about the axis of its neck, its sternal end rises and falls. This movement
increases the anteroposterior thoracic diameter in what is commonly referred to as a
“pump handle”−like motion.
REF: 159
40. Which of the following muscles are considered primary muscles of ventilation?
I. diaphragm
II. intercostals
III. scalenes
IV sternomastoid
A. I, III, and IV
B. I and II
C. III only
ANS: B
The diaphragm and intercostal muscles are the primary muscles of ventilation.
REF: 159
41. What external landmark can be used to show the highest point the dome of the right
hemidiaphragm reaches in a healthy individual?
A. fifth rib posteriorly
B. sixth rib posteriorly
C. seventh rib posteriorly
D. eighth rib posteriorly
ANS: D
The highest portion of the right dome sits at the eighth or ninth thoracic vertebra
posteriorly and at the fifth rib anteriorly.
REF: 161
Test Bank 8-14
42. Approximately what percent of the normal changes in thoracic volume during quiet
inspiration is due to the action of the diaphragm?
A. 15
B. 25
C. 50
D. 75
ANS: D
During quite breathing, the diaphragm is responsible for approximately 75% of the
change in thoracic volume.
REF: 161
43. How far is the diaphragm pulled down during tidal breathing?
A. 1 to 2 cm
B. 3 to 5 cm
C. 6 to 8 cm
D. 8 to 10 cm
ANS: A
When the muscle fibers of the diaphragm are tensioned during inspiration, the dome of
the diaphragm is pulled down 1 to 2 cm.
REF: 161-162
44. Compared to a normal diaphragm, contraction of a diaphragm that is low and flat may
result in which of the following?
A. compression of the thoracic cavity
B. enhanced venous return and thus cardiac output
C. greater diaphragmatic efficiency
D. larger than normal change in thoracic volume
ANS: A
Increased lung volume causes the diaphragm to flatten out. Contraction of a flattened
diaphragm can result in tension on the lower ribs that causes them to be pulled inward,
which results in compression of the thoracic cavity. This condition can occur in
individuals with severe gas trapping as a result of emphysema or asthma. To
compensate for this, these individuals must recruit other muscles to enlarge the thorax.
This results in less efficient breathing and excessive muscle work.
REF: 162
45. What pulmonary disorder could lead to acute flattening of the diaphragm?
A. adult respiratory distress syndrome
B. asthma
C. atelectasis
D. pneumonia
Test Bank 8-15
ANS: B
Increased lung volume causes the diaphragm to flatten out. This condition can occur in
individuals with severe gas trapping as a result of emphysema or asthma.
REF: 162
46. The diaphragm is innervated by which of the following nerves?

A. glossopharyngeal
B. phrenic
C. seventh cranial
D. vagus
ANS: B
Functionally, the diaphragm is divided into a right and left hemidiaphragm. Each
hemidiaphragm is innervated by a phrenic nerve that arises from branches of spinal
nerves C3, C4, and C5.
REF: 162
47. The nerves that innervate the diaphragm arise from which area?
A. lumbar region of the spine
B. sacral vertebrae 4 and 5
C. spinal plexuses at T2 to T11
D. spinal nerves C3 to C5
ANS: D
Functionally, the diaphragm is divided into a right and left hemidiaphragm. Each
hemidiaphragm is innervated by a phrenic nerve that arises from branches of spinal
nerves C3, C4, and C5.
REF: 162
48. What is the lowest level on the spinal cord that an injury could cause diaphragmatic
impairment or paralysis?
A. C3
B. L2
C. S5
D. T4
ANS: A
Spinal cord injuries at or above the level of the third cervical vertebrae result in
diaphragmatic paralysis.
REF: 162
Test Bank 8-16
49. Limited, short-term spontaneous ventilation is possible in a patient with a paralyzed

diaphragm.
A. true
B. false
ANS: A
Although the diaphragm is the primary ventilatory muscle, it is not essential for
survival. Limited, short-term ventilation is possible using accessory muscles, even if
the diaphragm is paralyzed.
REF: 162
50. What important role does the diaphragm play other than contraction during
inspiration?
A. enhances cardiac output
B. facilitates the final push for giving birth
C. active during forced exhalation
D. serves as a secondary muscle of expiration
ANS: B
The diaphragm does not actively participate in exhalation. During exhalation, it
returns to its resting position during the passive recoil of the lungs and thorax. During
forced exhalation, abdominal wall muscles compress the abdominal cavity and
increase pressure in the abdominal cavity. This forces the diaphragm upward and
compresses the lungs and forces gas from them. The diaphragm performs important
functions other than ventilation. It aids in generating high intraabdominal pressures by
remaining fixed while the abdominal muscles contract. This facilitates vomiting,
coughing, sneezing, defecation, and parturition.
REF: 162
51. Which accessory muscles are active during resting and active inspiration and pull up
on all the ribs expanding the thorax?
A. external intercostals
B. internal intercostals
C. scalenes
D. sternocleidomastoids
ANS: A
The external intercostals (Figure 8-22) originate on the upper ribs and attach to the
lower ribs. The fibers of these muscles run at an oblique angle between the ribs. When
they generate tension, they lift the ribs upward and cause the thoracic cavity to enlarge
the thorax.
REF: 162
Test Bank 8-17
52. Which of the following is the most important ventilatory function of the scalene
muscles?
A. activate if intrathoracic pressure fall to –40 cm H2O
B. elevate and fix the first seven ribs
C. lift upper chest particularly during times of high ventilatory demand
D. support the trachea within the thorax during heavy exercise
ANS: C
Three pairs of scalene muscles (scalenus anterior, scalenus medius, and scalenus
posterior) arise from the lower five or six cervical vertebrae and insert on the clavicle
and first two ribs (Figure 8-23). They lift the upper chest when active.
REF: 162-163
53. As ventilatory muscles, the sternomastoids do which of the following?

A. elevate the upper chest, increasing chest anteroposterior diameter
B. elevate the ribs and decrease chest anteroposterior diameter
C. increase lateral chest movement during inspiration
D. lower the sternum, thus increasing chest anteroposterior diameter
ANS: A
The sternocleidomastoid muscles can function to lift the upper chest. They receive
nerve impulses from branches of the accessory nerves (cranial nerve XI) and cervical
nerves C1 and C2. These muscles are active during forceful inspiration and become
visible as thick bands on either side of the neck during the inspiratory phase in an
individual who is in respiratory distress. This motion increases the anteroposterior
diameter of the chest.
REF: 163
54. When a COPD patient leans forward braced in a tripod position, this lends particular
advantage to which accessory muscles of inspiration?
B. pectoralis
C. scalenes
ANS: B
The major and minor pectoralis muscles are broad fan-shaped muscles of the upper
anterior chest (Figure 8-25). The pectoralis major originates on the humerus and
inserts onto the clavicle and sternum. The pectoralis minor originates on the scapula
and inserts on the anterior portions of ribs 3 through 5. When these muscles receive
impulses from the pectoral nerves, they normally function to adduct the arms in a
hugging motion. They are also capable of generating some anterior thoracic lift when
the arms are braced on a surface in front of a subject. Those individuals who suffer
with chronic shortness of breath often utilize these muscles by sitting in a “tripod”
position. This is performed by sitting upright and leaning forward with both arms
braced on a table.
REF: 163-164
Test Bank 8-18
55. Which accessory muscles of ventilation work to pull the ribs closer together?
B. internal intercostals
C. scalenes
ANS: B
The internal intercostal muscles (Figure 8-22) lie between the ribs and just behind the
external intercostal muscles. They originate along the inferior border of the upper ribs
and insert into the superior border of the lower ribs. The muscle fibers of the internal
intercostal muscles run downward and less obliquely than the external intercostal
muscle fibers. This orientation causes these muscles to pull the ribs together, which
results in compression of the thoracic cavity.
REF: 164
56. Which of the muscles below when stimulated will contract and push up on the
diaphragm?
I. external intercostals
II. external obliques
III. internal obliques
IV. rectus abdominous
A. I, II, and III

B. I and IV
C. II, III, and IV
ANS: C
When the abdominal wall muscles contract, they compress the abdominal cavity. This
forces the diaphragm upward and compresses the thoracic cavity. The abdominal
muscles include pairs of external oblique, internal oblique, transverse abdominis, and
rectus abdominous muscles (Figure 8-27).
REF: 164
57. The abdominal muscles can actually contribute to inspiration by contraction at the end
of exhalation.
A. true
B. false
ANS: A
The abdominals can also contribute to inspiration by contracting at end-exhalation.
This reduces end-expiratory lung volume, so the chest wall can recoil outward,
assisting the next inspiratory effort.
REF: 165
Test Bank 8-19
58. To what structures do the parietal pleural membranes adhere or cover?

A. fissures
B. intrapulmonary bronchi
C. lung
D. mediastinum
ANS: D
The parietal pleural membrane lines the chest wall and mediastinum, while the lungs
are covered by the visceral pleura.
REF: 165
59. What is the function of the very small amount of pleural fluid that is found in the
pleural space?
A. composes part of anatomic shunt
B. liquid barrier for pathogens
C. part of pulmonary blood flow
D. reduces friction
ANS: D
The small volume of pleural fluid is spread out over the entire surface of both lungs
and functions as a lubricant to reduce friction as the lungs move within the thorax and
as an airtight seal that adheres together the two pleural membranes.
REF: 165
60. What is the name given to the acute angle formed by the costal pleura joining the
diaphragmatic pleura?
A. angle of Louis
B. costophrenic angle
C. diaphragmatic groove
D. oblique fissure
ANS: B
The angles where the costal parietal pleura joins the diaphragmatic parietal pleura is
known as the costophrenic angle.
REF: 165
61. What will most commonly blunt the costophrenic angle as seen on chest radiograph in
an upright individual?
A. air
B. bile
C. excess fluids
D. liver on the right, intestines on the left
Test Bank 8-20
ANS: C
Excess fluids between the visceral and parietal pleura tend to pool here in an upright
individual. This causes the angle to appear blunted or flattened to 90 degrees when
viewed in the chest radiograph.
REF: 166
62. What is the mediastinum?

A. membranous sac surrounding the heart and great vessels
B. middle layer of muscle fibers constituting the heart
C. point of division of the trachea into the bronchi
D. structure separating the right and left thoracic cavities
ANS: D
The mediastinum lies between the left and right pleural cavities that contain the lungs
(Figure 8-16).
REF: 166
63. Why is the left lung narrower than the right lung?
A. Liver compresses the left lung.
B. Mediastinal organs push laterally into the left hemithorax.
C. There is poorer blood flow during fetal development.
D. There is upward pressure of the abdominal contents.
ANS: B
The organs within the mediastinum bulge into the left hemithorax, resulting in a
narrower and slightly smaller left lung.
REF: 166
64. About how far do the normal adult lungs extend above the clavicles?
A. 2 cm
B. 3 cm
C. 4 cm
D. 5 cm
ANS: A
The lungs extend from the diaphragm to a point 1 to 2 cm above the medial third of
the clavicles.
REF: 166
65. Which of the following statements describe a normal adult lung?

A. The left lung is bisected by two fissures.
B. The left lung has an upper, a middle, and a lower lobe.
C. The right lung has only an upper and a lower lobe.
D. The right lung has three lobes and two fissures.
Test Bank 8-21
ANS: D
Each lung is divided into two or three lobes (Figure 8-28), which are separated by one
or more fissures. The right lung has upper, middle, and lower lobes. The left lung has
only an upper and a lower lobe. Both lungs have an oblique fissure that begins on the
anterior chest at approximately the sixth rib at the midclavicular line. These fissures
extend laterally and upward until they cross the fifth rib on the lateral chest in the
midaxillary line. The fissures continue on the posterior chest to approximately the
third thoracic vertebra. The right lung also has a horizontal or “minor” fissure that
separates the upper and middle lobes.
REF: 166
66. What will happen when the lung is surgically removed from the thorax?
A. The lung will appear to undergo no change.
B. The lung will collapse.
C. The lung will expand.
D. The response of the lung will depend on its age and pathology.
ANS: B
When a lung is removed from the chest cavity, it quickly collapses to a smaller size.
REF: 167-168
67. What is the primary mechanism that stops the lungs from collapsing at the end of
exhalation?
A. Radial tethers, stretched to their maximum length, then halt lung collapse.
B. Surfactant neutralizes the tendency of the lung to collapse.
C. There is a tendency of the chest wall to lock at the level of FRC.
D. There is an equal opposing tendency of the chest wall to expand.
ANS: D
This tendency of the lung to collapse is counteracted by the thoracic wall’s tendency to
spring outward and to hold the lung inflated.
REF: 168
68. What forces establish the subatmospheric pressure found in the pleural space?
A. contraction of accessory muscles of inspiration
B. contraction of expiratory muscles
C. equal opposing tendency of the chest wall to expand and lung to collapse.
D. effect of gravity, particularly at the base of the lungs
ANS: C
This tendency of the lung to collapse is counteracted by the thoracic wall's tendency to
spring outward and to hold the lung inflated. The “tension” developed by these two
opposing tendencies results in development of subatmospheric intrapleural pressure.
REF: 168
Test Bank 8-22
69. Fluid transport to and from the lungs is provided by which of the following?
I. bronchial circulation
II. lymphatic system
III. pulmonary circulation
A. II and III
B. I and III
C. II only
D. I, II, and III
ANS: D
The vascular supply of the lungs is composed of the pulmonary and bronchial
circulations. The pulmonary circulation carries mixed venous blood from the systemic
circuit to the lungs to increase oxygen and reduce carbon dioxide content of blood.
The bronchial circulation provides systemic arterial blood to the airways and pleura to
support their metabolic needs. A network of lymphatics is also involved in fluid
transport from the lungs. The lymphatic system removes fluid from the lung tissue and
pleural space and returns it to the systemic circulation.
REF: 168
70. The pulmonary arterial circulation does which of the following?

I. delivers oxygenated blood back to the heart
II. delivers unoxygenated blood to the lungs
III. originates on the left side of the heart
IV. originates on the right side of the heart
A. I and IV
B. II and IV
C. I and III
D. II and III
ANS: B
The pulmonary circulation arises from the right heart (Figure 8-30) and carries the
entire cardiac output through the lung each minute. Oxygen-reduced systemic venous
blood returns to the right heart via the inferior and superior venae cavae. This blood is
pumped to the lungs by the right ventricle through the pulmonic semilunar valve and
on to the trunk of the pulmonary artery.
REF: 168
71. What percentage of the alveolar surface is covered with pulmonary capillaries?
A. 60%
B. 70%
C. 80%
D. 90%
Test Bank 8-23
ANS: D
The pulmonary arterial system continues to divide into increasing numbers all the way
to the distal air spaces, where they subdivide and form dense “sheet-like” beds of
alveolar capillaries that are found within the walls of the alveoli and are found just
below approximately 90% of the alveolar surface (Figure 8-31).
REF: 168
72. The pulmonary venous circulation does which of the following?

I. delivers oxygenated blood back to the heart
II. delivers unoxygenated blood to the lungs
III. empties into the left atrium
IV. empties into the right atrium
A. II and III
B. I and IV
C. II and IV
D. I and III
ANS: D
The pulmonary venous system drains the capillary beds that have received oxygen
from the alveoli and delivers the oxygenated blood into the left atrium.
REF: 168
73. Which of the following describes a function of pulmonary circulation?

A. breakdown of angiotensin II
B. filtering of blood clots
C. production of erythropoietin
D. regulation of breathing
ANS: B
The third function is nonrespiratory and participates in the production, processing, and
clearance of a large variety of chemicals and blood clots.
REF: 169
74. Compared with the systemic circulation, pressure in the normal pulmonary circulation
is:
A. higher
B. lower
C. the same
ANS: B
While the entire cardiac output passes through both pulmonary and systemic circuits,
the pulmonary circulation offers much lower resistance and, as a result, has a much
lower blood pressure.
REF: 169
Test Bank 8-24
75. Pressures in the pulmonary circulation are lower than those in the systemic circulation
because of what characteristic of the pulmonary circulation?
A. higher resistance than the systemic circulation
B. less blood flow than the systemic circulation
C. lower resistance than the systemic circulation
D. more blood flow than the systemic circulation
ANS: C
While the entire cardiac output passes through both pulmonary and systemic circuits,
the pulmonary circulation offers much lower resistance and, as a result, has a much
lower blood pressure.
REF: 169
76. Which of the following statements is NOT true regarding the pulmonary circulation?
A. Pulmonary blood flow is highly dependent on gravity.
B. The pulmonary circulation is a low-pressure system.
C. Toward the top of the upright lung, blood flow is high.
ANS: C
As a consequence of having a low blood pressure and being susceptible to gravity,
blood flow is much higher in the lung bases in resting upright subjects. Gravity-related
effects also occur in recumbent positions but are less pronounced.
REF: 169
77. How would lung perfusion in a “zone 1” area best be described?

A. increased
B. normal or average
C. reduced
ANS: C
Areas that experience higher airway pressure (e.g., during positive pressure
ventilation) that equal or exceed local arteriole and capillary pressure will have
reduced blood flow as a result of the opposing airway pressure (zone 1 airways).
REF: 169
78. How does the lung respond to regional lung hypoxia?

A. bronchial artery vasoconstriction
B. bronchial artery vasodilation
C. pulmonary artery vasoconstriction
D. pulmonary artery vasodilation
Test Bank 8-25
ANS: C
Areas of regional lung hypoxia, as the result of reduced ventilation, congestion, and/or
airway obstruction, can result in local pulmonary arterial vasoconstriction and cause
blood flow to be shifted from these areas toward areas of higher oxygen content and
pulmonary vasodilation.
REF: 169
79. How does the lung parenchyma receive most of its oxygen?
A. from the alveolar gases
B. from the bronchial arteries/capillaries
C. from the pulmonary arteries/capillaries
D. from the pulmonary lymphatic system
ANS: A
A separate arterial supply called the bronchial circulation supplies blood to the airways
from the trachea to the bronchioles and to most of the visceral pleurae. The metabolic
needs of the lung are comparatively low, and much of the lung parenchyma is
oxygenated by direct contact with inspired gas.
REF: 170
80. Via what pathway does much of the bronchial venous drainage occur?
A. bronchial veins emptying into the inferior vena cava
B. bronchopulmonary veins emptying into pulmonary veins
C. direct connections between bronchial and pulmonary arteries
D. thebesian venous drainage into the heart chambers
ANS: B
Bronchial venous blood drains through the azygos, hemiazygos, and intercostal veins
to the right atrium, and some drains through the pulmonary capillaries to the
pulmonary veins and to the left atrium.
REF: 170
81. How does the body compensate for a pulmonary embolus that occludes a branch of the
pulmonary artery?
A. Increased bronchial arterial flow to the area
B. increased cardiac output
C. pulmonary arteriole and metarteriole vasodilation
D. release of prostaglandins to fight inflammation
ANS: A
The bronchial and pulmonary circulations share an important compensatory
relationship. Decreased pulmonary arterial blood pressure tends to cause an increase in
bronchial artery blood flow to the affected area. This minimizes the danger of
pulmonary infarction, as sometimes occurs when a blood clot (pulmonary embolus)
enters the lung.
REF: 170
Test Bank 8-26
82. Which of the following statements are true of the pulmonary lymphatic system?
I. It consists of both superficial and deep vessels.
II. It drains into the right lymphatic or thoracic duct.
III. Vessels begin as dead-end lymphatic channels in the lung.
IV. With phagocytes, it defends against foreign material.
A. I, III, and IV
B. II, III, and IV
C. II only
ANS: D
The lymphatic system plays an important role in the specific defenses of the immune
system. It removes bacteria, foreign material, and cell debris via the lymph fluid and
through the action of various phagocytic cells (e.g., macrophages) that provide defense
against foreign material and cells that are able to penetrate deep into the lung. It also
produces a variety of lymphocytes and plasma cells to aid in defense. Both roles are
essential for maintaining normal function of the respiratory system.
Most of the pulmonary lymphatic system consists of superficial and deep vessels.
The superficial (pleural) vessels that drain the lung surface and pleural space are more
numerous over the lower half of the upright lung. Both drain the blind lymphatic
capillaries in the respective regions. The deeper lymph vessels are closely associated
with the small airways but do not extend into the walls of the alveolar-capillary
membranes.
Lymph fluid is collected by the loosely formed lymphatic capillaries and drains
through the lymph vessels toward the hilum. The lymph fluid rejoins the general
circulation after passing through the right lymphatic or thoracic duct, which drains into
the jugular, subclavian, and/or innominate veins. The lymph fluid then mixes with
blood and returns to the right heart.
REF: 170-171
83. What does the detection of lymphatic channels on standard chest radiographs indicate?
A. abnormally low pressures in the lymphatic channels
B. anastomoses with the pulmonary circulation
C. normal fibrotic changes that occur with aging
D. system that is overwhelmed by excessive fluid
ANS: D
Lymphatic channels are usually not visible on chest radiographs. They may be
detected if they are distended or thickened by disease. The “butterfly” pattern that
radiates from the hilar region of both lungs during acute development of pulmonary
edema is thought to largely be the result of interstitial and lymph vessel distension
with fluid. In this situation, the lymphatic drainage system has been overwhelmed by a
sudden and excessive surge of fluid from the circulation. The development of a pleural
effusion is also evidence that the lymphatic system is unable to remove excess fluid in
the lung.
REF: 172
Test Bank 8-27
84. What is the affect of damage to the recurrent laryngeal nerves?

A. diaphragmatic paralysis
B. pulmonary circulatory failure
C. inactivation of pulmonary surfactant production
D. vocal cord impairment or paralysis
ANS: D
Damage to laryngeal nerves can cause unilateral or bilateral vocal cord paralysis,
depending on which branches are involved. This may result in hoarseness, loss of
voice, and an ineffective cough.
REF: 172
85. What determines the airway diameter in the normal lung?

A. balance between sympathetic and parasympathetic tone
B. in large part, the amount of patient effort
C. activity level of the submucosal glands
D. amount of dopamine present in the airway walls
ANS: A
Both sympathetic and parasympathetic postganglionic efferents innervate the smooth
muscle and glands of the airways. They influence the diameter of the airway by
causing more or less tension in the smooth muscles that wrap the airway and influence
glandular secretion. The combined effects of the parasympathetic and sympathetic
nervous activity, which generally oppose each other's action, result in a balanced
control of airway diameter.
REF: 172-173
86. What is the name of the negative feedback reflex associated with the termination of
inspiration?
A. carotid sinus
B. Head’s paradoxical
C. Hering-Breuer
D. vagovagal
ANS: C
Pulmonary stretch receptors progressively discharge during lung inflation and are
linked to inhibition of further inflation. This is a type of negative feedback known as
the inflation reflex or the Hering-Breuer inflation reflex.
REF: 174
87. What is the name of the reflex associated with the sensory stimulation of the
pulmonary stretch receptors that stimulates a deeper breath upon inspiration?
A. carotid sinus
B. Head’s paradoxical
C. Hering-Breuer
D. vagovagal
Test Bank 8-28
ANS: B
Another reflex that is associated with stretch receptor activity is Head’s paradoxical
reflex. This reflex stimulates a deeper breath rather than inhibiting further inspiration.
It may be the basis for occasional deep breaths or gasps. Deep breaths or sighs occur
with normal breathing, presumably preventing alveolar collapse. Head’s reflex may
also be responsible for gasping in newborn infants as they progressively inflate their
lungs.
REF: 174
88. What may happen if the irritant receptors in the lung are stimulated?
I. bronchoconstriction
II. reflex closure of the glottis
III. reflex slowing of the heart (bradycardia)
A. II and III
B. I and III
C. II only
D. I, II, and III
ANS: D
When the irritant receptors are stimulated, it can result in bronchoconstriction,
hyperpnea, glottic closure, cough, and sneeze. Stimulation of these receptors can also
cause a reflex slowing of the heart rate (bradycardia).
REF: 174
89. The upper respiratory tract traditionally ends at what point?

A. branching of the trachea into right and left main-stem bronchi
B. hypopharynx
C. inferior border of the larynx
D. the end of the conducting airways
ANS: C
The upper respiratory tract is defined as those airways starting at the nose and mouth
and that extend down to the trachea (Figure 8-36).
REF: 174
90. What are the three bony projections that arise from the lateral walls of the nasal cavity
that enhance filtration and humidification?
A. alar nasi
B. frontal sinuses
C. palatine tonsils
D. turbinates
Test Bank 8-29
ANS: D
Three shelf-like bones protrude into the cavity from the lateral walls. These bony
shelves are called the superior, middle, and inferior concha or turbinates. The concha
function to increase the surface area of the nasal cavity, which enhances filtration and
humidification.
REF: 174
91. Which of the following is NOT a primary function of the nasal cavity?
A. conduction of gases
B. filtration and defense
C. gas exchange
D. heat and humidify
ANS: C
The primary functions of the nasal cavity are to serve as a gas passageway, and to
filter, humidifier, and heat inhaled gases.
REF: 174
92. Which of the following help comprise the defense system of the nose?
I. clearance of foreign matter by ciliary action
II. gross filtration by the large hairs of the nasal vestibule
III. impaction of particulate foreign matter on the nasal mucosa
IV. laminar flow through the concha
A. I, II, and III

B. II and IV
C. III only
ANS: A
Filtration of inhaled air is carried out by the hair in the anterior portion of the cavity
and the sticky mucous membrane that covers the complex surface of the cavity.
Filtration is enhanced by the flow pattern through the nasal cavity. Inspired gas is
accelerated to a high velocity through the anterior nares. It then changes direction
sharply as it enters the internal nasal cavity. This pattern causes particles larger than
10 m in diameter to impact on the nasal mucosa. Ciliary action or nose blowing then
clears these particles. Past the external nares, the cross-sectional area increases. This
results in a decrease in gas velocity. Turbulence increases because of the narrow
convolutions of the passages. Low velocity and turbulence combine to remove any
remaining particles.
REF: 175
Test Bank 8-30
93. What are the vascularized lymphoidal tissues that have a particularly active
immunological role in children?
A. lingual tonsils
B. palatine tonsils
C. pharyngeal tonsils
D. superior turbinates
ANS: B
The palatine tonsils are vascularized lymphoidal tissues that play an immunologic role,
especially in childhood.
REF: 177
94. What is your primary concern if you discover that a patient does not have a gag reflex?
A. fear of aspiration of bacteria or food
B. that their tonsilar tissues are grossly swollen
C. that they will not be able to breathe adequately
D. tracheal collapse
ANS: A
Reflexes of the mouth, pharynx, and larynx help to protect the lower respiratory tract
during swallowing. These protective functions can be severely compromised during
anesthesia or unconsciousness. Loss or compromise of these important reflexes can
result in aspiration of bacteria colonized saliva or food and can cause pulmonary
infection and asphyxiation in severe cases.
REF: 177
95. The subdivisions of the pharynx include which of the following?

I. nasopharynx
II. oropharynx
III. laryngopharynx
A. II and III
B. I and II
C. I and III
D. I, II, and III
ANS: D
The pharynx is subdivided into the nasopharynx, oropharynx, and hypopharynx or
laryngopharynx.
REF: 177
96. Into what structure do the eustachian tubes drain?

A. larynx
B. nasopharynx
C. oropharynx
D. vestibule
Test Bank 8-31
ANS: B
In the lateral nasopharynx, there are two openings into the left and right eustachian
tubes that link the upper airway with the middle ear (Figure 8-36). The eustachian
tubes drain fluid out of the middle ear and allows gas to move in or out of the middle
to equalize pressure on either side of the tympanic membrane.
REF: 177
97. What results in partial or total obstruction of the airway in an unconscious patient?
A. closed mouth coexistent with nasal congestion
B. epiglottis relaxes and occludes the laryngeal opening
C. relaxation of tongue and hypopharyngeal muscles.
D. the uvula occluding the airway
ANS: C
During unconsciousness, the muscles of the tongue and hypopharynx can relax and
allow the tongue and other soft tissues to collapse and occlude the opening of the
hypopharynx. This condition can result in partial to complete blockage of the upper
airway and limit air movement to and from the respiratory tract. This is a primary
cause of obstructive sleep apnea.
REF: 177
98. What is a primary function of the larynx?

A. cover the glottic opening during forced expiration
B. house Waldeyer’s ring of tonsilar material for airway defense
C. protect airway during eating or drinking
D. provide a common passageway for food and gas
ANS: C
Generally, it functions to protect the respiratory tract during eating and drinking and in
phonation.
REF: 177
99. What is the cartilage that is commonly referred to as the Adam’s apple?
A. arytenoid
B. cricoid
C. cuneiform
D. thyroid
ANS: D
The thyroid cartilage forms most of the upper portion of the larynx and is generally
referred to as the Adam's apple.
REF: 177
Test Bank 8-32
100. What is the only complete circular cartilage of the larynx?

A. arytenoid
B. corniculate
C. cricoid
D. thyroid
ANS: C
Just below the thyroid cartilage is the cricoid cartilage, which is the only laryngeal
structure that forms a complete ring of cartilage around the airway and is the narrowest
region of the upper airway in infants.
REF: 178
101. What is the leaf-shaped cartilage that extends from the base of the tongue and is
attached by ligaments to the thyroid cartilage?
A. arytenoid cartilage
C. cuneiform cartilage
D. epiglottis
ANS: D
The cartilaginous and leaf-shaped epiglottis lies within and is attached to the thyroid
cartilage by a flexible joint.
REF: 178
102. Three folds of tissue between the posterior base of the tongue and the epiglottis form a
small space that is a key landmark in oral intubation. What is this called?
A. false vocal cords
B. palatine fold
C. taurus tubularus
D. vallecula
ANS: D
The base of the tongue is attached to the epiglottis by three folds. These folds form a
space between the tongue and the epiglottis called the vallecula, which is a key
landmark in oral intubation (Figure 8-36).
REF: 178
103. What is the space that separates the true vocal cords?
A. epiglottis
B. glottis
C. vallecula
D. vestibule
ANS: B
The opening formed between the vocal cords is called the glottis.
REF: 179
Test Bank 8-33
104. Changes in the tension on the vocal cords, allowing phonation, are produced by the
interaction of the laryngeal muscles and the movement of which cartilage?
A. arytenoids
B. corniculates
C. cricoid
D. cuneiforms
ANS: A
The laryngeal component of speech is called phonation. It requires the adjustment of
vocal cord tension and position relative to one another. The action of the posterior
cricoarytenoid muscles causes the arytenoid cartilages to rotate and opens the vocal
cords. Closure of the vocal cords is carried out by rotating the arytenoids in the
opposite direction through the action of the lateral cricoarytenoid and oblique
arytenoid muscles.
REF: 179
105. What could the “effort closure” of the larynx facilitate?

A. crying
B. talking
C. whispering
D. yelling
ANS: D
Tight closure of the larynx and the buildup of intrapulmonary pressure through
muscular effort is called effort closure. Effort closure of the larynx is necessary for
generating loud sounds and for effective coughing and sneezing.
REF: 179
106. What position is used to open the airway in an unconscious patient?

A. neck extension
B. neck flexion
C. recovery position
D. sniff position
ANS: D
With loss of consciousness, the head flexes forward which can partially or completely
obstruct the upper airway. (Figure 8-41, A). Extension of the head and lower jaw into
the “sniff” position alleviates this obstruction (Figure 8-41, C). Extension of the head
moves the tongue away from the rear of the pharynx. This technique is used to
maintain the airway in unconscious patients and facilitates placement of artificial
airways.
REF: 181
Test Bank 8-34
107. The adult trachea is approximately how long?

A. 5 to 8 cm
B. 10 to 12 cm
C. 16 to 18 cm
D. 20 to 24 cm
ANS: B
The adult trachea is approximately 12 cm long and has an inner diameter of about 2.0
cm.
REF: 181
108. At what point does the trachea branch into two mainstem bronchi?
A. carina
C. glottis
D. manubrium
ANS: A
At the base of the trachea, the last cartilaginous ring that forms the bifurcation for the
two bronchi is called the carina. The carina is an important landmark that is used to
identify the level at which the two mainstem bronchi branch off from the trachea.
REF: 182
109. Why do most aspirated objects and fluids end up in the right mainstem bronchus
instead of the left mainstem bronchus?
A. The left bronchus is more in line with the trachea.
B. The left bronchus is shorter than the right.
C. The right bronchus is larger than the left.
D. The right bronchus is more in line with the trachea.
ANS: D
The right bronchus branches off from the trachea at an angle of about 20 to 30
degrees, and the left bronchus branches with an angle of about 45 to 55 degrees
(Figure 8-44). The right bronchus’s lower angle of branching results in a greater
frequency of foreign body passage into the right lung because of the more direct
pathway.
REF: 182-183
110. What portion of the left lung corresponds anatomically to the middle lobe of the right
lung?
A. cardiac notch
B. lingula
C. medial segment
D. superior segment
Test Bank 8-35
ANS: B
See Table 8-8.
REF: 183
111. Which of the following statements about the terminal bronchioles is true?
A. They are generally five divisions below the segmental bronchi.
B. They are the smallest of the purely conducting airways.
C. They average 3 to 4 mm in diameter.
D. They have well-defined and predictable amounts of cartilage.
ANS: B
Terminal bronchioles are the smallest conducting airways and function to supply gas
to the respiratory zone of the lung.
REF: 183
112. What type of flow is seen in and beyond the terminal bronchioles?
A. laminar
B. transitional
C. turbulent
D. varies among individuals
ANS: A
Low-velocity gas movement at the level of the terminal bronchiole and beyond is
physiologically important for two reasons. First, laminar flow develops, which
minimizes resistance in the small airways and decreases the work associated with
inspiration. Second, low gas velocity facilitates rapid mixing of gases.
REF: 184
113. What is the most common cell type found in the mucosa of the larger airways?
A. pseudostratified ciliated columnar epithelium
B. pseudostratified ciliated cuboidal epithelium
C. stratified ciliated squamous epithelium
D. stratified unciliated serous endothelium
ANS: A
The most common type of epithelia is the numerous pseudostratified, ciliated,
columnar epithelia.
REF: 185
Test Bank 8-36
114. What can the release of histamine and other chemical mediators from the mast cells in
the airways cause?
I. bronchoconstriction
II. bronchodilation
III. vasoconstriction
IV. vasodilation
A. II and IV
B. I and III
C. II and III
D. I and IV
ANS: D
Mast cells are also found in the submucosa and release numerous and potent
vasoactive and bronchoactive substances such as histamine. Histamine causes
vasodilation and bronchoconstriction, acting directly on smooth muscle.
REF: 186
115. What is the major source of respiratory tract secretions in the normal lung?
A. bronchial glands
B. Clara cells
C. goblet cells
D. mast cells
ANS: A
Normally, the respiratory tract produces about 100 ml of mucus per day. Most of the
mucus formed in the larger airways is produced by the bronchial glands.
REF: 186
116. Identify functions of airway mucus in the normal lung.

I. increased mucus production decreases bronchospasm
II. protect the airways from excessive water loss
III. shield the airway from toxic particles
IV. trap inhaled contaminants
A. I, II, and III

B. II, III, and IV
C. I and IV
D. III, and IV
ANS: B
Mucus functions to protect the underlying tissue. It helps to prevent excessive amounts
of water from moving into and out of the epithelia. It shields the epithelia from direct
contact with potentially toxic materials and microorganisms. It acts like sticky
flypaper to trap particles that make contact with it. This makes mucus an important
part of the pulmonary defenses.
REF: 186
Test Bank 8-37
117. What is the name given to the action produced by the forward stroking of millions of
cilia?
A. coughing
B. mucociliary escalator
C. mucus stroking
D. the wave
ANS: B
The stroking action of millions of cilia propels the surrounding mucus at a speed of
about 2 cm per minute. This action is commonly referred to as the mucociliary
escalator.
REF: 186
118. Which of the following can impair or inhibit ciliary activity?

I. drying of the respiratory tract mucosa
II. exposure to smoke
III. parasympatholytic drugs
A. I and II
B. I only
C. I, II, and III
D. II and III
ANS: C
Ciliary beating can be effectively slowed or even stopped if the viscosity of the sol
layer is increased by exposure to dry gas. Ciliary motion is also stopped following
exposure to smoke, high concentrations of inhaled oxygen, and drugs like atropine.
REF: 187
119. The patency of small airways is maintained by which of the following mechanisms?
I. cartilaginous support
II. traction of surrounding elastic tissue
III. transmural pressure gradients
A. I
B. I and II
C. II and III
D. I, II, and III
ANS: C
The small airways depend on transmural pressure gradients and the “traction” of
surrounding elastic tissues to remain open.
REF: 187
Test Bank 8-38
120. What is the common name given to classify the airway from the nares to the terminal
bronchioles?
A. conducting airways
B. respiratory airways
C. transitional airways
D. upper airway
ANS: A
The airways from the nares to and including the terminal bronchioles comprise the
conducting zone airways, which do not participate in gas exchange.
REF: 187-188
121. What is normal amount of anatomic deadspace found in a healthy lung?

A. 1 ml/kg ideal body weight
B. 2 ml/kg ideal body weight
C. 3 ml/kg ideal body weight
D. 4 ml/kg ideal body weight
ANS: B
These airways constitute the anatomic dead space of the respiratory system that is
rebreathed with each breath. In the adult human, the volume filling the airways of the
anatomic dead space is approximately 2 ml/kg of lean body weight, or about 150 ml in
the typical adult.
REF: 188
122. Which of the following describes an acinus?

A. Each acinus is comprised of five terminal respiratory units.
B. It consists of all structures distal to a terminal bronchiole.
C. It is composed of the smaller conducting airways.
D. It is the transitional portion of the lung between conduction and respiration.
ANS: B
A single terminal bronchiole supplies a cluster of respiratory bronchioles. Collectively,
this unit is referred to as the acinus.
REF: 188
123. What is called the “functional unit of the lungs”?

A. only the alveoli
B. acinus
C. alveolar-capillary membranes
D. terminal bronchioles
ANS: B
The primary lobule or acinus forms the functional unit of the lungs.
REF: 188
Test Bank 8-39
124. Where are the largest alveoli found in the lung?

A. acinus
B. apices
C. bases
D. middle
ANS: B
Alveoli found in the apical regions of the vertical lung have greater diameters than
those in the basal regions as a result of the gravitational effects. Those in the basal
regions are partially collapsed as a result of the weight of the organ.
REF: 188
125. What type of alveolar cells cover over 90% of the surface area of the alveolar-capillary
membrane?
A. alveolar macrophages
B. granular pneumocytes
C. type I cells
D. type II cells
ANS: C
The alveolar septa are covered with extremely flat squamous epithelia called type I
pneumocytes (Figure 8-54). While they represent only about 8% of all the cells found
in the alveolar region, the type I cells cover about 93% of the alveolar surface.
REF: 188
126. Pulmonary surfactant is secreted by which type of lung cells?

B. type I cells (pneumocytes)
C. type II pneumocytes
D. type III pneumocytes
ANS: C
Type II cells do not function as gas exchange membranes like the type I cells. They
manufacture surfactant, store it in vesicles called lamellated bodies, and secrete it onto
the alveolar surface.
REF: 191
127. Why is pulmonary surfactant such an important biologic substance?

A. It clears out cellular debris.
B. It is an alveolar macrophage.
C. It promotes lung contraction aiding exhalation.
D. It promotes lung stability.
Test Bank 8-40
ANS: D
Surfactant functions to reduce the surface tension of the alveolus, which results in
shedding water from the alveolar surface; helps to prevent alveolar surface
tension−driven collapse; improves lung compliance; and reduces the work of
breathing.
REF: 190-191
128. What are the free-wandering phagocytic cells that ingest foreign material in the
respiratory zone of the lungs?
B. granular pneumocytes
C. type I cells
D. type II cells
ANS: A
Macrophages are another common cell found in the alveolar region. They can move
from the pulmonary capillary circulation by squeezing through openings in the
alveolar septa and then move out onto the alveolar surface. They are defensive cells
that patrol the alveolar region and phagocytize foreign particles and cells (e.g.,
bacteria).
REF: 191
129. What intercommunicating channels permit collateral ventilation between adjacent

alveoli and primary lobules?
I. bronchial anastomoses
II. canals of Lambert
III. pores of Kohn
IV. terminal bronchioles
A. I, II, and III

B. I and IV
C. II and III
ANS: C
Small openings are located in the alveolar septa. Some of the openings allow gas to
move from one alveolus to another. These are called the pores of Kohn. Other
openings connect alveoli with secondary respiratory bronchioles. These passageways
are called the canals of Lambert. All of these alveolar openings and passageways
facilitate the collateral movement of gas and help maintain alveolar volume.
REF: 191
Test Bank 8-41
130. To what does the term “faster-weaker” refer when discussing the alveolar-capillary
membrane?
A. portion of the alveolar-capillary membrane that is average in thickness
B. shortest airways in the acinus, which allow fast gas exchange
C. thinnest portion of the alveolar-capillary membrane
D. thickest portion of the alveolar-capillary membrane
ANS: C
On one side of the alveolar wall, the type I cell and capillary endothelial cells lie close
together with a thin interstitial space. This part of the blood-gas barrier is, on average,
0.2 to 0.3 m thick and it is where the alveolar capillary bulges into the alveolar space.
On the other side, where there is a thicker interstitial space with greater fiber, matrix,
and nuclear material content, the barrier can be more than 3 to 10 times thicker. This
functionally results in “faster-weaker” and “slower-stronger” diffusion sides of the
blood-gas barrier.
REF: 192
131. Which of the following have been shown to injure the alveolar-capillary membrane?
I. excessive pressures
II. excessive tidal volumes
III. increased intracranial pressures
IV. pulmonary hypertension
A. I, II, and IV
B. II and III
C. IV only
ANS: A
Conditions of pulmonary hypertension (e.g., capillary pressure greater than 30 mm Hg
during congestive heart failure and high-altitude pulmonary edema) and excessive
tidal volume and airway pressure during positive-pressure ventilation (e.g., tidal
volume greater than 6 ml/kg and airway pressures greater than 30 cm H2O) can result
in stress failure of the blood-gas membrane. Stress failure results in endothelial and/or
type I cell stretching and shearing injuries.
REF: 193
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Chapter 8: The Respiratory System

1. What is the primary purpose of the respiratory system?

2. What is meant by “internal respiration”?

3. By what mechanism does gas exchange across the lung occur?

4. The human genome contains _____ pairs of chromosomes.

6. What genetic disorder has been linked to emphysema?

A. I, II, and III

8. Developmental morphogenesis of the human respiratory system can be categorized

11. During which phase of fetal development do mature alveoli appear?

13. What maintains lung inflation during fetal development?

16. What would be a normal P50 for a fetus?

A. I, II, and III

REF: 149, 151

23. What factor contributes to increased likelihood of an upper airway obstruction in an

25. Approximately how many alveoli are there in a 10-year-old’s lung?

29. Infants can generate auto-PEEP by which of the following methods?

31. What is the function of the thorax?

33. What is the name of the upper portion of the sternum?

34. Where does the sternal angle lie?

36. Which of rib pairs connect directly to the sternum?

37. What are rib pairs 11 and 12 known as?

46. The diaphragm is innervated by which of the following nerves?

49. Limited, short-term spontaneous ventilation is possible in a patient with a paralyzed

53. As ventilatory muscles, the sternomastoids do which of the following?

A. I, II, and III

58. To what structures do the parietal pleural membranes adhere or cover?

62. What is the mediastinum?

65. Which of the following statements describe a normal adult lung?

70. The pulmonary arterial circulation does which of the following?

72. The pulmonary venous circulation does which of the following?

73. Which of the following describes a function of pulmonary circulation?

77. How would lung perfusion in a “zone 1” area best be described?

78. How does the lung respond to regional lung hypoxia?

84. What is the affect of damage to the recurrent laryngeal nerves?

85. What determines the airway diameter in the normal lung?

89. The upper respiratory tract traditionally ends at what point?

A. I, II, and III

95. The subdivisions of the pharynx include which of the following?

96. Into what structure do the eustachian tubes drain?

98. What is a primary function of the larynx?

100. What is the only complete circular cartilage of the larynx?

105. What could the “effort closure” of the larynx facilitate?

106. What position is used to open the airway in an unconscious patient?

107. The adult trachea is approximately how long?

116. Identify functions of airway mucus in the normal lung.

A. I, II, and III

118. Which of the following can impair or inhibit ciliary activity?

121. What is normal amount of anatomic deadspace found in a healthy lung?

122. Which of the following describes an acinus?