Question 1

The MOST common body organ involved in direct metastasis from small cell carcinoma is which of the following?

Accepted Answer

Seventy-five percent of small cell carcinoma metastasizes to the central nervous system,65% to the liver,58% to the adrenal gland,30% to the pancreas,285 to bone,20% to the genitourinary system,10% to the thyroid,and 10% to the spleen.

Question 2

Which of the following types of bronchogenic carcinoma rapidly involves the vascular channels,lymph nodes,and soft tissue and is known to metastasize widely and early typically before the lung cancer diagnosis is made?

Accepted Answer

Small cell carcinoma tumors do not extend into the bronchial lumen,but spread through the submucosa and can cause obstructive and restrictive dysfunction.This type of lung cancer rapidly involves the vascular channels,lymph nodes,and soft tissue.It is known to metastasize widely and early,often before the lung cancer diagnosis is made.

Question 3

In a patient with adult respiratory distress syndrome (ARDS),fat emboli would be categorized as which of the following types of causes for ARDS?

Accepted Answer

Several categories exist to describe the varied primary causes of ARDS and fat emboli are categorized as trauma.

Question 4

A patient with restrictive lung disease develops a rise in pulmonary circulation pressure subsequently increasing the work of the right ventricle.This is BEST described as:

Accepted Answer

Pulmonary hypertension due to hypoxemia,fibrosis,and compression of the pulmonary capillaries leads to a type of right-sided heart failure termed cor pulmonale.The increase in pulmonary circulation pressure leads to pulmonary hypertension.

Question 5

Ventilation-perfusion mismatching in restrictive lung disease leads to which of the following classic signs?

Accepted Answer

Ventilation-perfusion mismatching in restrictive lung disease (RLD)leads to the classic sign of hypoxemia.Mismatching may be due to changes in the collagenous framework of the lung,scarring of capillary channels,distortion or narrowing of the small airways,compression from tumors within the lung,or bony abnormalities of the chest wall.

Question 6

Which of the following pathological occurrences associated with respiratory distress syndrome (RDS)in premature infants causes the overall retractive forces of the lung to be greater than normal?

Accepted Answer

RDS is caused primarily by abnormalities in the surfactant system and inadequate surfactant production.The surfactant dysfunction causes overall retractive forces of the lung to be greater than normal,which decreases lung compliance,increases the work of breathing,and leads to progressive diffuse microatelectasis,alveolar collapse,increased ventilation-perfusion mismatching,and impaired gas exchange.

Question 7

Which of the following specific types of pneumonia is considered a fungal pneumonia and is closely associated with AIDS?

Accepted Answer

P.carinii,originally described as a protozoan,is now thought to be a fungal organism.Pneumocystis carinii pneumonia (PCP)is closely associated with AIDS because nearly 75% of AIDS patients have at least one episode of PCP during their lifetime.

Question 8

The distribution of inspired air and pulmonary blood flow becomes less homogeneous with increasing age.This age-related change contributes MOST to which of the following clinical manifestations?

Accepted Answer

The alveolar walls become thinner and the capillary bed incurs considerable loss,with an increase in ventilation-perfusion mismatching.The distribution of inspired air and pulmonary blood flow becomes less homogeneous with age.Diffusing capacity is therefore reduced and the physiological space is increased.

Question 9

Which of the following specific types of pneumonia consists of a water-borne organism that can be emanated from an air-conditioning unit?

Accepted Answer

L.pneumophila can occur in epidemic proportions because the organism is water borne and can emanate from air-conditioning equipment,drinking water,lakes,river banks,water faucets,and shower heads.

Question 10

In a patient with restrictive lung disease energy expenditure is increased due to the increase in work of breathing and accessory muscle use.Which of the following exercise prescriptions would be MOST appropriate?

Accepted Answer

Lower extremity interval training such as walking is beneficial to the patient if the rest period is at least equal to exercise time as determined by patient tolerance.Any exercise requiring upper extremity use would exacerbate the muscle fatigue due to accessory muscle overuse for breathing.If a patient has an increase in energy expenditure due to increased work of breathing,low-intensity exercise would be more appropriate than moderate-intensity exercise.

Question 11

Which of the following types of bronchogenic carcinoma arises from the bronchial mucosa after repeated inflammation or irritation such as cigarette smoking?

Accepted Answer

Squamous cell carcinoma arises from the bronchial mucosa after repeated inflammation or irritation caused by cancer stimuli.It is therefore the type of lung cancer most closely associated with cigarette smoking.

Question 12

Which of the following aspects of pulmonary ventilation leads to the requirement of increased transpulmonary pressure for a given volume of air in patients with restrictive lung disease?

Accepted Answer

As lung tissue compliance diminishes or become stiffer,a greater transpulmonary pressure is required to expand the lung for a given volume of air.Low chest wall compliance limits thoracic expansion.Decreased IRV and increased work of breathing are a result of the higher pressures.

Question 13

Which of the following types of bronchogenic carcinoma is the least responsive to radiation?

Accepted Answer

Large cell carcinoma is the least responsive to radiation.Small cell lung carcinoma is the most radiosensitive,followed by squamous cell carcinoma and adenocarcinoma.

Question 14

Which of the following statements BEST describes a cause of compression atelectasis?

Accepted Answer

Atelectasis (compression)occurs as a result of expanding volume outside of the alveoli (in pleural space,interstitial space,etc.),which presses on the alveoli and prevents complete expansion.

Question 15

Which of the following causes of restrictive lung disease is characterized by necrosis of the respiratory epithelium in the affected bronchioles?

Accepted Answer

Bronchiolitis obliterans is characterized by necrosis of the respiratory epithelium in the affected bronchioles.This necrosis allows fluid and debris to enter the bronchioles and alveoli,causing alveolar pulmonary edema and partial or complete obstruction of these small airways.

Question 16

The key to medical treatment of pneumonia is which of the following?

Accepted Answer

The key to treatment of pneumonia is to first identify the microbe (virus versus gram-positive or gram-negative bacteria).Specific medical treatment (specific antibiotic)is based on the identification of the microbe.

Question 17

Hallmark symptoms of restrictive lung disease include dyspnea,an emaciated appearance,and which of the following?

Accepted Answer

Three hallmark symptoms typically experienced with RLD include dyspnea,a wasted and emaciated appearance,and an irritating,dry,and nonproductive cough.

Question 18

The primary causative factor of lung cancer is which of the following?

Accepted Answer

It has been well established through numerous studies that the primary causative factor of lung cancer is tobacco use.Approximately 80% to 90% of lung cancers are caused by tobacco.The average cigarette smoker has 10 times the risk of developing lung cancer as the nonsmoker.

Question 19

A patient is 1 day postlumbar fusion surgery.Upon initial evaluation by the physical therapist,the patient was recorded to have an SpO₂ of 92% on 2 L of O₂ via a nasal cannula.The physical therapist suspects acute atelectasis due to postoperative pain.Of the following,which is the BEST immediate intervention to improve oxygenation in this patient?

Accepted Answer

Acute atelectasis such as in postoperative or in other hospitalized patients can respond to deep breathing or incentive spirometry exercises as well as coughing.

Question 20

Survivors of pediatric respiratory distress syndrome who have been ventilated mechanically and received high concentrations of oxygen over a prolonged period of time may develop which of the following pulmonary restrictive lung diseases?

Accepted Answer

Bronchopulmonary dysplasia is a chronic pulmonary syndrome in neonates that occurs in some survivors of RDS who have been ventilated mechanically and have received high concentrations of oxygen over a prolonged period of time.

Quiz 5: Restrictive Lung Dysfunction