Autumn Repeat Examinations 2011/ 2012
Exam Code(s)
1MB3, 1MB7
Exam(s)
1st medical
Module Code(s)
MD122
Module(s)
Respiratory System
Paper No.
1
External Examiner(s)
Prof A Payne
Prof S Wray
Internal Examiner(s)
Dr A Hynes
Dr F Quondamatteo
Instructions:
Answer all 50 questions in the computer readable form provided
Students must select ONLY ONE OPTION in each question
ONLY ANSWERS ENTERED IN THE COMPUTER READABLE
FORM ACCORDING TO BLACKBOARD INSTRUCTIONS WILL
BE EVALUATED
Duration
Two Hours
Discipline
Course Co-ordinator
Physiology
Dr Ailish Hynes
Requirements:
NOT FOR RELEASE
MIS FORMS
The cranial nerve that travels in a caudal direction passing lateral to the aortic arch ….
1
A.
B.
a+ b supplies all muscles of larynx excepy
Contains motor fibres for the crico-thyroid muscle cricothyroid - it is innervated by external/ superior
laryngeal nerve
is
Has fibres that supply all muscles of the larynx
ervate th
D.
plxusves inn
rd
branchesthtoe ca
eicnic ner
r
ve
gi
h
=
c
p
Provides the pulmonary plexus with sympathetic supply
a m,
h diaphr
it
w
d
te
location
ocia
Supplies the diaphragm with motor fibres not ass
E.
Has fibres that supply the vocal muscle
C.
the right recurrent larygneal nerve (inferior) travels under the arch of the aorta
2
Which of the following respiratory structures is located at the level of C6?
A.
The only complete cartilaginous ring of the airways the c shaped hylaine cartilage is found at the top of the
B.
Highest point of the diaphragm
C.
Costo-diaphragmatic recess
D.
The Bochdalek triangle
E.
Tracheal bifurcation
3
t8-t12
T5
Which one of the following statements on lymphatic drainage from the respiratory organs
is INCORRECT?
A.
Lymph drained from the lungs passes through tracheo-bronchial nodes
B.
Hilar nodes are an important station for the lymph drained from the lung
C.
The tracheal bifurcation is a typical location of lymphatic nodes
D.
The entire lymph drained from the lungs will flow into the thoracic duct
E.
Lymph from the inferior lobe of the left lung is drained into the right broncho-mediastinal trunk
4
The tracheal bifurcation
A.
Gives rise to two extrapulmonary bronchi where cartilage is not present and the musculature
completely surrounds the airways
B.
Gives rise to two extrapulmonary bronchi where the left bronchus continues its course more
making it harder for the particles to get into the left bronchus vs the
horizontal than the right one right. right is known for having foregin partfcles. thus a coughing
sensation occurs
C.
Gives rise to two extrapulmonary bronchi where the right bronchus is narrower than the left one
D.
Is devoid of cartilage
E.
Is located in the posterior mediastinum
5
The impression marked by the arrow in the image below is left by:
A.
Arch of the Aorta
B.
Azygos vein
C.
Inferior vena cava
D.
Superior vena cava
E.
None of the above (a.-d.)
azygous
vein
brachicopehllia vein
superior vena cava
Image for question 5
esophagus
Netter Presenter Image, Copyright 2012, Icon Learning System.
All rights reserved
6
Which of the following diaphragmatic structures forms a sling around the oesophagus
caudal to its passage through the diaphragm?
A.
Central tendon
B.
Right crus
C.
Left crus
D.
Sternal portion
E.
None of the above
7
The nerve plexi formed by the vagus nerve in the posterior mediastinum cross the
diaphragm using the same hiatus as the:
A.
Aorta superior
B.
Azygos vein
C.
Inferior vena cava superior
D.
Oesophagus
E.
Thoracic duct -superior
posterior mediastinum runs anterior to t5-T12 vertebrae
posuerior to the pericardium and diaphram between parietal
pleur and two lungs
Normally posterior lateral part of diaphragm
Is a defect in the diaphragm - failure of canals to close
8
Select the CORRECT statement. The triangle (trigone, space) of Bochdalek is:
A.
A potential site for internal hernias located between the sternal and costal portions of the
diaphragm
B.
The space between the oesophageal hiatus, the hiatus of the inferior vena cava and the aortic
crossing of the diaphragm
C.
right = 9%
left = 57%
A potential site for internal hernias located between the lumbar and costal portions of the
diaphragm
D.
E.
9
Located posteriolaterally
Apex of triangle pointed towards central tendon
Located between the left and right crus of the diaphragm
from behind
Usually at 10-12th vertebral level
Another name for the central tendon of the diaphragm
The structure marked by the arrow in the airway shown in the image below is:
A.
Epithelium
B.
Vascular supply
C.
Muscle layer
D.
Goblet cells
E.
None of the above (a.-d.)
Image for Q9
10
Which one of the following organs leaves an indentation on both (right and left) lungs?
A.
Aortic arch
B.
Azygos vein
C.
Heart
D.
Inferior vena cava
E.
Superior vena cava
11
it denoates the to reliece immediate stress. needle
throacostomy,
edle thoracostomy is an emergency, potentially lifesaving, procedure that can be done if tube thoracostomy
cannot be done quickly enough.
The following location on the chest surface: - 2nd intercostal space on the left mid-clavicular
line…
A.
Denotes the auscultation site of the apex of the left lung
B.
Denotes a region of dull sound at percussion because of overlap of the projections of lung and
liver
C.
Denotes the level of a region in the left costo-diaphragmatic recess
D.
Denotes a region of dull sound at percussion because of overlap of the projections of heart and
lungs
E.
12
Does not denote any of the above (a.-d.)
Which one of the following pairs (pleura / nerve supply) is CORRECT?
A.
Costal pleura / intercostal nerves
B.
Diaphragmatic pleura / greater splanchnic nerve
C.
Mediastinal pleura / vagus nerve
D.
Visceral pleura / phrenic nerve
E.
None of the above (a.-d.)
13
Which of the following can be measured in the order of 3-5 cm?
A.
The depth of the costo-diaphragmatic recess
B.
The diameter of a bronchioles
C.
The thickness of the phrenic nerve
D.
The length of the trachea
E.
The normal excursion of the diaphragm in breathing
14
The following location on the chest surface: posterior aspect on the middle of the right half
of the thorax at the level of T2…..
A.
Denotes a region of dull sound at percussion because of overlap of the projections of lung and
liver
B.
Denotes an area of projection of the apex of the right lung on the thoracic surface
C.
Denotes an area of projection of the middle lobe of the right lung on the thoracic surface
D.
Denotes an area of projection of the superior lobe of the right lung on the thoracic surface
E.
Does not denote any of the above (a.-d.)
15
Which of the following cell types is thought to scavenge surfactant?
A.
Clara cells
B.
Fibroblasts
C.
Goblet cells
D.
Mesothelial cells of the parietal pleura
E.
Pneumocyte type II
16
Projection of the horizontal fissure of the lungs on the antero-lateral chest surface is
denoted by the course of which of the following ribs/intercostal spaces?
A.
Eight
B.
First
C.
Fourth
D.
Eleventh
E.
Twelfth
17
oblique fissure - line beginning at t3/tv IV disc, T5 at medial
scapula border. follows conuter of rib 6
Which of the following structures is part of the blood-air barrier?
A.
Alveolar basement membrane
B.
Bronchiolar musculature
C.
Mesothelial layer of the visceral pleura
D.
Submesothelial elastic fibres
E.
None of the above (a.-d.)
The alveolar basement membrane is dense and
amorphous, has filaments in the lamina rara
externa, and has discontinuities beneath type II
pneumocytes, but not beneath type I pneumocytes,
that allow penetration of cytoplasmic processes into
the interstitium.
18
A.
With regard to the nasal and paranasal cavities, select the CORRECT statement.
Healing of a frontal sinusitis is less complicated than healing of a maxillary sinusitis due to the
anatomical orientation of their openings in the nasal cavity
B.
Olfactory mucosa covers the entire wall of the nasal cavity upper region
C.
Most of the blood supply of the nasal cavity derives from the internal carotid artery and its
branches
D.
maxillary and facial arteries upply most of nose internal carotid
The opening of the naso-lacrimal duct in the nasal cavity is in the same concha as the opening of
the frontal and maxillary sinuses naso-lacrimal are middle concahe
E.
Inflammations of the frontal sinuses are particularly frequent in newborns
frontal sinses do not always develop at birth
19
The following location on the chest surface: 8th intercostal space on the left anterior axillary
line……..
is at 10th
A.
Denotes the auscultation site of the apex of the left lung
B.
Denotes a region of dull sound at percussion because of overlap of the projections of lung and
liver
C.
Denotes the level of a region in the left costo-diaphragmatic recess
D.
Denotes a region of dull sound at percussion because of overlap of the projections of lung and
heart
E.
heart is higher up
Denotes the auscultation site of the lower lobe of the left lung
ostodiaphragmatic recesses are the largest and clinically vital recesses. It is an
entrenched channel which is located at the lower border of the chest wall in the
middle of the costal pleura and the diaphragmatic pleura
20
Which is the tissue that composes the tracheal C-shaped rings?
A.
Bone
B.
Elastic cartilage
C.
Fibrous cartilage
D.
Hyaline cartilage
E.
None of the above (a.-d.)
21
Select the CORRECT statement
0.5-2.5 um
A.
The alveolar membrane is normally 300Pm in diameter
B.
Internal respiration involves the movement of air into and out of the lungs
C.
Prostaglandins are dactivated within the lungs
D.
The largest pressure drop in the pulmonary circulation is across the arterioles
E.
The pressure difference across the pulmonary circulation is approximately 10mmHg
22
= exchange of gases
Airway resistance
is the opposition to flow caused by the forces of friction. It is defined as the
ratio of driving pressure to the rate of air flow
A.
Will be increased as lung volume increases
B.
Will be decrease by parasympathetic stimulation
C.
Will be decreased by E2 adrenergic agonists
D.
Will be decreased by irritants
E.
Will be increased by adrenaline
23
During expiration….
A.
The intra pleural pressure is positive in order to deflate the lungs
B.
The external intercostal muscles are active in order to decrease thoracic cavity volume
C.
The alveolar pressure becomes more negative
D.
The lung volume will be less that it was at the same transpulmonary pressure during inspiration
E.
None of the above statements are true
24
A patient has a tidal volume of 400ml and a respiration rate of 15 breaths per minute with
a dead space of 300ml. His alveolar ventilation rate is
A.
4500ml
B.
6000ml
C.
5700ml
D.
1500ml
E.
Is not possible to calculate from the values given
25
The following are the results of blood gas analysis on five patients which one has normal
blood gas values (Pa = partial pressure in arterial blood: Pv = partial pressure in venous
blood)
A.
PaO2 = 100, PvO2 = 40, Pa CO2 = 40, PvCO2 = 46
B.
PaO2 = 46, PvO2 = 40, Pa CO2 = 40, PvCO2 = 100
C.
PaO2 = 100, PvO2 = 45, Pa CO2 = 40, PvCO2 = 46
D.
PaO2 = 100, PvO2 = 40, Pa CO2 = 46, PvCO2 = 100
E.
None of the above are normal
26
Which of the following factors will result in the shifting of the oxygen dissociation curve to
the right hand side?
A.
Alkaline conditions
B.
Decreased metabolism
C.
High PCO2
D.
Hypoxia
E.
Decreased temperature
27
A patient has the following blood results pH 7.2, PaCO2 40, HCO3- 20. Based on these
results this patient
A.
Is suffering from respiratory acidosis
B.
Is suffering from metabolic acidosis
C.
Is suffering from pneumonia
D.
Is normal
E.
It is impossible to tell from these results
28
The vital capacity
A.
Is normally approximately 25% of total lung capacity
B.
Will be increased in emphysema
C.
Will be increased in Pregnancy
D.
Is normally approximately 4.8L
E.
Cannot be measured using conventional spirometry
29
The functional residual capacity is
A.
The volume of gas remaining in the lungs after a forced expiration
B.
Approximately equal to 4.8L
C.
Increased in the newborn
D.
Increased in emphysema
E.
Increased in pulmonary fibrosis
30
The rhythm generator responsible for the basic respiratory pattern is located in
A.
The pons
B.
The medulla
C.
The cerebrum
D.
The carotid arch
E.
The aortic arch
31
The increased ventilatory response to acute hypercapnia is
A.
Mediated mainly by the peripheral chemoreceptors
B.
Due to increased hydrogen ions in the blood
C.
A result of increased medullary respiratory center activity
D.
Mediated via activation of the neurons in the pyramidal tracts
E.
All of the above
32
A.
Select the CORRECT statement about lung compliance
Lung compliance can be defined as a change in lung volume for a given change in alveolar
pressure
B.
Cortisol will indirectly increase lung compliance
C.
Pulmonary compliance will be reduced in patients with emphysema
D.
A lack of surfactant will result in decreased fluid in alveoli
E.
The effect of surfactant will be greatest in largest alveoli
33
Select the INCORRECT statement from those below
A.
Primary metabolic acidosis can be compensated for by hyperventilation
B.
Uncompensated hypoventilation would result in respiratory acidosis
C.
Normal plasma bicarbonate concentration is less than 22mEq/L
D.
A PaCO2 of 50mmHg could be compensated for by increased bicarbonate reabsorption
E.
A bicarbonate concentration of 30mEq/L could be compensated for by hypoventilation
34
With regards to gas transport Select the INCORRECT statement from those shown below
A.
In anaemia at rest haemoglobin will only normally be 50% saturated
B.
Every 100ml of arterial blood carries approximately 0.3ml of dissolved oxygen
C.
Mixed venous blood is normally approx. 75% saturated with oxygen
D.
A fever will result in greater binding of oxygen to haemoglobin at any give PO2
E.
Increased 2-3 DPG will shift the oxygen dissociation curve to the right hand side
35
A.
Select the CORRECT statement
In low ventilation perfusion ratio lung units the alveolar PO2 will tend to drop to arterial PO2
levels
B.
In high ventilation perfusion ratio lung units alveolar PCO2 will increase
C.
Increased pulmonary blood pressure will result in recruitment of new pulmonary blood vessels
D.
Pulmonary vascular resistance will be increased at a lung volume of 4L
E.
Hypoxic vasoconstriction can compensate for lung units with low ventilation perfusion ratios
36
Select the CORRECT statement with regards to the control of respiration
A.
The neurons within the ventral respiratory group are active only in inspiration
B.
The dorsal respiratory group contains neurons primarily active in inspiration
C.
Activation of apeunistic centre of the pons promotes expiration
D.
The immersion reflex stimulates tachycardia
E.
Potassium sensitive oxygen channels mediate the ventilatory response to hypercapnia
37
Hyperpnea is
A.
Characterized by decreased arterial PCO2
B.
An inappropriately high ventilation for the metabolic demand
C.
Characterized by decreased alveolar PO2
D.
An increase in ventilation to match increased metabolic demand
E.
Characterized by an unchanged tidal volume
38
With regards to gas transfer across the alveolar membrane
A.
Carbon monoxide transfer is limited by alveolar capillary blood flow
B.
In the abnormal lung due to the rapid increase in PO2 the transfer is perfusion limited
C.
Even if the alveolar membrane is thickened the end capillary PO2 will always reach alveolar PO2
D.
At a heart rate of 120 BPM the PO2 in the blood will reach alveolar PO2 after 0.25 sec
E.
None of the above are true
39
Which of the following statements on pulmonary circulation is CORRECT?
A.
The average resistance in the system is approximately 20mmHg/L/min
B.
The pressure within the vessels that open in the left atrium is normally greater than the pressure
within the vessel of the pulmonary circulation that derives from septation of the truncus
arteriosus
C.
The volume of blood contained within the system is 4900 ml
D.
The vascular resistance in the system decreases in inspiration
E.
Resistance in the pulmonary circulation decreases dramatically after birth
40
Slowly Adapting Stretch Receptors in the lungs
A.
Are located in the between the airway epithelia
B.
Respond mainly to chemical irritants in the airways
C.
Act to prolong inspiration
D.
Are activated in conditions of decreased airway compliance
E.
All of the above are true
41
The nerve that is located between the mediastinal pleura and the external aspect of the
pericardial sac
A.
Carries sensory fibres that exclusively supply organs/structures located in the thoracic cavity
B.
Activity of this nerve will result in a decrease in transpulmonary pressure
C.
The seventh cervical segment (C7) of the spinal cord is an important origin for it
D.
This is a purely motor nerve and has no sensory function
E.
Has no relation to respiratory function
42
Which of the following statements applies to the anatomical dead space?
A.
Only the segments of airways provided with hyaline cartilage in their wall are part of it
B.
Its volume can be altered by smooth muscle cell contraction
C.
It is normally approximately 350ml
D.
It is always equal to the physiological dead space
E.
It is entirely lined by respiratory epithelium
43
The normal diffusion capacity for carbon monoxide
A.
At rest is 25 ml per min per mmHg
B.
Is decreased significantly with exercise
C.
Will be increased in emphysema
D.
Will be increased pulmonary edema
E.
All of the of the above
44
With regard to the portion of the lung which is not contained in the thoracic cavity, select
the CORRECT statement:
A.
It has a ventilation/perfusion ratio which is less than one
B.
Its blood flow that will be determined by the alveolar - arterial pressure difference
C.
when examined, percussion of this region on the right side would give a dull sound since here the
lung ovelaps with the liver
D.
It is the pulmonary ligament
E.
None of the above applies because each lung is entirely contained in the thoracic cavity
45
The organ whose lumen is marked by the black star in the image below
A.
Divides at the level of T8
B.
Has stretch receptors that are rapidly adapting receptors
C.
Activation of the stretch receptors located in the structure shown prolongs expiration and
shortens inspiration
D.
Contains high amounts of fibrous cartilage in the region shown by the white stars
E.
Has no musculature
Image for Q45
46
A.
Which of the following statements on the thoracic cage is CORRECT?
Contraction of the external intercostal muscles leads to a decrease in the antero-posterior
diameter of the thoracic cavity
B.
The most important clinical aspect of posterior intercostal vessels is that they run along the upper
margin of each rib
C.
Expiratory muscles include the pectoralis major muscle
D.
In normal breathing, expiration is mainly due to contraction of abdominal muscles
E.
None of the above is correct
47
Which of the following statements on intrapulmonary airways is CORRECT?
A.
Bronchioli contain a higher amount of goblet cells in their wall than bronchi
B.
Respiratory bronchioli subdivide into terminal bronchioli into which alveoli open
C.
Resistance to airflow is greatest in the medium size bronchi
D.
In the bronchi, resistance to airflow is doubled when the bronchial diameter is halved
E.
The structures marked by the asterisks in the image below are alveolar sacs
*
*
*
*
*
*
Image for Q47
48
If blood flow to the structures marked by the stars in the images below is partially blocked,
which of the following will NOT occur?
A. pCO2 in the structures marked will be reduced
B. The pO2 in the blood leaving this area will increase
C. The pO2 in the structures marked would be greater than normal for these structures
D. The pressure in the pulmonary artery tends to increase
E. The ventilation/perfusion ratio will tend towards zero
Image for Q48
Image for Q48
49
In the image shown below the white arrows mark cells
A.
That are also termed "respiratory epithelium"
B.
Whose main function is to scavange the product of the cells marked by the black arrows
C.
That actively remove O2 from the structures marked by the stars
D.
That have no basement membrane at their basal aspect
E.
Across which the transfer of oxygen is perfusion limited in a healthy lung
Image for Q49
50
In the image shown below the black arrows mark:
A.
Cells whose activity is increased by cortisol
B.
Cells whose secretion product has mainly antibacterial function
C.
Cells that start to develop and differentiate during the first year of postnatal life
D.
Cells that deliver oxygen to blood capillaries by means of membrane bound active transporters
E.
Cells that together with capillary endothelia and their basement membrane form the blood-air
barrier
Image for Q50