Altered compliance in disease states US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Altered compliance in disease states. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Altered compliance in disease states US Medical PG Question 1: During a clinical study examining the diffusion of gas between the alveolar compartment and the pulmonary capillary blood, men between the ages of 20 and 50 years are evaluated while they hold a sitting position. After inhaling a water-soluble gas that rapidly combines with hemoglobin, the concentration of the gas in the participant's exhaled air is measured and the diffusion capacity is calculated. Assuming that the concentration of the inhaled gas remains the same, which of the following is most likely to increase the flow of the gas across the alveolar membrane?
- A. Deep exhalation
- B. Entering a cold chamber
- C. Treadmill exercise (Correct Answer)
- D. Standing straight
- E. Assuming a hunched position
Altered compliance in disease states Explanation: ***Correct: Treadmill exercise***
- **Treadmill exercise** increases cardiac output and pulmonary blood flow, which in turn recruits and distends more **pulmonary capillaries**. This increases the **surface area** available for gas exchange and reduces the diffusion distance, thereby enhancing the flow of gas across the alveolar membrane.
- Exercise also typically leads to deeper and more frequent breaths, increasing the **ventilation-perfusion matching** and overall efficiency of gas exchange.
- According to Fick's law of diffusion (Vgas = A/T × D × ΔP), increasing the surface area (A) directly increases gas flow.
*Incorrect: Deep exhalation*
- **Deep exhalation** would empty the lungs more completely, potentially leading to alveolar collapse in some regions and thus **decreasing the alveolar surface area** available for gas exchange.
- This would also reduce the **driving pressure** for gas diffusion by lowering the alveolar concentration of the inhaled gas.
*Incorrect: Entering a cold chamber*
- Exposure to a **cold chamber** can cause **bronchoconstriction** in some individuals, particularly those with reactive airways, which would increase airway resistance and potentially reduce alveolar ventilation.
- While metabolic rate may slightly increase in the cold, the primary effect on the lungs is unlikely to promote increased gas diffusion in a healthy individual.
*Incorrect: Standing straight*
- **Standing straight** is a normal physiological posture and does not significantly alter the **pulmonary capillary recruitment** or the alveolar surface area in a way that would dramatically increase gas flow compared to a seated position.
- There might be minor gravitational effects on blood flow distribution, but these are generally less impactful than dynamic changes like exercise.
*Incorrect: Assuming a hunched position*
- **Assuming a hunched position** can restrict chest wall expansion and diaphragm movement, leading to **reduced tidal volume** and overall alveolar ventilation.
- This posture, by reducing lung volumes and potentially compressing the lungs, would likely **decrease the effective surface area** for gas exchange and therefore reduce gas flow.
Altered compliance in disease states US Medical PG Question 2: A 60-year-old woman presents to the clinic with a 3-month history of shortness of breath that worsens on exertion. She also complains of chronic cough that has lasted for 10 years. Her symptoms are worsened even with light activities like climbing up a flight of stairs. She denies any weight loss, lightheadedness, or fever. Her medical history is significant for hypertension, for which she takes amlodipine daily. She has a 70-pack-year history of cigarette smoking and drinks 3–4 alcoholic beverages per week. Her blood pressure today is 128/84 mm Hg. A chest X-ray shows flattening of the diaphragm bilaterally. Physical examination is notable for coarse wheezing bilaterally. Which of the following is likely to be seen with pulmonary function testing?
- A. Decreased FEV1: FVC and decreased total lung capacity
- B. Normal FEV1: FVC and decreased total lung capacity
- C. Increased FEV1: FVC and decreased total lung capacity
- D. Decreased FEV1: FVC and increased total lung capacity (Correct Answer)
- E. Increased FEV1: FVC and normal total lung capacity
Altered compliance in disease states Explanation: ***Decreased FEV1:FVC ratio and increased total lung capacity***
- This patient's symptoms (shortness of breath on exertion, chronic cough, 70-pack-year smoking history, coarse wheezing, and diaphragmatic flattening on X-ray) are highly suggestive of **Chronic Obstructive Pulmonary Disease (COPD)**, specifically **emphysema**, an obstructive lung disease.
- In COPD, there is airflow limitation, causing a **decreased FEV1:FVC ratio** (typically <0.70). Over time, air trapping occurs due to damaged alveoli and loss of elastic recoil, leading to an **increased total lung capacity (TLC)** and residual volume.
*Decreased FEV1:FVC ratio and decreased total lung capacity*
- A **decreased FEV1:FVC ratio** indicates an **obstructive lung disease**.
- However, a **decreased total lung capacity (TLC)** is characteristic of a **restrictive lung disease**, which does not align with the patient's presentation typical of COPD/emphysema.
*Normal FEV1:FVC ratio and decreased total lung capacity*
- A **normal FEV1:FVC ratio** is inconsistent with the patient's strong history of smoking and symptoms suggestive of airflow obstruction.
- A **decreased total lung capacity (TLC)** indicates a restrictive lung disease, which is not the primary diagnosis here.
*Increased FEV1:FVC ratio and decreased total lung capacity*
- An **increased FEV1:FVC ratio** is not physiologically possible in significant lung disease and is therefore incorrect.
- A **decreased total lung capacity (TLC)** would point towards a restrictive pattern not seen in generalized emphysema.
*Increased FEV1:FVC ratio and normal total lung capacity*
- An **increased FEV1:FVC ratio** is not a characteristic finding in any lung disease and is therefore incorrect.
- A **normal total lung capacity** would not be expected in advanced emphysema where air trapping is prominent.
Altered compliance in disease states US Medical PG Question 3: Which of the following physiologic changes decreases pulmonary vascular resistance (PVR)?
- A. Inhaling the inspiratory reserve volume (IRV)
- B. Exhaling the entire vital capacity (VC)
- C. Exhaling the expiratory reserve volume (ERV)
- D. Breath holding maneuver at functional residual capacity (FRC)
- E. Inhaling the entire vital capacity (VC) (Correct Answer)
Altered compliance in disease states Explanation: ***Inhaling the entire vital capacity (VC)***
- As lung volume increases from FRC to TLC (which includes inhaling the entire VC), alveolar vessels are **stretched open**, and extra-alveolar vessels are **pulled open** by the increased radial traction, leading to a decrease in PVR.
- This **maximizes the cross-sectional area** of the pulmonary vascular bed, lowering resistance.
*Inhaling the inspiratory reserve volume (IRV)*
- While inhaling IRV increases lung volume, it's not the maximal inspiration of the entire VC where **PVR is typically at its lowest**.
- PVR continues to decrease as lung volume approaches total lung capacity (TLC).
*Exhaling the entire vital capacity (VC)*
- Exhaling the entire vital capacity leads to very low lung volumes, where PVR significantly **increases**.
- At low lung volumes, **alveolar vessels become compressed** and extra-alveolar vessels **narrow**, increasing resistance.
*Exhaling the expiratory reserve volume (ERV)*
- Exhaling the ERV results in a lung volume below FRC, which causes a **marked increase in PVR**.
- This is due to the **compression of alveolar vessels** and decreased radial traction on extra-alveolar vessels.
*Breath holding maneuver at functional residual capacity (FRC)*
- At FRC, the PVR is at an **intermediate level**, not its lowest.
- This is the point where the opposing forces affecting alveolar and extra-alveolar vessels are somewhat balanced, but not optimized for minimal resistance.
Altered compliance in disease states US Medical PG Question 4: A 62-year-old man presents to the emergency department for evaluation of a 2-year history of increasing shortness of breath. He also has an occasional nonproductive cough. The symptoms get worse with exertion. The medical history is significant for hypertension and he takes chlorthalidone. He is a smoker with a 40-pack-year smoking history. On physical examination, the patient is afebrile; the vital signs include: blood pressure 125/78 mm Hg, pulse 90/min, and respiratory rate 18/min. The body mass index (BMI) is 31 kg/m2. The oxygen saturation is 94% at rest on room air. A pulmonary examination reveals decreased breath sounds bilaterally, but is otherwise normal with no wheezes or crackles. The remainder of the examination is unremarkable. A chest radiograph shows hyperinflation of both lungs with mildly increased lung markings, but no focal findings. Based on this clinical presentation, which of the following is most likely?
- A. Decreased total lung capacity
- B. Increased DLCO
- C. Metabolic acidosis
- D. FEV1/FVC of 80% with an FEV1 of 82%
- E. FEV1/FVC of 65% (Correct Answer)
Altered compliance in disease states Explanation: ***FEV1/FVC of 65%***
- This patient's symptoms (shortness of breath, nonproductive cough, worsening with exertion), significant smoking history (40-pack-years), and chest X-ray findings (**hyperinflation**, mildly increased lung markings) are highly suggestive of **Chronic Obstructive Pulmonary Disease (COPD)**, particularly **emphysema** given the hyperinflation and decreased breath sounds.
- COPD is characterized by **airflow limitation** that is not fully reversible, which is reflected by a **reduced FEV1/FVC ratio** (typically < 0.7 or < 70%).
*Decreased total lung capacity*
- **Decreased total lung capacity (TLC)** is characteristic of **restrictive lung diseases**, where lung expansion is limited (e.g., pulmonary fibrosis, interstitial lung disease).
- COPD, and especially emphysema, typically presents with **increased TLC** due to air trapping and hyperinflation, not decreased TLC.
*Increased DLCO*
- **Increased DLCO** (diffusing capacity of the lung for carbon monoxide) can be seen in conditions like **pulmonary hemorrhage** or **asthma**.
- In COPD, particularly emphysema, there is destruction of alveolar-capillary membranes, leading to a **decreased DLCO** due to impaired gas exchange.
*Metabolic acidosis*
- **Metabolic acidosis** is not a primary or direct feature of uncomplicated COPD. While severe respiratory failure in later stages might lead to some acid-base disturbances, directly attributing metabolic acidosis as a defining characteristic is incorrect.
- COPD primarily causes **respiratory acidosis** due to CO2 retention in advanced stages.
*FEV1/FVC of 80% with an FEV1 of 82%*
- An **FEV1/FVC ratio of 80%** (or 0.8) and an **FEV1 of 82%** of predicted values are within the normal range and indicate **normal spirometry**.
- This would rule out significant airflow obstruction, which is central to the diagnosis of COPD.
Altered compliance in disease states US Medical PG Question 5: A 57-year-old man presents to the clinic for a chronic cough over the past 4 months. The patient reports a productive yellow/green cough that is worse at night. He denies any significant precipitating event prior to his symptoms. He denies fever, chest pain, palpitations, weight changes, or abdominal pain, but endorses some difficulty breathing that waxes and wanes. He denies alcohol usage but endorses a 35 pack-year smoking history. A physical examination demonstrates mild wheezes, bibasilar crackles, and mild clubbing of his fingertips. A pulmonary function test is subsequently ordered, and partial results are shown below:
Tidal volume: 500 mL
Residual volume: 1700 mL
Expiratory reserve volume: 1500 mL
Inspiratory reserve volume: 3000 mL
What is the functional residual capacity of this patient?
- A. 4500 mL
- B. 2000 mL
- C. 2200 mL
- D. 3200 mL (Correct Answer)
- E. 3500 mL
Altered compliance in disease states Explanation: ***3200 mL***
- The **functional residual capacity (FRC)** is the volume of air remaining in the lungs after a normal expiration.
- It is calculated as the sum of the **expiratory reserve volume (ERV)** and the **residual volume (RV)**. In this case, 1500 mL (ERV) + 1700 mL (RV) = 3200 mL.
*4500 mL*
- This value represents the sum of the **inspiratory reserve volume (3000 mL)** and the **residual volume (1700 mL)**, which does not correspond to a standard lung volume or capacity.
- It does not logically relate to the definition of functional residual capacity.
*2000 mL*
- This value represents the sum of the **tidal volume (500 mL)** and the **expiratory reserve volume (1500 mL)**, which is incorrect for FRC.
- This would represent the inspiratory capacity minus the inspiratory reserve volume, which is not a standard measurement used in pulmonary function testing.
*2200 mL*
- This value could be obtained by incorrectly adding the **tidal volume (500 mL)** and the **residual volume (1700 mL)**, which is not the correct formula for FRC.
- This calculation represents a miscombination of lung volumes that does not correspond to any standard pulmonary capacity measurement.
*3500 mL*
- This value is the sum of the **tidal volume (500 mL)**, the **expiratory reserve volume (1500 mL)**, and the **residual volume (1700 mL)**.
- This would represent the FRC plus the tidal volume, which is not a standard measurement and does not represent the functional residual capacity.
Altered compliance in disease states US Medical PG Question 6: A 57-year-old man comes to the physician because of a 2-year history of fatigue, worsening shortness of breath, and a productive cough for 2 years. He has smoked 1 pack of cigarettes daily for the past 40 years. Examination shows pursed-lip breathing and an increased anteroposterior chest diameter. There is diffuse wheezing bilaterally and breath sounds are distant. Which of the following parameters is most likely to be decreased in this patient?
- A. Thickness of small airways
- B. Work of breathing
- C. Lung elastic recoil (Correct Answer)
- D. Lower airway resistance
- E. Pulmonary vascular pressure
Altered compliance in disease states Explanation: ***Lung elastic recoil***
- The patient's presentation (long smoking history, dyspnea, pursed-lip breathing, increased AP diameter, distant breath sounds, and wheezing) is classic for **emphysema**, a form of **COPD**.
- Emphysema involves the destruction of **alveolar walls** and **elastic fibers**, leading to a significant decrease in the lung's ability to passively recoil during expiration.
*Thickness of small airways*
- In COPD, particularly chronic bronchitis, there is often **inflammation and thickening of the small airways** due to goblet cell hyperplasia and mucus gland hypertrophy, increasing their thickness, not decreasing it.
- This thickening contributes to increased airway resistance.
*Work of breathing*
- The **destruction of elastic recoil** in emphysema means the patient must actively use accessory muscles to exhale, significantly **increasing the work of breathing**, which is evident from pursed-lip breathing.
- Patients with COPD expend much more energy to breathe than healthy individuals.
*Lower airway resistance*
- Emphysema, while characterized by alveolar destruction, also has an obstructive component due to **airway collapse during expiration** (loss of radial traction) and potential inflammation/mucus, which leads to **increased lower airway resistance**, not decreased resistance.
- This increased resistance contributes to air trapping and wheezing.
*Pulmonary vascular pressure*
- Chronic hypoxia resulting from severe COPD can lead to **pulmonary vasoconstriction** and remodeling of the pulmonary arteries, causing **pulmonary hypertension** and an increase in pulmonary vascular pressure.
- This is a common complication in advanced COPD, not a decreased parameter.
Altered compliance in disease states US Medical PG Question 7: In which of the following pathological states would the oxygen content of the trachea resemble the oxygen content in the affected alveoli?
- A. Emphysema
- B. Exercise
- C. Pulmonary embolism (Correct Answer)
- D. Pulmonary fibrosis
- E. Foreign body obstruction distal to the trachea
Altered compliance in disease states Explanation: ***Pulmonary embolism***
- A pulmonary embolism blocks **blood flow** to a portion of the lung, creating **dead space ventilation** (high V/Q ratio).
- In the affected alveoli, **no blood perfusion** means no oxygen extraction occurs, so the alveolar oxygen content remains **high and similar to tracheal/inspired air**.
- This is the classic physiological state where ventilation continues but perfusion is absent, preventing gas exchange.
*Foreign body obstruction distal to the trachea*
- A complete obstruction **prevents fresh air** from reaching the affected alveoli.
- The trapped gas undergoes **resorption atelectasis**: oxygen is absorbed into capillary blood, CO2 diffuses in, and alveolar gas equilibrates with **venous blood** composition.
- Alveolar oxygen content becomes **very low**, not similar to tracheal air.
*Emphysema*
- Emphysema involves destruction of **alveolar walls** and enlargement of airspaces with impaired gas exchange.
- While V/Q mismatch occurs, oxygen is still extracted by perfusing blood.
- Alveolar oxygen content is **lower than tracheal air** due to ongoing (though inefficient) gas exchange.
*Exercise*
- During exercise, **oxygen consumption increases** dramatically with enhanced cardiac output and oxygen extraction.
- Alveolar oxygen content is **significantly lower** than tracheal air due to increased oxygen uptake by blood.
*Pulmonary fibrosis*
- Pulmonary fibrosis causes **thickening of the alveolar-capillary membrane**, impairing oxygen diffusion.
- Despite diffusion limitation, blood still perfuses the alveoli and extracts oxygen.
- Alveolar oxygen content is **lower than tracheal air**, though the A-a gradient is increased.
Altered compliance in disease states US Medical PG Question 8: A 60-year-old man presents with breathlessness for the past 3 months. His symptoms have been getting progressively worse during this time. He denies any history of cough, fever, or chest pain. He works at a local shipyard and is responsible for installing the plumbing aboard the vessels. His past medical history is significant for hypertension for which he takes metoprolol every day. He denies smoking and any illicit drug use. His pulse is 74/min, respiratory rate is 14/min, blood pressure is 130/76 mm Hg, and temperature is 36.8°C (98.2°F). Physical examination is significant for fine bibasilar crackles at the end of inspiration without digital clubbing. Which of the following additional findings would most likely be present in this patient?
- A. Increased pulmonary capillary wedge pressure
- B. Increased residual lung volume
- C. Reduced FEV1/FVC ratio
- D. Decreased diffusing capacity of CO (Correct Answer)
- E. Decreased pulmonary arterial pressure
Altered compliance in disease states Explanation: ***Decreased diffusing capacity of CO***
- This patient's occupation at a **shipyard**, progressive dyspnea, and bibasilar crackles without clubbing, along with normal vital signs, are highly suggestive of **asbestosis**, a type of **interstitial lung disease (ILD)**.
- ILDs cause **fibrosis of the alveolar-capillary membrane**, leading to impaired gas exchange and a characteristic **reduction in DLCO (diffusing capacity of the lung for carbon monoxide)**. This is a hallmark of parenchymal lung disease.
*Increased pulmonary capillary wedge pressure*
- An elevated **pulmonary capillary wedge pressure (PCWP)** indicates **left-sided heart failure** or **pulmonary venous hypertension**.
- While dyspnea can be a symptom of heart failure, the patient's normal blood pressure and absence of cardiac-specific symptoms or signs point away from primary cardiac pathology.
*Increased residual lung volume*
- **Increased residual lung volume** is a characteristic finding in **obstructive lung diseases** such as **COPD** and **asthma**, where there is air trapping due to airflow limitation.
- The patient's presentation with progressive dyspnea and bibasilar crackles is more consistent with a **restrictive lung disorder** like asbestosis, which typically causes **decreased lung volumes**.
*Reduced FEV1/FVC ratio*
- A **reduced FEV1/FVC ratio** is the hallmark of **obstructive lung diseases**, indicating airflow limitation.
- In **restrictive lung diseases** like asbestosis, both FEV1 and FVC are typically reduced proportionally, often resulting in a **normal or even increased FEV1/FVC ratio**.
*Decreased pulmonary arterial pressure*
- **Pulmonary arterial pressure (PAP)** is typically **normal or increased** in patients with interstitial lung disease due to **hypoxic vasoconstriction** and vascular remodeling.
- A decreased PAP would be an unusual and atypical finding in such a patient and is not associated with this clinical picture.
Altered compliance in disease states US Medical PG Question 9: A 55-year-old man with a 60 pack-year smoking history is referred by his primary care physician for a pulmonary function test (PFT). A previously obtained chest x-ray is shown below. Which of the following will most likely appear in his PFT report?
- A. Residual volume increased, total lung capacity decreased
- B. Residual volume normal, total lung capacity decreased
- C. Residual volume normal, total lung capacity normal
- D. Residual volume decreased, total lung capacity increased
- E. Residual volume increased, total lung capacity increased (Correct Answer)
Altered compliance in disease states Explanation: ***Residual volume increased, total lung capacity increased***
- The chest X-ray shows **hyperinflation** and a **flattened diaphragm**, which are classic signs of **emphysema**, a type of COPD.
- In emphysema, destruction of alveolar walls leads to air trapping, resulting in an **increased residual volume** and **total lung capacity**.
*Residual volume increased, total lung capacity decreased*
- An increased residual volume suggests **air trapping**, typical of obstructive lung diseases like emphysema.
- However, a **decreased total lung capacity** is characteristic of restrictive lung diseases, which would contradict the clinical and radiological findings for emphysema.
*Residual volume normal, total lung capacity decreased*
- A **normal residual volume** indicates no significant air trapping, which is inconsistent with emphysema.
- A **decreased total lung capacity** is seen in restrictive lung diseases, not obstructive diseases like emphysema.
*Residual volume normal, total lung capacity normal*
- **Normal lung volumes** would indicate healthy lung function, which is not expected in a patient with a heavy smoking history and radiological evidence of emphysema.
- The patient's 60 pack-year smoking history strongly points towards significant lung pathology.
*Residual volume decreased, total lung capacity increased*
- A **decreased residual volume** would suggest improved exhalation and less air trapping, which is contrary to the pathophysiology of emphysema.
- While total lung capacity can be increased in emphysema, the decrease in residual volume makes this option incorrect.
Altered compliance in disease states US Medical PG Question 10: An investigator is studying muscle contraction in tissue obtained from the thigh muscle of an experimental animal. After injection of radiolabeled ATP, the tissue is stimulated with electrical impulses. Radioassay of these muscle cells is most likely to show greatest activity in which of the following structures?
- A. H zone
- B. M line
- C. A band (Correct Answer)
- D. Z line
- E. I band
Altered compliance in disease states Explanation: ***A band***
- The **A band** contains the entire length of the **thick myosin filaments** along with the **overlap zone** where myosin and actin interact. Myosin has **ATPase activity**, meaning it binds and hydrolyzes **ATP** to power muscle contraction through cross-bridge cycling.
- Therefore, the greatest accumulation of **radiolabeled ATP** and its breakdown products would be found where **myosin heads** are located throughout the A band.
- The A band represents the most complete answer as it encompasses all regions containing myosin ATPase activity.
*H zone*
- The **H zone** is the central part of the **A band** where only **thick myosin filaments** are present, with no overlap with thin actin filaments.
- While myosin heads with ATPase activity are present here and would show radiolabeled ATP, the **H zone** is only a **subset** of the A band. The **A band** is the more comprehensive answer as it includes both the H zone and the overlap regions where most cross-bridge cycling occurs.
*M line*
- The **M line** is the very center of the **H zone** and anchors the **thick filaments**.
- It consists of structural proteins like **myomesin** and **creatine kinase**. While creatine kinase can phosphorylate ADP to regenerate ATP, it does not directly hydrolyze ATP for muscle contraction the way myosin ATPase does.
*Z line*
- The **Z line** (or Z disc) marks the boundaries of a **sarcomere** and anchors the **thin actin filaments**.
- It contains proteins like **alpha-actinin** and **desmin** but does not directly consume ATP for muscle contraction.
*I band*
- The **I band** contains only **thin actin filaments** and extends from the edge of the A band to the Z line.
- While actin is crucial for contraction, it does not possess **ATPase activity**; ATP hydrolysis primarily occurs at the **myosin heads** located in the A band.
More Altered compliance in disease states US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
