Pulmonary circulation hemodynamics — MCQs

A 43-year-old woman presents to her primary care provider with shortness of breath. She reports a 4-month history of progressively worsening difficulty breathing with associated occasional chest pain. She is a long-distance runner but has had trouble running recently due to her breathing difficulties. Her past medical history is notable for well-controlled hypertension for which she takes hydrochlorothiazide. She had a tibial osteosarcoma lesion with pulmonary metastases as a child and successfully underwent chemotherapy and surgical resection. She has a 10 pack-year smoking history but quit 15 years ago. She drinks a glass of wine 3 times per week. Her temperature is 98.6°F (37°C), blood pressure is 140/85 mmHg, pulse is 82/min, and respirations are 18/min. On exam, she has increased work of breathing with a normal S1 and loud P2. An echocardiogram in this patient would most likely reveal which of the following?

A 62-year-old woman with no significant past medical history presents with progressive dyspnea on exertion over the past 6 months. Echocardiogram reveals elevated pulmonary artery pressure (PAP) of 55 mmHg with normal left ventricular ejection fraction and no evidence of left-sided valvular disease. Right heart catheterization confirms mean PAP of 50 mmHg with pulmonary capillary wedge pressure of 10 mmHg. Intraoperative administration of intravenous adenosine causes the PAP to decrease to 35 mmHg. What pharmacological therapy is most likely to provide long-term benefit for this patient?

Which of the following physiologic changes decreases pulmonary vascular resistance (PVR)?

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?

Which mechanism is primarily responsible for the increase in pulmonary diffusing capacity during exercise?

A 37-year-old male presents to your clinic with shortness of breath and lower extremity edema. He was born in Southeast Asia and emigrated to America ten years prior. Examination demonstrates 2+ pitting edema to the level of his knees, ascites, and bibasilar crackles, as well as an opening snap followed by a mid-to-late diastolic murmur. The patient undergoes a right heart catheterization that demonstrates a pulmonary capillary wedge pressure (PCWP) of 24 mmHg. The patient is most likely to have which of the following?

A 35-year-old woman volunteers for a study on respiratory physiology. Pressure probes A and B are placed as follows: Probe A: between the parietal and visceral pleura Probe B: within the cavity of an alveolus The probes provide a pressure reading relative to atmospheric pressure. To obtain a baseline reading, she is asked to sit comfortably and breathe normally. Which of the following sets of values will most likely be seen at the end of inspiration?

A 33-year-old woman comes to the physician because of a 6-month history of worsening shortness of breath and fatigue. Her paternal uncle had similar symptoms and died of respiratory failure at 45 years of age. The lungs are clear to auscultation. Pulmonary function testing shows an FVC of 84%, an FEV1/FVC ratio of 92%, and a normal diffusion capacity. An ECG shows a QRS axis greater than +90 degrees. Genetic analysis shows an inactivating mutation in the bone morphogenetic protein receptor type II (BMPR2) gene. Which of the following is the most likely cause of this patient's symptoms?

A 22-year-old man volunteers for a research study on lung function. He has no history of lung disease or allergies and does not smoke. His pulmonary blood flow is measured in the various labeled segments of the lungs while standing. Then the volunteer, still standing, is given very low continuous positive airway pressure and the blood flow measured again. Which of the following sets of findings are most likely to be present in the second measurements relative to the first?

A 72-year-old obese man presents as a new patient to his primary care physician because he has been feeling tired and short of breath after recently moving to Denver. He is a former 50 pack-year smoker and has previously had deep venous thrombosis. Furthermore, he previously had a lobe of the lung removed due to lung cancer. Finally, he has a family history of a progressive restrictive lung disease. Laboratory values are obtained as follows: Oxygen tension in inspired air = 130 mmHg Alveolar carbon dioxide tension = 48 mmHg Arterial oxygen tension = 58 mmHg Respiratory exchange ratio = 0.80 Respiratory rate = 20/min Tidal volume = 500 mL Which of the following mechanisms is consistent with these values?